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

Hepatotoxicity and elevated liver enzymes.

Answer

Opioid-sparing effect leading to sedation.

Answer

Drug-induced lupus erythematosus.

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

The symptoms are likely unrelated to phenytoin, as the total level is not high enough to cause severe toxicity.

Answer

The fall was likely caused by a breakthrough seizure, indicating the phenytoin dose is subtherapeutic.

Answer

The resident is metabolizing phenytoin more slowly due to age, and the dose should have been empirically reduced upon admission.

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

Tardive dyskinesia and other extrapyramidal symptoms.

Answer

Hyponatremia and syndrome of inappropriate antidiuretic hormone (SIADH).

Answer

QTc prolongation and Torsades de pointes.

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

It is the leading cause of medication-induced nephrotoxicity.

Answer

It dramatically elevates the risk of serotonin syndrome.

Answer

It reliably causes severe anticholinergic toxicity.

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

Obtaining a new signed consent from the power of attorney before each dose is given.

Answer

Increasing the dose by a small amount every quarter to prevent tolerance.

Answer

Performing an Abnormal Involuntary Movement Scale (AIMS) assessment every two years.

Question 6

An 84-year-old resident taking sertraline 100 mg daily for depression is started on scheduled tramadol 50 mg twice daily for moderate pain. Two days later, the resident develops acute confusion, agitation, myoclonus, and tachycardia. This adverse event is most likely an example of which medication-related problem?

Accepted Answer

A drug-drug interaction resulting in serotonin syndrome.

Answer

Opioid-induced neurotoxicity from tramadol accumulation.

Answer

An additive anticholinergic effect from both medications.

Answer

A paradoxical reaction to the sertraline.

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:

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: