Medication Therapy Management and Follow-up
What this domain tests
MTM stations test whether you can identify drug-related problems across a patient's whole regimen, prioritize them, propose a plan, and set measurable follow-up. The examiner wants a structured review, not a spot check of one drug.
Core rules
- Work through the regimen systematically: indication, effectiveness, safety, and adherence for each medication. For every drug ask whether it has a current indication and whether every condition has a treated indication.
- Identify the drug-related problem category explicitly: untreated indication, unnecessary therapy, ineffective drug, dose too high, dose too low, adverse drug reaction, interaction, or non-adherence.
- Prioritize by clinical risk. A duplicated antihypertensive causing hypotension outranks a suboptimal statin dose.
- Set follow-up that is specific and measurable: what parameter, what target, when to recheck, and who is responsible.
- Coordinate changes with the prescriber and document the recommendation and response.
Worked example
A 74-year-old woman with hypertension, type 2 diabetes, and osteoarthritis presents with dizziness on standing. Her regimen: ramipril 10 mg daily, hydrochlorothiazide 25 mg daily, metformin 1000 mg twice daily, naproxen 500 mg twice daily as needed, and zopiclone 7.5 mg at bedtime.
Reasoning: dizziness on standing suggests orthostatic hypotension, plausibly compounded by the ACE inhibitor, the thiazide, and the sedative. Naproxen in an older adult with hypertension and diabetes raises risks of renal impairment, blood pressure elevation, and GI bleeding, and it may be reducing antihypertensive efficacy. Priorities: address the fall risk first (review blood pressure including standing values, reconsider the sedative, and question the ongoing need for naproxen), then propose safer analgesia, and set a follow-up to recheck blood pressure, renal function, and symptoms after changes. Each recommendation goes to the prescriber with rationale, and the plan is documented with a review date.
Traps that cost marks
- Reviewing only the drug the patient asked about.
- Naming the problem without proposing an actionable, prioritized plan.
- Vague follow-up ("monitor") with no parameter, target, or date.
- Ignoring fall risk and sedation in older adults.
- Failing to document the recommendation and the prescriber's decision.