CCP Patient Assessment and Monitoring 2 — Questions and Answers
Question 1: An 82-year-old nursing home resident has a serum creatinine of 0.7 mg/dL. Which method is most appropriate for estimating her renal function for drug dosing?
- Use raw serum creatinine as a marker of normal renal function
- Apply the Cockcroft-Gault equation using actual body weight (Correct answer)
- Use the CKD-EPI equation alone without adjusting for low muscle mass
- Assume normal renal function since creatinine is within normal range
Correct answer: Apply the Cockcroft-Gault equation using actual body weight
Cockcroft-Gault with actual body weight is preferred in elderly patients, recognizing that low muscle mass may cause deceptively low serum creatinine despite reduced GFR.
Question 2: A consultant pharmacist reviews a patient's medication list and finds duplicate therapy with two ACE inhibitors prescribed by different providers. What is the best initial action?
- Discontinue both and start an ARB
- Contact the prescribers to clarify intent and reconcile the medication list (Correct answer)
- Continue both since ACE inhibitors have complementary mechanisms
- Add a potassium supplement to counteract hyperkalemia risk
Correct answer: Contact the prescribers to clarify intent and reconcile the medication list
Medication reconciliation with prescriber communication is the appropriate first step to resolve duplicate therapy safely.
Question 3: Which validated tool is specifically designed to screen for depression in elderly patients in long-term care settings?
- PHQ-9
- Beck Depression Inventory
- Geriatric Depression Scale (GDS) (Correct answer)
- Columbia Suicide Severity Rating Scale
Correct answer: Geriatric Depression Scale (GDS)
The Geriatric Depression Scale was specifically developed and validated for screening depression in older adults.
Question 4: A patient receiving warfarin has an INR of 4.8 with no signs of bleeding. What is the most appropriate pharmacist recommendation?
- Hold warfarin for 1-2 doses and recheck INR (Correct answer)
- Administer vitamin K 10 mg IV immediately
- Continue current dose and recheck INR in 1 week
- Switch to direct oral anticoagulant immediately
Correct answer: Hold warfarin for 1-2 doses and recheck INR
For an elevated INR without bleeding, holding 1-2 doses of warfarin and rechecking INR is appropriate per ACCP guidelines.
Question 5: Which of the following best describes the purpose of a comprehensive medication review (CMR) in the Medicare Part D Medication Therapy Management program?
- To audit pharmacy billing practices
- To conduct a structured, interactive patient interview to optimize drug therapy (Correct answer)
- To identify medications eligible for generic substitution only
- To verify that all prescriptions are covered under the patient's formulary
Correct answer: To conduct a structured, interactive patient interview to optimize drug therapy
A CMR is a structured, interactive consultation aimed at identifying, resolving, and preventing drug therapy problems to optimize medication use.
Question 6: A nursing home patient on long-term opioid therapy for chronic pain appears sedated and has a respiratory rate of 10 breaths/min. What is the consultant pharmacist's priority assessment?
- Check for constipation as the cause of sedation
- Assess for opioid toxicity and consider naloxone administration (Correct answer)
- Increase the opioid dose to improve pain control
- Order a sleep study to evaluate for sleep apnea
Correct answer: Assess for opioid toxicity and consider naloxone administration
Sedation with respiratory depression in a patient on opioids indicates potential toxicity requiring immediate assessment and possible naloxone administration.
Question 7: When monitoring a patient on methotrexate for rheumatoid arthritis, which laboratory finding would indicate the need to hold the medication?
- Serum albumin of 3.8 g/dL
- ALT three times the upper limit of normal (Correct answer)
- Hemoglobin of 12.5 g/dL
- Creatinine clearance of 55 mL/min
Correct answer: ALT three times the upper limit of normal
Hepatotoxicity indicated by liver enzymes exceeding two to three times the upper limit of normal warrants holding methotrexate per standard guidelines.
CCP Patient Assessment and Monitoring 2
An 82-year-old nursing home resident has a serum creatinine of 0.7 mg/dL.
Which method is most appropriate for estimating her renal function for drug dosing?