MTM Comprehensive Medication Review & Optimization 5 — Questions and Answers
Question 1: A CMR patient reports forgetting her afternoon medication dose consistently. Which adherence strategy is most evidence-based for this pattern?
- Switching to a twice-daily formulation if a once-daily equivalent is available (Correct answer)
- Providing written instructions in smaller font
- Adding a second prescriber to oversee adherence
- Increasing the dose to compensate for missed doses
Correct answer: Switching to a twice-daily formulation if a once-daily equivalent is available
Simplifying regimens by switching to once-daily formulations is among the most effective strategies for improving adherence in patients who forget scheduled doses.
Question 2: Which laboratory value is most critical to review before recommending an ACE inhibitor dose increase during a CMR?
- Complete blood count (CBC)
- Serum potassium and serum creatinine/eGFR (Correct answer)
- Fasting lipid panel
- Hemoglobin A1c
Correct answer: Serum potassium and serum creatinine/eGFR
ACE inhibitors can cause hyperkalemia and acute kidney injury; potassium and renal function must be assessed before dose escalation.
Question 3: A patient completing a CMR is on quetiapine for bipolar disorder and newly reports fasting glucose of 130 mg/dL. What is the most appropriate response?
- Immediately discontinue quetiapine
- Document as a potential atypical antipsychotic-induced metabolic adverse effect and notify the prescriber (Correct answer)
- Add metformin empirically without contacting the prescriber
- Reassure the patient that glucose elevation is not related to quetiapine
Correct answer: Document as a potential atypical antipsychotic-induced metabolic adverse effect and notify the prescriber
Atypical antipsychotics including quetiapine carry a black-box warning for metabolic effects including hyperglycemia; the prescriber must be notified for collaborative management.
Question 4: When assessing medication safety during a CMR, the Beers Criteria is most appropriately applied to which patient population?
- Children under age 12
- Adults aged 65 and older (Correct answer)
- Pregnant women
- Patients with renal transplant
Correct answer: Adults aged 65 and older
The AGS Beers Criteria was developed specifically to identify potentially inappropriate medications for adults aged 65 and older.
Question 5: A CMR patient on warfarin reports starting cranberry juice daily. What is the pharmacist's concern?
- Cranberry juice has no effect on warfarin
- Cranberry may inhibit CYP2C9, increasing warfarin levels and bleeding risk (Correct answer)
- Cranberry directly activates platelet aggregation, reducing warfarin effect
- Cranberry causes warfarin to precipitate in urine
Correct answer: Cranberry may inhibit CYP2C9, increasing warfarin levels and bleeding risk
Cranberry products may inhibit CYP2C9, the primary enzyme metabolizing warfarin's S-enantiomer, potentially increasing INR and bleeding risk.
Question 6: A patient's Personal Medication Record (PMR) generated after a CMR should include which of the following?
- Pharmacy profit margins for each drug
- Patient allergies, all current medications with doses and indications, and OTC/supplements (Correct answer)
- Only the three most recently added medications
- The prescriber's DEA number for controlled substances
Correct answer: Patient allergies, all current medications with doses and indications, and OTC/supplements
The PMR is a comprehensive patient-held record including allergies, all medications (Rx, OTC, supplements) with dosing and indications.
Question 7: Which of the following scenarios best illustrates 'medication optimization' achieved through a CMR?
- Switching a patient from a generic to a brand-name drug at the same dose
- Identifying that a patient's HbA1c of 6.4% on metformin now meets remission criteria, allowing de-intensification (Correct answer)
- Adding three new medications to treat newly identified comorbidities
- Filling all prescriptions at a single pharmacy for convenience
Correct answer: Identifying that a patient's HbA1c of 6.4% on metformin now meets remission criteria, allowing de-intensification
De-intensification when therapeutic goals are exceeded (e.g., HbA1c below target in T2DM) is a core medication optimization outcome that reduces pill burden and adverse effects.
MTM Comprehensive Medication Review & Optimization 5
A CMR patient reports forgetting her afternoon medication dose consistently.
Which adherence strategy is most evidence-based for this pattern?