Allergy Season Has Sprung!

Brown bag events for your community pharmacy patient population need not be overly time-consuming. Offering to review a patient’s medication list with him or her present can help a community pharmacist connect personally with patients. This helps reinforce the value the pharmacy team brings to patients and the community. Brown bag conversations ideally lead to quality-of-life and safety discussions that can instill patient self-responsibility for health-related outcomes.

Asthma and seasonal allergy sufferers are particularly well suited for brown bag sessions. The pharmacist is in a unique position to assist with patients’ understanding of their ongoing or sporadic allergy or respiratory condition. Pharmacists can help ensure appropriate treatment choices and understand how to help patients maximize regimen adherence. Interventions may also help to curb financial problems.

The Case

TS, a 62-year-old woman, has been a patient at your pharmacy for 2 years. TS lives down the road from the pharmacy and enjoys her daily walks outside. You have gotten to know her and her habits. You have watched her become nonadherent to certain drug regimens due to acute and chronic issues. In your latest counseling session with her, you notice that she appears short of breath, with decreased energy. She also complains about “always having a runny nose.” She speculates that a prior sinus infection is to blame.

You ask TS if she would like to participate in a brown bag session. You explain the benefits of the brown bag process, and that you will review her medications with her. This allows TS to maximize her medication use and decrease the potential for possible adverse interactions. TS schedules a time to bring in all her medications when you have overlap pharmacist coverage for support.

Upon reviewing TS’s medication profile, you find the following:

• Levothyroxine 10-mcg tablet daily every morning; prescribed by Dr. X
• Montelukast 10-mg tablet daily; prescribed by Dr. Z
• ProAir HFA 1 to 2 puffs by mouth every 4 to 6 hours, as needed (flagged for overuse and early refills for the past 4 months); prescribed by Dr. X
• Sertraline 100-mg tablet daily; prescribed by Dr. X
• Furosemide 20 mg daily; prescribed by Dr. Y
• Atorvastatin 40 mg daily; prescribed by Dr. Y

When TS comes in for her scheduled session, you notice the following additional medications in her brown bag:

• Flunisolide nasal spray, 1 spray into each nostril once daily
• Loratadine 10-mg tablets
• Diphenhydramine 25-mg capsules
• Zithromax Z-Pak, unopened, filled 4 months ago at a competitor’s pharmacy; prescribed by Dr. X
• Fluticasone/salmeterol HFA 100/50; pharmaceutical sample; no directions label
• Advil PM capsules

After reviewing TS’s medications, you realize she would benefit from a medication therapy management (MTM) session. You schedule a follow-up appointment. TS is not eligible for MTM through her insurance provider. Nonetheless, offering TS a service that is designed as a similar alternative allows you to further communicate with TS’s health care providers, obtain lab values and pulmonary function tests, and further evaluate TS’s medical goals, particularly related to her undertreated asthma. It also gives you the opportunity to offer in-depth asthma and allergy education, as requested by TS. In the meantime, you have some questions and suggestions regarding her medications:

• You offer to contact TS’s prescribers regarding her respiratory symptoms. Her shortness of breath could be related to her asthma, allergy, or cardiac issues. You wonder if an inhaled corticosteroid is the best agent for TS’s allergic rhinitis and if the directions are correct. TS tells you she has never undergone pulmonary function testing.
• TS’s levothyroxine directions instruct her to take 1 tablet daily every morning. However, when you look in the bottle, you notice that TS has been cutting the tablets in half and she has been nonadherent according to your computer system. When you ask her about this, she says she was not following directions or taking the pill in the morning. She cuts her pills in half as a cost-saving measure, and says her health care provider is unaware of her manipulation. She admits to doing this with her atorvastatin, as well. TS cannot remember the last time her cholesterol and thyroid levels were checked.
• You ask TS how long she has had shortness of breath. She explains that with the change of seasons and her outdoor exercise routine, her allergies “act up all the time.” You explain that some of her medications may have unnecessary adverse effects, such as drowsiness, and some of the medications have expired. TS admits she does not know how to use inhalers, as no one taught her. She says she always tastes the medication in her throat so they are a waste.

Dr. Drury works as a clinical pharmacy specialist in Chicago, Illinois, and Milwaukee, Wisconsin. She earned her doctor of pharmacy degree from Midwestern University College of Pharmacy. Her blog, Compounding in the Kitchen, an innovative amalgam of pharmacy and cooking, appears on PharmacyTimes.com/blogs/compounding-inthe- kitchen. Read, and enjoy!