Pharmacy Connection, May/June 2002
As pharmacists, we have a responsibility to help patients adhere to prescribed medication regimens. For example, some patients may benefit by simplified medication schedules with the use of long-acting medications. Others may be able to discontinue long-standing medication(s) that no longer provide benefits to their health.
In the majority of cases, drug-related problems are uncovered through open communications with patients. Such was the case one spring day when Mrs. Macdonald paid a visit to Feel Good Pharmacy to refill her prescriptions for metformin and ramipril. Mrs. Macdonald is 57 and has Type 2 diabetes and high blood pressure.
Mrs. Macdonald’s full medication regimen was:
Metformin 500 mg 1 tablet BID
Ramipril 5 mg 1 capsule daily
Hydrochlorothiazide 25 mg 1/2 tablet daily
Celecoxib 200 mg 1 capsule daily prn
Blood Glucose testing strips as directed
Medication allergies: Penicillin
Mrs. Macdonald is a non-smoker and is overweight with a BMI of 29 kg/m2. She is a friendly woman who enjoys chatting. Pharmacist Pamela Burns finishes checking the prescriptions and notices a couple of things to discuss with Mrs. Macdonald. She invites Mrs. Macdonald over to the counselling area of the dispensary.
Pharmacist: Good day Mrs. Macdonald, how are you making out with your new blood glucose meter?
Mrs. Macdonald: Great! I’m testing twice a day and I’m getting 6’s and 7’s. I usually test first thing in the morning and then again before supper.
Pharmacist: That’s great, keep up the good work! There was one thing I wanted to check. Has your doctor ever talked with you about taking ASA once a day?
Mrs. Macdonald: Sometimes I take ASA for my headaches. Is that what you mean?
Pharmacist: No, there is another good reason for taking ASA. It’s been shown that taking a little bit of ASA every day can reduce the risk of heart attack in people over 30 with diabetes, like yourself. It does this by thinning the blood and preventing the blood clots that can lead to a heart attack. Even a coated ASA for babies is enough to help.
Mrs. Macdonald: That sounds good, should I buy some now?
Pharmacist: Not just yet, I checked your medication file, and I can’t see any particular reason why you wouldn’t be able to take it, but your doctor may have some of your medical information that I’m not aware of. We’ll need to check with her first. Are you still taking the capsules for your arthritis once a day?
Mrs. Macdonald: Which ones are those? The little red and white capsules?
Pharmacist: No. They’re the little blue and white capsules. They’re for arthritis and joint inflammation.
Mrs. Macdonald: Oh yes, I’m still taking those. I had done something to my back, but it seems a lot better now. I started on those pills around the same time as my blood pressure medication, so I forgot they were for my back. I just kept taking them. I don’t think they ever really helped. The whirlpool and water exercises at the local pool seemed to help more.
Pharmacist: When do you go back to your doctor Mrs. Macdonald?
Mrs. Macdonald: I go back for my blood work in about two weeks.
Pharmacist: Okay, in the meantime I was wondering if you would like me to check with your doctor about starting a daily coated baby ASA to protect your heart. That way your doctor could talk with you about it when you go for your appointment. If she says to start it right away, I could give you a call.
Mrs. Macdonald: You would do that for me? That’s wonderful!
Pharmacist: Why don’t you stop taking the celecoxib pill and see if you notice any difference in the way you feel? Since you said it didn’t make much of a difference I doubt it will be a problem.
Mrs. Macdonald: I had already made that decision as soon as you reminded me what it was for. I don’t like taking any more pills than I have to! Oh well, it looks like I’ll be giving up a pill I don’t need for one that will help me. Sounds like a fair trade to me!
Pharmacist: Just before you go, I would like to give you an updated list of your medications, what they are for, and your current doses. You should keep this list handy for times when you see other health professionals, and make sure that is updated if there are ever any changes in your medications. We need to list any vitamins or over-the-counter preparations you take as well. This list comes in handy if you have to visit a walk-in clinic or a hospital emergency. I’ll also write in the colour of each pill so you know which ones they are.
Mrs. Macdonald: That’s a great idea! Thanks!
Mrs. Macdonald walked away satisfied, and Pamela
proceeded to send a fax to her doctor.
May 1, 2002
Dear Dr. Long,
I have just spoken with our mutual patient Mary Macdonald (D.O.B. 5/9/1944). (Enclosed is a summary of her current
medications and dosage.)
In reviewing Mrs. Macdonald’s chart I noticed that she is not taking daily ASA for protection from circulatory and heart problems. As Mrs. Macdonald is over 30, has Type 2 diabetes and is hypertensive, she would appear to be a good candidate for ASA 81 mg – 325 mg daily as recommended by the 1998 Clinical Practice Guidelines for the Management of Diabetes in Canada1 and the Ontario Guidelines for the Pharmacotherapeutic Management of Diabetes Mellitus2. I understand that you may have other medical information that would preclude Mrs. Macdonald from taking ASA on a daily basis.
Also, in talking with Mrs. Macdonald, I noted that she has continued to take celecoxib 200 mg daily for back pain although she said that she had forgotten why she was taking this medication. Since she claimed it was not helping her, I suggested she discontinue the medication as it was labeled “prn”.
Mrs. Macdonald also indicated that she has an appointment with you in two weeks.
Please contact me at any time if you would like to discuss these matters further.
Sincerely,
Pamela Burns
Feel Good Pharmacy
Feel Good Pharmacy (Two weeks later)
Mrs. Macdonald goes to the pharmacy counter and asks the technician:
Mrs. Macdonald: Is Pamela here? I want to give her this prescription.
Pharmacist Pamela: Hi Mrs. Macdonald, how are you?
Mrs. Macdonald: I wanted to give this prescription to YOU.
Mrs. Macdonald: Dr. Long got your fax and appreciated your suggestions. She also wants me to lose weight. What do you think about me going on one of those high protein diets? My neighbour did it and claims she lost 15 pounds in three weeks!
Pharmacist Pamela smiled to herself. Two drug related problems solved, but there’s always another one on the horizon!
