MTM Comprehensive Medication Review & Optimization 2

Question 1

During a CMR, a patient taking warfarin reports recently starting fish oil supplements. What is the primary concern?

Accepted Answer

Additive anticoagulant effect increasing bleeding risk

Answer

Fish oil has antiplatelet properties that can potentiate warfarin's anticoagulant effect, increasing bleeding risk.

Question 2

A CMR reveals a patient is taking both a PPI and clopidogrel. What is the most clinically significant concern?

Accepted Answer

PPIs reduce clopidogrel's antiplatelet activation via CYP2C19 inhibition

Answer

PPIs (especially omeprazole) inhibit CYP2C19, reducing conversion of clopidogrel to its active metabolite and diminishing antiplatelet effect.

Question 3

Which STOPP criteria medication combination should prompt immediate reconciliation review in an elderly CMR patient?

Accepted Answer

NSAID + anticoagulant

Answer

STOPP criteria flag NSAID + anticoagulant combinations due to significantly elevated GI bleeding risk in elderly patients.

Question 4

A patient's MAP (Medication Action Plan) following a CMR should primarily be written for whom?

Accepted Answer

The patient in plain language they can understand

Answer

The MAP is a patient-facing document written in plain language to help patients understand and act on medication-related recommendations.

Question 5

During CMR documentation, a pharmacist identifies a drug without a documented indication. According to NCC MERP taxonomy, this best represents:

Accepted Answer

A drug therapy problem — unnecessary drug therapy

Answer

A drug lacking a documented indication classifies as unnecessary drug therapy under the Cipolle/Strand drug therapy problem framework.

(MTM) Medication Therapy Management Certification for Pharmacists Practice Test