Home' Australian Pharmacist : Australian Pharmacist February 2015 Contents Australian Pharmacist February 2015 I ©Pharmaceutical Society of Australia Ltd.
CONTINUING PROFESSIONAL DEVELOPMENT
KNOWLEDGE IN PRACTICE
The challenge of applying what
you learn to pharmacy practice!
Knowledge in practice is designed to
be difficult and aims to make you apply
information from articles in this month’s
Australian Pharmacist and other suggested
reading to the questions below, just as you
would for a client/patient. This section is not
meant to be easy. There are no simple clear-
cut answers to the questions. The standard
references listed below may be of use when
answering the questions.
1. Sansom LN, ed. Australian pharmaceutical
formulary and handbook, 22nd edn. Canberra:
Pharmaceutical Society of Australia; 2012.
2. Rossi S, ed. Australian medicines handbook.
Adelaide: Australian Medicines Handbook; 2015.
3. National Prescribing Service. At: www.nps.org.au
4. Merck Manual of Diagnosis and Therapy [online].At:
5. Product information – available from various
sources, e.g. MIMS, APP Guide or online on
6. Royal College of Pathologists of Australasia. RCPA
Manual. At: www.rcpamanual.edu.au
7. Therapeutic Guidelines Series. eTG complete
Melbourne: Therapeutic Guidelines Limited. At: http://
Knowledge in practice
Question 1. Patient monitoring
Additional reference: Campbell B, Burnett L. HbA1c flaws. MJA
Insight 8 December 2014. At: http://tinyurl.com/apv34011a
Mr Thompson (63 years old) has been
referred to you for a Home Medicines
Review (HMR). His medical history is notable
for the following:
• heart failure
• rheumatic heart disease with mechanical
aortic valve in situ
• chronic mild haemolytic anaemia
• type 2 diabetes mellitus.
His medication profile has been stable for
• bisoprolol 5 mg daily
• fosinopril 20 mg daily
• frusemide 20 mg daily when required
• iron sulphate 325 mg daily
• metformin 500 mg twice daily
• rosuvastatin 10 mg daily
• warfarin as per INR (currently 4 mg daily).
Which of the following recommendations
regarding the monitoring of Mr Thompson’s
therapy is the MOST appropriate?
a) Monitoring of Mr Thompson’s renal function
and electrolytes is unnecessary as his
medication profile has been stable for many
b) To accurately assess the long-term control
of Mr Thompson’s blood glucose levels,
his HbA1c should be measured every
c) If Mr Thompson’s INR has been stable
for a long period of time, monthly
monitoring may be sufficient unless there
is a change in his health.
d) Mr Thompson’s total cholesterol level
should be monitored as once it falls below
2.5 mmol/L, rosuvastatin can be ceased.
Through successful completion of this activity, the
learner will demonstrate their ability to:
• Use readily available information sources to
access and select relevant and up-to-date
clinical and practice based information
• Promote and contribute to the optimal use of
• Address primary healthcare needs of patients.
Competency standards (2010) addressed: 4.2,
6.1, 7.1, 7.2 .
Accreditation number: CAP150202F–G
Australian Pharmacist Continuing Professional
Development (CPD) is a central element of PSA’s
CPD & PI program.
The CPD section is recognised under the PSA
CPD & PI program as a Group 2 activity. Members
can choose which articles they want to answer
questions on and get CPD credits based on the
questions they answer.
CPD credits are allocated based on the length of
the article and the complexity of the information
presented. A minimum of 6 out of 8 questions, 4 out
of 5 questions, or 3 out of 4 questions correct is
required for the allocation of Group 2 CPD credits.
PSA members can answer online at www.psa.org.au.
• Login to submit your answers online. If you
do not have member access details, you can
request them via a link from the login page.
• Select Submit Answers.
• Select Australian Pharmacist CPD.
Submit your answers online before
1 April 2017 at www.psa.org.au and
receive automatic feedback.
Question 2. Patient
Additional reference: Perry-Keene D. Low testosterone in men.
Aust Prescr 2014;37:196–200. At: http://tinyurl.com/apv34012
Mr Gloom (72 years old, BMI 35 kg/m2) has a history
of hypothyroidism, chronic obstructive pulmonary
disease (COPD), rheumatoid arthritis and type 2
diabetes mellitus. His current medications are:
• thyroxine 75 mcg daily
• tiotropium 18 mcg daily
• ramipril 5 mg daily
• metformin 1 g daily
• prednisolone 10 mg daily (reducing dose)
• methotrexate 15 mg once weekly
(commenced three months ago)
• morphine CR 30 mg twice daily.
Mr Gloom visits his GP on a Wednesday at
3.30pm and tells him that recently he has
been feeling lethargic and has been unable to
maintain an erection. However, his pain control
is the best it has been for a long time. Mr
Gloom is a non-smoker and drinks two beers
approximately twice a week. While Mr Gloom is
in the surgery, the doctor takes a blood sample
to send off for testing.
Results of these tests include:
• ESR (erythrocyte sedimentation rate)
25 mm/hr (<30 mm/hr)
• TSH (thyroid stimulating hormone) 7 mIU/L
• T4 (free thyroxine) 18 picomol/L (10–25
• Total testosterone 6.4 nmol/L (8–35 nmol/L)
• Total cholesterol 4.9 mmol/L (<4 mmol/L).
Which of the following is the LEAST
appropriate management option for Mr
a) Commence Mr Gloom on atorvastatin
10 mg daily.
b) Increase his daily thyroxine dose from
75 mcg to 100 mcg.
c) Commence Mr Gloom on testosterone
1% gel, 5 g (containing testosterone 50 mg)
d) Continue reducing prednisolone and
consider reducing morphine.
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