Case 1: Headache Pain
Q: AS, a 44-year-old man, presents to the pharmacy with a headache that has been bothering him for the past few hours. He describes the pain as a throbbing pressure on his forehead, rating it 3 out of 10 in severity. He has no history of migraines and occasionally experiences tension headaches, but it has been over a year since he last had a headache. He reports no nausea, vomiting, sensitivity to light, or changes in vision. AS reports that he has not been sleeping well lately due to work stress, and he has recently decreased his salt and caffeine intake due to elevated blood pressure. Since making this change, his blood pressure has been approximately 115/70 mm Hg to 120/70 mm Hg. He is currently taking a multivitamin and dabigatran 150 mg twice daily because of a recent deep vein thrombosis, but he says he only has to take this for 1 more month. What recommendations do you have for AS?
A: Based on AS’s answers to the questions about his headache, it can be determined that AS has a tension headache that may be secondary to his decrease in caffeine intake, increased stress, and insufficient sleep. The primary therapeutic goal for AS at this time is to alleviate the pain, and his overall goal is to address the risk factors that may contribute to future headaches. Options for OTC treatment include acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen. Because AS does not have any contraindications to self-treatment but does have a potential drug-drug interaction with NSAIDs and dabigatran, acetaminophen is his optimal choice.
AS can be advised to take acetaminophen 500 mg every 4 to 6 hours, with a maximum of 4000 mg in 24 hours as needed. He should expect to experience pain relief approximately 30 minutes after the first dose. In addition, it is important to discuss how he is addressing the stressors in his life, ensuring proper hydration, and increasing sleep duration and quality. If his symptoms worsen or concerning symptoms arise, he should be advised to seek medical attention.1,2
Case 2: Joint Pain
Q: MM, a 59-year-old woman, visits the pharmacy complaining of worsening joint pain in her right knee over the past few months. She reports difficulty walking and getting up from a seated position and is seeking a recommendation for pain relief. MM was diagnosed 2 years ago with osteoarthritis in both knees and is currently taking amlodipine 10 mg daily, atorvastatin 20 mg daily, and fluoxetine 20 mg daily. She occasionally uses acetaminophen 500 mg but finds that she is not getting adequate relief. What else can MM do or take before taking a prescription medication?
A: Although acetaminophen can be an option for the pain, she is taking a low dose. One option could be to increase the dose to 1000 mg every 4 to 6 hours or use the arthritis formulation and take 2 caplets every 8 hours. Considering her hypertension, a topical NSAID would be a first-line option. Additionally, MM should be advised to include moderate exercise in her routine as a nonpharmacologic option.3,4
