Spring is in the Air

Jill Drury, PharmD
Published Online: Monday, April 14, 2014

Planning a brown bag session for your patients need not be overly time-consuming. The session may be offered to select patients whom you determine will benefit from follow-up care and counseling. The review of prescription and OTC medications, along with herbal supplements and vitamins, enables pharmacists to educate their patients and assess safety and quality of care.

Allergy and Asthma
Spring is in the air. Those spring blossoms, however, are not welcomed by everyone. Patients suffering from chronic respiratory conditions may benefit from brown bag sessions and medication therapy management (MTM). Asthma and seasonal allergy sufferers are particularly well suited for brown bag sessions. Pharmacists are in a unique position to assist with their patients’ understanding of their conditions, provide appropriate therapy, and offer advice on how to maximize regimen adherence. Pharmacist intervention may help with proper medication prescription, including long-term controller agents and quick-relief medications.

NB, a 36-year-old female, has been a patient at your pharmacy for 2 years. You have seen her become nonadherent to certain drug regimens due to acute and chronic issues. In your last counseling session, you noticed that NB appears short of breath with decreased energy. She also complains about frequent headaches and runny noses. She speculates that a prior sinus infection is to blame. You ask NB if she would like to participate in a brown bag session. You explain the benefits of the brown bag process and that you will review her medications, which will allow NB to maximize her medications and decrease the potential for potential adverse interactions.

Upon reviewing NB’s medication profile at your pharmacy, you find:
  • Levothyroxine 25-mcg tablet daily every morning—prescribed by Dr. Z
  • Montelukast 10-mg tablet daily—prescribed by Dr. Z
  • ProAir HFA 1 to 2 puffs by mouth every 4 to 6 hours as needed (flagged for overuse/early refills for the past 4 months)—prescribed by Dr. Y
  • Sertraline 50-mg tablet daily—prescribed by Dr. Y
  • Ortho Tri-Cyclen; use as directed—prescribed by Dr. Z
When NB arrives, you notice the following additional medications in her brown bag:
  • Flunisolide nasal spray 1 spray into each nostril once daily (filled at competitor pharmacy 3 months ago)—prescribed by Dr. Y
  • OTC multivitamin daily
  • Loratadine 10 mg daily (various unopened and expired OTC generic and brand boxes in her bag)
  • OTC acetaminophen 500 mg every 4 to 6 hours as needed
  • OTC diphenhydramine 25-mg capsules
  • Zithromax Z-Pak, unopened, filled 4 months ago at competitor pharmacy—prescribed by Dr. X
  • Fluticasone/salmeterol HFA 100 mg/50 mg, pharmaceutical sample
After reviewing NB’s medication, you realize she would also benefit from an MTM session. You schedule a followup appointment. NB is not eligible for MTM through her insurance provider. Nonetheless, offering NB this service, which is designed as a similar alternative, allows you to further communicate with NB’s health care providers, obtain lab values/pulmonary function tests, and further evaluate NB’s medical goals, particularly related to her asthma. It will also give you the opportunity to offer in-depth asthma and allergy education, as requested by NB. In the meantime, you have some questions about her medications and make the following suggestions:
  1. You suggest to NB that you contact her prescriber, Dr. Y, regarding her flunisolide nasal spray. You wonder if an inhaled corticosteroid is the best agent for her allergic rhinitis and if the directions are correct. NB tells you she has never had pulmonary function tests and her asthma and allergies have always been “self-diagnosed.”
  2. NB’s levothyroxine directions instruct her to take 1 tablet daily every morning. Yet you notice when you look in the bottle that NB has been cutting the tablets in half and her adherence has been off according to your computer system. You ask her about this, and she tells you she has not been following directions or taking the pill in the morning. She cuts her pills in half as a cost-saving measure and tells you her provider Dr. Z is unaware of her manipulation. She also cannot remember the last time her thyroid hormone level was checked.
  3. You ask NB how long she has been feeling short of breath. She explains that with the “change of seasons” and her new outdoor exercise routine, her allergies “act up all the time.” You explain that some of her medications come with side effects, such as drowsiness, and some are expired. You would like to refer her to 1 provider for consistent care to help her manage her allergy and asthma symptoms. NB admits she doesn’t know how to use inhalers because no one taught her. You explain that once the proper medications are prescribed, you make time to train NB and watch her inhaler technique.
What else would you suggest to NB before her follow-up session?


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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