Drug Information and Commuication Strategies in Pharmacy Flashcards
1
Q
- While researching a question regarding the interaction
between apixaban and cyclosporine, a pharmacist
discovers the following article through
a PubMed search: “Drug Interactions Between
Direct-Acting Oral Anticoagulants and Calcineurin
Inhibitors During Solid Organ Transplantation:
Considerations for Therapy” (Expert Rev Clin
Pharmacol 2019;12:781-90). Which best describes the
type of medical literature this article is considered?
A. Primary.
B. Secondary.
C. Tertiary.
D. Quaternary.
A
- Answer: C
In the abstract, the authors discuss that the article
was a comprehensive review prepared using PubMed,
Embase, and other secondary resources. Review articles
are considered tertiary resources because they
synthesize information from several primary literature
sources and do not present original research results,
even though they are published as journal articles
(Answer C is correct; Answers A is incorrect). The
article is not a secondary source because this type of
literature consists of indexing and abstracting services
(Answer B is incorrect). There is not a category of
“quaternary” literature under this scheme (Answer D
is incorrect).
2
Q
- A hospital institutes a new heart failure hospitalization
treatment protocol. To assess quality improvement,
100 randomly selected patients treated under
the new protocol are compared with 100 randomly
selected, matched patients who received treatment
under the previous protocol. Which design best
describes this study?
A. Case-control study.
B. Cluster randomized controlled trial (RCT).
C. Interrupted time series.
D. Noncontrolled trial.
A
- Answer: C
Because the study involves comparing outcomes for
patients who received treatment under a new, practice-
based initiative with outcomes for similar patients
who were not involved in the initiative, it is most like the
interrupted time series or a historical control (Answer
C is correct). If patients who experienced an outcome
(e.g., heart failure hospitalization) were compared with
similar patients who did not, the study would more
resemble a case-control study (Answer A is incorrect).
A cluster RCT or non-equivalent control group would
involve randomizing patients to treatment with the new
protocol or an older protocol on the basis of an external
factor, like their provider or hospital unit (Answer B is
incorrect). A noncontrolled trial would involve analysis
of a single group of patients who received treatment
under the new protocol (Answer D is incorrect).
3
Q
- An attending physician asks a clinical pharmacist
who practices in chronic disease management to
research whether it is better to administer lisinopril
twice daily instead of the typical once daily administration
to control blood pressure in a 57-year-old
patient being treated for hypertension. The patient
also has a history of aortic dissection and dyslipidemia.
Which PICOS question best describes the
clinical question?
A. P: Adult, I: Lisinopril Once Daily, C:
Lisinopril Twice Daily, O: Blood Pressure, S:
Community.
B. P: Aortic dissection, I: Twice Daily, C: Once
Daily, O: Blood Pressure, S: Outpatient.
C. P: Hypertension: I: Lisinopril Once Daily, C:
Lisinopril Twice Daily, O: Quality of Life, S:
Inpatient.
D. P: Hypertension, I: Lisinopril Twice Daily, C:
Lisinopril Once Daily, O: Blood Pressure, S:
Outpatient.
A
- Answer: D
The best PICOS question is hypertension/aortic dissection,
lisinopril twice daily, lisinopril once daily, blood
pressure, and outpatient/community. The most appropriate
“I” (intervention) term is lisinopril twice daily
because it includes the specific drug of interest and
represents the departure from “usual care” (Answers
A, B, and C are incorrect). The most appropriate “C”
(comparator) term is thus lisinopril once daily (Answer
D is correct). Hypertension and aortic dissection are
both relevant “P” (patient) terms because they are specific
to the requested use, though hypertension may
be more critical to include as a formal search term. Blood pressure is the most relevant “O” (outcome) term
because quality of life was not a focus of the question
compared with surrogate outcomes. The setting (“S”
term) is outpatient or community.
4
Q
- A pharmacist is performing medication reconciliation
for a middle-aged male patient with obesity
recently admitted to the ED for chest pain
and shortness of breath. No firm diagnosis has
yet been made. When discussing his prescription
for amiodarone 200 mg orally once daily, he asks
the pharmacist whether the drug has any adverse
effects. Which question is most important for the
pharmacist to ask next?
A. Can you tell me a little more about why you
are asking – do you think you’ve experienced
a side effect?
B. So that my records are as complete as possible,
could you share your exact weight?
C. This drug has many interactions, so please
give me a full list of everything you take.
D. This drug has many different side effects. Do
you remember why your doctor started it?
A
- Answer: A
One of the most important background questions
related to adverse effects inquiries is to determine
whether the question is theoretical or whether the person
suspects an adverse effect occurred. Asking this in
an open-ended way can help the pharmacist learn much
more about the patient’s recent experiences (Answer A
is correct). It may also be good to figure out why the
patient is taking the drug, but this is not as high priority
at the moment and possibly could also be verified
electronically (Answer D is incorrect). Because it is
already clear that the patient has obesity, the patient’s
exact weight is not needed at this time for this inquiry
(Answer B is incorrect). It would likely be relevant to
obtain the full list of medications and supplements to
determine whether an interaction is occurring, but it is
higher priority to learn about the adverse event of interest
first (Answer C is incorrect).
5
Q
- A pharmacist performs a PubMed search to determine
whether any articles describe a true increased
risk of major bleeding from interactions involving
direct oral anticoagulants (DOACs) and cyclosporine,
a CYP3A4 and P-glycoprotein inhibitor in
human clinical studies. The pharmacist combines
the Medical Subject Headings (MeSH) terms for
individual DOACs (combined with OR) with the
MeSH terms for drug interactions and cyclosporine.
The search results in about 50 articles. Which
is the best step the pharmacist could take to narrow
the search results?
A. Activate the clinical studies filter.
B. Add drug class MeSH terms to the list of
DOACs combined with OR.
C. Add the MeSH term for major bleeding.
D. Change to a non-MeSH term search approach.
A
- Answer: A
Because there are more than 25 but less than 100
results, activating a filter is likely the best strategy.
Using the clinical studies filter will remove commentaries,
reviews, and other articles and help focus the
search on the types of articles described in the question
(Answer A is correct). Adding a MeSH term for
major bleeding is the second-best choice, but at this
point, adding a “fourth” term might cause the search to
be overly specific (Answer C is incorrect). Combining
drug class terms with OR and changing to a non-MeSH
approach would likely increase the number of results
(Answers B and D are incorrect).
6
Q
- A pharmacy manager is trying to determine how
much physical space to have between the pharmacist
and the patient during new-prescription counseling
at a new pharmacy location. Which nonverbal communication
concept is most used in this situation?
A. Haptics.
B. Proxemics.
C. Kinesis.
D. Chromatics.
A
- Answer: B
Proxemics focuses on the physical distance between
people and thus is being used in the decision-making
process in this scenario (Answer B is correct). Haptics
involves the use of touch, kinesis involves the use of
body movements, and chromatics involves the use of
time (Answers A, C, and D are incorrect).
7
Q
- A physician within a health network sends a message
to an in-house clinical pharmacist asking to
review a patient’s medications for drug-drug interactions
with the addition of a new HIV medication.
The patient’s next visit is in 2 weeks. Which would
be the most appropriate form of communication for
the pharmacist to use to respond to the physician?
A. Standard message within the electronic health
record.
B. Urgent message within the electronic health
record.
C. Direct page to the physician with results.
D. Telephone call to the physician’s nurse.
A
- Answer: A
A low-priority message sent within the electronic health
record would be appropriate; this case does not require
urgent attention because the provider does not need an
answer within the next few weeks (Answer A is correct;
Answer B is incorrect). A direct page to the physician
with the results would be inappropriate unless additional
information is necessary (Answer C is incorrect),
and a call to the physician’s nurse would not be required
because this information can be communicated directly
with the physician (Answer D is incorrect).
8
Q
- A patient is working with the pharmacist to determine
a correct dosing regimen for bolus insulin.
The patient has had difficulty calculating the dose
given the carbohydrate ratio or correction factor, so
the pharmacist created a dosing chart with ranges
for the patient’s correction factor (e.g., 150–200
mg/dL = 5 units). After a few months, the patient
still cannot apply the simplified dosing regimen.
Which most closely resembles this patient’s
National Assessment of Adult Literacy category?
A. Below basic (level 1).
B. Basic (level 2).
C. Intermediate (level 3).
D. Proficient (level 4).
A
- Answer: A
This patient is having difficulty with the most basic levels
of mathematical calculations and inferences, even
with the simplest dosing schedule, so the patient would
fall under the “below basic (level 1)” health literacy
level (Answer A is correct). The difference between
basic and below basic would be the ability to do the
most basic calculations and inferences, which this
patient cannot do (Answer B is incorrect). Nor is the
patient is at the intermediate or proficient levels, given
the scenario (Answers C and D are incorrect).
9
Q
- A pharmacy team within an academic institution
is looking for a health literacy assessment tool to
use in a new study for patients in their outpatient
clinic setting. The clinic serves many Spanish- and
English-speaking patients, and the team is hoping to assess both literacy and numeracy. Pharmacists
implementing the test will not have much time
to complete the assessment, so they hope the test
can be administered in 10 minutes or less. Which
assessment would be most appropriate for the team
to implement in this setting?
A. Rapid Estimate of Adult Literacy in Medicine–
short form (REALM-SF).
B. Short Assessment of Health Literacy for
Spanish Adults (SAHLSA-50).
C. Single Item Literacy Screener (SILS).
D. Test of Functional Health Literacy in Adults–
short version (s-TOFHLA).
A
- Answer: D
The s-TOFHLA would fit each of the criteria in this scenario
because it can be administered in 7 minutes, is
available in both Spanish and English, and can assess
both literacy and numeracy (Answer D is correct).
The REALM-SF would be helpful but is not readily
available in Spanish (Answer A is incorrect). The
SAHLSA-50 is intended only for Spanish-speaking
patients; thus, English-speaking patients would not be
represented (Answer B is incorrect). The SILS assessment,
though administered quickly, would not be available
for Spanish-speaking patients and does not assess
numeracy (Answer C is incorrect).
9
Q
- Which would likely be most effective to implement
within a team of pharmacists to help increase their
cultural sensitivity?
A. Participate in a book club on new relevant
literature.
B. Compile resources from EthnoMed.org.
C. Take online inventories to assess implicit
biases.
D. Incorporate the ETHNIC model into patient
interactions.
A
- Answer: C
Cultural sensitivity requires individuals to assess
their personal implicit biases and increase their own
self-awareness in order to appropriately respond to others’
attitudes, feelings, and circumstances (Answer C
is correct). A book club might help increase cultural
sensitivity, but it would likely mainly promote cultural
knowledge (Answer A is incorrect). EthnoMed
resources help with cultural awareness within specific
patient populations (Answer B is incorrect). The ETHNIC model is the culmination of cultural competence
and may not be effective until cultural sensitivity
is increased (Answer D is incorrect).
10
Q
- A pharmacy team is looking to implement a study
to assess patient adherence to antihypertensive
drug regimens according to new guidelines. The
pharmacy team has existing collaborative practice
agreements for adjusting medications for hypertension.
Which adherence tool would be most helpful
to determine adherence to drug regimens for
patients within the study?
A. PEMAT.
B. “Adherence Estimator.”
C. Morisky questionnaire.
D. Newest vital sign (NVS) assessment.
A
- Answer: C
The Morisky questionnaire is effective at assessing
adherence to complex drug regimens and identifying
patients’ thoughts about their medications (Answer C
is correct). The Adherence Estimator is mainly used to
determine future adherence to one specific drug regimen,
but in this case, the antihypertensive regimens
may include more than one agent (Answer B is incorrect).
The PEMAT is useful in creating educational
materials for patients (Answer A is incorrect), and
the NVS is for assessing health literacy (Answer D is
incorrect).
11
Q
Patient Case
Questions 1–5 pertain to the following case.
1. A staff pharmacist at XYZ pediatric hospital receives a medication order for a 12-year-old female patient for
intravenous immunoglobulin (IVIG). The patient is currently admitted to the hospital for acute myocarditis
unrelated to rheumatic, septic, or toxic causes. The patient has no other discernible reason to receive IVIG,
but the pharmacist is unfamiliar with this off-label use. Which tertiary reference would best be checked to
gather more information about this topic from an off-label use perspective?
A. AHFS Drug Information.
B. DailyMed.
C. Drugs@FDA.
D. Manufacturer-provided PI.
A
Answer: D
From an off-label use perspective, many tertiary
resources could provide helpful information. In this
case the correct answer is AHFS Drug Information,
which provides fairly detailed overviews of a fair number
of potential off-label uses (Answer A is correct).
The manufacturer-provided PI would not provide this
information since it must be approved by FDA (Answer
D is incorrect). DailyMed and Drugs@FDA only provide
FDA-approved information and would not cover
off-label uses (Answers B and C are incorrect).
12
Q
Patient Case (cont’d)
2. The staff pharmacist at XYZ pediatric hospital located an endorsement that IVIG has an off-label use in
pediatric myocarditis, with the dose of 2 g/kg intravenously given as a single dose over 24 hours (limited and
variable efficacy data available), as well as a statement from the AHA that the medication has been used but
that study results have been mixed (grade III (no benefit)/B-N). Which does the grading most suggest?
A. Do not use the intervention because it causes harm.
B. Intervention can be considered, according to evidence from a well-designed RCT.
C. Intervention can be considered, according to anecdotal expert opinion.
D. It is not recommended, with the highest level of evidence from non-RCTs.
A
- Answer: D
A grade of III suggests either no benefit or harm
according to the AHA grading scheme (Answers B and
C are incorrect). In this case, the medication is stated
to be grade III, no benefit, suggesting it is not recommended
but is also not harmful (Answer A is incorrect).
A level of evidence of B-N could be several article
types, including observational or nonrandomized trials
(Answer D is correct).
13
Q
- The pharmacist at XYZ pediatric hospital also identifies an observational study in which patients admitted
to the hospital for acute myocarditis during a 3-year period were grouped according to whether they received
IVIG. The two groups were compared at the time of discharge to evaluate survival outcomes and left ventricular
function recovery. Which design best classifies this study?
A. Case-control study.
B. Interrupted time series.
C. Noncontrolled trial.
D. Retrospective cohort study.
A
- Answer: D
Because the groups are formed on the basis of an
exposure (i.e., IVIG or no IVIG) likely to influence
an outcome (i.e., survival or no survival) and because
the study was defined as observational (there was no
randomization or other formal group assignment), this
would be considered a cohort study (Answer D is correct).
It is retrospective/historical because it is based
on past rather than current exposures. It is not a casecontrol
study because the groups were not formed on
the basis of an outcome (Answer A is incorrect). It is not
an interrupted time series or noncontrolled trial because
it is observational rather than experimental (Answers B
and C are incorrect). It is also not considered a noncontrolled
trial because two groups are being compared.
14
Q
Patient Case (cont’d)
4. Which of the following PICOS terms correctly describe clinical question at XYZ pediatric hospital?
A. P – Acute myocarditis
B. I – Pediatric
C. C – IVIG
D. O – Hospitalization
A
- Answer: A
The most relevant terms in the case are acute myocarditis
(P, patient/problem), IVIG (I, intervention), and
inpatient (S, setting). No clear C (comparator/control)
or O (outcomes) terms are posed by the specific clinical
question. The answer that correctly pairs the PICOS
type with the term is P, since acute myocarditis is the
primary problem of interest (Answer A is correct). The other three terms are relevant but mispaired; pediatric
would be a secondary P term (Answer B is incorrect),
IVIG is the main drug of interest, the I term (Answer
C is incorrect), and hospitalization/inpatient represents
the setting of the question or S term (Answer D is
incorrect).
