Home' Australian Pharmacist : Australian Pharmacist March 2012 Contents 234 Australian Pharmacist March 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
Question 1. Paracetamol
Additional reference: Craig DG,
Bates CM, Davidson JS, et al. Staggered
overdose pattern and delay to hospital
presentation are associated with adverse
outcomes following paracetamol-induced
hepatotoxicity. Br J Clin Pharmacol. 2011
Nov 22. Accepted article; doi: 10.1111/1365-
2125.2011.04067.x [Epub ahead of print].
Based on the study reported in the
additional reference, which statement
below is FALSE?
A patient transferred to the Scottish Liver
Transplantation Unit who had ingested a
potentially toxic overdose of paracetamol:
a) Was more likely to experience
adverse outcomes if they ingested
four separate doses each of 3,000 mg
paracetamol in a 24-hour period than
the same total amount of paracetamol
as a single dose.
b) As a single time point overdose
was approximately 2.5% less likely
to survive spontaneously if they
presented to emergency services more
than 24 hours after ingestion than if
they presented less than 12 hours after
c) As a single time point overdose and
who had a serum paracetamol level
of 30 mg/L would be more likely to
develop hepatic encephalopathy than
one who had a serum paracetamol
level of 100 mg/L.
d) Did not have an increased risk of
death or orthotopic liver transplant
independently associated with their
age if the overdose was staggered.
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
1. Sansom L (ed). Australian Pharmaceutical Formulary and
Handbook, 21st Ed. Canberra: Pharmaceutical Society of
2. Rossi S (ed). Australian Medicines Handbook. Adelaide:
Australian Medicines Handbook Pty Ltd; 2011.
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.
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-
• 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
Question 2. New drugs
Additional reference: National
Prescribing Service. Rational Assessment
of Drugs and Research -- NPS RADAR.
Dec 2011. [online]. At: http://tinyurl.com/
Based on the information presented in
the additional reference, which of the
following statements is TRUE?
a) Asenapine (Saphris) is a more
appropriate choice than risperidone
for a patient who requires treatment
for schizophrenia and who also takes
b) A patient who is currently taking
morphine 40 mg twice daily and
Coloxyl with Senna two tablets twice
daily, yet still experiences constipation
as an adverse effect, should switch to
release tablets (Targin) 20/10 mg twice
daily, which would be an appropriate
analgesic conversion and reduce
c) A patient taking ticagrelor (Brilinta)
and aspirin daily as part of the PLATO
trial was 1.9% less likely to have died
from vascular causes, myocardial
infarction or stroke 12 months after
being hospitalised for an acute
coronary syndrome than if he or she
had taken clopidogrel and aspirin.
d) The recommended adult dose of
indacaterol (Onbrez) has been shown
to significantly improve symptomatic
outcomes when compared with twice-
daily eformoterol in people with mild
to severe COPD.
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