Home' Australian Pharmacist : September 2011 Contents Vol. 30 -- September #09, 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. Reducing
osteoporotic fracture risk
NPS. Osteoporosis. Prescribing
Practice Review Jun 2011;54.
Use the additional reference and the
links to online resources it provides
to determine which of the following
statements about osteoporotic
fracture risk is FALSE.
a) A 68-year-old woman who has
experienced one fall in the past
12 months, no fractures since age
50 and has a current T-score of
-2.5 has a lower 5 year risk of hip
fracture than a 68-year-old woman
who has experienced two falls
in the past 12 months with one
minimal trauma fracture since age
50 and has a current T-score of -1.5.
b) Assuming all other patient criteria
are equal, a 78-year-old male who
has used prednisolone for acute
skin rash from mango exposure
(50 mg daily for five days each
time) on average once a year for
the past three years has a higher
10 year risk of hip fracture than
current smoker, drinks more than
three units of alcohol per day and
has never used glucocorticoids.
c) To reduce the 10 year probability
of an osteoporotic hip fracture in a
60-year-old woman (height 150 cm,
weight 70 kg) who has had a
previous spontaneous fracture and
currently smokes, quitting smoking
is likely to be more effective than
reducing her BMI to within the
d) A 73-year-old male requires about
one more serving of regular milk
each day than a pre-menopausal
47-year-old woman to provide
adequate calcium intake to reduce
osteoporotic fracture risk.
Question 2. Atrial
Medi C, Hankey GJ, Freedman
SB. Atrial fibrillation. MJA
Mr Charles Brownlow is an apparently
fit and healthy 59-year-old regular
customer. You know he plays with the
local Masters Australian Rules Football
team (the Comets) every second week
in winter and is a top order batsman
in the local Masters cricket team (the
Meteors) during the summer. He visits
the pharmacy each month to collect
his regular repeats of perindopril
10 mg tablets, which he takes daily
for hypertension. He takes no other
regular medicines, but purchases the
occasional pack of paracetamol and
jokingly tells you, 'I'm not as young
as I used to be. It takes a bit longer to
recover from the injuries!'
Charles has been feeling a bit unwell
recently and visited his GP. He was
diagnosed with atrial fibrillation and
was commenced on sotalol 80 mg
twice daily for rhythm control. Charles'
CHADS2 score was calculated to be 1.
Which of the following
recommendations is the MOST
APPROPRIATE for other aspects of
a) Warfarin should be started
and the dose titrated to INR
2.0--3.0 to minimise the risk of
thromboembolism. Charles should
withdraw from all competitive sport
to minimise bleeding risk.
b) Aspirin 100 mg and clopidogrel
75 mg daily should be started
to minimise the risk of
thromboembolism while minimising
the risk of bleeding. Warfarin
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