Home' Australian Pharmacist : Australian Pharmacist September 2012 Contents 742 Australian Pharmacist September 2012 I ©Pharmaceutical Society of Australia Ltd.
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
• Promote and contribute to the
optimal use of medicines
• Address primary health needs
Competency standards (2010)
addressed: 4.2.1, 4.2.2, 4.2.3, 6.1.1,
6.1.2, 7.1.2, 7.1.3, 7.1.4, 7.2.2.
To answer Knowledge in practice
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
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 L (ed). Australian Pharmaceutical Formulary
and Handbook, 22nd Ed. Canberra: Pharmaceutical
Society of Australia, 2012.
2. Rossi S (ed). Australian Medicines Handbook.
Adelaide: Australian Medicines Handbook Pty Ltd;
3. National Prescribing Service [online]. At: www.nps.
4. Merck Manual of Diagnosis and Therapy [online].
5. Product information – available from various
sources, e.g. MIMS, APP Guide or online on
6. Royal College of Pathologists of Australasia. RCPA
Manual [online]. At: www.rcpamanual.edu.au
7. Therapeutic Guidelines Series. eTG complete [CD-
ROM]. Melbourne: Therapeutic Guidelines Limited.
Additional reference: Back I. Palliative Care Matters. Sdrivers - drug
compatibility database. 2012. At: http://tinyurl.com/apv31091
Two or three medicines are often
administered concurrently using a syringe
driver for continuous subcutaneous
infusions in palliative care.
Which of the following
combinations would be MOST
APPROPRIATE to use for symptoms
of nausea (caused by activation of
the chemoreceptor trigger zone),
pain and excessive respiratory
a) Glycopyrrolate, hydromorphone,
b) Cyclizine, hyoscine butylbromide,
c) Glycopyrrolate, haloperidol,
d) Hydromorphone, hyoscine
Additional reference: Cheng AC, Ferguson JK, Richards MJ, et
al. Australasian society for infectious diseases guidelines for the
diagnosis and treatment of Clostridium difficile infection. Med J
Aust 2011;194(7):353–8 . At: http://tinyurl.com/apv31092
Jane, 25 years old, presents with an
authority prescription for 40 vancomycin
125 mg capsules to be taken every
six hours for 10 days. She tells you
she developed severe diarrhoea with
abdominal cramping after a recent
course of antibiotics. A stool sample
confirmed Clostridium difficile infection.
Metronidazole was prescribed but
there was no response after three days
of treatment and the doctor has now
prescribed a different antibiotic. She has
a three-month-old baby whom she is
currently breastfeeding and she asks your
advice about the safety of vancomycin in
Which of the following is the MOST
APPROPRIATE advice to give?
a) Vancomycin has poor oral
bioavailability and is safe to use in
b) Oral vancomycin capsules are
formulated to enhance absorption and
are not safe to use in breastfeeding.
IV vancomycin is preferred.
c) Vancomycin capsules are not safe
to use while breastfeeding, and
breastfeeding should be ceased to
minimise harm to her baby.
d) Vancomycin is not safe to use while
breastfeeding and the best option
to treat Jane’s C. difficile infection is a
course of probiotics.
Knowledge in practice
KNOWLEDGE IN PRACTICE
Question 1. Medicine
combinations in palliative care
Question 2. Vancomycin
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