Home' Australian Pharmacist : Australian Pharmacist April 2012 Contents 318 Australian Pharmacist April 2012 I ©Pharmaceutical Society of Australia Ltd.
Continuing Professional Development
The articles in this series are independently researched and compiled by PSA commissioned authors and peer reviewed.
KNOWLEDGE IN PRACTICE
Knowledge in practice
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 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 questions
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. Discontinuing
Additional reference: Le Couteur D, Banks
E, Gnjidic D, McLachlan A. Deprescribing. Aust
Prescr 2011;34:182--5. At: http://tinyurl.com/
Mrs EN, a 90-year-old resident at the local
Aged Care Facility (ACF), has decided that
she would like to start ceasing some of her
medicines and would prefer to give some of
the money she spends on medicines to her
grandchildren. She is not clinically depressed.
Her most recent laboratory results are normal
and her blood pressure is 140/85 (pulse =
55 bpm). She weighs 50 kg. Her mother died
of breast cancer.
• Adjustment disorder with depressed mood
1997 (on admission to ACF)
• Vaginal prolapse (surgical repair 1986)
• Systolic heart failure stage 4 (2011)
• Hypertension (long-standing)
• Atrial fibrillation (since 1990; asymptomatic
• salbutamol 100--200 mcg when required
• metoprolol 50 mg twice a day
• valproate 2 g daily
• warfarin 3 mg daily
• tamoxifen 20 mg daily (since 1995)
• ramipril 5 mg daily (reduced from 10 mg
three months ago)
• frusemide 20 mg daily
• spironolactone 12.5 mg daily
• clonidine 150 mcg twice a day
• paroxetine 20 mg daily
• amiodarone 100 mg daily
Which of the following would be the LEAST
appropriate option for reducing Mrs EN's
a) Cease tamoxifen; monitor INR and adjust
warfarin dose accordingly.
b) Cease clonidine, wait for seven days and
then slowly withdraw metoprolol.
c) Cease amiodarone; monitor INR and
adjust warfarin dose accordingly over
d) Slowly withdraw paroxetine over
several weeks and adjust warfarin dose
Question 2. Heart failure
Additional reference: Heart Foundation
and the Cardiac Society of Australia and
New Zealand. Guidelines for the prevention,
detection and management of chronic
heart failure in Australia. Updated Oct 2011.
Mrs Sabo has a diagnosis of congestive
heart failure. Her symptoms have been
well managed. However, she has recently
experienced weight gain (about 2 kg in the
past two days), ankle oedema and has been
feeling tired. Her husband reports that she
appears to be out of breath sooner than
previously when walking up hills.
• Age: 81 years
• Height: 160 cm
• Current weight: 60 kg
• Serum creatinine: 130 micromol/L
• bisoprolol 5 mg in the morning.
• fosinopril 10 mg in the morning.
• frusemide 80 mg in the morning and
40 mg at midday.
• digoxin 62.5 micrograms in the morning.
Given this information, which of the
following would be the MOST appropriate
initial intervention to recommend to
Mrs Sabo's prescriber?
a) Increase her dose of fosinopril to 20 mg
once daily for four weeks, then to a
maximum dose of 40 mg once daily.
b) Increase her dose of bisoprolol to 7.5 mg
once daily for four weeks, then 10 mg
c) Increase her dose of frusemide by 20 mg
for each kilogram of weight gain over
her baseline weight, returning to her
usual dose if this corrects her weight gain
within 24 hours.
d) Increase her dose of digoxin to
125 micrograms daily.
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
1. Sansom L (ed). Australian Pharmaceutical Formulary and
Handbook, 22nd Ed. Canberra: Pharmaceutical Society of
2. Rossi S (ed). Australian Medicines Handbook. Adelaide:
Australian Medicines Handbook Pty Ltd; 2012.
3. National Prescribing Service [online]. At: www.nps.org.au
4. Merck Manual of Diagnosis and Therapy [online].
5. Product information -- available from various sources, e.g.
MIMS, APP Guide or online on manufacturers' websites.
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.
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