July 2021 Interactives: Case Studies
How would you respond to these patients' questions?
Case 1: AP is a 67-year-old woman with a history of depression, gout, and hypercholesterolemia. Her primary care provider issued a prescription for doxycycline for the treatment of cellulitis. AP is concerned about stomach problems, as most oral medications cause her to experience bloating and diarrhea. She remembers that the pharmacist recently told her she can take 1 of her medications with food or milk to help minimize stomach issues. AP wants to know if she can take her new prescription for doxycycline with milk. How should the pharmacist respond?
A: Counsel AP to take her doxycycline on an empty stomach 1 hour before or 2 hours after meals. The calcium in dairy products, such as milk, can interfere with the absorption of doxycycline. Calcium ions can bind to doxycycline and form a chelate, thus reducing its absorption. This may also reduce the effectiveness of AP's cellulitis treatment.1 To be safe, she will need to change how she takes her medications for the duration of her doxycycline therapy.
Meyer FP, Specht H, Quednow B, Walther H. Influence of milk on the bioavailability of doxycyclie—new aspects. Infection. 1989;17(4):245-246. doi:10.1007/BF01639529
Case 2: JC is a 21-year-old woman who calls the pharmacy in a panic. She reports having unprotected sex with a new partner about 12 weeks ago and is concerned about possible HIV infection. JC called her primary care provider's (PCP) office to schedule an appointment for HIV testing but learned that her PCP is on vacation this week. JC is very anxious about this situation and has been having trouble sleeping. She wants to know if there is a reliable screening test she can take or if she needs to wait until her PCP returns from vacation. What advice should the pharmacist give JC?
A: Because it has been 3 months since JC had unprotected sex, she can purchase an at-home HIV testing kit, such as OraQuick. The FDA-approved saliva-based test is designed to detect antibodies to the HIV virus. Results are reported in 20 to 40 minutes, which should give JC the answers she needs without waiting for her PCP to return from vacation. If the test is positive, a health care provider should confirm the result. If the test is negative, it is likely that JC does not have HIV, assuming she followed the directions carefully.
About the Authors
Isabella Bean and Alexandra Bieniek are PharmD candidates at the University of Connecticut School of Pharmacy in Storrs.
Stefanie C. Nigro, PharmD, BCACP, CDE, is an associate clinical professor at the University of Connecticut School of Pharmacy in Storrs.