Case ONE: RM, a 57-year-old woman, comes to the local pharmacy to pick up her prescriptions. When the technician asks whether RM has any questions, RM replies that she needs a recommendation on a calcium supplement.

When the pharmacist joins RM in the aisle, RM explains that her physician recommended that she start a calcium supplement with vitamin D. She has noticed that there are many different products on the shelf, and she is not sure whether there is a difference between them and which is best for her. The pharmacist is about to recommend calcium carbonate with vitamin D when he sees that RM is holding prescription bags in her hand. He asks what medications RM is currently taking. According to RM, she is taking only Fosamax and Nexium. Should the pharmacist recommend calcium carbonate with vitamin D?

Case TWO: PC, a 67-year-old woman who is well known at Drams Pharmacy, arrives at the store to pick up another prescription to treat her glaucoma. She complains to the pharmacist that she is frustrated with her glaucoma treatment. She is already using 3 different ophthalmic products, with a fourth being added today. Despite this therapy, she is not having any success in lowering her intraocular pressure. PC is concerned that she will need to have surgery if the pressure does not begin to reduce.

When the pharmacist inquires about PC's compliance and administration of her eyedrops, PC is adamant that she uses her medications every day as often as the doctor prescribed. She says that she administers her eyedrops before she heads to the country club with her friends.

The pharmacist asks PC to describe how she administers the eyedrops. PC says that she is usually in a rush to get to the country club, so she administers them quickly. Typically, all of the medications are administered within 1 minute.

Can the pharmacist recommend an improved method for the administration of PC's multiple eyedrops?

Dr. Schlesselman is a clinical pharmacist based in Niantic, Conn.

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CASE 1: The pharmacist should recommend calcium citrate with vitamin D, rather than calcium carbonate with vitamin D. Although vitamin D will help the absorption of calcium, the pharmacist also needs to consider RM's prescription medications. The Nexium that RM is taking can reduce the absorption of the carbonate salt.

CASE 2: To prevent dilutional effects, PC should wait at least 5 minutes between administering the drops. If a gel solution is administered, PC should administer it last and wait even longer between drops.