Rupal Patel Mansukhani, PharmD, FAPhA, NCTTP

GR, aged 38 years, has had congestion for the past few days and wants something to help open her airways. She says she usually uses pseudoephedrine but was recently diagnosed with high blood pressure (HBP), which she is trying to control through diet and exercise. Her blood pressure (BP) readings for the past week have been 138-156/90-98. GR does not take other medications. What should the pharmacist recommend?

Pseudoephedrine can be used as a decongestant. However, it can cause a slight increase in BP. In patients with controlled hypertension, the results of one meta-analysis showed that BP increased by 1 mm Hg. Patients who took higher doses had even higher increases.

 Because GR has uncontrolled BP, she should avoid pseudoephedrine. Patients with hypertension should use decongestants only if advised to do so by their physicians, and they should monitor their BP during use. OTC products that are marketed for patients with hypertension often do not include decongestants. GR can try to use a dehumidifier and nasal saline and see whether her congestion improves.

HH is a 48-year-old man looking for a BP monitor. He was recently diagnosed with hypertension, and his physician recommended that he monitor his BP at home. HH is looking for a wrist monitor because he wants a small device that is portable for work. He takes hydrochlorothiazide 25 mg and lisinopril 10 mg daily for HBP. HH is otherwise healthy. What should the pharmacist recommend?

 The American Heart Association recommends home monitoring for all patients with HBP to help assess and modify treatment. Finger and wrist BP monitors are not recommended because the readings may not be reliable.

 When choosing a monitor, it is important to assess appropriate cuff size; the cuff bladder should encircle 80% or more of the patient's arm circumference. HH should be seated comfortably with his back supported, a bare upper arm, and his legs uncrossed.

 Advise him not to drink caffeine, exercise, or smoke 30 minutes before measuring his BP. It is also important to take the reading at a similar time each day to see trends. HH can take his BP multiple times throughout the day to assess whether his medications are working. He should be familiar with his goal BP and contact a health care professional if the reading is elevated.

LM is a 55-year-old woman who would like a multivitamin. She was recently diagnosed with hypertension. LM was prescribed 2 medications, but her physician said she should also diet and exercise. Her medications include amlodipine 5 mg and losartan 50 mg daily and atorvastatin 20 mg at bedtime. LM began going to a gym a few days a week but is having trouble adhering to a diet and is tired of eating salads. She asks about a diet that can help reduce her BP. What should the pharmacist recommend?

The Dietary Approaches to Stop Hypertension (DASH) diet can help patients reduce their BP level. DASH recommends eating fruits, vegetables, and whole grains instead of refined grains. In addition, the diet suggests incorporating beans, fat-free or low-fat dairy products, fish, nuts, poultry, and nontropical vegetable oils to replace foods that are high in saturated fat, such as fatty meats, full-fat dairy products, and tropical oils (coconut, palm kernel, and palm oils).

 LM should also limit sugar-sweetened drinks and sweets. In addition, encourage her to limit her salt intake to less than 2300 mg daily, or approximately 1 teaspoon, because data show that less than 1 teaspoon of salt per day can lower BP by 2 to 8 mm Hg.

 However, if LM can tolerate less than 1500 mg per day, her BP will likely be even lower. LM should also speak with a dietician to assess daily caloric intake and learn how to read food labels.

GG is a 48-year-old woman who wants to refill her medication for lisinopril 10 mg daily. She has had hypertension for 5 years but has been able to control it with diet, exercise, and medication. A friend suggested GG use stevia instead of sugar in her coffee because it can lower BP. Should she try the stevia to help control her hypertension?

Advise GG that the data are conflicting regarding the use of stevia for hypertension. The results of 1 study showed that taking stevioside, a constituent of stevia, had a 12 mm Hg mean reduction in systolic BP and an 8 mm Hg reduction in diastolic BP.

 However, results of another study showed no reduction in BP when using stevioside in doses up to 15 mg/kg daily.

 Although stevia has conflicting data, its safety profile is relatively safe. Therefore, if GG wants to use stevia in her coffee, she can certainly try it. Advise her to monitor her BP daily and contact a health care professional if it increases.

Rupal Patel Mansukhani, PharmD, FAPHA, NCTTP, 

is a clinical associate professor at Ernest Mario School of Pharmacy at Rutgers, The State University of New Jersey in Piscataway, and a transitions-of-care clinical pharmacist at Morristown Medical Center in New Jersey.

is a clinical assistant professor of pharmacy practice and administration at Ernest Mario School of Pharmacy at Rutgers, The State University of New Jersey, in Piscataway, and an ambulatory care specialist at RWJBarnabas Health Primary Care in Shrewsbury and Eatontown, New Jersey.

1. Salerno SM, Jackson JL, Berbano EP. Effect of oral pseudoephedrine on blood pressure and heart rate: a meta-analysis. 

 2005;165(15):1686-1694. doi:10.1001/archinte.165.15.1686

2. Monitoring your blood pressure at home. American Heart Association. Updated November 30, 2017. Accessed July 20, 2021. 

https://www.heart.org/en/health-topics/high-blood-pressure/understanding-blood-pressure-readings/monitoring-your-blood-pressure-at-home

3. Smith L. New AHA recommendations for blood pressure measurement. 

4. DASH eating plan. National Heart, Lung, and Blood Institute. Accessed July 20, 2021. 

https://www.nhlbi.nih.gov/health-topics/dash-eating-plan

5. Lenfant C, Chobanian AV, Jones DW, Roccella EJ; Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Seventh report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7): resetting the hypertension sails. 

. 2003;41(6):1178-1179. doi:10.1161/01.HYP.0000075790.33892.AE

6. Chan P, Tomlinson B, Chen YJ, Liu JC, Hsieh MH, Cheng JT. A double-blind placebo-controlled study of the effectiveness and tolerability of oral stevioside in human hypertension. 

2000;50(3):215-220. doi:10.1046/j.1365-2125.2000.00260.x

7. Ferri LAF, Alves-Do-Prado W, Yamada SS, Gazola S, Batista MR, Bazotte RB. Investigation of the antihypertensive effect of oral crude stevioside in patients with mild essential hypertension. 

. 2006;20(9):732-736. doi:10.1002/ptr.1944

Articles

How would you answer these patients' questions?

August 2021: OTC Case Studies

RJ is a 3-year-old girl with dryness, redness, and scaling on her arms. Her mother calls the pharmacy with questions regarding atopic dermatitis (AD). She reports that RJ has been trying to scratch the itchy rash, which appears to be making the plaques thicker. RJ’s mother reports that her daughter has asthma as well. What should the pharmacist recommend to treat AD?

Advise RJ’s mother to limit exposure to all potential triggers for AD, including dyes, excessive bathing, extreme temperatures, irritating detergents and soaps, and tight-fitting clothing. Preventive measures can be implemented to reduce the symptoms of AD. RJ’s clothes and sheets should be thoroughly washed with unscented detergent, and dryer sheets should be avoided. Overall, bathing is recommended to remove bacteria and hydrate the skin, but excessive bathing should be avoided, and lukewarm water and mild, hypoallergenic cleansers should be used. RJ’s skin should be moisturized with unscented emollient products immediately after bathing. The skin barrier can be hydrated and maintained using emollient moisturizers that contain oils, petrolatum, or silicone.

If nonpharmacologic modalities do not provide relief, RJ should be treated with topical corticosteroids, which will suppress the cytokines involved in the inflammatory process. Hydrocortisone 0.5% and 1% topical creams are available over the counter and can be used for AD in ages >2 years. Hydrocortisone should be applied to RJ’s lesions twice daily before the application of her daily moisturizers.

RJ’s mother returns to the pharmacy a few weeks later regarding her daughter’s AD. She mentions that she learned from friends that fish oil and evening primrose oil are helpful for AD. She asks for your input on complementary therapies and evidence for use in AD. What information can you provide to RJ’s mother?

There is little evidence to demonstrate the efficacy of complementary therapies for use in AD. Some studies have shown, however, that phototherapy may be effective in AD after non-pharmacologic measures and topical corticosteroid use do not work. In pediatric patients specifically, ultraviolet A and B phototherapy have demonstrated efficacy and safety for AD. The guidelines now recommend phototherapy as a treatment option for refractory AD.

Other complementary therapies commonly used include borage, coconut, evening primrose, and fish oils. Despite the widespread use of oils for AD, there are insufficient data to support the use of borage, evening primrose, or fish oil. However, some data do support the use of topical coconut oil in AD.

MP is a 7-month-old boy with reddened skin under the diaper area developing over the past 3 days. The area appears wet, but there is no discharge. MP is otherwise healthy and does not appear to have any changes in body temperature, bowel movements, or energy level. His diaper is typically changed frequently, but he has a new nanny who may have a different schedule. What should the pharmacist advise for MP’s condition?

MP’s symptoms are consistent with the common presentation of diaper dermatitis. Given that he does not have diarrhea, fever, or oozing, and he has not had had the rash for > 7 days, he is eligible for treatment at home. Diaper dermatitis can occur in the setting of occlusion from the diaper and increased exposure to moisture from gastrointestinal contents and urine. Instruct MP’s nanny to increase awareness of wet diapers and change them more frequently—a minimum of 6 times per day. A modality that may be difficult but effective includes a “diaper holiday,” where MP would not wear a diaper and therefore avoid duration of contact with a wet diaper.

Additionally, the use of skin protectants with each diaper change will aid in preventing diaper dermatitis. The FDA has approved 17 skin protective ingredients for treatment of diaper dermatitis, including allantoin, calamine, cocoa butter, petrolatum, and zinc oxide. MP’s caregiver should use an OTC skin protectant after each diaper change for 7 days and observe for improvement. If the rash does not improve during that time, a medical referral is recommended. OTC antibacterial and antifungal topical agents are not recommended to treat diaper dermatitis.

PA is a 27-year-old woman who has a rash on her face. She visited the dentist earlier in the day and had a few cavities filled. Immediately following the appointment, PA noted a stinging, swollen rash at the outer corner of her mouth. She researched the material used during a filling and noted that the etching solution used contains phosphoric acid, which could cause contact dermatitis if skin is exposed to it. What advice should the pharmacist provide?

PA should first wash the exposed area with a generous amount of lukewarm water to remove the irritant and reduce skin contact time and exposure. To protect the skin from epidermal water loss, PA should apply copious amounts of petrolatum to the exposed area. In some cases, Burow’s solution (aluminum acetate) can be used for its antibacterial, antiinflammatory, and cooling effects. Unlike with atopic dermatitis, topical corticosteroids do not target the mechanism of irritant contact dermatitis. As such, OTC hydrocortisone would not be an appropriate treatment choice. Likewise, PA should avoid lactic and salicylic acids, propylene glycol, and topical anesthetics, which may cause more irritation and potentiate allergic contact dermatitis. Inform PA that the rash may become hyper- or hypopigmented and scaly. Given that the rash is on her face, the pharmacist should also refer her to a provider for evaluation.

Rupal Patel Mansukhani, PharmD, FAPhA, NCTTP, 

is a clinical associate professor at Ernest Mario School of Pharmacy at Rutgers, The State University of New Jersey, in Piscataway, and a transitions-of-care clinical pharmacist at Morristown Medical Center in New Jersey.

1. Paller AS, Simpson EL, Eichenfield LF, Ellis CN, Mancini AJ. Treatment strategies for atopic dermatitis: optimizing the available therapeutic options. 

. 2012;31(suppl 3):S10-S17. doi:10.1016/j.sder.2012.07.004

2. Hon KL, Leung AKC, Barankin B. Barrier repair therapy in atopic dermatitis: an overview. 

 2013;14(5):389-399. doi:10.1007/s40257-013-0033-9

3. Eichenfield LF, Tom WL, Berger TG, et al. Guidelines of care for the management of atopic dermatitis: section 2. Management and treatment of atopic dermatitis with topical therapies. 

 2014;71(1):116-132. doi:10.1016/j.jaad.2014.03.023

4. Sidbury R, Davis DM, Cohen DE, et al. Guidelines of care for the management of atopic dermatitis: section 3. Management and treatment with phototherapy of atopic dermatitis. 

. 2014;71(2):327-349. doi:10.1016/j.jaad.2014.03.030

5. Sidbury R, Tom WL, Bergman JN, et al. Guidelines of care for the management of atopic dermatitis: section 4. Prevention of disease flares and use of adjunctive therapies and approaches. 

 2014;71(6):1218-1233. doi:10.1016/j.jaad.2014.08.038

6. Evangelista MTP, Abad-Casintahan F, Lopez-Villafuerte L. The effect of topical virgin coconut oil on SCORAD index, transepidermal water loss, and skin capacitance in mild to moderate pediatric atopic dermatitis: a randomized, double-blind, clinical trial

 2014;53(1):100-108. doi:10.1111/ijd.12339

7. Stamatas GN, Tierney NK. Diaper dermatitis: etiology, manifestations, prevention, and management.

 L, Stamatas GN, Kottner J, Garcia Bartels N. Prevention of diaper dermatitis in infants—a literature review. 

 2014;31(4):413-429. doi:10.1111/pde.12348

9. Food and Drug Administration, HHS. Skin protectant drug products for over-the-counter human use; final monograph. Final rule. 

10. Eberting CL, Blickenstaff N, Goldenberg A. Pathophysiologic treatment approach to irritant contact dermatitis. 

11. Corazza M, Minghetti S, Bianchi A, Virigili A, Borghi A. Barrier creams: facts and controversies. 

. 2014;25(6):327-333. doi:10.1097/DER.0000000000000078

How would you respond to these patients' concerns?

OTC Case Studies: Dermatitis

PJ is a 7-year-old boy with complaints of ringing in his ears followed by trouble hearing with a sudden onset. His mother, ET, reported that he had a cold this past week and that he appears to have poor balance when walking. She asks about ear wax removal kits to improve the hearing problems. What should the pharmacist recommend?

PJ’s symptoms are consistent with common presentation of labyrinthitis, and the pharmacist should refer him to his PCP for further evaluation and treatment. The symptoms of hearing loss and poor balance, especially in a child with a recent common cold, suggest viral etiology. Viral infections are a common trigger for labyrinthitis. PJ’s PCP may conduct testing and refer the child to a specialist. In some cases, corticosteroids or antiviral medications may be prescribed.

MT, a 42-year-old man, has a prescription for ciprofloxacin and dexamethasone (Ciprodex). He has not used ear drops since he was a child, and his mother would pull his ear canal downward to apply the treatments. MT asks the pharmacist to walk him through the application for adults. How should the pharmacist instruct him to use the medication?

MT should first wash his hands with soap and water. He should then warm
the ciprofloxacin and dexamethasone bottle in his hands for 1 to 2 minutes prior to administration, as dizziness may occur if a cold otic suspension is instilled in the ear canal. The pharmacist should then instruct MT to remove the cap and place it on a clean dry surface. Unlike how children are administered ear drops, MT should tilt his head sideways and pull his affected ear up and back. He should then administer the ear drops using the applicator but avoid having the applicator tip enter the ear canal. To maximize the ciprofloxacin and dexamethasone exposure, he should lie down on his side with the affected ear up for 5 minutes or place a piece of cotton ball at the end of the outer ear canal of the affected ear for 20 minutes. Remind MT not to share this medication with others.

JP is a 3-year-old, 35-lb boy with mild to moderate ear pain who has had a 38 °C fever for the past 24 hours. His mother, MO, calls the pharmacy with questions about unilateral AOM. She noted that upon consultation, JP’s pediatrician recommended initial observation with pain control but without antibiotics. MO is concerned about the pediatrician’s recommendation and asks for the pharmacist’s input and what pain medications JP should take. What advice can the pharmacist give her?

Given that JP is an immunocompetent child older than age 2 without craniofacial abnormalities and ear discharge and with a temperature of less than 39 °C, study results support the approach of either immediate antibiotic treatment or initial observation. If his pain and symptoms worsen or do not improve after 48 to 72 hours, the pediatrician should give JP antibiotics. Typically, a pediatrician will choose either amoxicillin or amoxicillin-clavulanate antibiotic treatment for AOM if no recent allergies, antibiotic use, or resistance are noted. If JP’s symptoms improve in 48 hours, he should follow up with the pediatrician at the next health maintenance visit.

In terms of pain control, study results show that patients with AOM who received acetaminophen or ibuprofen experienced pain relief at 48 hours compared with a placebo. There are insufficient data to support the use of both acetaminophen and ibuprofen together. If using acetaminophen, give 160 mg oral liquid every 4 to 6 hours as needed, with a maximum of 5 doses per day and a maximum daily dose of 75 mg/kg or 4000 mg, whichever is less. If using ibuprofen, administer 100 mg oral liquid every 6 to 8 hours, with a maximum single dose of 400 mg and a maximum daily dose of 40 mg/kg per day.

HP is a 68-year-old man who asks about a nonprescription product to help with painful, water-clogged ears with discharge. He just returned from a family trip to an all-inclusive beach resort, where he spent much of the time in the pool. HP’s temperature has been running high for the past 2 days since his return, and he is having trouble hearing on the phone, which is a necessity for his work-from- home job. His coworker mentioned that OTC ear drops relieve discomfort. What advice should the pharmacist give HP?

The symptoms of discharge, ear pain, and fever, combined with a lot of time swimming recently are consistent with the common presentation of swimmer’s ear. Given the virulent nature of swimmer’s ear, refer HP to his primary-care provider (PCP) for further evaluation and treatment. In the meantime, HP should be instructed to avoid using cotton swabs. The PCP will likely first clean HP’s ear canal using an otoscope and then treat the infection and inflammation with a topical steroid and/or an oral or topical antibiotic. The PCP may recommend an OTC analgesic such as ibuprofen or naproxen to treat the ear pain. Throughout the duration of treatment for swimmer’s ear, HP should protect his ears from water using petroleum jelly–coated cotton balls when bathing and avoid swimming for 7 to 10 days.

If HP had had water-clogged ears without discharge, fever, or pain, he could have self- treated with a cerumen removal kit, such as carbamide peroxide. To reduce the risk of swimmer’s ear in the future, he should use ear plugs when swimming, and if water does enter his ears, tilt his head to each side to shake his ears dry. HP can also consider blow drying his ears at the lowest heat setting after water exposure by holding the dryer 1 foot away from his ears.

is a clinical associate professor at Ernest Mario School of Pharmacy at Rutgers, The State University of New Jersey, and a transitions-of- care clinical pharmacist at Morristown Medical Center in New Jersey.

is a clinical assistant professor of pharmacy practice and administration at Ernest Mario School of Pharmacy at Rutgers, The State University of New Jersey in Piscataway, and an ambulatory care specialist at RWJBarnabas Health Primary Care in Shrewsbury and Eatontown, New Jersey.

Baloh RW. Clinical practice. Vestibular neuritis. N Engl J Med. 2003;348(11):1027-1032.doi:10.1056/NEJMcp0211542.

Strupp M, Zingler VC, Arbusow V, et al. Methylprednisolone, valacyclovir, or the combination for vestibular neuritis. N Engl J Med.2004;351(4):354-361.doi:10.1056/NEJMoa0332803.

Ciprodex, otic suspension. Prescribing information. Alcon Laboratories Inc; 2019. Accessed May 20, 2021. 

https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/021537s017lbl.pdf4.

Spiro DM, Tay KY, Arnold DH, DziuraJD, Baker MD, Shapiro ED. Wait-and-see prescription for the treatment of acute otitis media: a randomized controlled trial. JAMA.2006;296(10):1235-1241. doi:10.1001/jama.296.10.12355.

Little P, Gould C, Williamson I, Moore M, Warner G, Dunleavey J. Pragmatic randomised controlled trial of two prescribing strategies for childhood acute otitis media.BMJ.2001;322(7282):336-342.doi:10.1136/bmj.322.7282.3366.

Cates C. An evidence based approach to reducing antibiotic use in children with acute otitis media: controlled before and after study. BMJ.1999;318(7185):715-716.doi:10.1136/bmj.318.7185.7157.

Siegel RM, Kiely M, Bien JP, et al. Treatment of otitis media with observation and a safety-net antibiotic prescription. Pediatrics. 2003;112(3 pt 1):527-531.doi:10.1542/peds.112.3.5278.

Chao JH, Kunkov S, Reyes LB, Lichten S, Crain EF. Comparison of two approaches to observation therapy for acute otitis media in the emergency department. Pediatrics. 2008;121(5):e1352-e1356.doi:10.1542/peds.2007-2278

Uitti JM, Tähtinen PA, Laine MK, Ruohola A. Close follow-up in children with acute otitis media initially managed without antimicrobials. JAMA Pediatr.2016;170(11):1107-1108.doi:10.1001/jamapediatrics.2016.154210.

American Pain Society. Principles of Analgesic Use in the Treatment of Acute Pain and Cancer Pain. 6th ed. American Pain Society; 2009.11.

Kliegman RM, Stanton BF, St. Geme J, Schor NF, Behrman RE, eds. Nelson Textbook of Pediatrics. 19th ed. Saunders; 2011.12.

Welch CM, Brown KD. Diseases of the external ear. In: Lalwani AK, ed. Current Diagnosis & Treatment: Otolaryngology–Head and Neck Surgery. 4th ed. McGraw-Hill Education; 2020:797-816.13.

Rosenfeld RM, Brown L, Cannon CR, et al; American Academy of Otolaryngology–Head and Neck Surgery Foundation. Clinical practice guideline: acute otitis externa. Otolaryngol Head Neck Surg. 2006;134(suppl 4):S4-S23.doi:10.1016/j.otohns.2006.02.01414.

Osguthorpe JD, Nielsen DR. Otitis externa: review and clinical update. Am Fam Physician. 2006;74(9):1510-1516.

OTC Cases: Ear Infections

ML is a 38-year-old woman who has had pain in her eyes for approximately 1 week, with no other issues. She says she feels as if she has something in her eyes, like sand. Upon inspection, ML's eyes look normal with no discoloration. She does not take any medications. What should the pharmacist recommend?

Dry eyes typically appear normal. However, patients often complain of a gritty, sandy feeling in their eyes. Allergens and anticholinergic medications can often cause or exacerbate dry eyes. Mild to moderate disease can be treated with OTC lubricants. One class of medications is substituted cellulose ethers, which include carboxymethylcellulose and hydroxypropyl methylcellulose.

 Other ingredients, such as carbomer polymers, glycerin, polyethylene glycol, polyvinyl alcohol, providone, and propylene glycol may be added as inactive ingredients to help with lubrication and viscosity. Gel formulations have higher viscosity and may be more beneficial for moderate disease. Newer OTC combination agents to not only lubricate eyes but also protect against evaporation of natural tears and provide a barrier to prevent loss of the aqueous component of the tears. Because ML has only had dry eyes for a short time, she may benefit from trying an OTC treatment containing caboxymethylcellulose and hydroxypropyl methylcellulose. ML should follow package directions because these can vary, depending on the product.

GG is a 27-year-old man seeking a treatment for his seasonal allergies, which have caused itchy eyes for the past 2 weeks. He takes loratadine 10 mg daily but has been playing golf frequently and thinks pollen is causing the itchiness. GG is looking for a short-term solution until the pollen count decreases. He takes no other medications and has no other symptoms. What should the pharmacist recommend?

Ideally, GG should try to avoid pollen or decrease exposure to it, because it triggers the itchiness. He can also try applying cold compresses, washing his eyes out with water when he goes indoors, and wearing sunglasses outside to reduce the itching. First-line treatment for allergic conjunctivitis is artificial lubricants such as carboxymethylcellulose and hydroxypropyl methylcellulose.

 These agents can help wash out allergens and relieve symptoms. If symptoms persist, GG can use mast cell stabilizer, ophthalmic antihistamine, or histamine receptor H1 antagonist products such as ketotifen fumarate or olopatadine. Because he is already taking an oral antihistamine, he should be evaluated if symptoms do not improve within 72 hours. Other antihistamines or nasal corticosteroids may also help GG. 

NM is a 19-year-old woman complaining of redness and swelling along her eyelid for the past 48 hours. She does not feel any pain. NM just returned from a spring break trip. She started using a new eyeliner while she was away but otherwise has not used any new cosmetics, lotions, or soaps. What is the best treatment strategy for NM?

NM may be suffering from contact dermatitis from her new eyeliner. The best treatment strategy is to discontinue using the eyeliner and see if symptoms resolve. If the redness and swelling continue, NM can try OTC diphenhydramine. She can also apply cold compresses 3 to 4 times per day. Advise NM that cleaning her eyelids with warm water and a washcloth may be beneficial. If symptoms persist, she should be evaluated. Other topical agents, such as calcineurin inhibitors or corticosteroids, can be used for contact dermatitis of the eye. Some study results suggest that corticosteroids may be more beneficial, but NM should consult with a health care professional before beginning treatment.

YU is a 48-year-old man complaining about eye pain. His eyes appear red with inflamed lids. YU has discharge every morning from his eyes that makes opening them difficult. He says he suffers from seasonal allergies. YU has been taking cetirizine hydrochloride and mometasone furoate nasal spray daily and the past few years during allergy season. During bad allergy seasons, he gets repeated sties. Last week, YU had another stye and his physician recommended using warm compresses to get rid of it. But this is the first time YU has had an inflamed lid. What recommendations can the pharmacist give him?

YU appears to have an eye infection. Potential symptoms include matting of the lashes; ocular discharge; red, thickened lids; and scaling. YU should see a physician to rule out a bacterial or fungal eye infection. In addition, good eyelid hygiene can help combat frequent sties.

 Advise YU to clean his eyelids by first washing his hands and then moistening a clean cotton swab or washcloth with a cleaning solution recommended by his physician or with water. He should gently wipe his eyelashed and lid margin on both eyes and then wash them out with warm water.

Rupal Patel Mansukhani, PharmD, FAPhA, NCTTP,

 is a clinical associate professor at Ernest Mario School of Pharmacy at Rutgers, The State University of New Jersey, and a transitions-of-care clinical phramacist at Morristown Medical Center in New Jersey.

 is a clinical assistant professor of pharmacy practice and administration at Ernest Mario School of Pharmacy at Rutgers, The State University of New Jersey in Piscataway, and an ambulatory care specialist at RWJBarnabas Health Primary Care in Shrewsbury and Eatontown, New Jersey.

Case studies include recommendations for eye pain and allergy relief.