Home' Australian Pharmacist : Australian Pharmacist August 2014 Contents Australian Pharmacist August 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.
Mr Lowe presents a prescription for
Actiq (fentanyl) 600 microgram lozenges
for his wife, Alana, who is undergoing
palliative care at home for breast cancer.
Mr Lowe explains that the lozenges
are to replace the Ordine (morphine)
that Alana has previously used for
breakthrough pain. The dose of Ordine
that she now needs to take is causing
severe nausea and vomiting. The doctor
has told her that the lozenges will work
faster and cause fewer side effects
than the Ordine. On reviewing Alana’s
medication history, you see that she has
also been taking MS Contin (morphine
controlled release) 40 mg twice daily for
the past two weeks.
Which of the following points would
be MOST appropriate to discuss with
a) The 600 microgram lozenges are not
suitable for initiation of fentanyl therapy.
All patients should be started on
200 microgram lozenges and the dose
gradually increased, regardless of their
previous opioid requirements.
b) Fentanyl lozenges have similar side
effects to morphine liquid, so this is not
an adequate reason for Alana to switch
c) Fentanyl lozenges have only been studied
in patients who are opioid-tolerant, and
Alana is not in this patient group.
d) The onset of action of fentanyl lozenges
is similar to that of morphine liquid, and
it is unlikely that Alana will obtain faster
Derek (58 years old) has been taking
Mesasal (mesalazine) 250 mg three
times a day as maintenance therapy for
ulcerative colitis. However, despite this,
he has been having frequent relapses,
and his doctor is considering starting
him on azathioprine. Derek weighs 80 kg.
He also has hyperlipidaemia and gout,
for which he is taking atorvastatin 20 mg
daily and allopurinol 300 mg daily.
Which of the following points regarding
azathioprine therapy for Derek
a) If Derek has high thiopurine
methyltransferase (TPMT) levels, he is
at increased risk of myelotoxicity if
he continues to take the Mesasal
(mesalazine) after commencing
b) An appropriate azathioprine starting
dose for Derek is 25 mg daily, increasing
gradually to a maintenance dose of
50 mg daily.
c) If Derek does not experience a
reduction in relapses within a month,
the azathioprine should be replaced with
an alternative maintenance medicine.
d) Because of its superior benefit/adverse
effect profile, it would be preferable
to give Derek budesonide rather
than azathioprine as an alternative
After reading this article, pharmacists should be
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
Address primary healthcare needs of patients.
Competency standards (2010) addressed: 4.2, 6.1,
7.1, 7.2 .
Accreditation number: CAP140808F-G
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