Ptcb Quiz: Pharmacist Intervention

A prescriber writes for clopidogrel 75 mg daily for a patient after a recent stent placement. While processing the prescription, the technician sees the patient's active medications include omeprazole 20 mg daily for reflux, atorvastatin, and lisinopril. The patient asks if they can continue taking their "stomach pill" because heart medications upset their stomach. The technician recalls that some acid-reducing medications can reduce the effect of clopidogrel, and the patient's recent cardiac procedure makes medication effectiveness especially important. The patient's history includes a prior gastrointestinal bleed years ago, which is why omeprazole was started. The technician is unsure how to balance bleeding risk and heart protection and knows this requires pharmacist judgment. Pharmacy policy requires pharmacist review for potential interactions that may reduce therapy effectiveness, especially after hospital discharge. The technician must determine what issue necessitates pharmacist oversight before finalizing the fill.

A patient picks up a new prescription for fluconazole 150 mg, one dose now and repeat in 3 days. The technician checks the profile and sees the patient takes citalopram 40 mg daily and hydroxyzine as needed for anxiety. The patient mentions feeling occasional "fluttering" in the chest and asks if fluconazole will be okay because they read it can affect the heart rhythm. The technician knows some medications can increase the risk of abnormal heart rhythms when combined, and that the patient is already on medicines that can cause drowsiness and other side effects. The technician also notes the citalopram dose is at the higher end and the patient is over 60 years old. Pharmacy policy requires pharmacist review for potential serious interactions and patient-reported symptoms like palpitations. The technician must decide what prompts pharmacist intervention in this situation.

A customer at the OTC aisle asks for a "strong cold medicine" for congestion and cough. The technician learns the customer takes sertraline 100 mg daily for depression, trazodone 50 mg at bedtime for sleep, and sumatriptan as needed for migraines. The customer points to a multi-symptom product containing dextromethorphan, doxylamine, and phenylephrine, and says they plan to take it every 4 hours. The customer also mentions feeling "extra jittery" lately and has had trouble sleeping, but attributes it to being sick. The profile shows no allergies on file. The technician knows some cough suppressants can interact with certain antidepressants and that combining multiple medicines that affect mood or alertness may increase adverse effects. The customer asks, "It's over-the-counter, so it's safe with my meds, right?" The pharmacy's policy requires pharmacist involvement when an OTC request may interact with prescription medications or worsen existing conditions. The technician needs to respond appropriately while keeping the customer safe and within scope of practice.

A new prescription for methotrexate 2.5 mg tablets is received with directions: "Take 6 tablets by mouth daily." The technician notices the patient's profile shows rheumatoid arthritis and folic acid daily, and that methotrexate is often taken on a weekly schedule for this condition. The patient is waiting and says, "My doctor said it's a strong medicine, so I want to be careful." The technician also sees the patient takes ibuprofen as needed and has a history of mild liver disease. The technician recognizes that a daily dosing direction may be an error and could cause serious harm. Pharmacy policy requires pharmacist review for unusual dosing, high-alert medications, and potential prescribing errors. The technician must decide the best course of action before the prescription is filled or dispensed.

A prescription arrives for nitrofurantoin 100 mg twice daily for 5 days for a urinary tract infection. While entering the order, the technician sees the patient is 82 years old and has a documented reduced kidney function note from a recent hospital discharge summary in the profile. The patient's medication list includes furosemide, losartan, and calcium/vitamin D. The patient calls and reports nausea and shortness of breath after the first dose taken last night, and wonders if they should keep taking it. The technician knows some antibiotics may not work well or may cause more side effects in patients with poor kidney function, and that new shortness of breath can be concerning. Pharmacy policy requires pharmacist review for possible adverse drug events and appropriateness concerns in older adults with kidney impairment. The technician must decide what should be escalated to the pharmacist immediately.

A patient requests an OTC nasal spray for allergies and points to oxymetazoline. The technician checks the profile and sees the patient has uncontrolled high blood pressure and takes phenelzine (an MAOI) for depression. The patient says they have had headaches and nose stuffiness for days and wants quick relief. The patient also mentions they recently started a new blood pressure medication but cannot recall the name. The technician knows some decongestants can raise blood pressure and may interact with certain antidepressants. The patient asks, "It's just a spray—can it really affect my other meds?" Pharmacy policy requires pharmacist consultation when OTC decongestants may be unsafe with patient conditions or medications. The technician must decide the best course of action to prevent harm.

A patient comes to the counter and says they started allopurinol last week for gout prevention. They now have a new rash on their chest and arms and feel feverish. The technician reviews the profile: allopurinol 300 mg daily is new, and the patient also takes hydrochlorothiazide and lisinopril. The patient asks if they should apply an OTC hydrocortisone cream and keep taking allopurinol because "it's probably just dry skin." The technician knows that new rash with fever after starting a medication can be a warning sign and may require urgent evaluation. The patient's history includes kidney problems, and the patient looks uncomfortable. Pharmacy policy requires immediate pharmacist involvement when a patient reports possible serious adverse drug reactions, especially after starting a new medication. The technician must decide the best course of action to ensure prompt and appropriate care.

A prescription is received for levothyroxine 200 mcg daily for a patient who previously filled levothyroxine 75 mcg daily at the same pharmacy. The technician checks the profile and sees the last 75 mcg fill was 10 days ago with 80 tablets remaining, suggesting the patient is not due. The patient says, "My doctor said my thyroid is still low," but also reports feeling shaky and having trouble sleeping lately. The technician notices the new prescription has no titration note and the dose increase seems large compared to the previous strength. The patient's history includes atrial fibrillation and use of metoprolol. The pharmacy's quality assurance rules require pharmacist review for significant dose changes, early refills that may indicate confusion, and symptoms that could suggest over-treatment. The technician must decide what should prompt pharmacist oversight before dispensing the new dose.

A prescriber sends an e-prescription for amoxicillin/clavulanate 875/125 mg twice daily for 10 days for a patient with sinusitis. While entering the order, the technician sees an allergy listed: "penicillin—hives and swelling (childhood)." The patient is waiting and says, "I'm not sure if it was a real allergy, but I remember breaking out." The profile shows previous fills for azithromycin and doxycycline, but no record of amoxicillin products. The patient also takes cetirizine daily and uses an albuterol inhaler as needed. The technician knows allergy histories can be unclear and that some reactions may be serious. The prescriber's note does not mention the allergy, and the patient asks if they can just try it and stop if they get a rash. Pharmacy policy requires pharmacist review when a prescription conflicts with a documented allergy or when the patient describes swelling. The technician must decide what action best supports patient safety and proper verification.

A prescriber sends a new prescription for tramadol 50 mg every 6 hours as needed for pain. The technician reviews the profile and sees the patient takes duloxetine 60 mg daily for neuropathy and bupropion XL 300 mg daily for depression. The patient asks if tramadol will make them sleepy and mentions they had a seizure years ago after a head injury. The technician knows some pain medicines can interact with antidepressants and that seizure history can increase concern with certain medications. The patient also says they are taking an OTC cough product occasionally but cannot recall the ingredient. Pharmacy policy requires pharmacist review for interaction risks, seizure history, and patient questions about safety. The technician must decide what potential issue necessitates pharmacist oversight before dispensing tramadol.

A patient requests an OTC antacid for heartburn and tells the technician they are taking mycophenolate for a transplant, along with tacrolimus and prednisone. The patient says they have been nauseated and want something "fast-acting," pointing to magnesium/aluminum hydroxide liquid. The patient also mentions they have had diarrhea recently and are worried about dehydration. The technician knows some antacids can affect absorption of certain prescription medications and that transplant medicines require consistent levels. The patient asks if they can take the antacid at the same time as their morning transplant medications to keep their routine simple. Pharmacy policy requires pharmacist consultation when OTC products may reduce effectiveness of critical therapies or when the patient reports ongoing gastrointestinal symptoms. The technician must decide how to proceed to support patient safety and therapy success.

A patient brings in a prescription for prednisone 40 mg daily for 5 days for an asthma flare. The technician sees the patient has type 2 diabetes treated with insulin glargine nightly and insulin lispro with meals. The patient says, "Steroids always make my sugar go crazy," and asks if they should cut their insulin in half to avoid weight gain. The patient also reports increased thirst and frequent urination since starting a previous steroid burst last year. The technician knows steroids can raise blood glucose and that insulin changes should be guided by a clinician. The patient's last A1c recorded in the profile is elevated, and the patient has had a prior emergency visit for high blood sugar. Pharmacy policy requires pharmacist review when patients request advice about adjusting prescription doses or report symptoms that could indicate uncontrolled glucose. The technician must decide the best course of action to protect the patient and stay within scope.

A patient asks the technician if they can start an OTC "natural" product containing St. John's wort for mood. The technician reviews the profile: the patient takes ethinyl estradiol/levonorgestrel oral contraceptive, sertraline 50 mg daily, and uses alprazolam as needed. The patient says they want to avoid increasing their antidepressant dose and assumes herbal products are gentle. The patient also says they cannot risk an unplanned pregnancy. The technician recalls that some supplements can affect prescription medication levels and that combining mood-related products may increase side effects. Pharmacy policy requires pharmacist consultation when supplements may interact with prescription medications or affect contraception effectiveness. The technician must decide how to proceed in a way that is safe and consistent with pharmacy standards.

A patient presents a new prescription for glipizide 10 mg daily. The technician reviews the medication history: the patient currently takes glyburide 5 mg twice daily, metformin 1000 mg twice daily, and atorvastatin 40 mg nightly. The patient says their doctor "changed my diabetes pill because my sugars were low sometimes," and they are worried about taking the wrong one. The new prescription does not include any note to discontinue glyburide, and the patient has an active refill ready for glyburide. The patient reports a recent episode of sweating and shakiness that improved after drinking juice. The technician recognizes that glipizide and glyburide are similar medications used for blood sugar control and that taking both could increase the risk of low blood sugar. The pharmacy's DUR system flags "therapeutic duplication" but requires pharmacist review to interpret and act. The technician must determine the best course of action to prevent an adverse event and clarify the prescriber's intent.

A patient drops off a new prescription for lisinopril 20 mg daily. The technician reviews the profile: lisinopril 10 mg daily was filled last week, plus hydrochlorothiazide 25 mg daily, metformin 1000 mg twice daily, and ibuprofen 600 mg three times daily as needed for back pain. The patient history shows chronic kidney disease stage 3 and a prior note of elevated potassium. The patient says, "My doctor increased my blood pressure pill because my numbers were high," and asks if they should take both lisinopril bottles until the old one runs out. The technician notices the directions on the new prescription do not say "replace prior dose," and the patient has refills remaining on the 10 mg strength. The technician also recalls that frequent NSAID use with an ACE inhibitor and diuretic can increase kidney risk, especially in someone with kidney disease. The patient reports mild dizziness since starting the diuretic but denies swelling, rash, or trouble breathing. The pharmacy's quality checks require pharmacist review for dose changes, therapeutic duplication, and high-risk combinations. The technician must decide what should be escalated to the pharmacist immediately to prevent harm and ensure the prescriber's intent is followed.

A caregiver brings a prescription for a child for acetaminophen-codeine liquid for a cough. The technician reviews the patient record and sees the child is 7 years old with a history of sleep-disordered breathing and prior tonsil surgery. The caregiver says the child is "very sleepy" after the first dose given from an old bottle at home and asks if they should continue. The technician knows some opioid-containing cough products are not appropriate for children and that excessive sleepiness can be a warning sign. The caregiver is in a hurry and wants the prescription filled quickly. Pharmacy policy requires pharmacist review for pediatric opioid use, possible adverse events, and any report of excessive sedation. The technician must determine the best action to ensure safe care and appropriate counseling.

A prescription is received for potassium chloride 20 mEq twice daily. The technician reviews the profile and sees the patient takes lisinopril 40 mg daily and spironolactone 25 mg daily for heart failure. The patient's last lab note in the profile mentions "potassium high—diet counseling," and the patient is also taking a salt substitute at home. The patient calls to ask if they should start the potassium right away because the prescriber said it would help with leg cramps. The technician recognizes that some blood pressure and heart medications can increase potassium, and adding a supplement may raise the level further. The technician also knows leg cramps can have multiple causes and that lab values may need review. Pharmacy policy requires pharmacist intervention for potential high potassium risk and when lab-dependent medications are prescribed. The technician must decide what should prompt pharmacist oversight.

A patient calls the pharmacy and says they started a new antibiotic yesterday: sulfamethoxazole/trimethoprim (SMX/TMP) twice daily for a skin infection. The technician pulls up the medication record: warfarin with a stable weekly schedule, lisinopril 20 mg daily, and spironolactone 25 mg daily. The patient reports new bruising on their arms and gums that bleed when brushing teeth. They also feel weak and slightly lightheaded. The patient asks if they should skip warfarin doses until the antibiotic is finished. The technician notes the last INR was in range two weeks ago, and the patient has no recent dose changes documented. The patient history also includes "high potassium in the past" and mild kidney impairment. The pharmacy has a quality assurance rule to involve the pharmacist for possible serious side effects, anticoagulant interactions, and any patient request to self-adjust therapy. The technician must decide the safest next step and what requires pharmacist intervention right away.

A patient picking up medications tells the technician, "Ever since I started my new water pill, I feel my heart racing and my muscles cramp." The technician checks the profile: furosemide 40 mg daily was started three days ago, along with existing digoxin 0.125 mg daily for heart failure and metoprolol succinate 50 mg daily. The patient also takes a potassium supplement intermittently but is not sure how often. The patient denies chest pain but feels dizzy when standing. The technician knows that some diuretics can lower potassium, and that low potassium can increase the risk of side effects with certain heart medications. The patient asks whether they should take extra potassium tablets today. The pharmacy's policy requires pharmacist involvement when a patient reports possible medication side effects, dizziness, or symptoms that could indicate electrolyte problems. The technician must decide how to proceed to ensure patient safety and appropriate clinical assessment.

A new prescription is received for metoprolol tartrate 50 mg twice daily. The technician sees the patient already has an active prescription for metoprolol succinate 50 mg daily with refills remaining. The patient says they were discharged from the hospital yesterday and were told "the metoprolol changed," but they are not sure which bottle to use. The discharge paperwork is not available, and the new prescription does not clearly state whether it replaces the old one. The patient's history includes low heart rate noted at a prior visit and episodes of dizziness. The technician recognizes the two metoprolol forms are different and that taking both could cause too much beta-blocker effect. Pharmacy policy requires pharmacist review for therapeutic duplication, transitions of care, and unclear medication changes after hospitalization. The technician must determine what prompts pharmacist intervention before dispensing.