Home' Australian Pharmacist : Australian Pharmacist October 2015 Contents Australian Pharmacist October 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, 23rd edn. Canberra:
Pharmaceutical Society of Australia; 2015.
2. Rossi S, ed. Australian medicines handbook.
Adelaide: Australian Medicines Handbook; 2015.
3. NPS MedicineWise. At: www.nps.org.au
4. Merck Manual of Diagnosis and Therapy.At: www.
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.
Knowledge in practice
TO ANSWER KNOWLEDGE IN
Answers for Knowledge in practice can only be
submitted online through the PSA members-only
area of the PSA website at: www.psa.org.au
PSA members will receive instant feedback on
the correct answers with an explanation of why
the answer is correct. If you do not have member
access details for the PSA website, you can request
them via a link from the login page.
Question 1. Medication review
Mrs Richards (54 years old, 178 kg) is
referred for a home medicines review
(HMR) to investigate options for
optimising her weight and diabetes
management. She has a medical
• gastro-oesophageal reflux disease
• morbid obesity
• osteoarthritis (particularly of the knees)
• recurrent vaginal thrush
• type 2 diabetes mellitus.
Her current medications are:
• atorvastatin (Lipitor) 20 mg at night
• mirtazapine (Avanza) 45 mg at night
• fluconazole (Diflucan) 50 mg daily
• frusemide (Lasix) 40 mg twice daily
• metformin (Diaformin) 500 mg
• pantoprazole (Somac) 20 mg in the
• paracetamol/codeine (Panadeine
Forte) 500/30 mg two four times daily
• ramipril (Tritace) 2.5 mg in the morning
• thyroxine (Oroxine) 100 mcg in the
Mrs Richards is very aware of the many
benefits weight loss would have for her
health, and has been reviewed for lap
band surgery. However, she has been
told that she needs to lose around
30 kg before she will be considered a
candidate for surgery. She is finding
exercise very difficult at present because
of severe knee pain.
Her HbA1c has consistently been
around 70 mmol/mol (8.6%) for the past
year. A higher dose of metformin was
trialled a few weeks ago, but this caused
intolerable nausea and diarrhoea and
was reduced back to 500 mg twice daily.
Which ONE of the following
recommendations is MOST appropriate
for Mrs Richards at this time?
a) She should commence canagliflozin
(Invokana) 100 mg daily to improve her
blood glucose control.
b) Mirtazapine should be changed to
escitalopram (Lexapro) 10 mg daily to
avoid mirtazapine-related weight gain.
c) The dose of thyroxine should be
increased to accelerate her metabolism
and promote weight loss.
d) She should commence meloxicam
(Mobic) 15 mg daily when required
to reduce knee pain and enable her
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: CAP151010E
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