GPhC Medicines Optimisation 3

Question 1

Medicines reconciliation is best defined as:

Accepted Answer

Comparing a patient's current medication orders to all medications the patient has actually been taking, to identify and resolve discrepancies

Answer

Reviewing a patient's medicines to assess adherence and concordance

Answer

Verifying that a prescription has been dispensed accurately by the pharmacy

Answer

Ensuring that medicines are optimally dosed based on individual patient pharmacokinetics

Question 2

At which transition of care is medicines reconciliation most critical for preventing medication errors?

Accepted Answer

On admission to or discharge from hospital

Answer

When a patient collects a repeat prescription from the pharmacy

Answer

When a patient requests a new OTC product from the pharmacist

Answer

When a patient changes their registered community pharmacy

Question 3

Deprescribing is best described as:

Accepted Answer

The planned and supervised process of reducing or stopping medications that may no longer be beneficial or may be causing harm

Answer

The cessation of all non-essential medications in patients approaching end of life

Answer

The substitution of brand-name medicines with bioequivalent generic alternatives

Answer

Reducing medicine costs by switching patients to less expensive formulary alternatives

Question 4

The NO TEARS tool is used to structure medication reviews. What does the letter 'T' represent in this mnemonic?

Accepted Answer

Tests and monitoring

Answer

Tolerability of side effects

Answer

Toxicity risk assessment

Answer

Therapeutic outcome targets

Question 5

A 78-year-old patient is taking a long-term NSAID for joint pain alongside a PPI for gastric protection. Which medicines optimisation approach is most appropriate during their review?

Accepted Answer

Consider whether the NSAID is still necessary given the patient's age and risk profile, and explore safer alternatives

Answer

Increase the PPI dose to provide enhanced gastric mucosal protection

Answer

Add an H2 antagonist alongside the PPI for dual gastric protection

Answer

Switch from an oral to topical NSAID without further clinical review

Question 6

Which class of medication is most commonly identified by STOPP criteria as potentially inappropriate in older adults due to risk of falls and cognitive impairment?

Accepted Answer

Benzodiazepines and Z-drugs (non-benzodiazepine hypnotics)

Answer

ACE inhibitors and angiotensin receptor blockers

Answer

Statins and antihypertensive agents

Answer

SSRIs and SNRIs

Question 7

A pharmacist reviewing a patient's medication record identifies that ramipril and candesartan are both prescribed concurrently. What is the most appropriate action?

Accepted Answer

Contact the prescriber to discuss the combination, as dual RAAS blockade increases the risk of renal failure, hyperkalaemia, and hypotension

Answer

Continue both medications as dual renin-angiotensin system blockade is endorsed in heart failure management

Answer

Dispense both medications but counsel the patient to monitor their blood pressure at home

Answer

Withhold both medications immediately and arrange an urgent GP appointment