CAOP - Competency Assessment of Overseas Pharmacist Implementing Medication Plans Questions and Answers — Questions and Answers
Question 1: A patient presents a new prescription for apixaban. Upon reviewing their medication history, you notice they are also taking amiodarone. Which of the following is the most appropriate initial action for the pharmacist to take when implementing the medication plan?
- Contact the prescriber to discuss a potential dose reduction of apixaban. (Correct answer)
- Dispense both medications as prescribed with a caution to monitor for bleeding.
- Refuse to dispense the apixaban due to the high risk of a severe interaction.
- Advise the patient to stop taking amiodarone while they are on apixaban.
Correct answer: Contact the prescriber to discuss a potential dose reduction of apixaban.
Amiodarone is a moderate inhibitor of both CYP3A4 and P-glycoprotein, which can significantly increase the concentration of apixaban, thereby increasing the risk of bleeding. Standard Australian drug interaction resources recommend considering a dose reduction of apixaban when co-administered with amiodarone. The most appropriate and collaborative action is to contact the prescriber to discuss this interaction and recommend a potential dose adjustment to ensure patient safety. Dispensing without consultation is not best practice, and refusing to dispense or advising the patient to alter their chronic amiodarone therapy is inappropriate without prescriber consultation.
Question 2: According to the Pharmacy Board of Australia's 'Guidelines on dose administration aids and staged supply of dispensed medicines', which information is NOT a mandatory requirement for the label of a Dose Administration Aid (DAA)?
- The name, strength, and dose form of each medicine.
- The directions for use for each medicine.
- The name of the prescribing doctor for each medicine. (Correct answer)
- The date the DAA was packed.
Correct answer: The name of the prescribing doctor for each medicine.
The Pharmacy Board of Australia Guidelines specify that the label on a DAA should include the patient's name, the pharmacy details, the date of packing, and for each medicine: the name, strength, dose form, directions for use, and any required cautionary labels. While good practice, listing the individual prescriber for each medication within the DAA is not a mandated requirement on the DAA label itself.
Question 3: A 75-year-old patient requests a new supply of their 'little white water pill' but cannot remember its name. The prescription on file is for hydrochlorothiazide 25mg daily. The pharmacy has two different generic brands in stock. When implementing the medication plan, which action best reflects the principles of continuity of care and medication safety?
- Provide any of the available generic brands as they are bioequivalent.
- Refuse to supply the medication until the patient can confirm the name.
- Check the dispensing history to identify the previously supplied brand and provide the same one if possible. (Correct answer)
- Ask the patient to describe the tablet markings to identify the correct brand.
Correct answer: Check the dispensing history to identify the previously supplied brand and provide the same one if possible.
To ensure continuity of care and prevent patient confusion, which can lead to non-adherence or errors, it is best practice to supply the same brand of medication the patient is familiar with. Checking the dispensing history is the most reliable way to identify this. While generics are bioequivalent, changes in tablet appearance can be confusing for patients, especially the elderly. Asking the patient to describe markings may be unreliable, and refusing supply is not patient-centered.
Question 4: A prescription for a Schedule 8 (S8) medication is presented with the quantity written in words and figures, but there is a discrepancy between them (e.g., '10 (ten)' and '20 (twenty)' are both written). According to Australian dispensing practice guidelines, what is the correct procedure?
- Dispense the larger quantity as it represents the prescriber's most recent intention.
- Dispense the quantity written in words.
- Contact the prescriber for clarification before dispensing. (Correct answer)
- Dispense the smaller quantity to minimize the risk of diversion.
Correct answer: Contact the prescriber for clarification before dispensing.
For Schedule 8 (Controlled Drug) prescriptions, all details must be clear and unambiguous to be considered legally valid. Any discrepancy, such as a mismatch between the quantity in words and figures, renders the prescription invalid until clarified. The pharmacist has a professional and legal obligation to contact the prescriber to confirm the intended quantity before dispensing. Dispensing either quantity without clarification would be a breach of dispensing standards.
Question 5: When implementing a medication plan that involves packing oral cytotoxic medicines into a Dose Administration Aid (DAA), which of the following is a key consideration according to the Pharmacy Board of Australia guidelines?
- Oral cytotoxic medicines are strictly prohibited from being packed in a DAA.
- A risk assessment must be conducted to ensure the benefit of adherence outweighs the risk of exposure. (Correct answer)
- Only a pharmacist with a specialized oncology certification is permitted to pack cytotoxic medicines.
- The DAA must be returned to the pharmacy for disposal after use.
Correct answer: A risk assessment must be conducted to ensure the benefit of adherence outweighs the risk of exposure.
The Pharmacy Board of Australia's guidelines state that oral cytotoxic and other hazardous medicines should only be packed into a DAA if there is evidence that the benefit of improved patient adherence outweighs the risk of exposure during packing or administration. This requires a careful risk assessment and discussion with the patient or carer. It is not strictly prohibited, nor does it require a specific certification beyond appropriate training. While safe disposal is important, the guidelines do not mandate return to the pharmacy.
Question 6: A patient is being discharged from the hospital with a new medication plan. Which of the following is the most critical element for the pharmacist to ensure seamless implementation of this plan in the community setting?
- Receiving the patient's complete hospital medication chart.
- Obtaining a detailed and accurate medication reconciliation and discharge summary. (Correct answer)
- Ensuring the patient has a full month's supply of all new medications.
- Personally counselling the patient's general practitioner on the changes.
Correct answer: Obtaining a detailed and accurate medication reconciliation and discharge summary.
A detailed and accurate medication reconciliation and discharge summary is the most critical document. It provides a comprehensive list of medicines the patient should be taking, medicines that were stopped, and the reasons for these changes. This information is vital for the community pharmacist to accurately update the patient's records, dispense the correct medications, and provide appropriate counselling, thereby preventing medication errors and ensuring a safe transition of care.
CAOP - Competency Assessment of Overseas Pharmacist Implementing Medication Plans Questions and Answers
A patient presents a new prescription for apixaban.
Upon reviewing their medication history, you notice they are also taking amiodarone.
Which of the following is the most appropriate initial action for the pharmacist to take when implementing the medication plan?