MTM Comprehensive Medication Review & Optimization 3 — Questions and Answers
Question 1: A patient's CMR reveals she takes levothyroxine with calcium supplements simultaneously each morning. What optimization is indicated?
- Switch levothyroxine to evening dosing only
- Separate levothyroxine and calcium by at least 4 hours (Correct answer)
- Discontinue calcium supplementation
- No change needed; interaction is not clinically significant
Correct 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.
Question 2: 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?
- Trust the pharmacy record exclusively as it is more accurate
- Trust the patient's report exclusively
- Clarify the discrepancy by reviewing prescriber records and interviewing the patient (Correct answer)
- Flag as a medication error and notify the state board
Correct 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.
Question 3: A CMR patient taking amlodipine 10 mg daily reports persistent ankle edema. The most appropriate pharmacist-initiated recommendation is:
- Add furosemide to treat the edema
- Switch to an ACE inhibitor
- Reduce amlodipine dose or switch to an alternative antihypertensive if tolerated (Correct answer)
- Refer patient to cardiology immediately
Correct 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.
Question 4: Which therapeutic outcome best aligns with the goal of medication optimization in an MTM CMR?
- Maximizing the number of brand-name medications prescribed
- Achieving clinical endpoints while minimizing drug therapy problems and adverse effects (Correct answer)
- Ensuring all medications are filled at one pharmacy
- Reducing the total number of medications to fewer than five
Correct 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.
Question 5: A patient on long-term prednisone for rheumatoid arthritis has no documented bone protection therapy. What gap in care should the pharmacist address?
- Recommend adding a bisphosphonate and calcium/vitamin D supplementation (Correct answer)
- Recommend discontinuing prednisone immediately
- No action needed unless DEXA scan confirms osteoporosis
- Add calcitonin nasal spray only
Correct 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.
Question 6: In the context of a CMR, 'efficacy' of a medication is best assessed by:
- The number of pills dispensed per month
- Whether the medication is on the formulary
- Whether the patient is achieving the therapeutic goal for the indicated condition (Correct answer)
- The brand versus generic status of the medication
Correct 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.
Question 7: 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?
- Less than 160/100 mmHg
- Less than 140/90 mmHg
- Less than 130/80 mmHg (Correct answer)
- Less than 120/70 mmHg
Correct 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.
MTM Comprehensive Medication Review & Optimization 3
A patient's CMR reveals she takes levothyroxine with calcium supplements simultaneously each morning.
What optimization is indicated?