Home' Australian Pharmacist : Australian Pharmacist July 2013 Contents 72
Australian Pharmacist July 2013 I ©Pharmaceutical Society of Australia Ltd.
KNOWLEDGE IN PRACTICE
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
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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, 22nd Ed. Canberra: Pharmaceutical
Society of Australia, 2012.
2. Rossi S (ed). Australian Medicines Handbook.
Adelaide: Australian Medicines Handbook Pty Ltd;
3. National Prescribing Service [online]. At: www.nps.
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.
Additional reference: NPS. Fatal arrhythmias – drugs and the QT. NPS
Direct, Apr 2013. At: http://tinyurl.com/apv32071
Which of the following clinical
scenarios contains the MOST
a) Mr Glass (72 years old, hypothyroidism,
COPD, hypertension, Parkinson’s
disease) has recently been complaining
of nausea. His current medications are
thyroxine 100 mcg daily, tiotropium
18 mcg daily, ramipril 5 mg daily and
levodopa/carbidopa 50/12.5 mg four
times daily (recently increased from
three times daily). Mr Glass should be
commenced on domperidone 10 mg
four times a day.
b) Mr Smith (40 years old, hyperthyroidism,
Conn’s syndrome, bipolar disorder)
has presented to the emergency
department with torsades de pointes.
The medicines he takes are: carbimazole
5 mg daily, amiloride 5 mg daily and
sertindole 8 mg daily. The sertindole
should be ceased immediately and
replaced with ziprasidone.
c) Mrs Jones (68 years old, hypertension,
permanent atrial fibrillation, GORD)
takes ramipril 5 mg daily, aspirin 100 mg
daily, sotalol 80 mg twice daily and
omeprazole 20 mg daily. Yesterday,
during a routine medical check-up, an
ECG identified a prolonged QT interval.
It would be advisable to replace Mrs
Jones’s sotalol with metoprolol.
d) Mrs Hope (70 years old, heart failure,
hyperlipidaemia, penicillin allergy)
takes fosinopril 20 mg daily, carvedilol
12.5 mg twice daily, aspirin 100 mg
daily, simvastatin 10 mg daily and
frusemide 20 mg daily. She has
just been diagnosed with mild
She should commence clarithromycin
250 mg 12-hourly.
Question 1. QT interval
Question 2. Diabetes therapy
Additional reference: Royal Australian College of General Practitioners
(RACGP) and Diabetes Australia. Diabetes management in general
practice: Guidelines for type 2 diabetes, 17th edn 2011/12. At: http://
You are asked to complete a medication
review for Mrs O’Shea (68 years old, weight
66 kg, height 165 cm). You are provided with
the following information:
• Medical history: type 2 diabetes,
atrial fibrillation and myocardial
infarction. Most recent blood pressure
• Recent laboratory results:
• Sodium: 138 mmol/L (135–145 mmol/L)
• Potassium: 4.5 mmol/L (3.8–4.9 mmol/L)
• Total cholesterol: 3.85 mmol/L
• Low density lipoprotein cholesterol
(LDL-C): 2.4 mmol/L (<2.5 mmol/L)
• High density lipoprotein cholesterol
(HDL-C): 0.95 mmol/L (>1.0 mmol/L)
• Triglycerides: 1.5 mmol/L (<1.7 mmol/L)
• HbA1c: 9.4% or 79 mmol/mol (<7% or
• Creatinine: 132 micromol/L (50–
• INR: 2.5 (2.0–3.0)
• Liver Function Tests: Normal
• Metformin 500 mg twice daily
• Gliclazide CR 60 mg, two each morning
• Warfarin 5 mg daily
• Digoxin 62.5 mcg, two each morning
• Simvastatin 40 mg daily
• Metoprolol 50 mg twice daily
• Ramipril 5 mg daily
Which of the following recommendations
would be the MOST appropriate option
to improve Mrs O’Shea’s blood glucose
a) Increase Mrs O’Shea’s metformin dose to
500 mg three times daily.
b) Add exenatide 5 mcg SC twice daily
before morning and evening meals to her
c) Add glargine insulin 10 units SC at
bedtime to her current therapy.
d) Add acarbose 50 mg daily to her current
therapy, titrating the dose according to
Knowledge in practice
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