Case Studies

Author: Craig I. Coleman, PharmD

CASE ONE

Time for a Refill?


YA is a 17-year-old woman with a medical history of mild persistent asthma. She comes to the pharmacy to pick up her inhaler refills, including Pulmicort Flexhaler 180 mcg, 1 puff twice daily, and ProAir HFA 90 mcg, 1 to 2 puffs every 4 to 6 hours as needed. The pharmacist asks YA how her asthma has been doing lately, and she replies that with the change in weather, she has noticed increased shortness of breath 2 to 3 times a week during the day. She notes, however, “taking a few puffs of ProAir usually does the trick.” YA also states, “Although I feel the ProAir on my throat, it hasn’t been working as well as it usually does.” The pharmacist notices YA has been filling her Pulmicort regularly; however, she has not filled her ProAir in several months. The pharmacist asks YA how she knows when it is time to refill her inhalers. YA replies, “Well, the Pulmicort has a window that shows when I am running low, but the ProAir doesn’t.” She continues, “My friend told me I can float the ProAir in water, so I do that.” YA notes that her ProAir inhaler still floats, so she assumes it is not empty yet.

How should the pharmacist counsel YA to help her determine when her inhaler is empty?


CASE TWO

New MS Treatment


AC is a 41-year-old white woman with relapsing-remitting multiple sclerosis (MS). She has been receiving interferon beta- 1a (Avenox) 30-mcg intramuscular injections once weekly to manage her disease. Recently, AC began complaining to her neurologist of walking difficulty. Today, AC’s neurologist gave her a new prescription for dalfampridine 10 mg twice daily. When AC approaches the counter, she asks the pharmacist, “I have been taking the same drug to treat my MS for a long time now, why all of a sudden do I need another one?”

How should the pharmacist respond to AC?



Dr. Coleman is an associate professor of pharmacy practice and director of the pharmacoeconomics and outcomes studies group at the University of Connecticut School of Pharmacy.