Long-Term Care Pharmacy Services Flashcards

A nursing facility wants to implement an antibiotic stewardship program. Which role is the consultant pharmacist MOST suited to lead?

Answer: Reviewing antibiotic appropriateness, duration, and culture sensitivity results

The consultant pharmacist is ideally positioned to review antibiotic prescribing patterns, recommend de-escalation based on culture data, and guide stewardship policy.

Which of the following medications requires special handling and monitoring in LTC residents due to its narrow therapeutic index?

Answer: Digoxin

Digoxin has a narrow therapeutic index and requires regular serum level monitoring, especially in elderly LTC residents who are at higher risk for toxicity.

Under the Medicare Prescription Drug Improvement and Modernization Act, Part D sponsors must include which provision for LTC residents?

Answer: A long-term care pharmacy network and access to a 31-day emergency supply

Part D regulations require plan sponsors to include an adequate LTC pharmacy network and ensure access to a 31-day emergency supply for beneficiaries in LTC facilities.

A consultant pharmacist identifies a resident taking five or more chronic medications. This condition is referred to as:

Answer: Polypharmacy

Polypharmacy is defined as the concurrent use of five or more medications and is associated with increased risk of adverse drug events in elderly LTC residents.

A resident's medication order reads 'metoprolol succinate 50 mg daily.' The LTC pharmacy only carries metoprolol tartrate. What should the consultant pharmacist do?

Answer: Contact the prescriber to clarify the order because these two salts have different dosing and release profiles

Metoprolol succinate (extended-release) and tartrate (immediate-release) are not directly interchangeable; the prescriber must authorize any formulation change.

What is the primary purpose of the 'prescribing cascade' concept that consultant pharmacists must recognize in LTC?

Answer: A new drug is prescribed to treat an adverse effect of an existing medication, leading to unnecessary polypharmacy

A prescribing cascade occurs when a drug's adverse effect is misidentified as a new condition, prompting additional prescribing that compounds medication burden.

Which Beers Criteria category of medications is most commonly flagged by consultant pharmacists in LTC due to anticholinergic burden in elderly residents?

Answer: First-generation antihistamines such as diphenhydramine

First-generation antihistamines like diphenhydramine have strong anticholinergic properties and are listed in the Beers Criteria as potentially inappropriate for older adults due to risks of confusion, urinary retention, and falls.