Case Studies in Self-Care
Author: Rupal Patel Mansukhani, PharmD, and Mary Barna Bridgeman, PharmD, BCPS, CGP
MG is a 60-year-old woman who comes to the pharmacy seeking a recommendation for a garlic supplement. she says her friend, Peggy, was diagnosed with high cholesterol years ago and has been using natural means to reduce her cholesterol. MG adds that she has just been diagnosed with high cholesterol herself and that her primary care physician wants her to start taking a statin medication. She says Peggy told her that statins are dangerous with numerous side effects so she would prefer to use a natural supplement. MG’s prescription profile shows she is taking warfarin 2.5 mg daily and lisinopril 10 mg daily. She has no allergies and is not taking any other OTC medications. What other counseling would you provide to MG about her condition?
Many patients use garlic to lower cholesterol. Based on the results of many trials, however, garlic should not be recommended to patients as a replacement for conventional therapies. Early studies suggested that garlic reduced low-density lipoprotein cholesterol and triglycerides, but many turned out to have design flaws or were small trials of short duration. Recent studies with better designs have shown that garlic does not significantly reduce cholesterol levels.1,2
Therefore, it is important to advise MG not to rely on garlic to lower her cholesterol. It may be more beneficial for her to adjust her diet and increase her exercise to improve her cholesterol levels. It is also important to educate MG that natural supplements have the potential to interact with her prescription medication. MG is taking warfarin, and taking garlic may increase her risk of bruising or bleeding. Because MG is concerned about taking a statin medication due to potential side effects, it is important to educate her on the risks and benefits of statins. If she remains concerned, it may be beneficial for MG to see her primary care physician so he can switch her to another class of medication.
NM is a 48-year-old woman who comes to the pharmacy looking for a blood pressure monitor. She is taking lisinopril 10 mg and hydrochlorothiazide 25 mg. NM says that her physician wants her to self-monitor her blood pressure at home. Her friend is currently using a wrist monitor, and NM wants to know if you would recommend the same for her. She also wants you to explain the benefits of home monitoring. NM feels blood pressure monitors are a waste of time. What advice would you give NM regarding the benefits of home monitoring and selection of a monitor?
Because NM is hesitant to take her blood pressure at home, it is important to inform her that the American Heart Association recommends that anyone who has hypertension monitor his or her blood pressure at home. Home monitoring will allow her to measure her blood pressure in the comfort of her home, when she is most relaxed. It can also help her ensure that her medications are working correctly and alert her if her blood pressure increases. NM should also be informed that taking her blood pressure at home can help her see how her daily habits of diet and exercise affect her blood pressure.
When selecting a monitor, the American Heart Association recommends an automatic, cuff-style, bicep (upper arm) monitor. Wrist and finger monitors are not recommended because they yield less reliable readings. It is important to assess cuff size when recommending a home blood pressure monitor to ensure that NM receives the correct cuff so her measurements are accurate.
Dr. Mansukhani is a clinical pharmacist in South Plainfield, New Jersey, and clinical assistant professor, Ernest Mario School of Pharmacy, Rutgers University. Dr. Bridgeman is an internal medicine clinical pharmacist in Trenton, New Jersey, and clinical assistant professor, Ernest Mario School of Pharmacy, Rutgers University
Berthold HK, Sudhop T, von Bergmann K. Effect of a garlic oil preparation on serum lipoproteins and cholesterol metabolism. JAMA. 1998;279:1900-1902.
Superko HR, Krauss RM. Garlic powder, effect on plasma lipids, postprandial lipemia, low-density lipoprotein particle size, high-density lipoprotein subclass distribution and lipoprotein(a). J Am Coll Cardiol. 2000;35:321-326.