Case Studies

OCTOBER 10, 2012
Craig I. Coleman, PharmD, and Gretchen Stern, PharmD Candidate
Case One
DS is a 76-year-old normotensive woman who was diagnosed with osteoarthritis (OA) in her right hand. After trying acetaminophen 1 g 4 times daily with no relief, her physician suggested that she try naproxen 500 mg twice daily. At her 2-week follow-up visit, DS reports far less discomfort in her hand. but her blood pressure is now 142/84 mm Hg. The physician considers prescribing hydrochlorothiazide 12.5 mg once daily, but would like the input of a pharmacist first.
What recommendation should the pharmacist provide DS’s prescriber?

Case Two
DW is a 48-year-old woman who presents to the clinic with dysuria, frequent urination, and suprapubic tenderness. Her urine dipstick is positive for nitrite and leukocyte esterase. The physician diagnoses DW with an uncomplicated urinary tract infection (UTI) and prescribes levofloxacin 250 mg once daily for 3 days. The pharmacist working alongside the physician would like to assure DW that she is being treated according to available guideline recommendations. The pharmacist looks over local resistance patterns at their affiliated hospital and sees that Escherichia coli (the pathogen causing uncomplicated cystitis in 80%-85% of patients) has a low (<80%) susceptibility to trimethoprim/sulfamethoxazole (TMP/SMX).
What treatment recommendations, if any, should the pharmacist make to the prescribing physician?

Dr. Coleman is associate professor of pharmacy practice and director of the pharmacoeconomics and outcomes studies group at the University of Connecticut School of Pharmacy. Ms. Stern is a PharmD candidate from the University of Connecticut School of Pharmacy.




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