Home' Australian Pharmacist : Australian Pharmacist March 2012 Contents Australian Pharmacist March 2012 I ©Pharmaceutical Society of Australia Ltd. 233
Continuing Professional Development
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1 May 2012 at www.psa.org.au
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PSA CPD answers
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NZCP CPD answers,
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Australian Pharmacist Continuing Professional
Development (CPD) is a central element of PSA's
CPD&PI program. It is also part of the New Zealand
College of Pharmacists (NZCP) education program
for NZ pharmacists.
The CPD section is recognised under the PSA
CPD&PI program as a Group 2 activity. Members
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questions on and get CPD credits based on the
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CPD credits are allocated based on the length of
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presented. A minimum of 6 out of 8 questions, 4
out of 5 questions, or 3 out of 4 questions correct is
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has been receiving may have been
insufficient for her symptoms. Consider
increasing the dose of risperidone to
0.5 mg twice daily. Regularly review
treatment and cease if ineffective, not
tolerated or is no longer required (as
BPSD is often temporary).
2. Olanzapine may be considered if
risperidone has failed or cannot be
tolerated. However, because of the lack
of evidence for psychotic symptoms
of AD, this may only be appropriate if
Mrs RC's most troubling symptom is
aggression. It is important to note that
this is not an approved indication of
olanzapine and is not eligible for subsidy
on the PBS. The implications of this
would need to be discussed with Mrs
RC's relevant substitute decision maker.
3. Benzodiazepines should be avoided
in patients with dementia because
they worsen cognition, increase the
risk of falls (and fracture) and, like all
sedatives, may worsen constipation.8
Furthermore, long-acting agents such
as diazepam have more pronounced
adverse effects in the elderly.5
If diazepam has been prescribed for
anxiety, it should not be used for
longer than two weeks.8 Given Mrs
RC's declining cognitive function
and osteoporosis, consider gradual
withdrawal of diazepam after two
weeks or earlier if behaviours settle.8
BPSD commonly occurs at some point
of the disease progression of dementia.
Symptoms can be distressing to family
and carers and are often difficult to
control. Both pharmacological and non-
pharmacological interventions are often
required. Risperidone and olanzapine
offer a modest benefit in improving
aggression but olanzapine has not
been shown to be effective for treating
delusional symptoms of dementia. The
'off label' prescribing of olanzapine may
be justified for symptoms of aggression
where risperidone has failed or is not
tolerated. However, this has potential
medico-legal consequences and is not
subsidised under the PBS.
1. Dementia in Australia: National data analysis and development.
Canberra: AIHW; 2006.
2. Brodaty H, Draper B, Low L-F. Behavioural and psychological
symptoms of dementia: a seven tiered model of service delivery.
MJA. 2003; 178(5):5.
3. Hollingworth S, Siskind D, Nissen L, et al. Patterns of
antipsychotic medication use in Australia 2002--2007. Aust NZ J
Psychiatry. 2010; 44:372--7.
4 Gould L, Westbury J. Essential CPE Dementia -- Part2: Treatment
of dementia in Australia. PSA. May 2011. p 25--6.
5. Rossi S, ed. Australian Medicines Handbook. Adelaide: AMH;
6. Gazarian M, Kelly M, McPhee J, et al. Off-label use of medicines:
consensus recommendations for evaluating appropriateness.
MJA. 2006; 185(10):4.
7. Ballard C, Waite J. The effectiveness of atypical antipsychotics
for the treatment of aggression and psychosis in Alzheimer's
disease. Cochrane Database Syst Rev. 2006.
8. Byrne G. Pharmacological treatment of behavioural problems
in dementia. Aust Prescr. 2005; 28:67--70.
1. The following antipsychotic(s) IS/ARE
PBS listed for BPSD:
d) all of the above.
2. Which one of the following statements
a) Risperidone has modest efficacy for
symptoms of BPSD.
b) Olanzapine is not superior to placebo for
the psychotic symptoms of dementia.
c) Olanzapine has a lower risk of adverse
effects compared with risperidone.
d) BPSD affects the majority of people with
dementia at some stage of the disease.
3. Which statement is TRUE regarding 'off
a) 'Off label' prescribing is the same as
prescribing outside PBS restrictions.
b) 'Off label' prescribing is never in line with
evidence based medicine.
c) Informed consent does not apply to
d) Some well accepted 'off label' uses of
drugs have been shown to cause harm.
4. Which statement is TRUE regarding
a) Most people with BPSD will suffer with
b) Psychotic symptoms in dementia are
produced by a similar mechanism as in
c) Non-pharmacological treatment of BPSD
is rarely useful.
d) None of the above (all statements
A score of 3 out of 4 attracts 0.75 CPD credits.
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