May 2021 Interactives: Case Studies
How should pharmacists help these patients?
Case 1: New mom SN comes to the pharmacy counter with CN, her 6-month-old daughter who started teething this week. SN is concerned that CN is a little more irritable and crying more frequently because of the pain. SN wants to know if she can give CN Orajel that she used for herself after a root canal. While looking at the ingredients on the package label, the pharmacist notices that the active ingredient is benzocaine 10%. How should the pharmacist respond to SN?
Answer: The pharmacist should advise against using Orajel to treat CN's teething pain. Although adults can still use Orajel, the FDA has recommended against the use of products containing benzocaine by children younger than 2 years because of the risk of a rare by potentially fatal blood condition called methemoglobinemia.1 Methemoglobinemia has been reported with benzocaine concentrations as low as 7.5%. The American Academy of Pediatrics does not recommend treatment with any teething creams because they usually wash out of the baby's mouth within minutes. Instead, they recommend giving children a teething ring chilled in the refrigerator or gently rubbing the child's gums with clean fingers to relieve teething symptoms.2
1. Risk of serious and potentially fatal blood disorder prompts FDA action on oral over-the-counter benzocaine products used for teething and mouth pain and prescription local anesthetics. FDA. Updated May 31, 2018. Accessed March 22, 2021. https://www.fda.gov/drugs/drug-safety-and-availability/risk-serious-and-potentially-fatal-blood-disorder-prompts-fda-action-oral-over-counter-benzocaine
2. Teething: 4 to 7 months. HealthyChildren.org. Updated October 6, 2016. Accessed March 22, 2021. https://www.healthychildren.org/English/ages-stages/baby/teething-tooth-care/pages/Teething-4-to-7-Months.aspx
Case 2: LD is a 70-year-old woman who calls the pharmacy with questions about the shingles vaccine. She wonders whether she needs the vaccine because she does not recall having had chicken pox as a child.
Answer: Chicken pox and shingles are caused by the varicella-zoster virus. Individuals can only get shingles if they have already had chicken pox. Those who never had chicken pox and have not received the varicella vaccine but are exposed to an individual with shingles can develop chicken pox. Once an individual has had chicken pox, he or she is susceptible to contracting shingles if exposed to the virus again. Encourage LD to receive the shingles vaccine, preferably Shingrix, because she is older than 50 years.1 Shingrix is more effective at preventing shingles than Zostavax and provides and provides longer immunity.2 LD should receive a 2-dose series of Shingrix, with doses spaced 2 to 6 months apart. Alternatively, LD can be tested for immunity to the varicella-zoster virus. If she tests negative, she should get the chicken pox vaccine.
1. Shingles vaccination. CDC. Updated January 25, 2018. Accessed March 23, 2021. https://www.cdc.gov/vaccines/vpd/shingles/public/shingrix/index.html?CDC_AA_refVal=https%3A3A%2F%2Fwww.cdc.gov%2Fvaccines%2Fvpd%2Fshingles%2Fpublic%2Findex.html
2. Tricco AC, Zarin W, Cardoso R, et al. Effi cacy, eff ectiveness, and safety of herpes zoster vaccines in adults aged 50 and older: systematic review and network meta-analysis. BMJ. 2018;363:k4029. doi:10.1136/bmj.k4029