GPhC Medicines Optimisation 1 — Questions and Answers
Question 1: Which of the following best describes the concept of medicines optimisation as defined by NICE?
- Ensuring patients take all prescribed medications at the correct dose
- A person-centred approach to safe and effective medicines use to achieve the best possible outcomes (Correct answer)
- Minimising the total number of medications a patient takes
- Ensuring prescribers adhere strictly to national formulary guidelines
Correct answer: A person-centred approach to safe and effective medicines use to achieve the best possible outcomes
NICE defines medicines optimisation as a person-centred approach to safe and effective medicines use to help patients achieve the best possible outcomes.
Question 2: Which NICE guideline specifically addresses medicines optimisation: the safe and effective use of medicines to enable the best possible outcomes?
- NG15
- NG28
- NG5 (Correct answer)
- NG76
Correct answer: NG5
NICE guideline NG5, published in 2015, sets out the key principles and recommendations for medicines optimisation in the NHS.
Question 3: The STOPP/START criteria are primarily used to:
- Identify potentially inappropriate medications and omissions in older patients (Correct answer)
- Calculate renal dose adjustments for commonly prescribed drugs
- Screen for drug interactions in patients on polypharmacy
- Assess patient adherence to long-term medication regimens
Correct answer: Identify potentially inappropriate medications and omissions in older patients
STOPP (Screening Tool of Older People's Prescriptions) identifies potentially inappropriate medicines and START (Screening Tool to Alert to Right Treatment) identifies treatment omissions in older patients.
Question 4: A patient is found to be taking 12 different regular medications concurrently. This situation is best described as:
- Polypharmacy (Correct answer)
- Hyperpharmacy
- Complex prescribing syndrome
- Multimorbidity pharmacotherapy
Correct answer: Polypharmacy
Polypharmacy refers to the concurrent use of multiple medications; complex or problematic polypharmacy is typically defined as 10 or more medicines.
Question 5: A medication review that involves the patient in a detailed discussion of all their medicines and aims to optimise therapy through shared decision making is classified as which level of review?
- Prescription review
- Adherence review
- Clinical medication review (Correct answer)
- Repeat dispensing review
Correct answer: Clinical medication review
A clinical medication review is the highest level of medication review, conducted with the patient present, covering all aspects of therapy with the aim of optimising outcomes.
Question 6: Which of the following is one of the four key principles of medicines optimisation as defined by the Royal Pharmaceutical Society?
- Prescribe the fewest medicines possible to manage conditions
- Aim to understand and respect the patient's experience of taking medicines (Correct answer)
- Prioritise adherence above individual patient preferences
- Ensure all medicines are reviewed at least every 12 months
Correct answer: Aim to understand and respect the patient's experience of taking medicines
The RPS four principles include understanding the patient's experience, ensuring medicines are used as intended, applying evidence-based choice, and making medicines optimisation a routine part of practice.
Question 7: During a home medicines review, a pharmacist notices an elderly patient is using a pressurised metered-dose inhaler (pMDI) without a spacer device. What is the most appropriate intervention?
- Report this immediately to the GP as a drug safety incident
- Advise the patient that a spacer device is recommended to improve drug delivery and inhaler technique (Correct answer)
- Arrange urgent substitution of the pMDI with a breath-actuated device
- Document the finding but make no intervention as the patient appears to be managing
Correct answer: Advise the patient that a spacer device is recommended to improve drug delivery and inhaler technique
Spacer devices significantly improve drug delivery from pMDIs, particularly in elderly patients with poor inspiratory coordination, and patient counselling on technique is a key pharmacist intervention.
GPhC Medicines Optimisation 1
Which of the following best describes the concept of medicines optimisation as defined by NICE?