Take the Brown Bagging Pharmacist Challenge: Gastrointestinal Issues

Understanding the characteristics of gastrointestinal issues, the challenges of patient care, and the available treatment options is essential to providing comprehensive patient care in pharmacy.

Gastrointestinal (GI) disorders are the reason for many visits made to health care providers, hospitals, and community outpatient care centers in the United States. Conditions involving symptoms such as heartburn, diarrhea, and constipation can be challenging to properly diagnose and treat. The diagnostic evaluations performed on patients can involve a variety of invasive procedures that some patients are not willing to undergo. For many, the topic itself can be uncomfortable, and ultimately, that feeling may prevent an individual from seeking professional care.

Patients also have the option to bypass the health care system as a whole with the opportunity to self-diagnose and treat with the surplus of OTC medications available. Many do not seek help until the symptoms become unbearable, and by that time complications may have occurred. An understanding of the basic characteristics of GI issues, the challenges behind patient care, and the available treatment options is essential to providing the best comprehensive patient care in the pharmacy.

KR is a 35-year-old female who is a returning customer to your pharmacy. She is a hard-working teacher by day and a waitress by night. A self-proclaimed “foodie,” she is always talking to you about the new hot spots in town during your counseling sessions. She loves to experiment with new foods, flavors, and recipes. Her energy and passion for life are astounding.

Today, KR stops in the pharmacy to pick up her early refill prescription for her albuterol inhaler. You notice she is not her usually energetic self and when you ask how she is doing, she doesn’t give you her typical thumbs up. She seems shy about the issue so you do not press. You counsel her on the albuterol and quickly explain the concept behind a brown bag session. You tell her that since she suffers from asthma, has had past compliance issues, and is on multiple medications, you think she would be an ideal candidate to participate in a brief review. You ask KR if she would be interested in bringing in all of her medications and going over them with you for proper use. KR is curious and happy to have your attention. She sets up an appointment to meet with you tomorrow.

To prepare for tomorrow’s session, you pull up KR’s pharmacy profile so you are able to compare it with what is in her brown bag:

• albuterol inhaler 1 to 2 puffs every 4 to 6 hours as needed*
• fluticasone propionate 250 mcg/salmeterol 50 mcg Diskus twice daily*
• norgestimate/estradiol tablets (Ortho Tri-Cyclen Lo) once daily**
• ibuprofen 600 mg every 6 to 8 hours as needed for cramps/stomach pains**

* prescribed by pulmonologist

** prescribed by OB/GYN

KR arrives the next day for your appointment. She empties her brown bag and you notice these additional medications:

• OTC famotidine 20 mg twice daily
• calcium carbonate 500 mg as needed
• adult multivitamin with iron once daily
• OTC omeprazole 20 mg once daily
• OTC ibuprofen (Advil) 200 mg as needed

As you review the medications for accuracy, KR tells you in confidence that with her limited budget and insecurity about her GI symptoms, she is not always able or willing to seek medical advice. You ask her about those symptoms, and KR claims the medications only seem to provide temporary relief. Her quality of life is not what it was a few months ago. Yet, KR expresses that she prefers to browse the pharmacy aisles in private and make treatment decisions on her own. To make her decisions, she uses the Internet and the information she hears from doctors on television.

You ask KR about her goals, and she tells you she just wants quick relief and comfort so she can eat and drink whatever she wants like a “normal” person. You and KR briefly discuss her diet and your concerns. KR is on many OTC medications and has not disclosed these to her providers. Moreover, she has a limited budget and seems to be spending a significant amount of money on her medications. It is also important to note that KR has never been officially diagnosed with a GI issue, but it is clear she needs to be referred for proper treatment. KR does not have a regular primary care physician but does accept a list of providers you recommend for consult. Because of your brown bag session, KR is very interested in participating in the MTM session you offer as follow-up.

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.