Medications and Medical Concepts
What the exam expects
MTM work assumes working fluency in chronic-disease pharmacology: diabetes, hypertension, dyslipidemia, heart failure, COPD/asthma, depression, anticoagulation, and chronic kidney disease. For each, know the first-line classes (metformin for type 2 diabetes; an ACE inhibitor, ARB, thiazide, or dihydropyridine calcium channel blocker for hypertension; a statin for most patients with elevated risk; a beta blocker plus a renin-angiotensin agent and often an MRA for heart failure with reduced ejection fraction), the monitoring lab (A1c, lipid panel, eGFR/creatinine, potassium, INR), and the classic adverse effects.
Numbers to know
A1c goal is generally under 7% for nonpregnant adults and is relaxed (often under 8%) for frail, elderly, or hypoglycemia-prone patients. Blood pressure is commonly targeted below 130/80. INR is typically 2.0-3.0 for most warfarin indications and higher for mechanical mitral valves.
Traps
The most frequent trap is mislabeling therapeutic duplication. Two drugs are duplicative only when they share the same mechanism or target; the same indication reached through different mechanisms is intentional combination therapy. Other traps: applying one glycemic goal to every patient, mixing brand and generic names, and blaming a new symptom on a long-standing drug without checking the timeline.
Rule of thumb
Same disease plus different mechanism is usually appropriate; same mechanism is duplication. Lisinopril plus losartan is RAAS duplication with hyperkalemia and kidney-injury risk; metformin plus glipizide is not duplication.