Case Studies

Author: Craig I. Coleman, PharmD, Christine G. Kohn, PharmD, and Daniel Young, PharmD Candidate

Case One
MM is a 45-year-old woman who presents with a 2-week history of mild but gradually worsening constipation. She complains of bloating, gas, and lower abdominal discomfort with irregular timing of bowel movements. In the past she has tried OTC laxatives and stool softeners to relieve the constipation with minimal effect and/ or intolerable side effects. MM is concerned because these episodes of constipation are occurring more frequently. MM asks you, the pharmacist, for alternative recommendations to alleviate her constipation. She reports the only medication she is taking is diphenhydramine 50 mg at bedtime 2 to 3 times a week to help her fall asleep.
As the pharmacist, what would you suggest?


Case Two
LP is a 34-year-old man with a diagnosis of major depressive disorder (MDD). He was started on antidepressant therapy with paroxetine 20 mg once daily upon diagnosis. LP noted feeling better after only a month of treatment, and initially only experienced mild side effects. Today, however (5 months after drug initiation), LP presents to the pharmacy complaining of multiple significant side effects that he attributes to paroxetine that have been appearing on and off for the past few weeks, including nausea, diarrhea, trouble sleeping, and increased agitation. LP says he takes his paroxetine in the morning, but admits frequently missing doses (often a few days in a row) because of his hectic work schedule. Paroxetine is LP’s only prescription or OTC medication. His physician is considering switching LP to a different antidepressant class and would like the input of a pharmacist.
What advice should the pharmacist give LP’s physician?


Dr. Coleman is associate professor of pharmacy practice and director of the pharmacoeconomics and outcomes studies group at the University of Connecticut School of Pharmacy. Dr. Kohn is an outcomes research fellow at the University of Connecticut School of Pharmacy. Mr. Young is a PharmD Candidate at the University of Connecticut School of Pharmacy