Comprehensive Medication Review & Optimization Flashcards
7 cards from real MTM practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Comprehensive Medication Review & Optimization flashcards as text
During a CMR, a patient taking warfarin reports recently starting fish oil supplements. What is the primary concern?
Answer: Additive anticoagulant effect increasing bleeding risk
Fish oil has antiplatelet properties that can potentiate warfarin's anticoagulant effect, increasing bleeding risk.
A CMR reveals a patient is taking both a PPI and clopidogrel. What is the most clinically significant concern?
Answer: PPIs reduce clopidogrel's antiplatelet activation via CYP2C19 inhibition
PPIs (especially omeprazole) inhibit CYP2C19, reducing conversion of clopidogrel to its active metabolite and diminishing antiplatelet effect.
Which STOPP criteria medication combination should prompt immediate reconciliation review in an elderly CMR patient?
Answer: NSAID + anticoagulant
STOPP criteria flag NSAID + anticoagulant combinations due to significantly elevated GI bleeding risk in elderly patients.
A patient's MAP (Medication Action Plan) following a CMR should primarily be written for whom?
Answer: The patient in plain language they can understand
The MAP is a patient-facing document written in plain language to help patients understand and act on medication-related recommendations.
During CMR documentation, a pharmacist identifies a drug without a documented indication. According to NCC MERP taxonomy, this best represents:
Answer: A drug therapy problem — unnecessary drug therapy
A drug lacking a documented indication classifies as unnecessary drug therapy under the Cipolle/Strand drug therapy problem framework.
A 72-year-old patient on metformin has a new lab showing eGFR of 28 mL/min/1.73m². The appropriate CMR recommendation is:
Answer: Discontinue metformin due to lactic acidosis risk below eGFR 30
Metformin is contraindicated when eGFR falls below 30 mL/min/1.73m² due to accumulation risk and potential for lactic acidosis.
Which element is REQUIRED in a completed CMR encounter documentation per CMS guidelines?
Answer: A medication list with indication, dose, route, and frequency
CMS requires the CMR documentation to include a comprehensive medication list with indication, dose, route, and frequency for each medication.