Pain Medications, Part 2

GM is a patient at your pharmacy for whom you conducted a brown bag session (see the September 2016 Brown Bag Consult^®). During the session, GM primarily focused on his recent stomach discomfort and not on his chronic pain. He told you he has a limited budget and is unhappy about his health and medications. You briefly discussed his diet and his many OTC medications, which he did not clear with his health care providers. You questioned the use of his pain medications and uncovered that GM does not actively manage his depression and hypertension. GM admitted that he has not had lab work done in more than 3 years. In addition, GM has never had any medication titrations.

A month later, GM arrives for a scheduled counseling update. Because GM qualifies for a billable medication therapy management service, you treat today’s session as an extensive follow-up to the brown bag review. Since his last visit, GM has seen his primary care provider. Now that he has re-established quality care, you have communicated with GM’s physician and team. GM was instructed to have general lab work performed. In addition, he was referred to a cardiologist to address his many symptoms.

GM’s nurse addressed your first suggestion regarding GM’s medications. His OTC esomeprazole and caffeine were discontinued. Due to cost, GM’s Movantik prescription was also discontinued, as he was ineligible for co-pay assistance. Based on the severity of some of GM’s symptoms, which included bloating, drowsiness, night sweats, and headaches, GM’s specialty care team did further testing and discovered he has serious cardiac abnormalities and uncontrolled hypertension. Despite the temporary financial setback from these discoveries, GM agrees that once he adjusts to his new lifestyle and diet, his quality of life will improve. GM tells you that, because his care team has discovered the underlying issue to his discomfort, he will no longer be spending money to buy OTC medications to treat symptoms. GM also shares with you that he has not had to overuse his pain medication after re-establishing physical therapy for his back pain.

You were also concerned about GM’s depression and ibuprofen use. GM’s nurse agreed with you that GM should stick to using only OTC acetaminophen or ibuprofen for short-term pain control when needed. The nurse discontinued the ibuprofen prescription on file at your pharmacy. The nurse consulted with the physician, and they think GM’s depression and mood swings may be seasonal and/ or related to his heart health. They provided GM with some nonpharmacologic tips before they titrate his medication.

GM expresses interest in purchasing a home blood pressure monitor and wants your suggestions. You review the available options and his blood pressure goals and evaluate his technique when using the monitor. GM says he needs a coronary angiogram and will likely need an intervention. How can you help GM prepare for the additional medication costs and lifestyle challenges he may be facing?

GM leaves the pharmacy with a positive outlook, feeling much more confident and happy knowing he has a caring health care team. You appreciate his loyalty and look forward to helping him again next month.

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!