Mixed Deck — All MTM Topics Flashcards

An MTM pharmacist is completing a comprehensive medication review for a 72-year-old on oxycodone 10 mg q6h. Which Beers Criteria concern is most relevant?

Answer: Opioids increase risk of falls, fractures, delirium, and respiratory depression in older adults

The AGS Beers Criteria identifies opioids as potentially inappropriate in older adults due to increased risks of falls, fractures, confusion, delirium, and respiratory depression.

A CMR patient reports forgetting her afternoon medication dose consistently. Which adherence strategy is most evidence-based for this pattern?

Answer: Switching to a twice-daily formulation if a once-daily equivalent is available

Simplifying regimens by switching to once-daily formulations is among the most effective strategies for improving adherence in patients who forget scheduled doses.

Which regulatory body has primary oversight authority for enforcing HIPAA Privacy Rule compliance in MTM documentation?

Answer: The Office for Civil Rights (OCR) within the Department of Health and Human Services

The HHS Office for Civil Rights (OCR) is the primary enforcer of the HIPAA Privacy and Security Rules, including for MTM-related PHI documentation.

When a MTM professional encounters an unfamiliar challenge in specialty medication management, what is the recommended first course of action?

Answer: Research applicable standards, consult with subject matter experts, and document the approach

Professional practice requires a methodical approach to unfamiliar challenges: research the applicable standards, consult experts when needed, and document the reasoning for the chosen approach.

Which antipsychotic is most associated with QTc prolongation and requires baseline and periodic ECG monitoring?

Answer: Ziprasidone

Ziprasidone is associated with the greatest QTc prolongation among atypical antipsychotics, necessitating ECG monitoring and avoidance with other QTc-prolonging drugs.

Which laboratory test is most appropriate to monitor anticoagulant effect when using argatroban in a patient with HIT?

Answer: Activated partial thromboplastin time (aPTT)

Argatroban, a direct thrombin inhibitor, is monitored using the aPTT with a target of 1.5–3 times the baseline normal value.

A patient on warfarin for atrial fibrillation is starting fluconazole for a vaginal yeast infection. What action should be taken?

Answer: Decrease the warfarin dose by approximately 25–50% and monitor INR closely

Fluconazole is a strong CYP2C9 inhibitor that significantly increases warfarin levels, requiring a warfarin dose reduction and close INR monitoring.

Which statement about trimethoprim (TMP) and serum creatinine is clinically important for MTM pharmacists?

Answer: TMP blocks tubular creatinine secretion, raising serum creatinine without true GFR change

Trimethoprim competitively inhibits tubular creatinine secretion, causing a rise in serum creatinine that does not reflect actual GFR decline.

In the Naylor Transitional Care Model, which professional serves as the primary coordinator for high-risk older adults during care transitions?

Answer: Advanced practice nurse

The Naylor Transitional Care Model uses advanced practice nurses as dedicated transition coaches for high-risk elderly patients.

Which communication technique is most effective in building trust with patients?

Answer: Active listening and empathy

Active listening involves fully concentrating on what the patient is saying, both verbally and non-verbally, and demonstrating understanding. Empathy is the ability to understand and share the feelings of another. These communication techniques are crucial for building trust because they show patients that their concerns are heard, valued, and respected, fostering a strong therapeutic relationship and encouraging open communication about their health.

A pharmacist is managing an anticoagulation clinic and receives labs for a patient on warfarin who also started taking naproxen OTC. Which concern is most clinically relevant?

Answer: Naproxen can displace warfarin from protein binding and inhibit platelet function, increasing bleeding risk

NSAIDs like naproxen inhibit platelet aggregation and can displace warfarin from albumin, compounding bleeding risk even if the INR does not markedly change.

In the context of MTM certification, what is the most important consideration when implementing transitions of care & reconciliation?

Answer: Ensuring alignment with established standards, stakeholder needs, and best practices

When implementing transitions of care & reconciliation, MTM professionals must ensure alignment with industry standards and stakeholder needs. Hasty implementation without proper planning often leads to compliance issues and suboptimal outcomes.

In a patient with stage 4 CKD (eGFR 22 mL/min/1.73m²) and type 2 diabetes, which glucose-lowering agent requires the most significant dose adjustment?

Answer: Metformin

Metformin is contraindicated when eGFR falls below 30 mL/min/1.73m² due to risk of lactic acidosis from drug accumulation.

A patient on fluoxetine is prescribed tramadol for pain. What pharmacokinetic interaction is most concerning?

Answer: Fluoxetine inhibits CYP2D6, reducing tramadol's conversion to active analgesic metabolite and increasing serotonin syndrome risk

Fluoxetine inhibits CYP2D6, reducing tramadol conversion to O-desmethyltramadol (active metabolite), decreasing analgesia; additionally, both drugs are serotonergic, increasing serotonin syndrome risk.

Which communication approach is MOST effective when a patient has low numeracy skills and needs to understand a dosing schedule?

Answer: Use simple visual aids such as pictures, pill calendars, or color-coded charts

Visual aids such as pill calendars and color-coded charts are proven effective for patients with low numeracy or health literacy.

How should MTM professionals handle confidential information related to renal dosing & adjustments?

Answer: Follow established protocols for data protection, access control, and disclosure in accordance with applicable regulations

Confidential information must be handled according to established protocols, regulatory requirements, and professional ethics standards, including proper access control and disclosure procedures.

Which of the following medications used in heart failure has been shown to improve glycemic control in patients with T2DM by reducing insulin resistance?

Answer: Carvedilol

Carvedilol, unlike other beta-blockers, has alpha-1 blocking activity that may improve insulin sensitivity and is considered metabolically favorable.

When assessing adherence in a patient with poorly controlled hypertension, which objective measure provides the most reliable verification?

Answer: Pharmacy refill records over 6 months

Pharmacy refill records (medication possession ratio) provide an objective, longitudinal measure of adherence that is less subject to white-coat bias than clinic-based assessments.

Which patient counseling point is MOST critical for a patient self-administering subcutaneous methotrexate at home for rheumatoid arthritis?

Answer: Take folic acid supplementation daily to reduce mucositis and liver toxicity

Daily folic acid (1 mg) or folinic acid supplementation substantially reduces methotrexate-related toxicities including mucositis and elevated transaminases.

When using the Medication Appropriateness Index (MAI) during polypharmacy assessment, how many criteria does the tool evaluate for each medication?

Answer: 10

The MAI evaluates 10 criteria for each medication including indication, effectiveness, dosage, directions, drug interactions, and cost.