PSI Clinical Therapeutics 2 — Questions and Answers
Question 1: A patient presents with symptoms of an uncomplicated urinary tract infection (UTI). What is the first-line recommended antibiotic treatment in Ireland?
- Nitrofurantoin (modified release) for 3 days in non-pregnant women (Correct answer)
- Ciprofloxacin for 7 days
- Amoxicillin for 5 days
- Co-amoxiclav for 14 days
Correct answer: Nitrofurantoin (modified release) for 3 days in non-pregnant women
Irish antibiotic prescribing guidelines recommend nitrofurantoin MR 100mg twice daily for 3 days as first-line treatment for uncomplicated UTIs in non-pregnant women. Trimethoprim is an alternative. Fluoroquinolones should be reserved for complicated infections due to resistance concerns.
Question 2: What are the key considerations when dispensing methotrexate for a patient?
- Ensure the correct WEEKLY dose (not daily), counsel on folate supplementation, warn about teratogenicity, and advise on monitoring requirements (blood tests) (Correct answer)
- Methotrexate can be taken daily without concern
- No special counselling is needed
- Methotrexate has no serious side effects
Correct answer: Ensure the correct WEEKLY dose (not daily), counsel on folate supplementation, warn about teratogenicity, and advise on monitoring requirements (blood tests)
Methotrexate is a HIGH-RISK medication. The most critical safety point is ensuring it is taken WEEKLY (not daily — daily dosing has caused fatalities). Patients need folic acid supplementation, regular blood monitoring (FBC, LFTs, renal function), and pregnancy prevention counselling.
Question 3: What is the role of inhaler technique review in managing asthma and COPD?
- Poor inhaler technique is a major cause of treatment failure; pharmacists should assess and correct technique at every opportunity, as up to 90% of patients use inhalers incorrectly (Correct answer)
- Inhaler technique does not affect treatment outcomes
- Only doctors should review inhaler technique
- Technique review is only needed when first prescribed
Correct answer: Poor inhaler technique is a major cause of treatment failure; pharmacists should assess and correct technique at every opportunity, as up to 90% of patients use inhalers incorrectly
Studies show that 50-90% of patients use their inhalers incorrectly, leading to poor disease control. Pharmacists should review inhaler technique at every dispensing opportunity, demonstrate correct use, observe the patient's technique, and correct any errors. A change of device may be needed.
Question 4: What monitoring is required for a patient on Direct Oral Anticoagulants (DOACs) such as apixaban or rivarelbane?
- Renal function (eGFR) should be monitored at least annually (more frequently if impaired), along with hepatic function and haemoglobin; no routine INR monitoring is needed (Correct answer)
- DOACs require weekly INR monitoring like warfarin
- No monitoring is needed for DOACs
- Only blood pressure monitoring is required
Correct answer: Renal function (eGFR) should be monitored at least annually (more frequently if impaired), along with hepatic function and haemoglobin; no routine INR monitoring is needed
Unlike warfarin, DOACs do not require routine INR monitoring. However, renal function must be monitored (at least annually, more frequently if eGFR <60) as renal impairment affects drug clearance. Hepatic function and haemoglobin should also be checked. Dose adjustments may be needed based on renal function.
Question 5: A patient on an SSRI antidepressant wants to buy an OTC product containing ibuprofen. What should the pharmacist consider?
- SSRIs increase the risk of GI bleeding, which is further increased by concurrent NSAID use; recommend paracetamol as an alternative or advise use of gastroprotection if an NSAID is essential (Correct answer)
- There is no interaction between SSRIs and NSAIDs
- SSRIs make NSAIDs more effective
- Recommend a higher dose of ibuprofen
Correct answer: SSRIs increase the risk of GI bleeding, which is further increased by concurrent NSAID use; recommend paracetamol as an alternative or advise use of gastroprotection if an NSAID is essential
SSRIs affect platelet function by depleting serotonin in platelets, increasing bleeding risk. Combined with NSAIDs (which also impair platelet function and cause GI mucosal damage), the risk of GI bleeding is significantly increased. Paracetamol is a safer analgesic alternative.
Question 6: What is the pharmacist's role in managing chronic disease conditions like diabetes or hypertension?
- Providing medication counselling, monitoring adherence, reviewing medication appropriateness, conducting health screenings, and supporting self-management education (Correct answer)
- Pharmacists have no role in chronic disease management
- Only dispensing medications without any further input
- Referring all queries to the GP without comment
Correct answer: Providing medication counselling, monitoring adherence, reviewing medication appropriateness, conducting health screenings, and supporting self-management education
Pharmacists play an increasingly important role in chronic disease management through medication therapy reviews, adherence support, health screenings (blood pressure, blood glucose), lifestyle counselling, identifying drug-related problems, and working collaboratively with GPs and other healthcare professionals.
PSI Clinical Therapeutics 2
A patient presents with symptoms of an uncomplicated urinary tract infection (UTI).
What is the first-line recommended antibiotic treatment in Ireland?