MTM Polypharmacy Assessment & Reduction 3

Question 1

A patient takes warfarin and is started on fluconazole for a fungal infection. During an MTM follow-up, the INR rises from 2.4 to 4.8. This is BEST classified as which type of drug-drug interaction?

Accepted Answer

Pharmacokinetic interaction via CYP2C9 inhibition

Answer

Fluconazole inhibits CYP2C9, the primary enzyme responsible for warfarin (S-enantiomer) metabolism, leading to elevated warfarin levels and increased anticoagulation.

Question 2

When using the Medication Appropriateness Index (MAI) during polypharmacy assessment, how many criteria does the tool evaluate for each medication?

Accepted Answer

10

Answer

The MAI evaluates 10 criteria for each medication including indication, effectiveness, dosage, directions, drug interactions, and cost.

Question 3

A 72-year-old patient with hypertension, heart failure, and CKD stage 3 is taking lisinopril 40 mg, spironolactone 25 mg, and potassium chloride supplements. Which concern should the pharmacist prioritize?

Accepted Answer

Hyperkalemia risk from concurrent use of multiple potassium-retaining agents

Answer

Concurrent use of an ACE inhibitor, aldosterone antagonist, and potassium supplement significantly increases the risk of life-threatening hyperkalemia.

Question 4

Which principle guides the deprescribing process in polypharmacy management?

Accepted Answer

Tapering or discontinuing one medication at a time to monitor for withdrawal or disease recurrence

Answer

Discontinuing one medication at a time allows for monitoring of withdrawal effects and disease recurrence attributable to each specific medication.

Question 5

A pharmacist conducting an MTM session identifies that a patient takes aspirin 81 mg for primary prevention. Per current evidence, what is the MOST appropriate recommendation for a 76-year-old patient with no prior cardiovascular events?

Accepted Answer

Recommend deprescribing aspirin as benefits no longer outweigh bleeding risks in primary prevention for this age group

Answer

Current guidelines recommend against initiating or continuing aspirin for primary prevention in adults over 60 due to increased bleeding risk outweighing cardiovascular benefits.

(MTM) Medication Therapy Management Certification for Pharmacists Practice Test

(MTM) Medication Therapy Management Certification for Pharmacists Practice Test

MTM Polypharmacy Assessment & Reduction 3