Pharmacoeconomics and Safe Medication Use

Answer: B

The cost of a medication would be considered a variable

medical cost (Answer B is correct). The cost of the lights

in the clean room would be considered a fixed medical

cost (Answer A is incorrect). The time resulting in loss

of work for a patient requiring this medication would

be considered an indirect cost (Answer C is incorrect).

Additional use of blood products after administration of

this medication would be considered an incremental cost

(Answer D is incorrect).

Given the need to consider efficacy and cost, a cost-

effectiveness analysis would be the best type of analysis

(Answer B is correct). A cost-benefit analysis would

be used if your institution were purely interested in a

monetary outcome (Answer A is incorrect). A cost-min-

imization analysis would only evaluate the difference in

costs between these medications (Answer C is incorrect).

A cost-utility analysis includes the patient perspective,

which was not a focus of this evaluation (Answer D is

incorrect).

Answer: D

A preventable ADE, by definition, is a medication

error that occurs and reaches the patient to cause harm

because of a breach of standard professional behavior

or practice. The patient had a documented history of

cefuroxime allergy with shortness of breath but still

received ceftriaxone and developed another life-threat-

ening anaphylactic reaction; this is a medication error,

and the anaphylactic reaction is the harm. Allergy cross-

reactivity between cefuroxime and ceftriaxone is well

documented for patients with a history of shortness of

breath because of similarity in side chains; therefore, this

is a preventable ADE (Answer D is correct). Although

this case of ceftriaxone-induced life-threatening ana-

phylaxis is an ADE, a preventable ADE best describes

this case (Answer C is incorrect). In general, ADRs and

side effects are synonymous terms, and a ceftriaxone-

induced allergy is an ADR; however, a preventable ADE

best describes this case (Answers A and B are incorrect).

Answer: D

Prothrombin complex concentrate would be the best

tracer for an ADE associated with apixaban (Answer D is

correct). Coagulation factor VIIa would not be effective

for this indication (Answer A is incorrect). Phytonadione

would be an appropriate tracer for a warfarin-induced

bleeding event (Answer B is incorrect). Protamine would

be an appropriate tracer for a heparin- or enoxaparin-

induced bleeding event (Answer C is incorrect).

Answer: C

The guidelines provide several recommendations, with

only one having a strong recommendation, which is

based on the dispensing of medications and streamlin-

ing them as only being from the pharmacy (Answer C

is correct). The other potential answers are potential

opportunities to improve medication safety but are based

on weak recommendations (Answers A, B, and D are

incorrect).

Answer: B

The guidelines suggest (not recommend) that patient/

caregiver-reported outcomes be integrated into routine

patient care (Answer A is incorrect). Data analyses on

the benefit of these interactions are limited to non-ICU

environments, though the theoretical benefits listed in

Answers C and D may be true (Answers C and D are

incorrect; Answer B is correct).

Answer: B

To determine the probability of a drug interaction

between meropenem and valproic acid, the drug inter-

action probability scale should be used (Answer B is

correct). A drug interaction database would provide gen-

eral information and is not a patient-specific evaluation

(Answer A is incorrect). The Naranjo nomogram inves-

tigates the likelihood of an ADE but is not specific to a

drug interaction (Answer C is incorrect). The RUCAM

evaluates the likelihood of drug-induced liver injury

(Answer D is incorrect).

Answer: C

Broad-spectrum antimicrobials should be restricted to

the appropriate clinicians with expertise in this area

(Answer C is correct). Restricting use to intensivists

would not be appropriate because non-ICU patients may

require this agent (Answer A is incorrect). Although

FDA approved only for complicated UTIs, restriction

to pneumonia would not be appropriate (Answer B is

incorrect). Cardiac monitoring is not required for this

medication (Answer D is incorrect).