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Australian Pharmacist January 2014 I ©Pharmaceutical Society of Australia Ltd.
CONTINUING PROFESSIONAL DEVELOPMENT
1. Which ONE of the following signs or
symptoms is LEAST consistent with
b) Gastrointestinal pain.
c) Elevated serum C-reactive protein.
d) Poor memory.
2. Which ONE of the following
statements regarding fibromyalgia is
the LEAST appropriate?
a) It is most common in middle-aged
b) Symptoms usually resolve around a year
c) Disturbed sleeping patterns is a
d) Associated with inappropriate central
3. Which ONE of the following
medicines is MOST effective in
managing pain associated with
d) No medication is definitively more
effective than another.
4. A 55 year old man has a medical
history of significant depression and
hypertension. He is newly diagnosed
with fibromyalgia, and describes
pain and insomnia as his most
concerning symptoms. His current
medications are sertraline 100 mg
and quinapril 20 mg, both once daily
in the morning. His blood pressure is
well controlled and his mood is good
despite his recent diagnosis.
Which ONE of the following
recommendations is the LEAST
appropriate for this man at this time?
a) Referral to a psychologist for education
about self-efficacy and coping
b) Commence a trial of pregabalin to
improve his pain and sleep.
c) Encouragement to commence a gentle
exercise program if he leads a sedentary
d) Sertraline should be changed to a low
dose of amitriptyline.
recommended to consider two changes
to her medication regimen to simplify it:
• moving the thyroxine to a
single, possibly supervised, once
• changing twice daily cortisone to
once daily prednisolone, although
there is increasing evidence this may
confer a higher risk of long‐term
adverse metabolic effects compared
A final recommendation about
managing this patient’s FMS was to
consider checking her vitamin D level.
This was due to there being some
evidence that FMS is a risk factor
for hypovitaminosis D, which may
negatively impact upon her cognition.
Additionally, her coexisting osteopenia
was likely to benefit from an adequate
level of vitamin D and calcium intake.
At the time of writing, the patient had
ceased amitriptyline and was taking
30 mg duloxetine twice daily with
limited improvement in FMS‐associated
pain. However, cost was becoming an
issue for her as duloxetine is neither
licenced nor PBS‐subsidised for FMS in
Australia (although it is FDA‐approved
for this indication in the United States).
If the cost became prohibitive, her GP
intended to switch her to a cheaper
SSRI. Whilst she did not believe that her
memory had improved, she was using a
Dosette box and was confident that she
was no longer doubling up on doses of
This case is an example of the
complexities involved in the therapeutic
decision‐making process undertaken by
pharmacists in HMRs. It highlights how
a patient’s concerns must be addressed
within the context of their coexisting
conditions, medication regimen, social
circumstances and medication‐taking
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