Canadian Entry To Practice Canadian Entry To Practice Medication Therapy Management 2 — Questions and Answers
Question 1: Which validated tool is most commonly used to assess medication adherence in Canadian pharmacy practice?
- PHQ-9
- Morisky Medication Adherence Scale (MMAS) (Correct answer)
- GAD-7
- AUDIT-C
Correct answer: Morisky Medication Adherence Scale (MMAS)
The Morisky Medication Adherence Scale (MMAS) is a validated self-report tool used in pharmacy practice to assess patient adherence to prescribed medications.
Question 2: A patient on lisinopril develops a persistent dry cough. What is the most appropriate pharmacist recommendation?
- Advise the patient to take a cough suppressant
- Suggest switching to an angiotensin receptor blocker (ARB) as an alternative (Correct answer)
- Recommend doubling the lisinopril dose to overcome the cough
- Advise the patient to discontinue all antihypertensives
Correct answer: Suggest switching to an angiotensin receptor blocker (ARB) as an alternative
ACE inhibitor-induced cough is a class effect caused by bradykinin accumulation; switching to an ARB, which does not affect bradykinin, typically resolves the cough.
Question 3: When conducting a medication review for a patient with chronic kidney disease (CKD), what is the most critical pharmacokinetic parameter to evaluate?
- Drug protein binding
- Renal drug clearance and dose adjustment requirements (Correct answer)
- Volume of distribution
- First-pass metabolism
Correct answer: Renal drug clearance and dose adjustment requirements
Renal clearance is critical in CKD because many drugs and their active metabolites accumulate when GFR is reduced, requiring dose adjustments to prevent toxicity.
Question 4: What does polypharmacy typically refer to in the context of geriatric Medication Therapy Management?
- Use of any three or more drugs
- The concurrent use of five or more medications, often associated with increased adverse event risk (Correct answer)
- Use of medications from more than two drug classes
- Any combination of prescription and OTC drugs
Correct answer: The concurrent use of five or more medications, often associated with increased adverse event risk
Polypharmacy is conventionally defined as the use of five or more medications simultaneously and is associated with increased risk of drug interactions, falls, and adverse events in older adults.
Question 5: A pharmacist notices a patient is picking up their blood pressure medication only every 45 days despite a 30-day supply. What is the correct interpretation?
- The patient is taking double doses
- The patient has a refill adherence rate of approximately 67%, indicating poor adherence (Correct answer)
- The pharmacy has made a dispensing error
- The patient is receiving samples from their physician
Correct answer: The patient has a refill adherence rate of approximately 67%, indicating poor adherence
Refill adherence is calculated as (days supply dispensed / days elapsed) × 100; picking up a 30-day supply every 45 days yields approximately 67% adherence, which is below the recommended 80% threshold.
Question 6: Which outcome measure is most appropriate for monitoring the effectiveness of antihypertensive therapy in a patient with hypertension?
- Random blood glucose level
- Blood pressure readings at target versus goal (Correct answer)
- Serum creatinine only
- Body mass index (BMI)
Correct answer: Blood pressure readings at target versus goal
Blood pressure measurements compared to individualized target values are the primary clinical outcome measure for monitoring antihypertensive therapy effectiveness.
Canadian Entry To Practice Canadian Entry To Practice Medication Therapy Management 2
Which validated tool is most commonly used to assess medication adherence in Canadian pharmacy practice?