Knowledge deficits

Pharmacist CM knowledge is generally OK, but some major gaps remain, study finds

Australian pharmacists have a basic knowledge of complementary medicines with a defined clinical effect, but need specialised training on highly utilised CMs, say researchers who have surveyed a sample of the profession.

Researchers from LaTrobe University, Vic, conducted an online survey of pharmacists’ knowledge of a selection of complementary medicines that are defined as having therapeutic benefits in Australian Therapeutic Guidelines. In total 21 questions were asked and 535 complete surveys were returned and included in the final analysis.

They found an average mean score of 62% accurate knowledge among the respondents. Mean knowledge scores increased with a pharmacist’s level of experience suggesting “that education regarding complementary medicines may not be occurring through university courses and is instead being learnt ‘on the job’ or through continuing professional development,” said the authors.

Topics in which pharmacists appeared to have poor knowledge included the recognition of vitamin E as a therapy for reducing peripheral neuropathies; recognising an interaction between St John’s Wort and a prescription medicine (25% correct responses) and the required number of fish oil capsules required to obtain a therapeutic effect (29% correct responses).

Respondents did score highly in several areas. Questions with more than 90% correct responses included the recognition of symptoms associated with potassium toxicity; an understanding of vitamin B6 as a treatment option for nausea in pregnancy; the recognition of fat soluble vitamins; the recognition of excess alcohol consumption pertaining to thiamine deficiency; and the necessity of avoiding glucosamine if allergic to shellfish.

Accredited pharmacists were found to score significantly higher than both hospital pharmacists and community pharmacists. Also, hospital pharmacists, interns and community pharmacists were all found to utilise the ‘unsure’ option significantly more frequently than accredited pharmacists.

The authors said the latter group may more frequently handle queries regarding these products. 

“A recent survey of pharmacy customers in Australia found that 87% of consumers expect pharmacists to provide them with recommendations of efficacious complementary medicines,” the authors said. “A further 92%… expect the pharmacist to provide information regarding the safety of complementary medicines.”

“It is essential that pharmacists are equipped with the skills to improve the quality use of complementary medicines,” they concluded. “It is suggested that specialised targeted education about highly utilised complementary products, their evidence base and the risk and benefits of use, may be beneficial to pharmacists”.

The study was published in the Australian Journal of Primary Health.

The questions:

1. A lack of intrinsic factor can cause a deficiency of which vitamin?
(a) Cyanocobalamin (B12); (b) Pyridoxine (B6); (c) Thiamine (B1);
(d) Riboflavin
2. Deficiency of which vitamin may result in night blindness, complete
blindness and xerophthalmia?
(a) VitaminA; (b) Vitamin C; (c) Cyanocobalamin (B12); (d) Thiamine (B1)
3. A lack of which of the following nutrients can cause megaloblastic
(a) Iron; (b) Vitamin D; (c) Cyanocobalamin (B12); (d) Vitamin A
4. What is the recommended daily intake of folic acid for pregnant women in
their first trimester?
(a) 0.6 mgdaily; (b) 5 mg daily; (c) 0.5 mgtwice daily; (d) 6 mg twice daily
5. Toxicity of which of the following results in arrhythmia and myocardial
(a) Vitamins C; (b) Potassium; (c) Vitamin D; (d) Vitamin A
6. What is the recommended daily intake of vitamin D for adults who are at risk
of vitamin D deficiency?
(a) 600–800 IU; (b) 1000–2000 IU; (c) 2000–40 000 IU; (d) 3000–50 000
7. Which of the following is routinely given to neonates to prevent
haemorrhagic disease of the newborn?
(a) Vitamin K; (b) Iron; (c) Cyanocobalamin (B12); (d) Folic Acid
8. Risk of which of the following has been shown to increase with daily
supplementation of Calcium and Vitamin D?
(a) Myocardial Infarction; (b) Pancreatitis; (c) Hashimoto’s Disease;
(d) Cholecystitis
9. Which of the following may help prevent nausea associated with
(a) Pyridoxine (B6); (b) Calcium; (c) Vitamin D; (d) Vitamin A
10. Which of the following may reduce the development of peripheral
neuropathies in chemotherapy patients?
(a) Magnesium; (b) Iron; (c) Vitamin E; (d) Riboflavin (B2)
11. Which of the following are fat soluble vitamins?
(a) Vitamins A, D,EandK; (b) Vitamins B12, C,Dand A; (c) Vitamins C, E,
Thiamine and A; (d) Vitamins B12, Thiamine, B6 and C
12. When treating iron deficiency, what is the usual duration of oral treatment
required to replenish iron stores?
(a) 1–3 months; (b) 3–6 months; (c) 6–9 months; (d) 9–12 months
13. How many doses of standard commercial 1 g fish oil-containing capsules
are required daily to induce an anti-inflammatory response?A (Each contain
300 mg of Omega-3, 180 mg of EPA and 120 mg of DH(A).)
(a) 3; (b) 6; (c) 9; (d) 12
14. Patients with which allergy should avoid intake of glucosamine?
(a) Gluten; (b) Nuts; (c) Shellfish; (d) Eggs
15. Which of the following complementary medicines has been shown to
interact with warfarin?
(a) Cranberry; (b) Gingko Biloba; (c) Echinacea; (d) Black Cohosh
16. What is the recommended dose of Cranberry used for prophylactic
management of UTI?
(a) The effective prophylactic dose is unknown; (b) 15 000 mg daily;
(c) 10 000mg daily; (d) 20 000 mg daily
17. What is the recommended daily dose of ginger that can assist with the
management of nausea in pregnancy?
(a) 1–2g; (b) 2–3 g; (c) 3–4 g; (d) 4–5 g
18. What is the clinical use of black cohosh?
(a) Prevent liver failure; (b) symptoms of menopause; (c) symptoms of
dysmenorrhea; (d) assist with fertility
19. Which laboratory test can be affected by the intake of glucosamine?
(a) HbA1c; (b) INR; (c) BGL; (d) GFR
20. In a patient using St John’s Wort, which of the following drugs should be
used with caution because of risk of developing serotonin toxicity?
(a) Metoclopramide; (b) Phenelzine; (c) Mirtazapine; (d) Cyproheptadine
21. Excessive alcohol consumption causes a significant deficiency of which
(a) Vitamin D; (b) Vitamin A; (c) Vitamin C; (d) Thiamine (B1)

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1 Comment

  1. Thelma Tantalos

    Can AJP add a link with the answers to the questions?

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