MTM Polypharmacy Assessment & Reduction 5 — Questions and Answers
Question 1: A 65-year-old patient taking a statin, ACE inhibitor, beta-blocker, aspirin, diuretic, and two diabetes agents following an MI presents with new myalgia. Which medication is MOST likely responsible?
- Statin therapy causing drug-induced myopathy (Correct answer)
- ACE inhibitor causing musculoskeletal side effects
- Beta-blocker causing peripheral muscle fatigue
- Aspirin causing anti-inflammatory rebound myalgia
Correct answer: Statin therapy causing drug-induced myopathy
Statin-induced myopathy is a well-recognized adverse effect presenting as myalgia or elevated creatine kinase levels, particularly when combined with interacting medications.
Question 2: Which interprofessional approach is MOST effective for reducing polypharmacy in the ambulatory care setting?
- Pharmacist-led medication review communicated to prescribers with collaborative prescribing authority (Correct answer)
- Pharmacist-generated medication lists sent to patients without physician involvement
- Primary care physician review of medication lists without pharmacy input
- Automated electronic alerts to patients about drug interactions
Correct answer: Pharmacist-led medication review communicated to prescribers with collaborative prescribing authority
Pharmacist-led CMRs with collaborative practice agreements and direct communication to prescribers have the strongest evidence for achieving medication reduction in ambulatory settings.
Question 3: A frail 85-year-old patient with moderate dementia is taking a cholinesterase inhibitor, memantine, and antipsychotic. Which consideration is MOST relevant for the MTM pharmacist?
- Antipsychotics carry an FDA black box warning for increased mortality in elderly patients with dementia-related psychosis (Correct answer)
- Cholinesterase inhibitors are contraindicated in patients over 80
- Memantine should be discontinued when antipsychotics are added
- All three medications should be continued indefinitely for dementia management
Correct answer: Antipsychotics carry an FDA black box warning for increased mortality in elderly patients with dementia-related psychosis
The FDA requires a black box warning on antipsychotics regarding increased risk of death in elderly patients with dementia-related psychosis, making their use a high-priority deprescribing candidate.
Question 4: What is the PRIMARY goal of a Comprehensive Medication Review (CMR) in the context of polypharmacy?
- Identify, resolve, and prevent medication-related problems to optimize therapeutic outcomes (Correct answer)
- Reduce medication costs for the insurance payer
- Ensure patient adherence to all prescribed medications
- Generate a complete list of medications for the patient's chart
Correct answer: Identify, resolve, and prevent medication-related problems to optimize therapeutic outcomes
The CMR systematically identifies medication-related problems including inappropriateness, interactions, and duplications to optimize therapy and improve patient outcomes.
Question 5: A patient with osteoporosis takes calcium carbonate 500 mg twice daily and is also prescribed levothyroxine, ciprofloxacin, and ferrous sulfate. Which interaction requires timing separation?
- Calcium carbonate reduces absorption of levothyroxine, ciprofloxacin, and ferrous sulfate when taken simultaneously (Correct answer)
- Calcium carbonate potentiates the antibiotic effect of ciprofloxacin
- Ferrous sulfate increases thyroid hormone levels when combined with calcium
- Ciprofloxacin blocks calcium absorption in the GI tract
Correct answer: Calcium carbonate reduces absorption of levothyroxine, ciprofloxacin, and ferrous sulfate when taken simultaneously
Calcium forms insoluble complexes with levothyroxine, fluoroquinolones, and iron, significantly reducing their absorption when taken at the same time.
Question 6: Which definition BEST describes 'hyperpolypharmacy' as used in geriatric pharmacotherapy literature?
- Concurrent use of 10 or more medications (Correct answer)
- Concurrent use of more than 4 medications
- Any use of medications without a documented diagnosis
- Prescribing two or more medications from the same drug class
Correct answer: Concurrent use of 10 or more medications
While polypharmacy is generally defined as 5 or more medications, hyperpolypharmacy refers specifically to concurrent use of 10 or more medications.
Question 7: A pharmacist receives a referral for a patient who takes NSAIDs chronically for osteoarthritis and is also prescribed antihypertensives, diuretics, and an anticoagulant. Which drug-related problem should be addressed FIRST?
- NSAIDs increase bleeding risk with anticoagulants and blunt antihypertensive and diuretic efficacy, making them inappropriate in this combination (Correct answer)
- The antihypertensive dose should be doubled to overcome NSAID-mediated blood pressure elevation
- The diuretic should be discontinued to prevent dehydration
- Anticoagulant monitoring frequency should be reduced to avoid inconveniencing the patient
Correct answer: NSAIDs increase bleeding risk with anticoagulants and blunt antihypertensive and diuretic efficacy, making them inappropriate in this combination
Chronic NSAID use is contraindicated with anticoagulants due to additive bleeding risk and interferes with antihypertensive and diuretic mechanisms, representing multiple concurrent drug-related problems.
MTM Polypharmacy Assessment & Reduction 5
A 65-year-old patient taking a statin, ACE inhibitor, beta-blocker, aspirin, diuretic, and two diabetes agents following an MI presents with new myalgia.
Which medication is MOST likely responsible?