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
A patient's CMR reveals she takes levothyroxine with calcium supplements simultaneously each morning. What optimization is indicated?
Answer: Separate levothyroxine and calcium by at least 4 hours
Calcium significantly reduces levothyroxine absorption; separating administration by at least 4 hours prevents this interaction.
During medication reconciliation as part of a CMR, a discrepancy is found between the pharmacy refill record and the patient's self-reported medication list. What is the best next step?
Answer: Clarify the discrepancy by reviewing prescriber records and interviewing the patient
Reconciliation requires triangulating multiple sources — pharmacy records, prescriber notes, and patient report — to resolve discrepancies accurately.
A CMR patient taking amlodipine 10 mg daily reports persistent ankle edema. The most appropriate pharmacist-initiated recommendation is:
Answer: Reduce amlodipine dose or switch to an alternative antihypertensive if tolerated
Peripheral edema is a dose-dependent side effect of dihydropyridine CCBs; reducing dose or switching class can resolve it without adding diuretics.
Which therapeutic outcome best aligns with the goal of medication optimization in an MTM CMR?
Answer: Achieving clinical endpoints while minimizing drug therapy problems and adverse effects
Medication optimization in MTM targets achieving desired clinical outcomes while identifying and resolving drug therapy problems and minimizing harm.
A patient on long-term prednisone for rheumatoid arthritis has no documented bone protection therapy. What gap in care should the pharmacist address?
Answer: Recommend adding a bisphosphonate and calcium/vitamin D supplementation
Long-term corticosteroid use requires bone protection with a bisphosphonate plus calcium/vitamin D per ACR and USPSTF guidelines.
In the context of a CMR, 'efficacy' of a medication is best assessed by:
Answer: Whether the patient is achieving the therapeutic goal for the indicated condition
Efficacy in CMR is evaluated by determining whether the patient's condition is controlled or the therapeutic target is being met.
A CMR patient with type 2 diabetes and CKD stage 3 is on lisinopril 10 mg. Her blood pressure is 148/92 mmHg. Based on ADA guidelines, what is the target BP?
Answer: Less than 130/80 mmHg
ADA guidelines recommend a blood pressure target of <130/80 mmHg in patients with diabetes to reduce cardiovascular and renal risk.