CCP Polypharmacy & Medication Reconciliation 3 — Questions and Answers
Question 1: A chronic care manager is conducting a comprehensive medication review for a patient with heart failure, diabetes, and COPD on 9 medications. Which framework best guides identification of unnecessary medications?
- SOAP note documentation
- Prescribing Cascade identification (Correct answer)
- HEDIS measure tracking
- PHQ-9 screening
Correct answer: Prescribing Cascade identification
The prescribing cascade occurs when a new drug is added to treat a side effect of an existing drug, making it the key framework for identifying unnecessary medications.
Question 2: A patient on lisinopril develops a chronic dry cough. Her provider adds dextromethorphan to manage it. This scenario best illustrates which concept?
- Therapeutic duplication
- Prescribing cascade (Correct answer)
- Drug-disease interaction
- Medication non-adherence
Correct answer: Prescribing cascade
Adding dextromethorphan to treat an ACE inhibitor-induced cough is a classic prescribing cascade rather than recognizing and switching the causative agent.
Question 3: Which patient factor most significantly increases the risk of adverse drug reactions in the context of polypharmacy?
- High health literacy
- Renal impairment (Correct answer)
- Young age
- Single-provider care
Correct answer: Renal impairment
Renal impairment reduces drug clearance, leading to drug accumulation and increased adverse effects, especially in polypharmacy.
Question 4: During a home visit, a care manager discovers a patient taking both brand-name Tylenol and a generic cold medicine containing acetaminophen. Which risk does this represent?
- Drug-disease interaction
- Therapeutic duplication (Correct answer)
- Drug-food interaction
- Subtherapeutic dosing
Correct answer: Therapeutic duplication
Taking two products that both contain acetaminophen creates therapeutic duplication and risks hepatotoxicity from cumulative overdose.
Question 5: A care coordinator is performing medication reconciliation for a patient just transferred from the ICU. Which source is considered the MOST accurate for the patient's home medication list?
- Hospital pharmacy dispensing records
- Patient's own medication bottles (Correct answer)
- Previous discharge summary
- Physician memory
Correct answer: Patient's own medication bottles
The patient's own medication bottles provide the most accurate real-world picture of what the patient was actually taking at home.
Question 6: A 70-year-old patient on warfarin begins eating large amounts of leafy green vegetables. Which laboratory change would be expected?
- INR increases (over-anticoagulation)
- INR decreases (under-anticoagulation) (Correct answer)
- No change in INR
- Platelet count decreases
Correct answer: INR decreases (under-anticoagulation)
Leafy greens contain high amounts of vitamin K, which antagonizes warfarin's effect and decreases INR.
Question 7: Which medication reconciliation step specifically involves verifying the medication list with the patient to confirm what they are actually taking versus what was prescribed?
- Medication transcription
- Medication verification
- Best Possible Medication History (BPMH) (Correct answer)
- Medication administration record review
Correct answer: Best Possible Medication History (BPMH)
The Best Possible Medication History (BPMH) is a structured interview process to compile the most accurate possible record of a patient's actual medication use.
CCP Polypharmacy & Medication Reconciliation 3
A chronic care manager is conducting a comprehensive medication review for a patient with heart failure, diabetes, and COPD on 9 medications.
Which framework best guides identification of unnecessary medications?