MTM Medication Safety & Error Prevention 2 — Questions and Answers
Question 1: A patient on warfarin is started on fluconazole by their PCP without consulting the pharmacist. Which medication safety process was most likely bypassed?
- Allergy screening
- Drug-drug interaction screening (Correct answer)
- Therapeutic duplication check
- Renal dose adjustment review
Correct answer: Drug-drug interaction screening
Fluconazole significantly inhibits CYP2C9, increasing warfarin levels and bleeding risk — a critical drug-drug interaction that should be screened at dispensing.
Question 2: Which of the following is the BEST description of a 'near miss' in medication safety terminology?
- An error that reached the patient but caused no harm
- An error that was caught before reaching the patient (Correct answer)
- An error that caused minor reversible harm
- An error reported anonymously to ISMP
Correct answer: An error that was caught before reaching the patient
A near miss (also called a close call) is an error that was intercepted before it reached the patient, representing a key learning opportunity.
Question 3: An MTM pharmacist identifies that a patient is taking two ACE inhibitors prescribed by different providers. This is an example of which medication-related problem?
- Adverse drug reaction
- Therapeutic duplication (Correct answer)
- Subtherapeutic dosing
- Inappropriate indication
Correct answer: Therapeutic duplication
Therapeutic duplication occurs when two drugs from the same class are prescribed concurrently without clinical justification, increasing toxicity risk.
Question 4: The ISMP High-Alert Medications list is MOST useful for which safety practice?
- Reducing polypharmacy in elderly patients
- Prioritizing independent double-checks and special safeguards (Correct answer)
- Identifying drugs requiring renal dose adjustment
- Screening for QT-prolonging combinations
Correct answer: Prioritizing independent double-checks and special safeguards
High-alert medications require additional safeguards such as independent double-checks, special labeling, and restricted access because errors with them are more likely to cause serious harm.
Question 5: A patient reports they split their extended-release metoprolol succinate tablets because they are too large to swallow. What is the primary safety concern?
- Increased risk of bradycardia from dose dumping (Correct answer)
- Decreased bioavailability leading to under-treatment
- Drug-food interaction with grapefruit
- Photosensitivity from altered coating
Correct answer: Increased risk of bradycardia from dose dumping
Splitting extended-release tablets destroys the controlled-release mechanism, potentially causing rapid drug release (dose dumping) and excessive beta-blockade including severe bradycardia.
Question 6: During an MTM session, a patient describes taking their evening dose of a sleep aid in the morning by mistake. Using NCCMERP taxonomy, this error is best classified as:
- Category A — no error occurred
- Category B — error did not reach patient
- Category C — error reached patient, no harm (Correct answer)
- Category D — error reached patient, required monitoring
Correct answer: Category C — error reached patient, no harm
NCCMERP Category C means an error reached the patient but caused no harm — taking a sleep aid at the wrong time of day is an error with no expected harmful outcome.
Question 7: Which strategy BEST addresses the risk of sound-alike/look-alike (SALA) drug name errors in written prescriptions?
- Using abbreviations to shorten drug names
- Writing the drug's indication on the prescription (Correct answer)
- Dispensing in original manufacturer packaging only
- Requiring verbal orders for all controlled substances
Correct answer: Writing the drug's indication on the prescription
Including the drug's indication on the prescription allows the pharmacist or patient to verify the drug name makes sense clinically, reducing SALA confusion errors.
MTM Medication Safety & Error Prevention 2
A patient on warfarin is started on fluconazole by their PCP without consulting the pharmacist.
Which medication safety process was most likely bypassed?