Case Studies

ANSWERS

CASE ONE:
Gastrointestinal side effects from iron supplementation are strongly and positively correlated with the amount of elemental iron administered; therefore, it is not surprising that the physician sees less stomach upset with ferrous gluconate because it contains a lower amount of elemental iron than other preparations (gluconate: 28-36 mg/tablet; sulfate: 65 mg/tablet; fumarate: 106 mg/tablet). The pharmacist should make the physician aware that prescribing one ferrous gluconate tablet 3 times daily will not provide his patients with the recommended daily amount of elemental iron (150-200 mg/day) required to treat iron deficiency anemia, and consequently, may explain why his patients do not always respond adequately to treatment. The pharmacist might suggest the patient take one ferrous sulfate 325-mg tablet 3 times daily (perhaps with 250 mg of ascorbic acid to increase absorption) in order to provide her with the amount of elemental iron she needs.

CASE TWO:
An attempt to stop antisecretory medications, such as proton pump inhibitors and histamine-2 antagonists, is reasonable in patients being treated for heartburn and who have a good response to initial therapy. If symptoms recur in a patient within 3 months, however, the heartburn is often best treated with continuous or maintenance therapy. If symptoms reappear more than 3 months after stopping therapy, repeated courses of acute treatment (roughly 8 weeks in duration) may be effective. Therefore, the pharmacist should inform PI that it is likely that he will continue to be prescribed lansoprazole even if his symptoms disappear in order to prevent symptom recurrence and the development of esophagitis.