Editor’s note: Case is not based on an actual patient.

Brown bag consults can be essential educational and safety tools to measure and ensure quality care. By asking patients to bring in all their current medications, including OTC, mail order, specialty, and herbal products, pharmacists can guarantee appropriate and up-to-date care.

Pharmacists are key providers in the continuum of care, consistently identifying potential problems and concerns that may require follow-up with prescribers or a medication therapy management session. It
is essential that a pharmacist’s workflow allow for brown bag consults, which can do the following:
  • Develop the pharmacist–patient relationship to help create better individualized service, forge patient loyalty and trust, and prevent medical errors
  • Provide insight into a patient’s lifestyle and quality of care
  • Show how well patients understand their conditions and medications
Offering to review medications one-on-one can give pharmacists the opportunity to connect with patients by serving as trusted medical professionals in the community. Brown bag sessions do not have to be time-consuming scheduled events. They can be offered anytime a pharmacist thinks that a patient needs follow-up care after a typical counseling session.

Menopause often causes uncomfortable symptoms in women. Many pharmacological and nonpharmacological treatments make it challenging for patients to understand what is effective and safe. In the past,
health care providers typically prescribed hormone therapy, whereas they now increasingly prescribe medications to treat specific symptoms. When counseling patients experiencing menopause, pharmacists should understand the treatments available and the key differences among the various delivery systems.

KS is a 49-year-old woman and returning customer to the pharmacy. She is a hard-working mail carrier by day and an even harder-working waitress by night and on weekends. KS stops by the pharmacy to refill
her monthly prescriptions. She seems irritable and stressed. KS says that she cannot seem to focus, has a terrible headache, and is tired because she has not been sleeping well. She says she is warm, even though it is 25°F outside. KS says she goes from feeling on fire to feeling like she is as cold as ice throughout the day. As a result, she cannot maintain a comfort level, does not wear the right clothes, and has an overall high stress level. You suspect that KS is experiencing hot flashes and ask her if she would be interested in discussing her medications and symptoms. You suggest that she bring in all her medications so you can go over them together for proper use. KS is curious about your offer to help and is happy to talk. She made an appointment with her obstetrician/gynecologist (OB/GYN) to discuss her symptoms, but it is not for another few weeks. KS schedules an appointment to meet with you before her waitressing shift.

To prepare for the session, you pull up and print her pharmacy profile, so that you are able to compare it to what is in her brown bag. Here is what you find:
  • Alprazolam, 0.5 mg as needed, 30-day supply, no refills
  • Atomoxetine 80 mg, once daily every morning
  • Atorvastatin 20 mg, once daily
  • Bupropion XL, 300 mg, daily
  • Drospirenone/ethinyl estradiol tablets, once daily
  • Levothyroxine, 100 mcg, once daily
KS arrives for the appointment and empties her brown bag. You notice these additional medications:
  • Adult multivitamin, once daily
  • Estroven capulets, OTC herbal
  • Levothyroxine, 125 mcg once daily, last fill 2 months ago at a competitor pharmacy
  • OTC acetaminophen, 500 mg, as needed
  • OTC famotidine, 20 mg, twice daily
  • OTC ibuprofen 200 mg, as needed
  • Soy capsules, OTC herbal
As you review the medications for accuracy, KS says that she has been self-medicating with alprazolam, which is supposed to be used for airplane travel, and taking OTC medications for her fatigue, frequent headaches, hot flashes, and irregular menstrual cycle. She says that she does not maintain a healthy diet and has been drinking alcohol more frequently. KS also says that her quality of life is not what it was 6 months ago. You ask her about her health goals and medication, and she says that she wants comfort and relief so that she can feel good and return to her daily activities.

You tell KS that her increased stress is likely the main contributing factor to her health issues. You tell her, however, that the symptoms surrounding her menstrual concern you and you want her to follow up with her OB/GYN. You explain how hot flashes and night sweats are related to menopause. KS can help control her reaction to hot flashes by employing relaxation techniques; turning on air conditioning; using a small, personal fan; and wearing light, cotton clothing. A return to healthy eating, more restful sleep, and regular exercise will hopefully reduce stress. You also ask KS about her OTC herbal supplements. She says that a friend recommended them, yet KS does not really notice anything after taking the supplements. You advise her to hold off on taking any more until she talks to her physician.

You encourage KS to come into the pharmacy for additional counseling whenever she wants and tell her that pharmacists can help patients manage their medications, lower their stress levels, and reduce their financial burdens.
 
Jill Drury, PharmD, is a clinical pharmacy specialist in Chicago, Illinois, and Milwaukee, Wisconsin.