A 75 year old man with a history of depression and hypertension visits a pharmacy to buy a decongestant and cough suppressant for a bad chest cold. The pharmacist recommends Sudafed for his congestion and Robitussin DM for his cough. Within 1 hour, his wife needed to call for an ambulance. The emergency medical services team verifies that the man takes phenelzine for depression, and atenolol for his hypertension.
For this assignment, provide the following information in a 1-page Word document:
- What is the significance of the man’s use of phenelzine, atenolol, and the OTC cold and cough medications?
- What mistake did the pharmacist make in helping the man choose OTC cough and cold preparations?
- Who is responsible for patient education of prescription and OTC medications?
- Does age play a factor in this scenario (think about pharmacokinetics)?
Expert Solution Preview
Introduction: This scenario involves a 75-year-old man with a history of depression and hypertension who developed adverse effects after taking an over-the-counter (OTC) decongestant and cough suppressant medication. The following questions relate to the significance of the patient’s medication history, the mistakes made by the pharmacist, responsibility for patient education, and the impact of age on pharmacokinetics.
1. The significance of the man’s use of phenelzine, atenolol, and the OTC cold and cough medications is that these drugs can interact and cause adverse effects. Phenelzine is a monoamine oxidase inhibitor (MAOI) used to treat depression, and it can interact with sympathomimetic agents like Sudafed, leading to hypertensive crisis. Atenolol is a beta-blocker used to treat hypertension, and it can mask the symptoms of hypoglycemia caused by the OTC cough suppressant Robitussin DM, which contains dextromethorphan. Therefore, the combination of these medications with OTC cold and cough preparations can be dangerous and require caution.
2. The mistake the pharmacist made in helping the man choose OTC cough and cold preparations was recommending Sudafed and Robitussin DM without checking the patient’s medication history or warning him of potential drug interactions. The pharmacist should have known that MAOIs and beta-blockers can interact with sympathomimetic agents and cough suppressants, respectively, and advised the patient to consult with his healthcare provider before taking any new medication.
3. The responsibility for patient education of prescription and OTC medications lies with both the healthcare provider and the pharmacist. However, ultimately, it is the patient’s responsibility to be aware of their medication history, inform healthcare providers and pharmacists of any changes, and follow instructions on medication labels and accompanying materials.
4. Age may play a factor in this scenario because pharmacokinetic changes often occur with aging, affecting the metabolism, distribution, and elimination of drugs. For example, older adults may have decreased liver and kidney function, which can impair drug clearance and increase the risk of adverse effects. Additionally, older adults may be more susceptible to drug interactions due to the cumulative effects of multiple medications. Therefore, it is important to consider age-related pharmacokinetic changes when prescribing or recommending medications to older adults.
