VA is a 24 year old female with newly diagnosed depression, who comes to your pharmacy with a new prescription for Bupropion SR 150mg at bedtime from Dr. Anthony Fleming.
DRPs:
1) Safety > Adverse Drug Reaction > Unsafe drug for patient
The use of bupropion is contraindicated in patients with a history of bulimia. This medication cannot be dispensed to this patient, therefore the doctor must be called to make him aware of this. Another antidepressant may be suggested such as fluoxetine, which will not interact with her current medications and is not contraindicated in patients with a history of bulimia.
2) Effectiveness > Dosage too low > Dose too low
This patient has inadequate blood pressure control. Her most recent blood pressure was 140/88, which is not within the goal of <140/90. Therefore, the hydrochlorothiazide could be titrated up to 25 mg PO daily.
3) Effectiveness > Dosage too low > Dosage too low
This patient has trouble sleeping even though she is taking diphenhydramine 25 mg at bedtime. The dose of diphenhydramine for patients with insomnia is up to 50 mg PO at bedtime. Consider 50 mg of diphenhydramine PO at bedtime.
4) Indication > Needs Additional Drug Therapy > Preventative Therapy
We do not know her immunization history, but the patient may be due for the following immunizations: Flu, Tetanus, HPV, and Varicella.
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