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Dr. Schlesselman is an assistant clinical professor at the University of Connecticut School of Pharmacy.
TG, a fourth professional?year pharmacy student, is completing an experiential rotation at a resort infirmary pharmacy. A first-professional-year pharmacy student approaches the pharmacy counter, asking what OTC product TG would recommend to alleviate her sunburn. TG notices that the student has visible first-degree sunburn on her face. She also has second-degree blisters on her arms and legs. When TG questions her about the sunburn, she explains that she developed the sunburn while there on vacation for spring break. She insists that she applied sun protection factor 30 sunscreen each day and would reapply the sunscreen throughout the day. She claims that she usually develops a suntan easily and rarely burns.
With approval of the pharmacist, TG recommends the student use ibuprofen 3 times a day to alleviate her sunburn. When TG rings up the ibuprofen, the student asks if she can also pick up her prescription, which was transferred here because she wanted to stay a few days longer and did not bring enough medication. TG retrieves her prescription for doxycycline.
When TG asks if the student has been taking the doxycycline while on vacation, she replies that she has faithfully taken the prescription to control her acne. TG suddenly realizes that the student's sunburn may be caused by the doxycycline therapy. When TG explains this, the student wants to know if she should discontinue the doxycycline. How should TG respond?
TH is a 35-year-old woman who is newly diagnosed with type 2 diabetes mellitus. She arrives at the clinic for a follow-up appointment. While reviewing her chart, the pharmacist notices that both of TH's parents have a history of hypertension. Considering this family history, the pharmacist decides to check TH's blood pressure. Her blood pressure is 140/80 mm Hg. The pharmacist knows that, according to the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) guidelines, the blood pressure goal for a patient with diabetes is <130/80 mm Hg.
After initiating lifestyle changes to attempt to control her blood pressure, TH returns to the clinic for a follow-up visit 2 months later. At this appointment, her blood pressure is 138/88 mm Hg. The pharmacist is concerned that TH has not reached her goal blood pressure even though she is still classified as having prehypertension.
Is TH a candidate for medication therapy despite only being classified as having prehypertension?
Photosensitivity reactions are known to occur with doxycycline. Photosensitivity reactions appear to be phototoxic in nature due to accumulation in the skin. These reactions are more severe and more frequent with demeclocycline, but photosensitivity can occur with tetracycline and doxycycline. Photosensitivity develops within minutes to hours after sun exposure. The primary treatment is discontinuance of doxycycline therapy. The reaction will persist 1 to 2 days after discontinuance of the causative agent.
TH is a candidate for medication therapy because she has diabetes. According to the JNC 7 guidelines, patients with prehypertension who also have diabetes and/or kidney disease should be considered candidates for appropriate drug therapy if a trial of lifestyle modification fails to reduce their blood pressure to 130/80 mm Hg or less.