MTM Polypharmacy Assessment & Reduction 2 — Questions and Answers
Question 1: A 78-year-old patient taking 11 medications is referred for an MTM visit. Which validated screening tool is MOST appropriate for identifying potentially inappropriate medications in this patient?
- Beers Criteria (Correct answer)
- CAGE questionnaire
- PHQ-9
- AUDIT-C
Correct answer: Beers Criteria
The AGS Beers Criteria is a validated tool specifically designed to identify potentially inappropriate medications in older adults.
Question 2: During a comprehensive medication review, a pharmacist identifies that a patient is taking a PPI, an H2 blocker, and antacids simultaneously. This situation BEST represents which polypharmacy concern?
- Therapeutic duplication (Correct answer)
- Drug-drug interaction
- Inappropriate indication
- Subtherapeutic dosing
Correct answer: Therapeutic duplication
Using multiple agents from the same therapeutic class (PPI, H2 blocker, antacids) for the same indication constitutes therapeutic duplication.
Question 3: Which of the following is a key principle of the 'prescribing cascade' concept in polypharmacy management?
- A new medication is prescribed to treat an adverse effect of an existing medication (Correct answer)
- Multiple physicians prescribe medications without coordination
- Patients fill prescriptions at multiple pharmacies
- Dose escalation occurs due to tolerance development
Correct answer: A new medication is prescribed to treat an adverse effect of an existing medication
A prescribing cascade occurs when an adverse drug reaction is misidentified as a new medical condition, leading to prescription of an additional medication.
Question 4: A pharmacist uses the STOPP/START criteria during an MTM encounter. What does the START component specifically identify?
- Medications that should be initiated but are being withheld inappropriately (Correct answer)
- Medications that should be stopped immediately
- Drugs with the highest risk of adverse effects
- Medications requiring therapeutic drug monitoring
Correct answer: Medications that should be initiated but are being withheld inappropriately
The START (Screening Tool to Alert to Right Treatment) component identifies evidence-based medications that are indicated but not being prescribed.
Question 5: When calculating a patient's medication burden, which factor is MOST important to include beyond prescription medications?
- Over-the-counter medications, vitamins, and herbal supplements (Correct answer)
- Only medications prescribed in the last 30 days
- Medications the patient has previously discontinued
- Only medications covered by insurance
Correct answer: Over-the-counter medications, vitamins, and herbal supplements
A complete medication list must include OTC products, vitamins, and herbal supplements as these can contribute to drug interactions and adverse effects.
Question 6: A pharmacist reviews a patient's medication list and notes metformin, sitagliptin, glipizide, and insulin glargine are all prescribed for type 2 diabetes. Which action is MOST appropriate to evaluate first?
- Assess glycemic control and determine if all agents are contributing to therapeutic goals (Correct answer)
- Discontinue the oldest prescribed medication
- Add a GLP-1 agonist to simplify the regimen
- Request HbA1c testing before any changes
Correct answer: Assess glycemic control and determine if all agents are contributing to therapeutic goals
Evaluating whether each medication is contributing to therapeutic goals helps determine which agents may be reduced or eliminated.
Question 7: Which patient characteristic is MOST strongly associated with polypharmacy-related adverse outcomes in elderly patients?
- Reduced renal and hepatic function affecting drug metabolism and clearance (Correct answer)
- Higher educational level
- Living in an urban area
- Having private health insurance
Correct answer: Reduced renal and hepatic function affecting drug metabolism and clearance
Age-related declines in renal and hepatic function significantly impair drug metabolism and clearance, increasing the risk of toxicity with multiple medications.
MTM Polypharmacy Assessment & Reduction 2
A 78-year-old patient taking 11 medications is referred for an MTM visit.
Which validated screening tool is MOST appropriate for identifying potentially inappropriate medications in this patient?