Case Studies

Author: Craig I. Coleman, PharmD, and Tayla Thompson, PharmD Candidate

Case One
DL is a 74-year-old woman with a past medical history of hypertension, heartburn, and iron deficiency anemia. She presents to the clinic for a scheduled follow-up visit, and serum iron and ferritin levels reveal that her iron stores remain low. Upon questioning, DL states she consistently takes ferrous sulfate 325 mg 3 times daily. The physician contacts you, the clinical pharmacist, to determine if DL’s other medications could be contributing to this problem. In addition to ferrous sulfate, her current medication list includes: hydrochlorothiazide 25 mg daily, lisinopril 20 mg daily, and omeprazole 40 mg daily.

What drug–drug interaction could be contributing to decreased efficacy of oral iron supplementation?

Case Two
RG is a 43-year-old woman newly diagnosed with relapsing-remitting multiple sclerosis. Her past medical history is significant for hypertension, diabetes, and high cholesterol (elevated low-density lipoprotein). She also smokes 2 packs of cigarettes per day. RG presents to the neurology clinic for initiation of MS treatment. She states that she is weary of giving herself subcutaneous injections. Her physician considers prescribing fingolimod, but then recalls that the FDA recently made changes to the drug’s contraindications and precautions due to cardiovascular concerns. He asks the pharmacist to provide a complete explanation of FDA guidance.

What key information should the pharmacist provide in regard to this drug information request?

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. Ms. Thompson is a PharmD candidate from the University of Connecticut School of Pharmacy.