Case Studies

Pharmacy Times
Volume 0

Dr. Schlesselman is an assistant clinical professor at the University of Connecticut School of Pharmacy.


AJ, a 56-year-old man,brings a new prescription tobe filled at By-the-BayPharmacy. The prescriptionis written for zonisamide 100mg daily for 2 weeks, to beincreased to 200 mg daily for3 weeks, and then increasedto 300 mg daily.

While the pharmacist isentering the prescription, AJ asks that she also refill his prescriptionfor an epinephrine self-injector. The pharmacistreviews AJ's profile and notes that he has numerous documentedmedication allergies, including hydrochlorothiazide,furosemide, celecoxib, and sulindac.

AJ expresses concern that this new medication will causean allergic reaction as well. He explains that the physicianhas not been able to determine a link between the medicationsto which he is allergic, so AJ keeps epinephrine available"just in case." To AJ's surprise, the pharmacist says thatshe would like to contact the physician about this new medicationhe prescribed because she suspects that AJ will havean allergic reaction. AJ wants to know how the pharmacistcan know that when he has not taken a dose yet.

Why does the pharmacist suspect the zonisamide willcause an allergic reaction?


CG, a 45-year-old pharmacist,made a serious mistakewhile dispensing a prescriptionto a young child, due tohis heroin intoxication.

CG has recently completeda rehabilitation program.Now he wishes to return towork. As part of the criteriaestablished by the board of pharmacy for reinstatement ofCG's pharmacist license, he must undergo drug testing priorto returning to work and every 6 months.

CG is brought before the state board of pharmacy for ameeting pertaining to his recent drug test. The head of theboard explains to CG that his recent drug test was positivefor morphine, codeine, and 6-acetylmorphine. He questionsCG about the results, and CG presents a note from the doctorat the rehabilitation center explaining that CG is currentlytaking morphine and ibuprofen for chronic back pain.

The head of the board believes CG's claim of using onlyprescription medications. One of the other board membersis not convinced.

Which board member's beliefs are corroborated by thetest results?



The pharmacist is concerned because zonisamide is a sulfonamide. All of the medications to which AJ is allergic contain asulfa moiety, often the cause of allergic reactions.


The other board member?s beliefs are corroborated by the test results. If CG was using only morphine, his urine drug test would be positivefor morphine and codeine. Morphine is not metabolized to 6-acetylmorphine. The presence of 6-acetylmorphine is indicative of heroin use.

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