Dr. Schlesselman is an assistant clinical professor at the University of Connecticut School of Pharmacy.
AJ, a 56-year-old man,
brings a new prescription to
be filled at By-the-Bay
Pharmacy. The prescription
is written for zonisamide 100
mg daily for 2 weeks, to be
increased to 200 mg daily for
3 weeks, and then increased
to 300 mg daily.
While the pharmacist is
entering the prescription, AJ asks that she also refill his prescription
for an epinephrine self-injector. The pharmacist
reviews AJ's profile and notes that he has numerous documented
medication allergies, including hydrochlorothiazide,
furosemide, celecoxib, and sulindac.
AJ expresses concern that this new medication will cause
an allergic reaction as well. He explains that the physician
has not been able to determine a link between the medications
to which he is allergic, so AJ keeps epinephrine available
"just in case." To AJ's surprise, the pharmacist says that
she would like to contact the physician about this new medication
he prescribed because she suspects that AJ will have
an allergic reaction. AJ wants to know how the pharmacist
can know that when he has not taken a dose yet.
Why does the pharmacist suspect the zonisamide will
cause an allergic reaction?
CG, a 45-year-old pharmacist,
made a serious mistake
while dispensing a prescription
to a young child, due to
his heroin intoxication.
CG has recently completed
a rehabilitation program.
Now he wishes to return to
work. As part of the criteria
established by the board of pharmacy for reinstatement of
CG's pharmacist license, he must undergo drug testing prior
to returning to work and every 6 months.
CG is brought before the state board of pharmacy for a
meeting pertaining to his recent drug test. The head of the
board explains to CG that his recent drug test was positive
for morphine, codeine, and 6-acetylmorphine. He questions
CG about the results, and CG presents a note from the doctor
at the rehabilitation center explaining that CG is currently
taking morphine and ibuprofen for chronic back pain.
The head of the board believes CG's claim of using only
prescription medications. One of the other board members
is not convinced.
Which board member's beliefs are corroborated by the
The pharmacist is concerned because zonisamide is a sulfonamide. All of the medications to which AJ is allergic contain a
sulfa moiety, often the cause of allergic reactions.
The other board member?s beliefs are corroborated by the test results. If CG was using only morphine, his urine drug test would be positive
for morphine and codeine. Morphine is not metabolized to 6-acetylmorphine. The presence of 6-acetylmorphine is indicative of heroin use.