Case Studies

APRIL 13, 2010
Craig I. Coleman, PharmD


Opioid Dependence

RT is a 54-year-old man who has recently moved to the area and comes to the pharmacy as a new customer. He presents a prescription for Suboxone (buprenorphine HCl/naloxone HCl dihydrate) 8/2 mg, take 2 tablets daily, to the pharmacy intern and mentions he will come by tomorrow to pick up the prescription. The pharmacy intern ensures that the physician is authorized to prescribe Suboxone by verifying the prescription contains the unique “X” identifying number and Drug Enforcement Administration number. While processing the prescription, the intern notices that Suboxone not only has buprenorphine but also naloxone in the tablet. The intern asks the pharmacist, “Why is there naloxone in the tablet? On my emergency medicine rotation, a patient who overdosed on narcotics was given naloxone intravenously to reverse the overdose. Won’t this make RT suffer from symptoms of withdrawal?”

How should the pharmacist respond to the pharmacy intern? How should the pharmacist counsel RT on the proper use of Suboxone tablets?


Type 2 Diabetes Mellitus

TW is a 57-year-old Mexican man with type 2 diabetes mellitus diagnosed 5 years ago. He comes into the pharmacy today to refill his diabetes medications. He currently takes metformin 1000 mg twice daily and glyburide 10 mg daily. Two hemoglobin A1C values—7.5% and 7.3%—obtained 6 months apart over the past year demonstrate suboptimal glycemic control. TW tells the pharmacist that his fasting blood sugars have mostly fallen between 132 and 155 mg/dL over the past several weeks. He seems discouraged and frustrated today because he has been adherent to his medications and has made good effort in modifying his lifestyle. TW mentions to the pharmacist, “Back home we use prickly pear cactus for diabetes. I am sick of these pills, they are not helping me. I should just start eating prickly pear cactus to see if that helps my sugar.”

How should the pharmacist respond to TW? Are there any potential drug interactions between prickly pear cactus and TW’s current medications?

Dr. Coleman is an associate professor of pharmacy practice and director of the pharmacoeconomics and outcomes studies group at the University of Connecticut School of Pharmacy.

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