CPC Medication Management and Reconciliation 2 — Questions and Answers
Question 1: A community paramedic finds opened and unopened pill bottles scattered throughout a patient's home with no organized system. The MOST appropriate intervention is to:
- Dispose of all outdated medications without patient consent
- Assist the patient in organizing medications and introduce pill organizer use, with physician notification (Correct answer)
- Photograph the bottles and leave them as found for the physician to address
- Contact the pharmacy to cancel all refills pending a physician review
Correct answer: Assist the patient in organizing medications and introduce pill organizer use, with physician notification
Helping the patient organize medications and introducing adherence tools like a pill organizer directly addresses the safety risk while supporting the patient's independence and informing the care team.
Question 2: Which of the following medications requires the MOST careful monitoring for signs of toxicity during a community paramedic home visit?
- Vitamin D supplements
- Digoxin (Correct answer)
- Docusate sodium (stool softener)
- Loratadine (antihistamine)
Correct answer: Digoxin
Digoxin has a narrow therapeutic index, and toxicity — presenting as nausea, visual changes, and arrhythmias — can be life-threatening, requiring close monitoring.
Question 3: A patient on warfarin reports eating significantly more leafy green vegetables over the past month. A community paramedic should recognize this as potentially:
- Beneficial because vegetables improve cardiovascular health
- A reason to increase the warfarin dose independently
- A dietary change that may reduce warfarin's anticoagulant effect and require INR monitoring (Correct answer)
- Irrelevant to the patient's medication regimen
Correct answer: A dietary change that may reduce warfarin's anticoagulant effect and require INR monitoring
Leafy green vegetables are high in vitamin K, which antagonizes warfarin's anticoagulant effect, potentially increasing clot risk and necessitating INR monitoring and dose adjustment.
Question 4: A community paramedic performs a home visit and finds a patient stockpiling unused insulin without refrigeration. The MOST immediate concern is:
- The patient may be selling the insulin
- The insulin may have lost potency due to improper storage, leading to uncontrolled blood sugar (Correct answer)
- The patient is over-prescribed and needs fewer vials
- The stockpile indicates the patient is not eating properly
Correct answer: The insulin may have lost potency due to improper storage, leading to uncontrolled blood sugar
Insulin stored at room temperature for extended periods loses potency, which can result in dangerously elevated blood glucose levels when the degraded insulin is administered.
Question 5: In the context of community paramedicine, medication adherence is BEST supported by which intervention?
- Threatening to report non-adherence to the physician as non-compliance
- Identifying and addressing the patient's specific barriers to adherence (cost, complexity, side effects, beliefs) (Correct answer)
- Simplifying the regimen to a single medication regardless of clinical need
- Switching all medications to injectable formulations for reliability
Correct answer: Identifying and addressing the patient's specific barriers to adherence (cost, complexity, side effects, beliefs)
Identifying and addressing patient-specific adherence barriers is evidence-based and patient-centered, addressing root causes rather than simply reinforcing prescribed behavior.
Question 6: A patient discharged from the hospital has a new prescription for a beta-blocker but says they cannot afford it. The BEST community paramedic response is to:
- Advise the patient to take the medication every other day to make it last
- Connect the patient with pharmaceutical patient assistance programs or $4 generic pharmacy programs (Correct answer)
- Document non-adherence and defer to the physician at the next office visit
- Recommend the patient use a relative's similar medication
Correct answer: Connect the patient with pharmaceutical patient assistance programs or $4 generic pharmacy programs
Patient assistance programs and low-cost generic pharmacy programs are legitimate resources that address cost barriers to medication adherence and are a core community paramedic function.
CPC Medication Management and Reconciliation 2
A community paramedic finds opened and unopened pill bottles scattered throughout a patient's home with no organized system.
The MOST appropriate intervention is to: