Home' Australian Pharmacist : October 2011 Contents Vol. 30 -- October #10, 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
Question 1. Gliptins
Additional reference: NPS News
Radar July 2011: Sitagliptin,
vildagliptin and saxagliptin --
dipeptidyl peptidase-4 inhibitors
('gliptins') for add-on therapy
in type 2 diabetes mellitus.
Mrs Harriette Singh (67 years, 78 kg,
154 cm) has been to her GP today for
some repeat prescriptions and follow-up.
She recently had her HbA1c measured
and it was found to be 7.8% despite
good adherence to medication. Harriette
has been experiencing episodes of
hypoglycaemia despite eating regular
meals. Her GP would like to commence
a new agent to control her diabetes.
Harriette's medical history includes:
• type 2 diabetes for 15 years;
• allergies to printing ink and aspirin;
• hypertension; acute coronary
syndrome; and eczema.
Harriette's most recent laboratory
• ALT: 32 (<35 units/L)
• AST: 25 (<40 units/L)
• Na: 136 mmol/L (135--145)
• K: 3.8 mmol/L (3.5--5)
• Cr: 99 mmol/L (50--110 micromol/L)
Harriette's current medications are:
• hydrocortisone 1% topically when
• metformin XR 2 g each morning
• gliclazide MR 120 mg each morning
• clopidogrel 75 mg daily
• ramipril 5 mg daily
Of the following options, which
would be the MOST APPROPRIATE
recommendation? (Assume patient
requires the medicine to be PBS-
a) Cease metformin and then
commence saxagliptin 5 mg daily.
b) Cease metformin and then
commence sitagliptin 100 mg daily.
c) Cease gliclazide and then
commence vildagliptin 50 mg daily.
d) Cease gliclazide and then
commence saxagliptin 5 mg daily.
Question 2. Migraine
Lisette Molen (27 years, 65 kg, 154 cm)
has been experiencing recurrent
migraines for the past 12 months.
Six months ago her doctor prescribed
pizotifen. Lisette is concerned about her
weight gain over the past five months.
Her GP has asked for your opinion.
Lisette's current medications are:
• Ketoprofen 100 mg rectally when
required (uses twice a week with
• Metoclopramide 10 mg
intramuscularly when required (uses
twice a week)
• Creon 5,000 capsules
(uses 8 capsules each day for
• Terbutaline (Bricanyl Turbuhaler)
500 mcg (uses three times a week
• Budesonide (Pulmicort Turbuhaler)
400 mcg (uses 2 puffs twice a day)
• Pizotifen 3 mg daily (used for last 6
months with little effect)
Of the following, which would be the
MOST APPROPRIATE recommendation?
a) Cease pizotifen and commence
amitriptyline 25 mg at night.
b) Cease pizotifen and commence
sodium valproate200 mg twice
c) Cease pizotifen and commence
oestradiol gel 1.5 mg daily.
d) Cease pizotifen and commence
propranolol 40 mg twice daily.
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