CCP Patient Assessment and Monitoring 2 — Questions and Answers
Question 1: An 82-year-old nursing home resident has a serum creatinine of 0.7 mg/dL. Which method is most appropriate for estimating her renal function for drug dosing?
- Use raw serum creatinine as a marker of normal renal function
- Apply the Cockcroft-Gault equation using actual body weight (Correct answer)
- Use the CKD-EPI equation alone without adjusting for low muscle mass
- Assume normal renal function since creatinine is within normal range
Correct answer: Apply the Cockcroft-Gault equation using actual body weight
Cockcroft-Gault with actual body weight is preferred in elderly patients, recognizing that low muscle mass may cause deceptively low serum creatinine despite reduced GFR.
Question 2: A consultant pharmacist reviews a patient's medication list and finds duplicate therapy with two ACE inhibitors prescribed by different providers. What is the best initial action?
- Discontinue both and start an ARB
- Contact the prescribers to clarify intent and reconcile the medication list (Correct answer)
- Continue both since ACE inhibitors have complementary mechanisms
- Add a potassium supplement to counteract hyperkalemia risk
Correct answer: Contact the prescribers to clarify intent and reconcile the medication list
Medication reconciliation with prescriber communication is the appropriate first step to resolve duplicate therapy safely.
Question 3: Which validated tool is specifically designed to screen for depression in elderly patients in long-term care settings?
- PHQ-9
- Beck Depression Inventory
- Geriatric Depression Scale (GDS) (Correct answer)
- Columbia Suicide Severity Rating Scale
Correct answer: Geriatric Depression Scale (GDS)
The Geriatric Depression Scale was specifically developed and validated for screening depression in older adults.
Question 4: A patient receiving warfarin has an INR of 4.8 with no signs of bleeding. What is the most appropriate pharmacist recommendation?
- Hold warfarin for 1-2 doses and recheck INR (Correct answer)
- Administer vitamin K 10 mg IV immediately
- Continue current dose and recheck INR in 1 week
- Switch to direct oral anticoagulant immediately
Correct answer: Hold warfarin for 1-2 doses and recheck INR
For an elevated INR without bleeding, holding 1-2 doses of warfarin and rechecking INR is appropriate per ACCP guidelines.
Question 5: Which of the following best describes the purpose of a comprehensive medication review (CMR) in the Medicare Part D Medication Therapy Management program?
- To audit pharmacy billing practices
- To conduct a structured, interactive patient interview to optimize drug therapy (Correct answer)
- To identify medications eligible for generic substitution only
- To verify that all prescriptions are covered under the patient's formulary
Correct answer: To conduct a structured, interactive patient interview to optimize drug therapy
A CMR is a structured, interactive consultation aimed at identifying, resolving, and preventing drug therapy problems to optimize medication use.
Question 6: A nursing home patient on long-term opioid therapy for chronic pain appears sedated and has a respiratory rate of 10 breaths/min. What is the consultant pharmacist's priority assessment?
- Check for constipation as the cause of sedation
- Assess for opioid toxicity and consider naloxone administration (Correct answer)
- Increase the opioid dose to improve pain control
- Order a sleep study to evaluate for sleep apnea
Correct answer: Assess for opioid toxicity and consider naloxone administration
Sedation with respiratory depression in a patient on opioids indicates potential toxicity requiring immediate assessment and possible naloxone administration.
Question 7: When monitoring a patient on methotrexate for rheumatoid arthritis, which laboratory finding would indicate the need to hold the medication?
- Serum albumin of 3.8 g/dL
- ALT three times the upper limit of normal (Correct answer)
- Hemoglobin of 12.5 g/dL
- Creatinine clearance of 55 mL/min
Correct answer: ALT three times the upper limit of normal
Hepatotoxicity indicated by liver enzymes exceeding two to three times the upper limit of normal warrants holding methotrexate per standard guidelines.
