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Brown Bag Consult

Sick Day! ‘Tis the Season…

Jill Drury, PharmD
Published Online: Tuesday, November 12, 2013   [ Request Print ]


Pharmacists can have a positive impact when it comes to identifying and helping patients during influenza season. While patients frequently visit multiple physician specialists for various conditions, pharmacists often are the most consistent health care provider. Knowing your patients and their ailments is essential when recommending flu shots and short-term OTC remedies.

Pain and fever relievers, along with cough and cold symptom controllers, fill pharmacy shelves from top to bottom. Walking down the aisle may give patients anxiety as they pick up box after box trying to figure out what differentiates products. The pharmacist has an excellent opportunity to not just assist patients with questions in the pharmacy, but also to branch out to the aisles and provide consultation. If more follow-up and goal setting is needed, a brown bag or medication therapy management session is one way to adequately inform the patient and care for his or her long-term health. These simple offerings can help avoid unnecessary medical costs and possibly even curb potential dangerous OTC self-medicating.

EC is a 45-year-old male who has been coming to your pharmacy for the past 4 years on an infrequent basis. He does not have maintenance medications filled—only the occasional antibiotic or pain medication. You know from past counseling sessions that he is a teacher at the local university and actively volunteers his time within the community. Based on his medication and doctor visit history, he usually gets the flu around the same time every year. You see EC browsing through the pharmacy aisles, and he looks a bit confused, picking up box after box. You step outside the pharmacy, say hello, and ask him if he needs some assistance. EC gives you a hazy look, tells you his symptoms, and asks for help. He can’t miss another day of work and still feels awful from a cough and cold he has been battling. He has every possible medication at home and nothing seems to be making him feel better. You ask EC to join you by the pharmacy counter so you can ask him some additional questions.

When EC comes to the counter, you ask if he would be interested in participating in a brown bag session. You explain what happens during a brown bag consult and tell EC you are interested in reviewing his medications and re-educating him. EC appreciates the opportunity to talk with you in depth, one on one. He confesses that he “never even thought the pharmacist could help me” and that he thought pharmacists were just there to “count pills.” He even apologizes for not asking for your help sooner, as he now feels foolish that he spent so much money on OTC drugs prior to your consult. You schedule a time to meet later in the day, after he has had time to go home and collect his medications.

On reviewing EC’s current profile at your pharmacy, you find the following:
  • Norco 10/325 mg every 4 to 6 hours daily as needed (last filled 1 month ago)
  • Triamcinolone cream 1%; apply to affected areas as needed (last filled 3 months ago)
  • Ibuprofen 800 mg every 6 hours as needed (last filled 2 months ago)
  • Sulfa and egg allergies
When EC returns, you notice the following additional medications in his brown bag:
  • OTC brand name ibuprofen 200-mg tablets
  • OTC acetaminophen 500-mg tablets
  • OTC omeprazole 20-mg capsules
  • OTC brand name diphenhydramine 25-mg capsules
  • OTC multivitamin daily
  • Hydrocodone/acetaminophen 5/500 every 4 to 6 hours daily as needed (filled at competitor pharmacy 2 weeks ago; 1/6 refills)
  • Tussionex syrup (~60 mL remain, bottle unlabeled, not from your pharmacy)
  • OTC caffeine pills
  • OTC 24-hour pseudoephedrine 240-mg tablets
  • OTC guaifenesin 1200-mg tablets
  • OTC brand name guaifenesin 600-mg/dextromethorphan 30-mg 12-hour combination tablets
After reviewing the medications in EC’s possession, you realize EC has a number of duplicate medications. You are curious about how he is using all of these medications. EC may not understand the differences between generic and name-brand medications, and how self-medicating with a surplus of OTC medications may put him at risk for toxicosis.

You educate EC on common OTC cough and cold treatments and help him clean out and simplify his medicine cabinet. EC also is the perfect candidate for additional education concerning preventive flu measures, such and proper hand washing and cough and cold symptom management. Such training is especially important for EC because he is a teacher and a volunteer.

EC is taking OTC acetaminophen and ibuprofen daily, along with his prescribed pain medications. You suggest he discontinue use of these products and offer to speak to his providers regarding duplicate therapy and possible lab tests to identify any resulting toxicosis. This may also be the reason behind his use of OTC omeprazole, as he mentions to you that he has been having new-onset stomach upset. You counsel him on side effects and adverse events and will follow up.


Dr. Drury works as a clinical pharmacy specialist in Chicago, Illinois, and Milwaukee, Wisconsin. She earned her doctor of pharmacy from Midwestern University College of Pharmacy. Her blog, Compounding in the Kitchen, appears on www.PharmacyTimes.com.




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