Home' Australian Pharmacist : Australian Pharmacist May 2014 Contents Australian Pharmacist May 2014 I ©Pharmaceutical Society of Australia Ltd.
CONTINUING PROFESSIONAL DEVELOPMENT
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. 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; 2014.
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.
Knowledge in practice
TO ANSWER KNOWLEDGE IN
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 an explanation of why
the answer is correct. If you do not have member
access details for the PSA website, you can request
them via a link from the login page.
Question 1. Smoking
cessation – drug
Mrs Peterson (63 years old), a regular
customer, asks to speak to you. She tells
you that she very much wants to give up
smoking. However, she has tried twice
before, using nicotine patches, without
success. Her friend has told her about
some tablets the doctor can prescribe to
help with smoking cessation. She asks
if you think they would be worth
trying. According to your records, she is
• metformin 500 mg three times daily
• warfarin 3 mg daily
• atorvastatin 20 mg daily
• digoxin 125 mcg daily
• esomeprazole 20 mg daily
• paroxetine 20 mg daily
Which of the following points is
CORRECT and appropriate to consider
when formulating your response to Mrs
a) Tobacco smoking inhibits CYP1A2 and, if
Mrs Peterson stops smoking, her INR may
fall and she may require an increase in
her dose of warfarin.
b) Mrs Peterson may need to take
varenicline at a lower dose because she is
on metformin. The active renal secretion
of varenicline is mediated by the cation
transporter OCT2, and its clearance may
be reduced by metformin, which is an
c) Mrs Peterson may need to take
bupropion at a lower dose because she is
on paroxetine. Bupropion is metabolised
by CYP2D6 and its serum concentration
may be increased by paroxetine, a strong
d) Mrs Peterson should avoid bupropion, as
she is taking paroxetine and concomitant
use may increase her risk of seizures.
e) Gabapentin 100 mg three times daily,
titrating to 300 mg three times daily.
Question 2. Emergency
Additional reference: Fact sheet on the safety of levonorgestrel-
alone emergency contraceptive pills. Geneva: World Health
Organization, 2010. At: http://tinyurl.com/apv33052
Wendy comes into the pharmacy late
one Sunday evening with a repeat
prescription for Amoxil 500 mg three
times a day for a recurrence of a UTI.
She tells you she has just returned from
a week’s camping trip in the bush and
asks you to supply her with emergency
contraception. She is concerned
because a condom split on Wednesday
night. On further questioning, you
discover that she is 32 years old, her
monthly cycle varies between 26 and
35 days, her last period was about three
weeks ago, she takes no other medicines
(apart from the Amoxil) and, two years
ago, after undergoing successful
treatment for breast cancer, she was told
that she should never take the pill.
Which of the following statements is the
a) Due to the time that has elapsed since
unprotected sexual intercourse, Wendy
should seek medical advice, as using
emergency contraception (EC) at this
stage would not be effective.
b) Wendy’s medical history does not
preclude the use of EC.
c) Wendy should wait for a couple of
days before starting the Amoxil, as it
may reduce the serum concentration
of levonorgestrel, reducing the
effectiveness of the EC.
d) Because of the risk of teratogenesis,
Wendy should avoid EC if she thinks there
is a chance she may already be pregnant.
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
Promote and contribute to the optimal use of
Address primary health needs of patients.
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.
Accreditation number: CAP140505F-G
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