Home' Australian Pharmacist : Australian Pharmacist December 2015 Contents Australian Pharmacist December 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.
Mrs Randolph (61 years old, 58 kg) is referred for a HMR to check whether she is
managing her medications appropriately, as she sees a number of specialists.
She has a medical history of:
Type 2 diabetes.
Her current medications are:
Aspirin (Astrix) 100 mg in the morning
Rosuvastatin (Crestor) 20 mg in the
Etanercept (Enbrel) 50 mg s/c weekly
Glyceryl trinitrate (Nitrolingual)
400 mcg when necessary
12.5 mg in the morning
Leflunomide (Arava) 10 mg in the
Metformin (Diabex) 500 mg twice
Metoprolol (Minax) 50 mg half a tablet
Perindopril (Coversyl) 10 mg in the
Relevant blood test results from 2 weeks ago are as follows:
137 mmol/L (135–145)
Potassium 4.1 mmol/L (3.8–4.9)
8.8 mmol/L (3–8)
Creatinine 67 micromol/L (50–110)
9 mg/L (<5)
(equivalent to 7.2%).
Mrs Randolph’s medication regimen has been stable for at least a year, with the
exception of etanercept, which was commenced four months ago. Prior to this,
she had been using abatacept, but this was changed to etanercept because of a loss
During the HMR interview she tells you that her rheumatoid arthritis is now well
controlled and she is essentially pain-free. However, she is disappointed that her
weight has increased by around 4 kg in the past two months, despite the fact that
she is able to exercise more easily.
Her major concern is that recently she has been urinating at night more frequently
than usual. Each night she wakes up to urinate a couple of hours after going to
bed, and she has to go to the toilet another four or five times throughout the night.
She thinks that this is peculiar, as she is urinating less during the day.
Which ONE of the following is the MOST appropriate assessment and plan for
Mrs Randolph’s urinary symptoms?
a) The nocturia is most likely to be due to a urinary tract infection associated with her
immunosuppressive therapy. She should be referred back to her GP urgently for antibiotic
b) The diuretic effect of hydrochlorothiazide can be prolonged, and is the most likely cause of
Mrs Randolph’s nocturia. Hydrochlorothiazide should be changed to frusemide 20 mg in
c) The nocturia is most likely to be caused by exacerbation of heart failure associated
with etanercept. She should be referred back to her GP to arrange urgent review by her
d) The most likely cause of her nocturia is glycosuria associated with hyperglycaemia,
causing osmotic diuresis. Her blood glucose levels should be checked and the metformin
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.
Competencies addressed: 4.2, 6.1, 7.1, 7.2 .
Accreditation number: CAP151212G
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