Therapeutics and Dispensing: Applying Evidence to Patients
Core concepts
Therapeutics questions present a patient scenario and ask for the best drug, dose, or monitoring plan. Use a structured approach: identify the problem, assess severity and comorbidities, choose first-line therapy per guidelines, individualize dose, and plan monitoring. Know common first-line choices: hypertension (ACE inhibitor/ARB, CCB, thiazide, β-blocker), type 2 diabetes (metformin first unless contraindicated), asthma (inhaled corticosteroid ± LABA), and community-acquired pneumonia (empiric antibiotics based on setting).
Dispensing and monitoring
Understand how to translate a therapeutic plan into a dispensing decision: dosage form selection, administration timing, food interactions, and device technique. Monitoring parameters include efficacy markers (blood pressure, HbA1c, INR, lipid panel) and safety markers (renal function, potassium, liver enzymes, CBC). Know therapeutic drug monitoring for narrow-index drugs (digoxin, lithium, vancomycin, phenytoin, cyclosporine).
Special situations
Know adjustments in renal/hepatic impairment, pregnancy, and pediatrics. Recognize drug interactions that change management (e.g., warfarin + NSAIDs; statins + macrolides; MAOIs + sympathomimetics).
Traps and rule of thumb
Questions often ask for the next best step - usually monitoring or dose adjustment before switching therapy. Rule of thumb: if the patient is stable but not at goal, optimize the current regimen; if there is an adverse effect or contraindication, change therapy.