MTM Comprehensive Medication Review & Optimization 4 — Questions and Answers
Question 1: A CMR reveals a patient with atrial fibrillation and a CHA₂DS₂-VASc score of 3 is not on anticoagulation. This represents which type of drug therapy problem?
- Adverse drug reaction
- Unnecessary drug therapy
- Need for additional drug therapy (Correct answer)
- Subtherapeutic dosage
Correct answer: Need for additional drug therapy
A CHA₂DS₂-VASc score ≥2 in men or ≥3 in women warrants anticoagulation; its absence represents a need for additional drug therapy.
Question 2: During a CMR, a pharmacist discovers that a patient is taking two different NSAIDs concurrently prescribed by two different providers. This represents:
- Therapeutic duplication requiring intervention (Correct answer)
- An acceptable combination for breakthrough pain
- A contraindicated combination only in renal failure
- Standard polypharmacy with no action required
Correct answer: Therapeutic duplication requiring intervention
Concurrent use of two NSAIDs provides no additional benefit and doubles the risk of GI bleeding, renal injury, and cardiovascular events — a classic therapeutic duplication.
Question 3: When conducting a brown-bag review during a CMR, which item should the pharmacist ask the patient to bring?
- Only prescription medications from the past 30 days
- All prescription medications, OTC drugs, vitamins, herbals, and supplements (Correct answer)
- Only medications prescribed by the primary care physician
- Medications costing over $50/month only
Correct answer: All prescription medications, OTC drugs, vitamins, herbals, and supplements
A brown-bag review is only comprehensive when it includes ALL medications: Rx, OTC, vitamins, herbals, and dietary supplements.
Question 4: A patient on simvastatin 80 mg is newly prescribed amlodipine. What is the pharmacist's appropriate action?
- No action needed; the combination is safe
- Recommend reducing simvastatin dose to no more than 20 mg/day (Correct answer)
- Discontinue amlodipine and use a different antihypertensive
- Switch patient to rosuvastatin without prescriber notification
Correct answer: Recommend reducing simvastatin dose to no more than 20 mg/day
Amlodipine inhibits CYP3A4-mediated simvastatin metabolism; FDA recommends a simvastatin dose cap of 20 mg/day with amlodipine to reduce myopathy risk.
Question 5: Which of the following best describes the difference between a CMR and a TMR in the MTM framework?
- CMR reviews a single medication; TMR reviews all medications
- CMR is a comprehensive annual review; TMR targets a specific condition or set of medications (Correct answer)
- CMR is conducted by physicians; TMR is conducted by pharmacists
- CMR is billable; TMR is not covered under Medicare Part D
Correct answer: CMR is a comprehensive annual review; TMR targets a specific condition or set of medications
A CMR is a comprehensive annual medication review covering all medications, while a TMR focuses on a specific condition or targeted subset of medications.
Question 6: A CMR patient is adherent to her antihypertensive but blood pressure remains uncontrolled. After ruling out white-coat effect and medication interactions, what is the most appropriate recommendation?
- Refer to endocrinology for hormonal workup
- Intensify therapy by increasing dose or adding a complementary agent (Correct answer)
- Discontinue current antihypertensive and restart at a lower dose
- Recheck blood pressure in 6 months without changes
Correct answer: Intensify therapy by increasing dose or adding a complementary agent
When a patient is adherent but the therapeutic goal is unmet, the appropriate response is therapy intensification — dose increase or addition of a complementary mechanism.
Question 7: A pharmacist completes a CMR and identifies five drug therapy problems. In what order should they generally be prioritized?
- Alphabetically by drug name
- By cost of the medication
- By clinical urgency and potential for patient harm (Correct answer)
- By which prescriber is easiest to contact
Correct answer: By clinical urgency and potential for patient harm
Drug therapy problems are prioritized based on clinical urgency and the potential severity of harm if left unaddressed.
MTM Comprehensive Medication Review & Optimization 4
A CMR reveals a patient with atrial fibrillation and a CHA₂DS₂-VASc score of 3 is not on anticoagulation.
This represents which type of drug therapy problem?