Case One: EM, a 66-year-old woman, comes to her local pharmacy to refill her prescriptions and in search of a product to relieve her cold symptoms. She approaches the pharmacy counter, where she is greeted by the pharmacist. As the pharmacist is processing the refills, EM explains that she is miserable due to her cold. She would like to find some relief, but she feels that she takes enough medications and does not want to take any more.
As the pharmacist is asking EM what symptoms she is experiencing, EM's daughter approaches with 2 herbal products and asks if either one would work well for EM. The first product contains licorice, and the second contains echinacea and marshmallow.
The pharmacist reviews EM's medication profile and medical history before making a recommendation. According to the pharmacy's computerized records, EM's current medications include:
Her medical history is significant for congestive heart failure, hypertension, coronary artery disease, type 2 diabetes mellitus, and osteoarthritis.
She has no known medication allergies, but she does have an allergy to ragweed.
Should the pharmacist recommend either of these products for EM's cold symptoms?
ST, a 57-year-old male nurse who works for the local pulmonologist, arrives at work one day complaining of weakness and fatigue. He explains that these symptoms have worsened over several days. He reports feeling out of breath when walking around the office but denies having had these difficulties in the past.
ST's medical history is significant for hypertension and benign prostatic hypertrophy. Three months ago he was hospitalized with a ventricular arrhythmia. His current medication regimen includes:
ST denies the use of herbal products or OTC medications. He denies tobacco use but admits to social drinking. His family history is significant for hypertension.
The pulmonologist for whom ST works is concerned about ST's symptoms and performs a physical examination, along with laboratory work. ST's vital signs are reported as follows: blood pressure, 150/95 mm Hg; heart rate, 90 beats/min, temp 98.6°F, and respiratory rate, 20 breaths/min. The exam is unremarkable, with no signs of pulmonary congestion, lower extremity edema, or signs of infection. The basic metabolic panel and complete blood count are within normal limits. The only lab result found to be outside of normal limits is an elevated erythrocyte sedimentation rate (ESR).
The pulmonologist is concerned that ST's medications may be causing pulmonary problems. He performs a bronchoscopy to obtain a lung biopsy, which demonstrates diffuse alveolar damage and fibrosis.
Should the pulmonologist recommend any changes in ST's medication regimens?
Dr. Schlesselman is an assistant clinical professor at the University of Connecticut School of Pharmacy.