CCP Medication Regimen Review Questions and Answers — Questions and Answers
Question 1: A consultant pharmacist is performing a monthly Medication Regimen Review (MRR) for an 82-year-old resident of a long-term care facility. The resident was recently treated for a UTI and now complains of new-onset dizziness and confusion. The pharmacist notes a new prescription for oxybutynin for urinary incontinence. Which of the following medication-related problems is the MOST likely cause of the resident's new symptoms?
- Drug use without indication
- Prescribing cascade (Correct answer)
- Subtherapeutic dosage
- Untreated condition
Correct answer: Prescribing cascade
A prescribing cascade occurs when an adverse drug event is misinterpreted as a new medical condition, leading to the prescription of another medication to treat the side effect. In this case, the oxybutynin, with its anticholinergic effects, was likely prescribed to manage urinary symptoms that may have been a side effect of another medication or misinterpreted, and is now causing dizziness and confusion, which could be misdiagnosed as another new condition.
Question 2: According to CMS regulations for long-term care facilities, which of the following actions is required by the consultant pharmacist after identifying a clinically significant irregularity during a Medication Regimen Review?
- Discontinue the medication immediately and document the action.
- Contact the resident's family to discuss the finding.
- Report the finding in a separate, written report to the attending physician, medical director, and director of nursing. (Correct answer)
- Adjust the medication dosage and monitor the resident for 48 hours.
Correct answer: Report the finding in a separate, written report to the attending physician, medical director, and director of nursing.
CMS regulations mandate that any irregularities identified during a pharmacist's monthly medication regimen review must be reported in a separate written report to the resident's attending physician, the facility's Medical Director, and the Director of Nursing. This ensures that all key members of the care team are aware of the issue and can act upon the pharmacist's recommendations.
Question 3: Which of the following BEST defines the primary goal of deprescribing within the Medication Regimen Review process?
- Reducing the total number of medications to decrease pharmacy costs.
- Stopping all medications identified by the Beers Criteria.
- Systematically withdrawing medications when the potential for harm outweighs the potential for benefit. (Correct answer)
- Replacing brand-name drugs with generic alternatives whenever possible.
Correct answer: Systematically withdrawing medications when the potential for harm outweighs the potential for benefit.
Deprescribing is a patient-centered process of withdrawing inappropriate medications, supervised by a healthcare professional, with the goal of managing polypharmacy and improving outcomes. The core principle is to systematically re-evaluate and discontinue drugs for which the potential harms outweigh the current or anticipated benefits for the individual patient.
Question 4: A consultant pharmacist reviews the regimen of a 75-year-old patient with type 2 diabetes, hypertension, and osteoarthritis. The patient takes 12 different medications. Which category of medication-related problems, as defined by Hepler and Strand, would apply if the pharmacist discovers the patient is taking a medication for which there is no valid medical reason?
- Adverse drug reaction
- Improper drug selection
- Overdosage
- Drug use without indication (Correct answer)
Correct answer: Drug use without indication
Hepler and Strand's categories of medication-related problems (MRPs) provide a framework for MRR. 'Drug use without indication' is the specific category for when a patient is taking a medication for no medically valid condition or reason. This is a common finding in patients with polypharmacy.
Question 5: During an admission MRR for a patient transferring from a hospital to a skilled nursing facility, the consultant pharmacist's MOST critical first step is to:
- Screen for appropriate immunizations.
- Perform a thorough medication reconciliation. (Correct answer)
- Develop a deprescribing plan.
- Assess the patient's health literacy.
Correct answer: Perform a thorough medication reconciliation.
Medication reconciliation is the foundational first step in an admission MRR. It involves creating the most accurate list possible of all medications a patient is taking and comparing that list against the admission orders to avoid errors such as omissions, duplications, or dosing discrepancies that are common during transitions of care.
Question 6: When evaluating the medication regimen of a patient in a long-term care facility, which of the following tools is specifically designed to identify both potentially inappropriate medications to stop and potentially beneficial medications to initiate in older adults?
- The Beers Criteria
- The Medication Appropriateness Index (MAI)
- The STOPP/START criteria (Correct answer)
- The Drug Burden Index (DBI)
Correct answer: The STOPP/START criteria
The STOPP (Screening Tool of Older Persons' Prescriptions) and START (Screening Tool to Alert to Right Treatment) criteria are complementary tools. STOPP helps identify potentially inappropriate prescriptions, while START helps identify indicated medications that are not being prescribed. This dual focus makes it uniquely comprehensive for optimizing geriatric regimens.
CCP Medication Regimen Review Questions and Answers
A consultant pharmacist is performing a monthly Medication Regimen Review (MRR) for an 82-year-old resident of a long-term care facility.
The resident was recently treated for a UTI and now complains of new-onset dizziness and confusion.
The pharmacist notes a new prescription for oxybutynin for urinary incontinence.
Which of the following medication-related problems is the MOST likely cause of the resident's new symptoms?