Case ONE: RM, a 57-year-old woman, comes to the local pharmacy topick up her prescriptions. When the technician asks whetherRM has any questions, RM replies that she needs a recommendationon a calcium supplement.
When the pharmacist joins RM in the aisle, RM explains thather physician recommended that she start a calcium supplementwith vitamin D. She has noticed that there are many differentproducts on the shelf, and she is not sure whether there is adifference between them and which is best for her. The pharmacistis about to recommend calcium carbonate with vitamin Dwhen he sees that RM is holding prescription bags in her hand.He asks what medications RM is currently taking. According toRM, she is taking only Fosamax and Nexium. Should the pharmacistrecommend calcium carbonate with vitamin D?
Case TWO: PC, a 67-year-old woman who is well known at DramsPharmacy, arrives at the store to pick up another prescriptionto treat her glaucoma. She complains to the pharmacist thatshe is frustrated with her glaucoma treatment. She is alreadyusing 3 different ophthalmic products, with a fourth beingadded today. Despite this therapy, she is not having any successin lowering her intraocular pressure. PC is concernedthat she will need to have surgery if the pressure does notbegin to reduce.
When the pharmacist inquires about PC's compliance andadministration of her eyedrops, PC is adamant that she usesher medications every day as often as the doctor prescribed.She says that she administers her eyedrops before she headsto the country club with her friends.
The pharmacist asks PC to describe how she administersthe eyedrops. PC says that she is usually in a rush to get to thecountry club, so she administers them quickly. Typically, all ofthe medications are administered within 1 minute.
Can the pharmacist recommend an improved method for theadministration of PC's multiple eyedrops?
Dr. Schlesselman is a clinical pharmacist based in Niantic, Conn.
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CASE 1: The pharmacist should recommendcalcium citrate with vitamin D,rather than calcium carbonate with vitaminD. Although vitamin D will help theabsorption of calcium, the pharmacistalso needs to consider RM's prescriptionmedications. The Nexium that RM is takingcan reduce the absorption of the carbonatesalt.
CASE 2: To prevent dilutional effects,PC should wait at least 5 minutesbetween administering the drops. If a gelsolution is administered, PC shouldadminister it last and wait even longerbetween drops.