Ensuring Heart Health in a Young Woman

Community pharmacists can have a positive impact in terms of encouraging patients to be proactive about their health. During February, as we celebrate all things red, warm, and loving, it is a good time to remind patients to mend their neglected hearts. By simply asking patients when they had their last blood pressure or cholesterol reading, you are opening a heart-healthy dialogue. Pharmacists can aid in early detection of cardiovascular issues by focusing on patients, especially women, who are at increased risk for silent diseases. By virtue of their patient access, pharmacists provide frontline health education and screenings to many patients who do not even know they are in need.

The Case

JD is a 32-year-old woman and returning customer to your pharmacy. She is a hard-working nurse by day, and an even harder-working mother of 2, by night. Today, JD stops into the pharmacy to refill her monthly prescriptions. You notice she seems somewhat stressed and tired. When you ask how she is doing, she does not respond with her typical smile. Like many younger women, JD seems hesitant to discuss the issue that is causing her distress. Given the active public setting, you choose not to press the issue.

You refill her prescriptions and notice she is late refilling some of them. When you approach JD to counsel her, she appears anxious. She explains she has a terrible headache, cannot seem to focus, and has increased perspiration. As a result, she is sleep deprived and having trouble finding a positive work-life balance.

In response, you briefly explain the concept of a brown bag session. You tell JD that she would be an ideal candidate to participate in a brief review of her medications and lifestyle. You ask JD if she would be interested in bringing in all of her medications and reviewing their proper use with you. JD is curious and happy to have your attention. As a nurse and mother, who is busy caring for others, she admits she has not been good at taking care of herself. JD sets up an appointment to meet with you before her next work shift.

To quickly prepare for the session, you print JD’s pharmacy profile so you are able to compare it to what is in her brown bag:

• Norgestimate/estradiol tablets (Ortho Tri-Cyclen) once daily
• Ibuprofen 600 mg every 6 to 8 hours, as needed for pain
• NuvaRing; prescription dated 5 months earlier; on hold
• Fluoxetine 20 mg once daily; never filled
• Alprazolam 0.5 mg once daily, as needed
• Albuterol inhaler, as directed, for exercise- induced asthma

JD arrives for your appointment. When she empties her brown bag, you notice additional medications:

• OTC famotidine 20 mg twice daily
• OTC vitamin D
• Adult multivitamin once daily
• OTC brand Advil (ibuprofen) 200 mg, as needed
• OTC acetaminophen 500 mg, as needed

As you review the medications for accuracy, JD tells you in confidence that, as a nurse, she does not always seek medical advice and tends to self-medicate. She appreciates being able to talk to a pharmacist, at no charge, and without judgment. JD explains she has been under increased stress over the past few months and relies more on her alprazolam. She feels there is a stigma when it comes to taking her prescribed antidepressant. Her work has become more demanding because her unit is short-staffed. She is also trying to balance her new family schedule because her children need extra help with their homework in the evening. You remind JD that there is nothing to be ashamed of and encourage her to ask for help and learn how to accept it. She agrees to follow up with her health care provider about properly managing her stress pharmacologically and nonpharmacologically.

JD confesses that she has not been maintaining a healthy diet for her and her family. Her weight has increased since she has been eating and serving fast food for dinner. JD has also been drinking more alcohol to unwind in the evening.

You ask her about her headaches and sleep quality. She tells you her medications only provide temporary relief, and she has never discussed this in detail with her health care providers.

JD’s quality of life has clearly declined in the past few months. You ask her about her medication and health goals, and she tells you she wants relief and comfort so she can be at her best when caring for her family and tending to daily activities. You explain to JD that her increased stress and lack of sleep are likely the contributing factors to her health issues. You tell her, however, that the symptoms surrounding her menstrual cycle concern you, and that you would like her to follow up with her obstetrician/ gynecologist. A return to healthy eating, regular exercise, and time management will help reduce JD’s stress.

You also discover that JD’s blood pressure is severely elevated, and she has never had her cholesterol checked. JD does not regularly see a primary health care provider. At your suggestion, she makes a few follow-up appointments with your pharmacy’s in-house clinic to have her blood pressure and cholesterol evaluated.

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!