Home' Australian Pharmacist : June 2011 Contents Vol. 30 -- June #06
Continuing Professional Development
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
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. Influenza
vaccination of the egg--
Additional reference: Australian
Society of Clinical Immunology and
Allergy. ASCIA guidelines for medical
practitioners: influenza vaccination
of the egg-allergic individual [online].
Sep 2010 [accessed 26 Apr 2011].
Isabelle is a 15-month-old female
infant who has been diagnosed
with cystic fibrosis. Her respiratory
specialist considers that it is essential
for her to be vaccinated against
influenza for the winter of 2011.
Isabelle has not previously received
an influenza vaccine and her mother
is concerned that she may suffer
an adverse reaction to the vaccine
as Isabelle's father has had an
anaphylactic response to scrambled
eggs in the past. Isabelle has also
experienced mild urticaria in the
past after accidentally ingesting cake
batter made with raw egg; however
she has since eaten a teaspoonful
of scrambled egg with no signs of
Using the flowchart in the provided
reference as a guide, of the following
options the most appropriate
advice to provide to Isabelle's
mother regarding her influenza
a) Isabelle may be immunised with
0.1 mL of Intanza (as a single dose)
in a general practice surgery, with a
final 15-minute waiting period after
b) Isabelle should have skin-prick
allergy tests with the vaccine
prior to vaccination. If the results
are positive then she should not
receive the influenza vaccination.
c) Isabelle may be immunised with
Fluad (in a split-dose regimen --
10% initially, then the remaining
90% thirty minutes later) in an
allergy clinic with a final 30-minute
waiting period after the final dose.
d) Isabelle may be immunised with
0.25 mL of Influvac (as a single
dose) in a general practice surgery,
with a final 30-minute waiting
period after the dose.
Question 2. Cardiac
effects of non-cardiac
Additional reference: Hopper I.
Cardiac effects of non-cardiac drugs
[online]. Australian Prescriber. 2011
[accessed 8 May 2011]; 34(2):52--4.
Greg, an accredited pharmacist, is
performing a medication review on
Mrs Smith. Mrs Smith is 65 years of
age and has the following diagnoses:
type 2 diabetes (since 2000);
osteoporosis (2009); rheumatoid
arthritis (2000); New York Heart
Association (NYHA) heart failure class
I (2010); and atrial fibrillation (2000).
She is unable to tolerate metformin
and sulfonylureas. The GP is
concerned that Mrs Smith's diabetes
and pain caused by her rheumatoid
arthritis are not well-controlled. Mrs
Smith uses the following medications:
• insulin glargine 20 units each night
• rosiglitazone 4 mg daily
• naproxen 250 mg twice a day when
• risedronate 35 mg once a week
• methotrexate 10 mg weekly
• amiodarone 100 mg daily
• warfarin 2 mg daily
• ramipril 5 mg daily
• cholecalciferol 1,000 IU daily
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