Comprehensive Medication Review & Optimization Flashcards
7 cards from real MTM practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Comprehensive Medication Review & Optimization flashcards as text
A CMR patient reports forgetting her afternoon medication dose consistently. Which adherence strategy is most evidence-based for this pattern?
Answer: Switching to a twice-daily formulation if a once-daily equivalent is available
Simplifying regimens by switching to once-daily formulations is among the most effective strategies for improving adherence in patients who forget scheduled doses.
Which laboratory value is most critical to review before recommending an ACE inhibitor dose increase during a CMR?
Answer: Serum potassium and serum creatinine/eGFR
ACE inhibitors can cause hyperkalemia and acute kidney injury; potassium and renal function must be assessed before dose escalation.
A patient completing a CMR is on quetiapine for bipolar disorder and newly reports fasting glucose of 130 mg/dL. What is the most appropriate response?
Answer: Document as a potential atypical antipsychotic-induced metabolic adverse effect and notify the prescriber
Atypical antipsychotics including quetiapine carry a black-box warning for metabolic effects including hyperglycemia; the prescriber must be notified for collaborative management.
When assessing medication safety during a CMR, the Beers Criteria is most appropriately applied to which patient population?
Answer: Adults aged 65 and older
The AGS Beers Criteria was developed specifically to identify potentially inappropriate medications for adults aged 65 and older.
A CMR patient on warfarin reports starting cranberry juice daily. What is the pharmacist's concern?
Answer: Cranberry may inhibit CYP2C9, increasing warfarin levels and bleeding risk
Cranberry products may inhibit CYP2C9, the primary enzyme metabolizing warfarin's S-enantiomer, potentially increasing INR and bleeding risk.
A patient's Personal Medication Record (PMR) generated after a CMR should include which of the following?
Answer: Patient allergies, all current medications with doses and indications, and OTC/supplements
The PMR is a comprehensive patient-held record including allergies, all medications (Rx, OTC, supplements) with dosing and indications.
Which of the following scenarios best illustrates 'medication optimization' achieved through a CMR?
Answer: Identifying that a patient's HbA1c of 6.4% on metformin now meets remission criteria, allowing de-intensification
De-intensification when therapeutic goals are exceeded (e.g., HbA1c below target in T2DM) is a core medication optimization outcome that reduces pill burden and adverse effects.