Pharmacoeconomics and Safe Medication Use

Answer: A

Indirect costs occur from loss of employment or pro-

ductivity as the result of illness (Answer A is correct).

Effects from stress would be considered an intangible

cost (Answer B is incorrect). Costs from fentanyl and

transportation would be considered direct costs (Answers

C and D are incorrect).

A mild ADE is defined as an ADE that resulted in a

heightened need for patient monitoring with or without a

change in vital signs but no ultimate patient harm, or as

any adverse event that resulted in the need for increased

laboratory monitoring. Enalapril-induced hyperkalemia

managed by one dose of sodium zirconium cyclosilicate

did not require aggressive interventions, nor did it lead

to any patient harm; however, it did require increased

laboratory monitoring, making Answer A correct and

Answers B, C, and D incorrect.

Answer: C

A severe ADE results in patient harm, prolonged hospi-

talization, transfer to a higher level of care, permanent

organ damage, or death, which did occur in this case

(Answer D is incorrect). Haloperidol-induced torsades

de pointes is a life-threatening dysrhythmia (end-organ

damage) that required aggressive and successful man-

agement with intravenous magnesium and patient

transfer to a higher level of care (Answer C is correct).

A moderate ADE is defined as an ADE that resulted in

the need for aggressive intervention with antidotes or

an increased length of hospital stay (Answer B is incor-

rect). A mild ADE is defined as an ADE that resulted in

a heightened need for patient monitoring with or without

a change in vital signs but no ultimate patient harm, or as

any adverse event that resulted in the need for increased

laboratory monitoring, which did not occur in this case,

making Answer A incorrect.

Answer: A

Because this patient developed lisinopril-induced

angioedema, had no history of allergy to angiotensin-

converting enzyme inhibitors, and missed no lisinopril

doses, his ADE was not a preventable error (Answer B

is incorrect). This was also not a medication error, given

the information provided (Answer C is incorrect). There

is no such thing as a preventable ADR because an ADR

occurs from normal use of a medication and is therefore

by definition nonpreventable (Answer D is incorrect).

Therefore, this would be considered an ADE (Answer

A is correct).

Answer: C

A severe ADE is defined as an ADE that results in patient

harm, prolonged hospitalization, transfer to a higher

level of care, permanent organ damage, or death, with

the probable ADE causality nomogram score. Because

this patient developed life-threatening lisinopril-induced

angioedema and needed a tracheotomy, resulting in

patient harm, hospitalization, and transfer to a higher

level of care, this case meets the criteria for a “severe”

ADE, making Answer C correct and Answers A, B, and

D incorrect.

Answer: D

When considering what to include in a drug evaluation

monograph for formulary addition, it is important to

consider the data analyses available supporting its use.

According to what was provided in the case, ATII was

only compared with placebo (Answer A is incorrect),

did not show any significant differences in mortality

(Answer B is incorrect), and was studied in an intrave-

nous formulation (Answer C is incorrect). Answer D is

correct because considering the inclusion criteria for the

study would be helpful for formulary restriction, espe-

cially given the institutional concern of cost.

Answer: B

Considerations for formulary addition are important

before P&T committee proposals. According to the

ATHOS-3 trial, ATII was not compared with other cur-

rently available medications (Answer A is incorrect),

there were no significant differences in ADEs (Answer

C is incorrect), and no data analyses are available sug-

gesting that ATII is cost-saving (Answer D is incorrect).

Considering how often you might require the use of ATII

would be an important initial consideration (Answer B is

correct).

Answer: A

The first medication use evaluation is recommended

to occur within 3–6 months of formulary addition.

Therefore, March would be the most appropriate month

(Answer A is correct). Although June would fall in the