Lauren S. Schlesselman, PharmD
HM, a 55-year-old obeseAfrican-American female, presents
to the pharmacy to obtain refills onher lisinopril and atorvastatin
prescriptions. She is well known tothe pharmacist because she
often picks up prescriptions for hersister. HM's sister is unable
to come for her own prescriptionsbecause she is confined to a
wheelchair due to severe peripheralvascular disease.
When picking up her medications, HMasks to speak with
the pharmacist. She has just usedthe pharmacy's blood pressure
machine, and she wants to knowwhether a blood pressure
of 160/95 mm Hg is normal. While inthe consultation
area, HM mentions to the pharmacistthat she has an appointment
this week with her physician. Beforeher appointment,
she also must have blood work done,including a fasting glucose
test. She does not understand whyshe needs a fasting
Why is HM at risk for type 2diabetes?
HM returns to the pharmacy to havenew prescriptions filled
for her sister. Her sister'sinsulin regimen will now consist of
separate regular and NPH insulins.She was previously receiving
them in a premixed preparation.
Because HM helps her sister injectthe insulin, she has questions
for the pharmacist. HM does notunderstand why her sister
can no longer use the premixedpreparation. The pharmacist
explains that the premixed productdoes not allow the flexibility
of dosing that the new regimenprovides. HM is very upset that
she now will have to give her sister2 injections, rather than the
1 injection she administeredpreviously. She admits that the
doctor told her she could mix the 2insulins in the same syringe.
Since she does not remember in whichorder he said to draw
them up, she resigns herself togiving separate injections.
The pharmacist offers to teach HMthe correct order in
which to draw up the insulins.
In what order should the insulins bedrawn up into a
DR, a district supervisor for aretail pharmacy chain,
receives an urgent phone call from apharmacy manager.
When DR arrives at the store, thepharmacy manager explains
that she is concerned that apharmacist in the store may be
abusing narcotics. When she startednoticing narcotics missing
during the monthly inventory, shebegan monitoring the other
pharmacists. She noticed that 1pharmacist often had small
pupils, was markedly drowsy, andfrequently scratched his
face. The pharmacy manager wants DRto help her confront
DR immediately removes thepharmacist in question from
the pharmacy. He drives him to thehospital where a drug
screen is performed. He informs thepharmacist that he is on
administrative leave until theresults are returned.
When the urine drug screen reportcomes back, it is positive
for codeine and a small amount ofmorphine. DR calls the
pharmacist to discuss the results.The pharmacist denies using
any narcotic agents. He attempts toexplain the report as the
result of frequently ingestingpoppy-seed bagels.
Should DR believe the pharmacist?