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Dr. Schlesselman is an assistant clinical professor at the University of Connecticut School of Pharmacy.

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CASE ONE

Two patients arrive at the walk-in clinic located at the local pharmacy. Both patients wish to be evaluated for their cold symptoms. While waiting, the patients chat about their symptoms and how long they have been "suffering."

The first patient to be seen by the clinician is a 70-year-old woman. Her medical history is significant for congestive heart failure and chronic bronchitis. After examining the patient, the clinician suspects she has developed acute bronchitis. The clinician prescribes multiple medications and recommends that the woman follow-up with her primary care provider.

The second patient is a 25-year-old man. He has no significant medical history. Having witnessed the first patient leave with multiple prescriptions, the man enters the exam room believing he will receive an equal number of prescription medications. After examining the man, the clinician prescribes a cough syrup.

The patient cannot believe that he did not receive as many prescriptions as the first patient! When he brings the prescription over to the pharmacy, he complains to the pharmacist that he and the first patient had the same symptoms. Despite this fact, he only received a cough syrup, whereas the other patient had "a stack of prescriptions." The man then exclaims, "I bet she even had a prescription for an antibiotic! That is what I need." The first patient hears the man's comments and confirms that she did indeed receive a prescription for an antibiotic.

How can the pharmacist explain the differences in prescriptions?

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CASE TWO

MT, a 50-year-old woman, presents to the pharmacy and asks to speak with the pharmacist. When the pharmacist enters the counseling room, MT explains that she would like the pharmacist to recommend an herbal product to "boost her energy level." She explains to the pharmacist that she has been extremely fatigued and lethargic for the last few months. Although she does not have an appetite, she is gaining weight. During their conversation, the pharmacist also notices that MT's skin appears dry and scaly. Also, her hair appears dry and brittle, and her nails appear thick and brittle.

The pharmacist reviews MT's medication profile, noting that MT currently does not use any chronic medications. She asks if MT has a history of hypothyroidism. Although MT denies ever being diagnosed with hypothyroidism, she says that her mother has it.

What signs and symptoms of hypothyroidism does MT exhibit? What risk factors does she have?

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