I have a brief question that I'd like your thoughts on. I recently did the MUR assessment Part 3 and failed it for the second time. As I passed the other two sections no problem, I thought I'd sound out others to see if I'm going about this the wrong way. Screen captures of the two case-studies are below: MUR1a.jpg
For the first one on Asthma,
He's not over using his inhaler - 2-3 times a day is well within guidelines, but may suggest he needs better control.
Next step would be Long-acting B2, not Leukotriene.
Stepwise reduction every three months if appropriate - True
Determining HOW they work? I know we must check patients know purpose and how to use, and in this situation, he's already shown that he knows the difference between 'Preventer' and 'Reliever' - surely we don't need to inflict 'short-term bronchodilation via sympathomimetic stimulation' and 'corticosteroid-mediated anti-inflammatory effect reducing airway resistance' on the patient?
She's on MTX, so clearly alarm bells should be ringing about mouth soreness. But let's leave the first statement for later. Of the other ones (b-e)
Doxycycline isn't affected my milk, mainly just indigestion, so she can take it with milk if she wants (but do they want us to be overly cautious and blanket ban anything with polyvalent ions?)
Clearly she needs to be reporting stuff, and if I were conducting this MUR, I would be recommending she sees her GP
Intevention MURs can be carried out wherever the Pharmacist thinks there is justification, regardless of a recent routine MUR.
So back to that first statement. Should she make an appointment? Well, there is an increased risk of toxicity when Doxycycline given concurrently with MTX, but I wouldn't think it warrants an URGENT appointment - surely the reminder to report any neutropenic signs covers this?
I think my frustration is that I know what I would say, but then I feel like I should be jumping through hoops and looking out for 'trick' questions.
