Home' Australian Pharmacist : Australian Pharmacist January 2012 Contents 68 Australian Pharmacist January 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
Question 1. Menopause
Additional reference: NPS. NPS News
64: Therapeutic choices for menopausal
symptoms. Available at: http://tinyurl.com/
You receive a HMR referral from one of
the GPs in your town, Dr Goodfellow.
Dr Goodfellow asks you to visit Mrs
Brenda Ball, who is experiencing
menopausal symptoms. The specific
request in the HMR referral is for
you to advise Dr Goodfellow of the
best treatment option for Mrs Ball's
menopausal symptoms in the context of
her other conditions.
You know Brenda reasonably well. She is
a 54-year-old with the following medical
and medication history:
Hypertension Amlodipine 10 mg
Type 2 diabetes Metformin XR 500
mg, 2 at night
Hyperlipidaemia Pravastatin 40 mg at
Evening primrose oil
1 g 3 times daily
Brenda's other medical conditions
are well controlled with her current
medications. The only abnormalities on
her laboratory tests are elevated LFTs,
and Dr Goodfellow's referral explains that
Brenda's LFTs were elevated before she
started taking pravastatin. He sought
specialist advice and Brenda continues to
be monitored by a specialist for her mild
During the HMR interview, Brenda
tells you her mother is a breast cancer
survivor (ER-negative) and remains in
remission. Brenda also tells you she
had a hysterectomy two years ago and
has regular mammograms to check for
breast cancer. She also says the evening
primrose oil is not controlling her hot
flushes or mood swings and she would
like to achieve better symptom control.
Which of the following recommendations
is the MOST APPROPRIATE for Brenda?
a) Black cohosh (Cimicifuga racemosa).
c) Oral oestrogen-only HRT.
d) Transdermal oestrogen-only HRT.
Question 2. Antiplatelet
drugs, anticoagulants and
Additional reference: Merriman E, Tran
H. Antiplatelet drugs, anticoagulants
and elective surgery. Aust Prescr. Oct
2011;34(5):139-43. At: http://tinyurl.com/
Which of the following scenarios is
MOST LIKELY to lead to the highest
risk of adverse perioperative effects?
a) Anna (55 years old) has hypertension
and diabetes. Her absolute risk of a
major cardiovascular event in the
next five years is greater than 15%.
She takes aspirin 100 mg daily. She
requires extraction of two molar teeth
and has been advised by her dentist to
continue taking aspirin.
b) Brian had a bare metal stent inserted
three months ago. He currently takes
aspirin 100 mg daily and clopidogrel
75 mg daily. He requires excision of
a basal cell carcinoma and has been
advised by his cardiologist to continue
taking aspirin and to cease clopidogrel
seven days before the procedure,
with subsequent review to determine
c) Charlotte has a mechanical heart
valve and takes warfarin. Her current
INR is 3.0. She requires excision of a
cataract and has been advised by her
ophthalmologist to cease warfarin five
days before surgery, allowing her INR to
reach below 1.5, and to restart it on the
evening after the procedure at her usual
d) Darryl (59 years old) has non-valvular
atrial fibrillation and takes warfarin.
His current INR is 2.5. He requires a
diagnostic upper gastrointestinal
endoscopy, and has been advised by
his gastroenterologist to continue
taking warfarin at his usual dose.
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, 21st Ed. Canberra: Pharmaceutical Society of Australia,
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].
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 login page.
Links Archive Australian Pharmacist February 2012 December 2011 Navigation Previous Page Next Page