Take the Brown Bag Challenge: Handling Stress

For many centuries, the pharmacist has been recognized as an accessible and available health care professional: the first line of health information for inquisitive patients. Not surprisingly, community pharmacists are ideal candidates for offering educational information to patients. The community pharmacist can have a strong impact on all health issues. Pharmacists can identify patients at increased risk for various diseases. Pharmacists can also help in early detection of disease.

Case: Stress

MC is a 23-year-old female and a returning customer to your pharmacy. She is a hard-working student by day, and an even harder working waitress by night. Today, MC stops into the pharmacy to refill her monthly prescriptions. You notice she seems somewhat depressed. When you ask how she is doing, she does not respond with her typical smile. Like many younger women, MC seems hesitant to discuss the issue causing her distress. Given the public setting, you choose not to press the issue. You refill her prescriptions and notice she is late refilling some of her medications. When you walk over to counsel MC, she appears upset. She explains that she has a terrible headache and cannot seem to focus. As a result, she performed poorly on a test, and it has affected her mood. You briefly explain the concept of a brown bag session. You tell MC that she would be an ideal candidate to participate in a brief review of her medication. You ask MC if she would be interested in bringing in all of her medications and going over them with you for proper use. MC is curious and is happy to have your attention. She makes an appointment to meet with you before her waitressing shift.

To quickly prepare for the session, you pull up and print MC’s pharmacy profile so you can compare it with what is in her “brown bag”:

• Norgestimate/estradiol tablets (Ortho Tri-Cyclen Lo) once daily
• Ibuprofen 600 mg every 6 to 8 hours as needed for cramps/stomach pains
• NuvaRing; 5-month-old prescription; on hold
• Fluoxetine 20 mg once daily
• Retin-A 0.04% Micro Gel, use as directed

MC arrives for her appointment. She empties her brown bag, and you note the following additional medications:

• OTC famotidine 20 mg twice daily
• Calcium carbonate 500 mg as needed
• Adult multivitamin with iron once daily
• OTC ibuprofen 200 mg as needed

As you review the medications for accuracy, MC tells you in confidence that, with her limited budget, she is not always able to seek medical advice. She appreciates being able to talk to a pharmacist at no charge. MC explains she has been under increased stress lately. School has become more demanding, and graduate school applications are looming over her head. She has been self-medicating due to her frequent headaches and stomach irritations. MC has not been maintaining a healthy diet, as she admits to eating junk food for dinner and drinking alcohol more frequently. You ask MC about her headaches. She tells you that her medications only provide temporary relief. MC’s quality of life is not what it was a few months ago. When you ask MC to describe her symptoms, she admits that her headaches and other health issues worsen before her irregular menstrual cycle. At times, nothing relieves the pain in her forehead, except for pressure and a dark room. You ask MC about her medication and health goals, and she tells you she wants relief and comfort so she can return to her daily activities.

You explain to MC that her increased stress is likely the main contributing factor to her health issues. You tell her, however, that the symptoms surrounding her menstrual cycle concern you and you would like her to follow up with her obstetrician/gynecologist. A return to healthy eating, regular exercise, and time management techniques should help reduce MC’s stress. You notice that MC seems to be spending a significant amount of her limited budget on her medications. MC asks if you could follow up with her prescribing physicians, and you assure her that you will. You explain to her that her physicians might offer discount prescription cards or generic alternatives.

You encourage MC to come to the pharmacy for additional counseling. You suggest that a community pharmacist can help manage her medications, reduce her financial burden, and, most important to MC, reduce her stress. You explain to MC that frequent communication with a community pharmacist can be a key step in preventing chronic issues.

You explain that you can also recommend OTC remedies and set up affordable vaccinations and health screenings. You emphasize to MC that communication is essential in achieving a healthy lifestyle.

Dr. Drury works as a clinical pharmacy specialist in Chicago, Illinois, and Milwaukee, Wisconsin. She earned her doctor of pharmacy from Midwestern University College of Pharmacy. Her blog, Compounding in the Kitchen, appears on www.PharmacyTimes.com.