Case Studies

MAY 15, 2014
Elizabeth S. Mearns, PharmD, and Craig I. Coleman, PharmD
Case 1
AM, a 25-year-old woman, has no significant medical history and is not taking prescription medications. She approaches your pharmacy counter to ask about something “stronger” for her migraines. OTC ibuprofen initially helped her migraines, which were occurring once every few weeks, but now she is having almost daily throbbing headaches with associated nausea and photophobia. She is taking ibuprofen multiple times a day, every day, with little relief, and has been missing work frequently.
What would you recommend to AM regarding treatment options for her migraines?

Case 2
HC is a 73-year-old Caucasian man with essential hypertension. He comes to your pharmacist-run hypertension clinic today for his semiannual visit, and his blood pressure (BP) reading is 127/80 mm Hg. He has been taking lisinopril 20 mg once daily and hydrochlorothiazide 12.5 mg once daily for the past 2 years, and his BP has consistently been well controlled (<140/90 mm Hg). Over this this same period, HC has not complained of any side effects due to his antihypertensive medications. HC has no other comorbidities and takes no other prescription or OTC medications (other than occasional acetaminophen use). You recall that the recently released “Evidence-Based Guideline for the Management of High Blood Pressure in Adults” from the Eighth Joint National Committee (JNC 8) raised the BP goal for persons 60 years and older to <150/90 mm Hg.
Do HC’s antihypertensive medications need to be adjusted in lieu of these new BP goals?
Dr. Mearns is health economics and outcomes research fellow at Hartford Hospital Evidence-Based Practice Center, and Dr. Coleman is professor of pharmacy practice, as well as codirector and methods-chief at Hartford Hospital Evidence-Based Practice Center, at the University of Connecticut School of Pharmacy.

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