- A patient has an active prescription for alprazolam 0.5 mg as needed for anxiety. A new prescription is transmitted for lorazepam 1 mg as needed for anxiety. This combination represents a therapeutic duplication because both drugs are:
Answer: Benzodiazepines
Alprazolam (Xanax) and lorazepam (Ativan) both belong to the benzodiazepine class of medications. They have similar mechanisms of action and are used for anxiety. Using them together is redundant and increases the risk of sedation, respiratory depression, and dependence.
- A patient who is currently taking lisinopril for hypertension presents a new prescription for valsartan. The pharmacy technician should recognize this as a potential therapeutic duplication because both medications affect the:
Answer: Renin-angiotensin-aldosterone system
Lisinopril is an ACE inhibitor and valsartan is an angiotensin II receptor blocker (ARB). Both drug classes act on the renin-angiotensin-aldosterone system (RAAS) to lower blood pressure. Concurrent use is considered a duplication of mechanism and is generally not recommended due to increased risk of adverse effects.
- A patient profile indicates an active prescription for cetirizine 10 mg daily. The patient asks to purchase an over-the-counter product containing diphenhydramine for sleep. Combining these two medications would be an example of:
Answer: Therapeutic duplication
Both cetirizine (Zyrtec) and diphenhydramine (Benadryl) are H1-receptor antagonists (antihistamines). Using them together is a therapeutic duplication that significantly increases the risk of anticholinergic side effects and excessive sedation.
- When entering a new prescription for glyburide, the technician sees that the patient already has an active prescription for glipizide. This is a therapeutic duplication because both are oral hypoglycemic agents in which drug class?
Answer: Sulfonylureas
Glipizide and glyburide both belong to the sulfonylurea class of medications for type 2 diabetes. They stimulate the pancreas to release insulin. Concurrent use is a therapeutic duplication and increases the risk of severe hypoglycemia.
- A patient taking daily naproxen for chronic arthritis pain is given a prescription for ketorolac tablets upon discharge from an urgent care center for an acute injury. The pharmacy technician should alert the pharmacist because this combination is a therapeutic duplication of which drug class?
Answer: Nonsteroidal anti-inflammatory drugs (NSAIDs)
Naproxen and ketorolac are both potent Nonsteroidal Anti-Inflammatory Drugs (NSAIDs). Their concurrent use is a therapeutic duplication that significantly increases the risk of serious gastrointestinal and renal adverse effects and is explicitly contraindicated.
- A patient on a stable dose of warfarin for atrial fibrillation is discharged from the hospital with a new prescription for apixaban. Taking both of these medications concurrently would represent a therapeutic duplication that significantly increases the risk of:
Answer: Bleeding
Warfarin (a vitamin K antagonist) and apixaban (a direct factor Xa inhibitor) are both anticoagulants used to prevent blood clots. Using them together is a serious therapeutic duplication that does not improve efficacy and dramatically increases the risk of life-threatening bleeding.
- A patient's medication profile includes fluoxetine 20 mg daily. The pharmacy receives a new prescription for sertraline 50 mg daily. Why should this be brought to the pharmacist's attention?
Answer: This combination represents a therapeutic duplication of SSRIs.
Both fluoxetine (Prozac) and sertraline (Zoloft) are selective serotonin reuptake inhibitors (SSRIs) used to treat depression and other mood disorders. Using two SSRIs at the same time is a therapeutic duplication and increases the risk of serotonin syndrome.
- A patient was discharged from the hospital with a prescription for oxycodone 5 mg every 6 hours as needed for pain. Their medication profile shows they also have an active prescription for hydrocodone/acetaminophen 5/325 mg every 6 hours as needed for pain. This is a potential issue due to:
Answer: A therapeutic duplication of opioids
Oxycodone and hydrocodone are both opioid analgesics. Prescribing two different short-acting opioids for 'as needed' use simultaneously is a therapeutic duplication. This can lead to confusion, unintentional overdose, and increased risk of adverse effects like respiratory depression.
- An elderly patient is taking oxybutynin for overactive bladder. A new prescription for dicyclomine is added for irritable bowel syndrome. The technician should alert the pharmacist because this combination creates a duplication of which therapeutic effect, leading to an increased risk of side effects like dry mouth and confusion?
Answer: Anticholinergic
Both oxybutynin and dicyclomine are drugs with strong anticholinergic properties. Using them together results in a duplication of this effect, also known as 'anticholinergic burden,' which can lead to an increased incidence of side effects, especially in the elderly.
- A medication profile review for a patient shows active prescriptions for both metoprolol tartrate and carvedilol. This should be flagged for pharmacist review as a potential therapeutic duplication because both medications are:
Answer: Beta-blockers
Metoprolol and carvedilol are both beta-adrenergic blockers (beta-blockers). While they have some differences, their concurrent use would be a duplication of beta-blockade therapy and could lead to excessive bradycardia and hypotension.
- Which of the following pairs of medications, if found on the same patient profile for concurrent use, would constitute a therapeutic duplication?
Answer: Carisoprodol and cyclobenzaprine
Carisoprodol (Soma) and cyclobenzaprine (Flexeril) are both centrally acting skeletal muscle relaxants. Using two different muscle relaxants at the same time is a therapeutic duplication that enhances the risk of side effects like dizziness and drowsiness. The other pairs represent common combinations of a muscle relaxant with an analgesic.
- A patient's profile shows they are prescribed amlodipine 10 mg daily. They present a new prescription for nifedipine ER 30 mg daily. This should be questioned by the pharmacy staff because it is a therapeutic duplication of:
Answer: Dihydropyridine calcium channel blockers
Amlodipine (Norvasc) and nifedipine (Procardia) are both dihydropyridine calcium channel blockers. They have a similar mechanism of action and are used for hypertension and angina. Prescribing both concurrently is a therapeutic duplication.
- A pharmacy receives a prescription for amphetamine/dextroamphetamine salts (Adderall) for a teenager. Their profile shows an active prescription for methylphenidate ER (Concerta) from a different prescriber. Using both medications concurrently is considered a therapeutic duplication because both are:
Answer: CNS stimulants
Both amphetamine/dextroamphetamine and methylphenidate are central nervous system (CNS) stimulants. They are the two major classes of first-line medications for ADHD. Concurrent use is a therapeutic duplication that increases the risk of cardiovascular side effects, insomnia, and abuse potential.
- A patient drops off a new prescription for rosuvastatin 10 mg. A review of their medication profile reveals they have an active prescription for simvastatin 20 mg. Which of the following pairs represents a therapeutic duplication?
Answer: Rosuvastatin and simvastatin
Rosuvastatin (Crestor) and simvastatin (Zocor) are both HMG-CoA reductase inhibitors, commonly known as 'statins.' They have the same mechanism of action for lowering cholesterol. Using two statins simultaneously is a therapeutic duplication.
- A patient who uses sumatriptan for migraine attacks asks if they can also take a rizatriptan tablet that a family member gave them if the first medication doesn't work. The technician should know that taking these two medications together is not recommended because it is a:
Answer: Duplication of therapy within the triptan class
Sumatriptan (Imitrex) and rizatriptan (Maxalt) are both serotonin (5-HT1B/1D) receptor agonists, known as triptans. Using two different triptans within a 24-hour period is a therapeutic duplication and is contraindicated due to the increased risk of vasoconstrictive side effects.
- A patient's profile includes an active prescription for Symbicort (budesonide/formoterol). The pharmacy receives a new prescription for Advair (fluticasone/salmeterol). This represents a therapeutic duplication because both inhalers contain:
Answer: A long-acting beta-agonist and an inhaled corticosteroid
Both Symbicort and Advair are combination inhalers used for the maintenance treatment of asthma and COPD. Each contains an inhaled corticosteroid (budesonide, fluticasone) and a long-acting beta-agonist or LABA (formoterol, salmeterol). Using them together is a duplication of both drug classes.
- A patient regularly purchases over-the-counter famotidine (Pepcid AC). Their doctor sends in a new prescription for cimetidine. This presents a potential therapeutic duplication because both drugs work by:
Answer: Blocking H2-receptors to reduce acid production
Famotidine and cimetidine are both H2-receptor antagonists (or H2 blockers). They reduce stomach acid production by blocking histamine at the H2 receptors on parietal cells. Using them together is redundant and offers no benefit over an appropriate dose of a single agent.
- Upon reviewing a patient's refill request, a technician notices the patient has prescriptions for both omeprazole and pantoprazole. This should be flagged for the pharmacist because it represents a potential therapeutic duplication within which drug class?
Answer: Proton pump inhibitors
Omeprazole (Prilosec) and pantoprazole (Protonix) are both proton pump inhibitors (PPIs). They work by the same mechanism to reduce stomach acid. Prescribing two different PPIs for concurrent use is a therapeutic duplication.
- A patient is prescribed chlorthalidone 25 mg daily. Their medication profile also lists an active prescription for hydrochlorothiazide (HCTZ) 25 mg daily. This combination is an example of therapeutic duplication because both drugs are:
Answer: Thiazide-type diuretics
Hydrochlorothiazide and chlorthalidone are both classified as thiazide-type diuretics. They work in the same part of the kidney tubule to promote water and salt excretion. Using them together is redundant and increases the risk of electrolyte imbalances and dehydration.
- A patient's profile shows they are taking OTC ibuprofen 200 mg every 6 hours as needed for headaches. They present a new prescription for celecoxib 200 mg daily for arthritis. Which of the following describes the potential issue?
Answer: Therapeutic duplication
Both ibuprofen and celecoxib are Nonsteroidal Anti-Inflammatory Drugs (NSAIDs). Taking them concurrently constitutes a therapeutic duplication, which increases the risk of adverse effects like gastrointestinal bleeding and kidney damage without providing additional benefit.
