Case Studies

SEPTEMBER 01, 2008
Craig I. Coleman, PharmD

Dr. Coleman is an assistant professor of pharmacy practice and director of the pharmacoeconomics and outcomes studies group at the University of Connecticut School of Pharmacy.

Fluoxetine Interactions

BD, a 65-year-old man with heart failure, comes to the pharmacy with a prescription for fluoxetine HCl (Prozac) 20 mg a day and tells you that he has been very depressed lately because of his worsening heart failure symptoms. The fourth-year pharmacy intern is working that day and asks if she can enter the prescription and review the patient's medication profile, because she just completed a school examination on heart failure. Under the watchful eye of the precepting pharmacist, the intern reviews the patient's profile and finds that he is currently taking carvedilol (Coreg) 25 mg twice a day. The student is concerned because she recognizes an interaction between BD's current medications and his new prescription.

What is the mechanism behind the interaction, and what is the significance of it? What should the intern/pharmacist do?

Cholesterol-lowering Phytosterols

BA, a 62-year-old man who suffered a myocardial infarction a year ago, comes into your pharmacy to pick up his prescription for atorvastatin 80 mg once daily. When he goes to pay for his prescription, he also hands the pharmacist a bottle of the storebrand baby aspirin and a similar-sized bottle of Bayer Aspirin with Heart Advantage. He mentions to the pharmacist that his physician stressed that, because he had a heart attack, it was important for him to take an 81-mg tablet of aspirin every day. He has been using the store-brand aspirin for the last year, but when he drew it off the shelf today, he noticed this new type of aspirin in a fancy box. BA wants to know what is different about this aspirin and whether he should be using this one instead?