Brown Bag Consult: A Patient with Parkinson's Disease and Depression

In this series, Jill Drury, PharmD, a clinical pharmacy specialist, provides patients with "Brown Bag" consultations. Patients bring to the pharmacy their current medications and over-the-counter products, giving the pharmacist an additional resource for pharmaceutical counsel. In this video, a patient with Parkinson's disease is experiencing depression. He is a military veteran who is unsure of the medical instructions given by the VA.

Jill Drury, PharmD: My next patient is Matthew, who is a regular customer at the pharmacy. Even though he is a veteran and gets most of the medications for his chronic conditions filled at the pharmacy inside the local VA hospital, he still comes to our pharmacy, too, as it is closer to where he lives and we have a trusted patient-pharmacist relationship. He received a diagnosis of Parkinson's disease and depression about 10 months ago, and he has faced many personal ups and downs.

Hi, Matthew. How are you doing today?

Matthew, patient: Hi, Dr. Drury. I have a list of medications here and laboratory data from a recent doctor’s visit.

I was recently at the VA hospital for some appointments, and I left feeling confused and frustrated. No one listens to me. I have all these papers, and I have no idea what I am supposed to do. Instead, I just get more and more medications.

Jill Drury, PharmD: OK, well, I certainly understand and I can empathize. Let's try to figure things out today, okay? I'm going to take a look at the medication reconciliation that you just handed me, that was performed by another pharmacist at the VA, and I'm going to compare it to what I have in our pharmacy profile.

And you brought in your medications today for our brown bag session, right?

Matthew, patient: Yes, Dr. Jill. Here they are.

Jill Drury, PharmD: Wonderful. Let me look at these, and give me a minute, and I'll get back to you, okay?

(Break)

So, I'm looking over all this paper work and I see the med rec that was done by the other pharmacist, and I'm getting a little concerned because there are a lot of discrepancies. So, let's take some time to go over things, and then maybe we can clarify it with your physicians, okay?

Matthew, patient: Yes.

Jill Drury, PharmD: So, let's start by going over what I have. I have your:

• Atenolol, 25 mg, once daily
• Duloxetine, 60 mg, once daily
• OTC multivitamin, once daily
• Niacin, 500 mg, once daily at bedtime
• and Rosuvastatin, 20 mg, once daily

I do not have access to all of the records at the VA. All I have is what you've handed me today and what I have in our computer system. So, some of the information might be a little incomplete. Please correct me if you notice any changes.

What I have in your brown bag:

• Atorvastatin, 40 mg, once daily
• Carbidopa/levodopa, 25 to 100 mg, 3 times daily
• Citalopram, 40 mg, once daily
• Duloxetine, 60 mg, once daily
• Lorazepam, 1 to 2 mg, as needed
• Dietary supplement niacin, in addition to your prescription strength niacin
• Sertraline, 50 mg, twice daily
• and Ondansetron, 4 mg, as needed

Anything else that I may be missing?

Matthew, patient: Not that I know of.

Jill Drury, PharmD: Well, Matthew, I think you need some more follow-up care, and I'm happy to sit down with you and involve some of your other providers. Would you be okay with me acting as a liaison for you, so we can get you the best information and on a path to good care?

Matthew, patient: Yes, that would be great. Thank you!

Jill Drury, PharmD: Great. What I discovered during the brown bag session will hopefully be resolved by the next time we see each other.

Matthew, patient: Okay

Jill Drury, PharmD: Wonderful. Thank you for stopping in today.

Matthew, patient: Dr. Jill, I'm so glad that we can go over my medical history and medication list. Thank you very much for listening to me. Thank you very much.

Jill Drury, PharmD: You're welcome.