Home' Australian Pharmacist : December 2011 Contents Vol. 30 -- December #12, 2011
Continuing Professional Development
knowledge in practice
The questions in this series are independently researched and compiled by PSA commissioned authors and peer reviewed.
Each question is worth 0.5 CPD credits.
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. is section
is not meant to be easy. ere are
no simple clear-cut answers to the
questions. e 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, 2009.
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
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-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
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.
medicines as companion
Additional reference: National
Prescribing Service. Examining
the evidence: complementary
medicines as companion products
[online]. 30 Sep 2011. At: http://
Charles (67 years old) has heard a lot
in the media recently about the use of
complementary medicines to reduce
the risk of adverse effects associated
with some prescription medicines.
He is wary of adverse effects after
friends in his home country of
Ghana became sick after taking
counterfeit drugs, and wants to do all
he can to protect his health. Charles
• aspirin 100 mg daily in the
• atorvastatin 20 mg daily in the
• calcium carbonate 1500 mg daily
in the evening
• omeprazole 20 mg daily in the
• Renitec Plus 20/6 (enalapril
20 mg and hydrochlorothiazide
6 mg) daily in the morning
• temazepam 10--20 mg at night
He reports no adverse effects with
these medicines and his medical
conditions are currently well managed.
Of the following options, which is the
MOST APPROPRIATE intervention for
you to investigate further for Charles?
a) Consider taking coenzyme Q10
b) Consider taking vitamin D
c) Consider taking magnesium
d) Consider taking zinc
Question 2. Management
of type 2 diabetes
Additional Reference: Controlling
hyperglycaemia with early insulin use.
Aust Fam Phys 2010;39(8):565-69.
Mr Michael Fagan (70 years, 89 kg,
174 cm, medium frame) has been
referred to the pharmacist for a Home
Medicines Review because of his
poorly controlled type 2 diabetes with
symptoms suggestive of hypoglycaemia
(hunger, irritability, anxiety).
Medications at review:
• Atorvastatin 20 mg at night
• Aspirin 100 mg daily
• Testosterone undecanoate 40 mg
twice a day
• Mixtard 30/70 35 units at 8 am
• Ramipril 2.5 mg daily
• Indapamide SR 1.5 mg daily
• Glipizide 5 mg twice daily at
• Type 2 diabetes (1995)
• Heart failure (2009)
• Testosterone deficiency (2007).
• Morning (fasting): usually
• 2 hours post-prandial (lunch): often
• Pre-evening meal: usually
• 2 hours post-prandial
(dinner): 14--15 mmol/L.
Recent laboratory results:
• HbA1c: 8%
• Cr: 230 micromol/L.
With regard to Michael's diabetes
management, which of the following
is the MOST APPROPRIATE initial
recommendation to make to his GP?
(a) Add metformin XR 500 mg
(b) Increase Mixtard night-time dose
to 40 units.
(c) Change glipizide to 20 mg at night.
(d) Reduce Mixtard morning dose
to 33 units.
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