CCP Drug Therapy Management Questions and Answers

Question 1

An 82-year-old resident with stable NYHA Class III heart failure, chronic kidney disease (Stage 3), and osteoarthritis is prescribed meloxicam 15 mg daily for knee pain. The consultant pharmacist's primary concern with this new order should be the increased risk of:

Accepted Answer

Worsening fluid retention and acute renal impairment.

Answer

Non-steroidal anti-inflammatory drugs (NSAIDs) like meloxicam inhibit prostaglandins, which can lead to sodium and water retention. In a patient with pre-existing heart failure, this can cause decompensation. NSAIDs also reduce renal blood flow, which can precipitate acute kidney injury, especially in patients with underlying chronic kidney disease.

Question 2

A 78-year-old resident on long-term phenytoin for a seizure disorder is admitted to the skilled nursing facility after a fall. The resident exhibits nystagmus, ataxia, and slurred speech. A lab report shows a total phenytoin level of 25 mcg/mL (therapeutic range 10-20 mcg/mL) and a serum albumin of 2.8 g/dL (reference range 3.5-5.0 g/dL). What is the most accurate interpretation of this clinical scenario?

Accepted Answer

The low albumin level is causing a disproportionately high level of free, active phenytoin, leading to toxicity despite a only moderately elevated total level.

Answer

Phenytoin is highly protein-bound (around 90%) to albumin. In a state of hypoalbuminemia, there are fewer binding sites available, which results in a higher fraction of unbound (free) drug. The free drug is pharmacologically active, and this increased fraction can lead to clinical signs of toxicity even when the total drug concentration is only moderately elevated. A corrected phenytoin level should be calculated to estimate the true active concentration.

Question 3

A consultant pharmacist is reviewing the regimen of a resident who has been taking omeprazole 40 mg daily for over three years for a history of 'indigestion'. There is no documented diagnosis of GERD, Barrett's esophagus, or a history of bleeding ulcers. A recommendation to attempt to deprescribe the omeprazole is most strongly supported by the increased long-term risk of which of the following?

Accepted Answer

Bone fractures and Clostridioides difficile infection.

Answer

Chronic use of proton pump inhibitors (PPIs) is associated with several potential adverse outcomes in older adults. The strongest evidence supports an increased risk of hip, wrist, and spine fractures due to decreased calcium absorption, as well as a higher risk of developing Clostridioides difficile-associated diarrhea due to the alteration of gut flora.

Question 4

According to the 2023 American Geriatrics Society (AGS) Beers Criteria®, which statement best describes the rationale for avoiding the concurrent use of three or more central nervous system (CNS)-active drugs?

Accepted Answer

It significantly increases the risk of falls and fractures.

Answer

The AGS Beers Criteria® specifically cautions against the concurrent use of three or more CNS-active medications (such as benzodiazepines, opioids, antidepressants, antipsychotics, and anticonvulsants) because this combination is associated with an increased risk of falls and fractures due to additive effects like dizziness, sedation, and impaired psychomotor function.

Question 5

A consultant pharmacist is performing a medication regimen review for a 75-year-old resident with dementia who is receiving risperidone for agitation. To ensure compliance with Centers for Medicare & Medicaid Services (CMS) regulations for psychotropic drug use in long-term care, the pharmacist must verify that the facility is:

Accepted Answer

Attempting a gradual dose reduction (GDR) unless it is clinically contraindicated.

Answer

CMS regulations (under F-Tag F758) mandate that residents receiving psychotropic drugs, including antipsychotics, must have their therapy managed to use the minimum effective dose for the shortest possible duration. This includes documented attempts at gradual dose reduction (GDR) unless a physician provides a valid clinical reason for why it is contraindicated.

(CCP) Certified Consultant Pharmacist Practice Test

(CCP) Certified Consultant Pharmacist Practice Test

CCP Drug Therapy Management Questions and Answers