Home' Australian Pharmacist : Australian Pharmacist October 2012 Contents Australian Pharmacist October 2012 I © Pharmaceutical Society of Australia Ltd.
Through successful completion of this
activity, the learner will demonstrate their
• Use readily available information
sources to access and select relevant and
up-to-date clinical and practice-based
• Promote and contribute to the optimal
use of medicines
• Address primary health needs of patients.
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,
Accreditation number: CAP121010g
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: Department of Veterans Affairs. Therapeutic brief 30: Know
your patient’s renal function – an important prescribing consideration. Mar 2012. At:
You have been asked to perform a Home
Medicines Review for Mr Wellington (65 years
old, 173 cm, 84 kg) who has type 2 diabetes,
hypertension, GORD and back pain. He has
been steadily gaining weight over the past
few months and has recently reported a
few episodes of hypoglycaemia. He has also
recently been experiencing symptoms of
• felodipine 20 mg each morning
• gliclazide 80 mg three times daily with
• irbesartan/hydrochlorothiazide 300/12.5
mg each morning
• metformin 1,000 mg three times daily
• oxycodone 10 mg at night when
• pantoprazole 40 mg each morning.
Current test results:
• HbA1c: 8.0%
• BP: 140/90 mmHg
• pre-prandial BGL: 6–10 mmol/L
• serum creatinine 137 micromol/L.
Which of the following recommendations
would be MOST appropriate to include in
your report to Mr Wellington’s GP?
a) Increase irbesartan/hydrochlorothiazide
to 300/25 mg daily in the morning.
b) Reduce metformin to 2 g (controlled
release) once daily.
c) Replace metformin with sitagliptin 100
mg once daily (PBS eligibility has been
d) Add nizatidine 300 mg twice daily to Mr
Wellington’s GORD therapy.
Additional Reference: Pisters R, Lane DA, Nieuwlatt R, et al. A novel user-friendly score
(HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation. Chest
2010;138(5):1093–100. At: http://tinyurl.com/apv31102a
Mrs Jones is a 65-year-old woman (58 kg, 166 cm,
medium frame) with a history of atrial fibrillation,
diabetes, hypertension, and left ventricular systolic
dysfunction (ejection fraction 35%). She regularly
drinks four standard drinks of alcohol per week.
She dislikes needles and experiences significant
haemophobia and has been having great difficulty
with regular INR monitoring.
Her current medicines are:
• warfarin (used for 10 weeks)
• ferrous sulphate
Her laboratory values as of today include:
• Hb: 105 g/L (115–165)
• Cr: 109 micromol/L (50–110)
• HbA1c: 7.2%
• Blood pressure: 140/84; pulse: 110 bpm
• Liver function tests: no abnormalities
• INR (measured every 2–4 weeks): 3.1 (most
recent), 3.2, 2.4, 1.8, 2.4
Which of the following is the MOST
appropriate recommendation regarding her
a) Warfarin can be ceased and dabigatran
commenced straight away at a dose of 150
mg twice daily.
b) Warfarin can be ceased and dabigatran
commenced at a dose of 110 mg twice daily
when her INR is below 2.0.
c) Warfarin can be ceased and dabigatran
commenced at a dose of 150 mg once daily
when her INR is below 3.0.
d) Mrs Jones is at significant risk of bleeding
and warfarin should be ceased. Stroke
prevention therapy should be maintained by
Knowledge in practice
Question 1. Considering
renal function in medication
KNOWLEDGE IN PRACTICE
Links Archive Australian Pharmacist September 2012 Australian Pharmacist November 2012 Navigation Previous Page Next Page