Case 1: Case 1: Patients who are hospitalized in the intensive care unit are often prescribed acid-suppressing therapy for the prevention of stress ulcers. Although the risk of bleeding from a stress ulcer is low, there is an associated mortality of 50%. Risk factors for stress ulcers include major trauma, severe head injury, multiple organ failure, burns, major surgeries, severe sepsis, shock, mechanical ventilation, coagulopathy, high-dose steroids, and tetraplegia. Histamine2- receptor antagonists, proton pump inhibitors, antacids, and sucralfate can be used to prevent stress ulcers during a hospital stay. Appropriate discontinuation of therapy at discharge is important to avoid subsequent unnecessary therapy and adverse events associated with acid suppressive therapy (ie, increased risk of Clostridium difficile infection, pneumonia, and fractures). The pharmacist should call the prescribing physician to verify the indication for FK’s omeprazole prior to filling the prescription.
Case 2: The Centers for Disease Control and Prevention suggest that symptomatic bacterial vaginosis in nonpregnant females be treated with oral metronidazole (500 mg twice daily for 7 days), vaginal metronidazole gel (0.75%, 1 applicatorful daily for 5 days), or vaginal clindamycin cream (2%, 1 applicatorful daily for 7 days). Patients treated with metronidazole should abstain from alcohol or the use of ethanol-containing products for the duration of therapy and for 3 days afterward due to the risk of disulfiram-like reactions. Such interactions have been reported in patients who have taken oral, intravenous, and vaginal tablet forms of metronidazole. In ML’s case, it is probably best to recommend clindamycin vaginal cream instead so that therapy is not delayed and the patient can be safely treated.