Home' Australian Pharmacist : November 2011 Contents Vol.30–November#11,2011
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. 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, 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.
Question 1. Management
Additional reference: National Heart
Foundation of Australia (National
Blood Pressure and Vascular Disease
Advisory Committee). Guide to
management of hypertension 2008.
Updated December 2010. At:
Mr Jon D is a 52-year-old regular
customer of yours. He has the following
• Type 2 diabetes
• Trigeminal neuralgia
• Moderate-severe asthma
• Metformin XR 500 mg 2 daily
• Gliclazide MR 30 mg 3 daily
• Aspirin 100 mg 1 daily
• Salbutamol 100 mcg MDI 2 qqh prn
• Budesonide 400 mcg DPI 2 bd
• Carbamazepine 200 mg 2 bd
• Amlodipine 10 mg 1 daily
• Rosuvastatin 10 mg 1 daily
Laboratory data (1 week old)
• Serum sodium 136 mmol/L (135–
• Serum potassium 5.0 mmol/L (3.8–
• Serum chloride 98 mmol/L (95–
• Serum bicarbonate 27 mmol/L (22–
• All other chemistry normal
• No evidence of microalbuminaria
Jonathon was previously trialled
on ramipril and developed severe
angioedema requiring emergency
hospital treatment. Because Jonathon’s
blood pressure has been consistently
elevated at an average of 145/95
mmHg, his GP seeks your advice on an
appropriate additional antihypertensive.
Which of the following antihypertensives
is the MOST APPROPRIATE to add to
a) Telmisartan 40 mg daily.
b) Indapamide 2.5 mg daily.
c) Metoprolol 50 mg bd.
d) Diltiazem 60 mg bd.
Question 2. Managing
antipsychotic adverse effects
Additional reference: Lambert T.
Managing the metabolic adverse
effects of antipsychotic drugs in
patients with psychosis. Aust Prescr
2011;34(4):97–9. At: http://tinyurl.com/
Dean (25 years old, 191 cm tall, 110 kg,
average frame) is a regular customer
in your pharmacy. He has been taking
olanzapine 10 mg daily for the last four
years. He is compliant with his regimen
and has been able to achieve satisfactory
management of his schizophrenia
symptoms after some initial instability.
However, he is concerned that he has
been slowly putting on weight since
starting olanzapine (weight when started
= 91 kg). Dean’s GP has been monitoring
his metabolic parameters, and his blood
glucose, blood pressure and lipids are
within the normal range. However, he has
been told by his GP that, because of his
weight gain, it is likely that he will need to
start anti-diabetic treatment in the future,
which he is very keen to avoid.
Of the following options, which would
be the MOST APPROPRIATE for Dean’s
prescribers to consider to lower Dean’s
risk of metabolic adverse effects
and delay the need for anti-diabetic
a) Change olanzapine to aripiprazole,
gradually reducing the olanzapine
dose and increasing the aripiprazole
to 10–15 mg daily during a crossover
phase of at least 1–2 weeks.
b) Gradually reduce olanzapine dose to
5 mg daily over at least 1–2 weeks,
and closely monitor Dean’s blood
glucose levels for signs of impaired
c) Cease olanzapine gradually over
at least 1–2 weeks and then inject
Risperdal Consta 25 mg every
two weeks by deep intramuscular
injection into deltoid or gluteal muscle;
if necessary, increase to a maximum
of 37.5–50 mg every two weeks.
d) Maintain olanzapine dose at 10 mg
daily, and discuss with Dean ways
that he can increase his physical
activity and consume a more
Summer in the Snowys
High end education in the high country
Saturday 26 and Sunday 27 November 2011
Lake Crackenback Resort, Crackenback NSW
For more information go to www.psa.org.au/education/conferences
or contact the ACT Branch on 02 6283 4726.
PSA Enabling your future.
Links Archive December 2011 October 2011 Navigation Previous Page Next Page