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 test results?
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.
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