June 2003: Case Study 3

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RF presents to Anything for Our Customer Pharmacy with a prescription for a fluticasone 500-mcg/salmeterol 50-mcg dry-powder inhaler. He is well known to the employees of the pharmacy due to his frequent medication purchases.

When the pharmacy intern receives the prescription from him, RF is adamant that he must start this medication today. He is leaving on vacation and does not want to wait until next week to initiate this change in his therapy.

The intern notices that the pharmacy is currently out of this particular strength inhaler. The lower-dose inhaler is available. According to RF?s medication profile, he was previously using the lower-dose inhaler.The intern asks the pharmacist whether he can call the doctor for approval to use 2 inhalations of the lower-dose inhaler in place of the higher dose until the other inhaler is available.

Should the pharmacist suggest the change to the physician?

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The pharmacist should not suggest this change to the physician. Using 2 inhalations of the lower-dose inhaler will provide an equivalent amount of fluticasone but will provide twice as much salmeterol. One inhalation from any strength fluticasone/salmeterol dry-powder inhaler contains 50 mcg of salmeterol. Fifty micrograms is the maximum recommended amount per dose.