Drug Utilization Review - Mpje

1. Which DUR check best addresses renal dosing safety when kidney function is reduced?

   Dose appropriateness review considering patient-specific factors (e.g., renal function). Incorporates organ function to adjust dosing and avoid accumulation or toxicity.

2. Identify the DUR concern: a patient is prescribed two drugs with a clinically significant interaction.

   Drug–drug interaction. Concurrent use may alter pharmacokinetics or pharmacodynamics, leading to toxicity or reduced efficacy.

3. Identify the DUR concern: a patient refills early in a manner suggesting excess use.

   Drug misuse or abuse (overutilization/early refill pattern). Patterns of early refills signal potential diversion, addiction, or non-prescribed excessive consumption.

4. Identify the DUR concern: a refill request occurs too soon based on days' supply and fill date.

   Overutilization (potential misuse/abuse or nonadherent dosing pattern). Early requests suggest excessive use, requiring evaluation for abuse or improper adherence.

5. Which patient-specific element must be reviewed in a prospective DUR: age, weight, or prescriber address?

   Age (patient-specific factor relevant to therapy appropriateness). Age influences dosing, contraindications, and therapy suitability based on developmental and physiological factors.

6. What is the appropriate response when a DUR issue presents an immediate patient safety risk?

   Hold dispensing, contact prescriber, and document actions and outcome. Withholds medication until resolved to mitigate harm, with records ensuring traceability.

7. What DUR-related patient information must pharmacies attempt to obtain for Medicaid OBRA '90 compliance?

   Patient profile data (e.g., allergies, current meds, relevant conditions). Collecting this enables thorough screening for interactions, allergies, and contraindications.

8. What DUR check addresses whether the medication is appropriate given the patient's diagnosis or condition?

   Drug–disease (contraindication/precaution) screening. Assesses if the drug could worsen the condition or is contraindicated based on patient health status.

9. What is the primary legal purpose of documenting DUR interventions in the dispensing record?

   To show compliance and support the clinical basis for dispensing decisions. Provides evidence of adherence to standards and justifies professional decisions in reviews.

10. Identify the correct documentation outcome: prescriber contacted and therapy changed.

    Document prescriber communication and new order/therapy modification. Records consultation and adjustments to reflect the updated, safe therapeutic plan.

11. Identify the DUR concern: directions would result in therapy longer than recommended duration.

    Incorrect duration of drug treatment. Extended use beyond guidelines may cause resistance, cumulative toxicity, or unnecessary exposure.

12. What DUR check specifically evaluates whether the dosage form and route are appropriate?

    Dosage form/route appropriateness review. Ensures the form and route align with patient capabilities and therapeutic needs for optimal delivery.

13. Which counseling-related item is explicitly tied to DUR and safe use: storage conditions or prescriber NPI?

    Storage conditions (patient counseling content related to safe/effective use). Advising on storage preserves potency and prevents degradation, enhancing medication effectiveness.

14. Identify the DUR concern: a new prescription duplicates an existing therapy in the same class.

    Therapeutic duplication. Involves multiple agents with similar mechanisms, increasing risk of adverse effects without therapeutic benefit.

15. Which action best resolves a clinically significant DUR alert: override without note or intervene and document?

    Intervene as needed and document the clinical rationale/outcome. Addresses alerts through action and records rationale to ensure patient safety and legal compliance.

16. What federal law requires pharmacists to perform prospective drug utilization review (DUR) before dispensing?

    OBRA '90 (Omnibus Budget Reconciliation Act of 1990). This legislation mandates prospective DUR for Medicaid prescriptions to ensure medication safety and appropriateness prior to dispensing.

17. What is the legally required timing of prospective DUR under OBRA '90?

    Before each prescription is dispensed (prospective review). Timing ensures potential issues are identified and resolved to prevent harm before the medication reaches the patient.

18. Identify the DUR concern: a patient does not refill chronic therapy on time and gaps occur.

    Underutilization (nonadherence or inadequate therapy continuation). Delayed refills indicate poor adherence, risking treatment failure or disease exacerbation.

19. Identify the DUR concern: the prescribed dose exceeds the usual maximum for the indication.

    Incorrect dose (dose too high). Exceeding recommended limits heightens adverse event risk without proportional therapeutic gain.

20. What DUR check evaluates whether timing of administration could reduce efficacy or increase toxicity?

    Drug–drug interaction and administration timing review. Evaluates scheduling to minimize interactions affecting absorption, efficacy, or safety profiles.

21. What is the legally required counseling standard under OBRA '90 for Medicaid patients at dispensing?

    Offer to counsel (and counsel if accepted) at the point of dispensing. Requires offering education on use, though patients may decline, to promote adherence and safety.

22. What is the minimum documentation expectation when a pharmacist resolves a significant DUR issue?

    Problem identified, intervention, and outcome (including prescriber contact if needed). Captures the issue, response, and resolution to demonstrate professional judgment and accountability.

23. What DUR check addresses whether the patient has a documented allergy to the prescribed drug or class?

    Drug–allergy interaction screening. Prevents anaphylaxis or hypersensitivity by cross-referencing allergies with prescribed agents.

24. Identify the correct documentation outcome: prescriber contacted and confirms original therapy is intended.

    Document prescriber confirmation and clinical rationale for dispensing. Notes affirmation and reasoning to justify dispensing despite initial concerns.

25. What is the key distinction between prospective DUR and retrospective DUR?

    Prospective occurs before dispensing; retrospective occurs after dispensing. Prospective timing prevents issues pre-dispensing, while retrospective analyzes usage patterns for systemic improvements post-dispensing.

Study these flashcards