CASE 1: Pediatric Vaccine Recommendations
CR is a 7-month-old boy who is brought to the pharmacy by his mother. She informs the pharmacist that she received her annual flu vaccine a week ago and is now considering whether CR should also receive the vaccine. She has concerns because she read online about potential links between vaccines and autism.
Q: What counseling points should the pharmacist provide to her?
A: The pharmacist should recommend that CR receive the influenza vaccine because it is recommended for everyone aged 6 months and older without medical contraindications. Children younger than 5 years—particularly those younger than 2 years—are at an increased risk of severe complications from influenza, including pneumonia and hospitalization.1 According to the CDC, between 7000 and 26,000 children younger than 5 years are hospitalized annually in the US due to influenza.2 Additionally, data from multiple large-scale studies have shown no link between vaccines and autism. Annual flu vaccination reduces the risk of flurelated hospitalization by 41% to 75% in children, making it a crucial preventive measure.3,4
CASE 2: Antipyretics and Analgesics
LK is a 65-year-old woman with a medical history of major depressive disorder (MDD) and a previous gastrointestinal (GI) bleed. She visits the pharmacy seeking an OTC medication to alleviate fever and body aches. LK also reports that she takes escitalopram (Lexapro; AbbVie Inc), a selective serotonin reuptake inhibitor (SSRI), for her MDD.
About the Authors
Alyssa Ureta, PharmD, is a PGY-1 pharmacy resident at Atlantic Health System in Morristown, New Jersey.
Deanna Fox, PharmD, is an acute care clinical pharmacist in emergency medicine and clinical care at Geisinger.
Kylie Helfenbein, PharmD, is a critical care clinical pharmacist at Overlook Medical Center in Summit, New Jersey.
Rupal Patel Mansukhani, PharmD, FAPhA, NCTTP, is a clinical professor of pharmacy practice and administration at Ernest Mario School of Pharmacy at Rutgers, The State University of New Jersey, in Piscataway and a transitions-of-care clinical pharmacist at Morristown Medical Center in New Jersey.
Q: What should the pharmacist recommend to LK?
A: The pharmacist should inform LK that there are 2 common OTC options for treating fever and pain: nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, and acetaminophen. Although both NSAIDs and acetaminophen are effective at relieving pain and reducing fever, NSAIDs are associated with an increased risk of bleeding, particularly in individuals with a history of GI bleeding or those taking SSRIs.5 The combination of NSAIDs with SSRIs heightens the risk of GI bleeding due to the potential for platelet function interference. Considering LK’s history of GI bleed and her use of an SSRI, the pharmacist should recommend that she avoid NSAIDs to prevent potential complications. Instead, an acetaminophen-based product is a safer option for managing her symptoms. Acetaminophen effectively reduces fever and alleviates pain without increasing the risk of GI bleeding, making it the appropriate choice for LK, given her health concerns and medication regimen. The pharmacist should also remind LK to follow the dosing instructions carefully to avoid acetaminophen overuse.
CASE 3: Cough Medicine and Decongestants
FN is a 58-year-old man with a medical history of hypertension. He visits the pharmacy, presenting with nasal congestion and a productive cough. FN is looking for an OTC medication to help relieve his symptoms.
Q: What recommendations should the pharmacist provide to FN?
A: The pharmacist should explain to FN that although common OTC decongestants such as pseudoephedrine and phenylephrine can be effective for relieving nasal congestion, they can also raise blood pressure and potentially worsen hypertension.6 Because FN has high blood pressure, the pharmacist should recommend using cold medications specifically designed for patients with hypertension, such as Coricidin HBP (Bayer). This product is formulated without ingredients that can elevate blood pressure, making it a safer choice for FN. For FN’s productive cough, the pharmacist should suggest a guaifenesin-based expectorant, which helps thin mucus, making it easier to cough up and clear from the airways. The pharmacist should also advise FN to avoid cough suppressants containing dextromethorphan, as these can inhibit the clearing of mucus, which may prolong his cough.7
CASE 4: Influenza Antivirals
TF is a 24-year-old man with a medical history of sickle cell disease. He comes to the pharmacy, presenting with fever, body aches, and a sore throat, which began the previous evening. TF is seeking an OTC medication to alleviate his symptoms.
Q: Given TF’s underlying condition, what should the pharmacist recommend for TF?
A: The pharmacist should advise TF to contact his primary care provider as soon as possible. Individuals with blood disorders such as sickle cell disease are at a higher risk of developing complications from influenza. Although OTC medications may help alleviate symptoms such as fever and body aches, they will not address the underlying infection or prevent complications. TF’s primary care provider may consider prescribing an antiviral medication, such as oseltamivir (Tamiflu; Genentech, Inc), which is most effective when started within 48 hours of the onset of influenza symptoms. Antiviral treatment can help shorten the duration of illness and reduce the likelihood of severe complications, including hospital admission. The pharmacist should emphasize the importance of seeking medical attention rather than relying solely on OTC products.8
REFERENCES
1. Committee on Infectious Diseases. Recommendations for prevention and control of influenza in children, 2024-2025: policy statement. Pediatrics. 2024;154(4):e2024068507. doi:10.1542/peds.2024-068507
3. Institute of Medicine Immunization Safety Review Committee. Immunization Safety Review: Vaccines and Autism. National Academies Press; 2004.
4. Bixby AL, VandenBerg A, Bostwick JR. Clinical management of bleeding risk with antidepressants. Ann Pharmacother. 2019;53(2):186-194. doi:10.1177/1060028018794005
8. Uyeki TM, Bernstein HH, Bradley JS, et al. Clinical practice guidelines by the Infectious Diseases Society of America: 2018 update on diagnosis, treatment, chemoprophylaxis, and institutional outbreak management of seasonal influenza. Clin Infect Dis. 2019;68(6):e1-e47. doi:10.1093/cid/ciy866
