EJ is a 55 year old male who comes to your pharmacy with a new prescription for Carvedilol 25mg BID.
He has a past medical history significant for hypertension, GERD, and hyperlipidemia. He has no known drug allergies. Of note, the patient has been complaining of a persistent dry cough for the past few months that will not go away.
FEEDBACK
1) Dose too high: Wrong dose: Patient has a prescription for Carvedilol 25mg BID which is the therapeutic dose of Carvedilol, but too high to initiate on. The patient must be started on 6.25mg BID for 1-2 weeks, then increase to 12.5mg BID for 1-2 weeks, then increase to 25mg BID as tolerated by the patient.
2) Inappropriate adherence: Does not understand directions: Patient’s last refill of HCTZ is late. this means he has been missing doses of his medication. Counsel patient on proper techniques to make sure he takes his medicine on time (pill boxes, reminders, etc.)
3) Adverse drug reaction: Undesirable effect: Patient’s lisinopril is causing ACE-inhibitor induced cough. Suggest switching to an ARB with appropriate dose.
4) Needs additional therapy: prophylactic therapy: flu shot and Tdap for vaccines. this patient is also a candidate for Aspirin 81mg daily to reduce his risks for myocardial infarction (USPSTF: Men 45-79 years old). The benefits outweigh the risk given the patient’s history for HTN/HPL, and not significant PMH for bleeding events.
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