Theory Test Revision

What is the green range for clozapine FBC, and what action should be taken in this range?

Green range is when both WCC > 3.5 AND NC >2.0. In this range, clozapine supply should continue as normal (with either weekly monitoring if the patient is in the first 18 weeks of therapy, or monthly monitoring thereafter), and appropriate counselling on adverse effects should be provided.

What is the amber range for clozapine FBC, and what action should be taken in this range?

Amber range is when WCC 3.0-3.5 AND/OR NC 1.5-2.0. In this range, treatment with clozapine should continue, but monitoring should be increased to twice weekly until FBC returns to normal range.

What is the red range for clozapine FBC, and what action should be taken in this range?

Red range is when WCC <3.0 AND/OR NC <1.5. In this range, stop treatment with clozapine immediately, then contact the patient’s haematologist and the Clozapine Monitoring Centre. The FBC should be repeated in 24 hours.

What are the guidelines for missed doses of clozapine?

• Missed dose <48 hours: No change to dose or monitoring requirements. Continue taking clozapine at the usual time, when the next dose is due.

• Missed dose >48 hours, but <3 days: Start clozapine again at 12.5mg and titrate up. No changes to monitoring requirements.

• Missed dose >3 days, but <4 weeks: Start clozapine again at 12.5mg and titrate up. Increase monitoring requirements to weekly for at least 6 weeks, or if a patient is already having weekly monitoring, ensure that they complete at least 6 weeks of additional monitoring (even if this means continuing weekly monitoring for longer than 18 weeks).

• Missed dose >4 weeks: Need to re-register with clozapine registry and recommence clozapine as for a new patient.

What are the four stages of implementation of a professional pharmacy service?

1. 1. Development or discovery

2. 2. Exploration and appraisal

3. 3. Preparation and planning

4. 4. Testing and initial operation

5. 5. Operation and implementation

6. 6. Sustainability and maintaining

What components need to be considered when in the exploration phase of implementing a professional pharmacy service?

1. 1. Problem analysis: Determining the gaps between the current system and needs

2. 2. Ecological approach and SWOT analysis

3. 3. Develop a broad aim or vision for the service

4. 4. Develop discrete business goals

5. 5. Determine the resources and money that will be required to implement the service

6. 6. Evaluation measures, including formative, process and impact evaluations

What is a SWOT analysis, and provide examples in relation to a women’s health service?

• Strengths: Strong staff interest, patient accessibility, rapport with local women’s organisations

• Weaknesses: Inadequate space, staff not sufficiently educated, no marketing background

• Opportunities: Large adult female population, media interest in women’s health, established guidelines available for HRT etc.

• Threats: Women’s education program at local hospital, encroachment on some GP’s interest areas, uncertain remuneration for service

What are the six stages of moral reasoning?

1. 1. Obedience: To avoid reprimand.

2. 2. Instrumental egoism and simple exchange: To give the patient what they want, and to do your job.

3. 3. Interpersonal concordance: To keep all stakeholders happy.

4. 4. Law and duty to the social order: To act in accordance with the law.

5. 5. Societal consensus: Working to develop a social system for handling unauthorised refills (e.g. working with the pharmacy owner and local physicians)

6. 6. Nonarbitrary social cooperation: Considering the ultimate welfare of the patient.

What are the seven strategic goals outlined by Australia’s National Digital Health Strategy?

1. 1. Health information that is available whenever and wherever it is needed.

2. 2. Health information that can be exchanged securely.

3. 3. High-quality data with a commonly understood meaning that can be used with confidence.

4. 4. Better availability and access to prescriptions and medicines information.

5. 5. Digitally enabled models of care that drive improved accessibility, quality, safety and efficiency.

6. 6. A workforce confidently using digital health technologies to deliver health and care.

7. 7. A thriving digital health industry delivering world-class innovation.

What is the difference between IHI, HPI-I and HPI-O?

• IHI: Individual patient receiving health care

• HPI-I: Individual healthcare provider (e.g. pharmacist, GP, nurse)

• HPI-O: Healthcare organisation (e.g. pharmacy, hospital, medical practice, pathology lab)

What is a digital certificate?

Also known as a public key infrastructure (PKI), it authenticates an organisation for the purposes of communicating information to a recipient.

What does PRODA mean?

Provider Digital Access: Online identity verification and authentication system developed and maintained by Services Australia.

What is HPOS?

Health Professional Online Services: An online portal maintained by Services Australia that allows healthcare professionals and administrators to interact electronically with government health services.

What is NASH?

National Authentication Service for Health: A system used to securely access and share information using national digital health systems.

What is a prescription delivery service?

A digital repository housing electronic prescriptions until downloaded into dispensing software via the use of a token. This includes both eScripts and paper scripts with a barcode.

What are the identification requirements when a pharmacist is registering a patient with an ASL?

• Medicare or DVA card, PLUS

• Either government-issued photo ID, or 100 points of ID

What are the two models of real-time prescription monitoring, and which one is used in WA?

DORA model and integrated model. The integrated model is used in WA.

What are the patient criteria for resupply of an oral contraceptive pill (OCP) by a pharmacist, as outlined in the SASA?

• Patients must be between the ages of 16-39

• Patient must have been prescribed the OCP by a GP or nurse practitioner within the past two years, have been using the same OCP consistently for at least two years, and have taken the OCP consistently since it was prescribed

• Patients between 16-17 years can receive a single resupply for up to 4 months

• Patients between 18-39 years can receive resupply for up to 12 months, as long as the supply does not extend the date of the patient’s last OCP review with a prescriber beyond two years

• The OCP is being taken for contraceptive purposes, and not for other purposes such as menstrual regulation

Which hormones cannot be supplied by a pharmacist in OCP resupply?

Cyproterone, estetrol, mestranol, high ethinylestradiol doses of 50mcg (but lower doses are fine)

What is the missed dose reintroduction schedule for methadone or sublingual buprenorphine?

• 1-2 days: Dose as usual.

• 3 days: Consult with prescriber or CAS before dosing. Approval to dispense treatment can be given to the pharmacist over the phone. For buprenorphine, the patient may be dosed as usual. For methadone, the dose should be reduced by half.

• 4 days: Pharmacist must withhold dose and the patient must be seen by the prescriber. For buprenorphine, the prescriber may recommend the same or a reduced dose. For methadone, the patient should be recommenced on either 40mg methadone or half the usual dose, whichever is lower. In either case, a new script needs to be provided to the pharmacist.

• 5+ days: Patient must be seen by the prescriber for re-introduction of OST. For buprenorphine, rapid dose re-induction may be used. For methadone, the usual induction dosing should be used.

What action should you take if a patient presents to the pharmacy for a CPOP dose while visibly intoxicated?

• If mildly intoxicated, contact the prescriber as a reduced dose may be preferable to not dosing at all

• If significantly intoxicated, ask the client to re-present later when not intoxicated (at least 3 hours later) and contact the prescriber.

What action should you take if a methadone patient vomits after taking a dose?

• If vomit >20 minutes after a dose: Adequately absorbed so no re-dose

• If vomit <20 minutes after a dose and you see the event: Re-dose a half dose, as long as the patient has had continuous treatment for at least 2 weeks

• If vomit <20 minutes after a dose and you do not see the event: Review the patient 4-6 hours after, and if they have signs of withdrawal, a dose supplement of up to half of the usual dose may be given

• If in doubt, call the prescriber