Case Studies in Self-Care

Author: Rupal Patel Mansukhani, PharmaD; Mary Barna Bridgeman, PharmaD, BCPS, CGP






Case 1—Smoking Cessation

JK is a 45-year-old woman who smokes between 7 and 10 cigarettes per day. Recently, a coworker was diagnosed with lung cancer, and JK reports this is her motivation for quitting. she has tried several times to quit “cold turkey” without success. JK reports a history of depression, diabetes, and hypertension, for which she takes escitalopram 10 mg daily, metformin 1000 mg twice daily, enalapril 10 mg daily, and hydrochlorothiazide 25 mg daily, respectively. she has no known medication allergies and denies suffering from any other medical conditions. What OtC smoking cessation aids can you recommend to JK at this time?

Answer

Approximately 45.3 million us adults 18 years and older smoke cigarettes, with smoking being more common among men than women.1 Smoking has been identified as the most common cause of preventable death, accounting for approximately 443,000 deaths each year.1 The goals of self-treatment for smoking cessation include complete and long-term abstinence from all nicotine-containing products.2 The Clinical Practice Guideline for treating tobacco use and dependence outlines 5 key components of comprehensive tobacco cessation counseling, including asking patients whether they use tobacco, advising tobacco users to quit, assessing patients’ readiness to quit, assisting patients with quitting, and arranging follow-up care, referred to as the “5 As.”

JK’s diabetes might preclude you from recommending nicotine gum or lozenge products, because of the potential for causing fluctuations in blood glucose levels. Recommend JK select a nicotine transdermal patch product, applied to the skin once daily. Based on JK’s smoking history, recommend she purchase the 14 mg/day patches to start and use 1 patch daily for 6 weeks, tapering down to the 7 mg/day patch for 2 additional weeks after that.

Remind JK that several prescription-strength nicotine replacement and smoking cessation agents also exist. Given her history of depression, if nicotine replacement therapy fails, she may want to consider discussing with her primary care provider the possibility of switching her antidepressant to buproprion, as this drug is indicated both for depression and smoking cessation.


Case 2—Hair Loss

CB is a 32-year-old man experiencing thinning of the hair on the crown of his head. CB is seeking an OtC product because he doesn’t feel this cosmetic condition warrants a trip to the physician. He has no known allergies or chronic medical conditions; however, he does have a history of sensitive skin, and is seeking your advice to insure that he doesn’t have a reaction. What OtC treatment options can you recommend for CB to restore his appearance and confidence?

Answer

Hair loss is a common condition that can affect individuals of either sex. Although there are a variety of classifications of adult hair loss, only androgenic alopecia, the most common form associated with progressive, patterned loss of hair from the scalp, may be treated with OtC agents.3 

The goals of self-treatment for hair loss include restoring the patient’s appearance or achieving an appearance that is acceptable to the patient.3 You may want to suggest CB use a combination of nonpharmacologic hair dyes, thickeners, or hair pieces to improve his appearance, in addition to an OtC topical product containing minoxidil. Minoxidil is available in a variety of strengths and dosage forms, and works by increasing blood flow to hair follicles.

Counsel CB that the foam formulation may be less likely than the topical solution to cause dermatitis, which has been attributed to the topical solution’s propylene glycol vehicle. One-half of a capful of foam may be applied to dry hair of the affected area twice daily, in the morning and at bedtime, and allowed to dry. Remind CB that hair growth takes time; the first sign this product is working increased hair density, including the appearance of fine, short hairs on the crown of the head.


Dr. Bridgeman is an internal medicine clinical pharmacist in Trenton, New Jersey, and clinical assistant professor, Ernest Mario School of Pharmacy, Rutgers University. Dr. Mansukhani is a clinical pharmacist in South Plainfield, New Jersey, and clinical assistant professor, Ernest Mario School of Pharmacy, Rutgers University.


References:
  1. Centers for Disease Control and Prevention. Adult cigarette smoking in the United States: current estimate. www.cdc.gov/tobacco/data_statistics/fact_sheets/adult_data/cig_smoking/index.htm. Accessed August 31, 2012.
  2. Smoking cessation. In: Krinsky DL, Berardi RR, Ferreri SP, et al, eds. Handbook of Nonprescription Drugs: An Interactive Approach to Self-Care. 17th ed. Washington, DC: American Pharmacists Association; 2011:885-907.
  3. Hair loss. In: Krinsky DL, Berardi RR, Ferreri SP, et al, eds. Handbook of Nonprescription Drugs: An Interactive Approach to Self-Care. 17th ed. Washington, DC: American Pharmacists Association; 2011:811-821.