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Australian Journal of Pharmacy : March 2005
ucation Balance/walking Mr Plonchnik has a problem with balance; he sees a physiotherapist twice a week He was an in-patient at a stroke centre, where he now attends rehabilitation twice weekly. He walks to the nearby shops every day and also walks 4km to his rehabilitation centre and back. Sometimes when Mr Plonchnik gets up he says it feels like his ‘legs are 10 feet long’, and if he walks for a long distance (for example, 7km) he feels like his legs are floating on clouds. He says ‘this sensation occurs periodically, but is getting better.’ He should be warned not to wear bifocal eyeglasses when he is going down stairs. Adherence: Mr Plonchnik says he remembers to take his medicines every day, and this is confirmed by the dispensing records. CPE POINTS Knowledge: Indications for all medications known, verbal information provided as required, no written information needed, he has a reasonable knowledge of his medications. He has a medication list and understand quite well generic issues. All his medications were found to be in-date and stored on the lounge room table. Summary: Mr Plonchnik is at high risk for a future metabolic event. He is compliant with his medication regimens, but requires assistance with weight loss. It would be of assistance to him and you (the pharmacist) to have some pathology test results (particularly lipids and HbA1c. He needs to be encouraged to maintain his walking and continue going to the rehabilitation and physiotherapy session. He would most likely benefit from some home help. Members of the Australian College of Pharmacy Practice may gain half (0.5) a credit point by either answering questions directly online at www.acpp.edu.au or forwarding the answers to: ACPP, PO BOX 7007, CANBERRA BC ACT 2610 by the 25th of the month following month of issue. There is only one correct statement per question. Answers will be listed on www.acpp.edu.au in due course. 1. All the following statements are true, except for: (a)Diabetes is the sixth leading cause of death in Australia. (b)About 50 per cent of people with diabetes are not diagnosed. (c) The risk of developing type 1 diabetes increases with age. (d)Type 2 diabetes is less common in younger persons. (e)The rates of diabetes in Aboriginal and Torres Strait islanders are among the highest in the world. 2. All the following statements are true, except for: (a)Insulin resistance is part of the metabolic syndrome. (b)The metabolic syndrome is associated with abdominal obesity, hypertension, lipidaemia, a prothrombotic state and insulin resistance. (c) Heart attacks and renal failure are the greatest cause of death in people with diabetes. (d)Up to 20 per cent of people diagnosed with diabetes already have retinopathy. (e)Coronary heart disease and stroke are the greatest cause of death in people with diabetes. 3. All the following statements are true, except for: (a)Microvascular complications are greater in type 2 diabetes than type 1. (b)Sulfonylureas reduce the risk of microvascular complications. (c) Metformin reduces the risk of microvascular and macrovascular complications. (d)Sulfonylureas may cause hypoglycaemia. (e)Metformin rarely causes hypoglycaemia. THE AUSTRALIAN JOURNAL OF PHARMACY VOL.86 MARCH 2005 ? 209 4. All the following statements are true, except for: (a)Interventions that combine dietary change with physical activity can be more cost effective than drug therapy. (b)Recommended levels of physical activity for people with diabetes are 20 minutes three times a week. (c) The goal for waist circumference in women is less than 90cm. (d)The goal for BMI in men and women is less than 25kg/m2 (e)The goal for ideal blood pressure is less than 130/80mmHg. 5. All the following statements are true, except for: (a)People with high risks for diabetes may benefit from statin use even if their cholesterol levels were relatively normal. (b)Total cholesterol for people with diabetes should be less than 4mmol/L. (c) Yearly assessment of microalbumin is recommended in people with diabetes. (d)The use of ACEI or angiotensin receptor blockers may prevent the progression of microvascular complications such as renal disease. (e)The glitazones require six-monthly liver function test monitoring for the first year of treatment. .