The technician at the drop-off counter referred a patient who was complaining of high blood pressure to the pharmacy clinic for a blood pressure check while her prescriptions were being filled. The 79 year old female patient came over to the pharmacy clinic for a blood pressure assessment. She reported that her at home readings were around 200/100 mmHg. We asked her to have a seat while we completed our pre-hypertension assessment questions. She shared that she had been experiencing these elevated readings for about 3 days and they were accompanied by a “funny” feeling that she further described as being headaches and dizziness. She explained to us that when she first saw these readings at home, she contacted her primary care provider and he informed her to wait another 2 hours, check her blood pressure again, and if they were continually elevated then she should consider visiting the emergency department.
Her complete medication list was as follows:
Anxiety | Alprazolam 0.5 mg Take one tablet by mouth once daily |
GERD | Omeprazole DR 20 mg Take one capsule by mouth once daily |
Chronic Pain | Cyclobenzaprine 10 mg Take one tablet by mouth three times daily Tramadol 50 mg Take one tablet by mouth twice daily |
Supplements | Potassium Chloride ER 20 mEq Take one tablet by mouth once daily Vitamin D 1.25mg Take once capsule by mouth once weekly |
Diabetes | Metformin HCl ER 24HR 500 mg Take one tablet by mouth with evening meal |
Seasonal Allergies | Cetirizine 10 mg Take one tablet by mouth once daily |
Hypertension | Losartan Potassium 100 mg Take one tablet by mouth once daily Metoprolol Succinate ER 24HR 25 mg Take one tablet by mouth once daily |
Hypothyroidism | Levothyroxine Sodium 100 mcg Take one tablet by mouth once daily |
Upon further interviewing, the patient admitted to drinking a small amount of caffeine, and significant stress in her life as of lately. She also reported that she had taken her usual medication regimen of Losartan 100mg, and Metoprolol Succinate 25mg. She also let us know that she had previously been taking Amlodipine 5mg, but it was discontinued in the last few months by her cardiologists after the patient had brought up concerns of pill burden.
In our clinic, her blood pressure reading was 190/110 mmHg in the right arm and 180/90 mmHg in the left. Once we verified these readings and confirmed her symptoms, my preceptor, Dr. Nicole Pezzino, encouraged the patient to report to the emergency department as a precaution due to the concerning symptoms of persistent headache, dizziness and ‘funny feeling’. This was met wit
h some hesitation from the patient. Nicole then suggested that we call the patient’s primary care provider. After sharing the situation, he suggested that the patient instead split her losartan dose in half to take twice daily, and double her metoprolol dose and take Metoprolol Succinate 25mg twice daily.
He also prompted the patient to come in for a same day visit to see him to check in as well. After this recommendation, we sat and educated the patient on signs and symptoms of stroke and heart attack as well as explaining her new dosing of blood pressure medications on the recommendation of her PCP. We then planned a follow-up over the phone after her appointment.
Notably, the patient’s primary care provider stated over the phone: “You’re the best pharmacist for sitting with her and talking with her.. Thank you for taking care of her, this means a lot to me that she’s in such good hands. Here’s my cell phone number, call me any time!”
Later that afternoon we called to check in and she reported that she was feeling much better and when her blood pressure was checked in the office, it had started to lower to 165/70 mmHg. She thanked us for the time we had spent with her and told us how much we helped her anxiety involved with the situation and how much we educated her. We assured her that we are always there to help.
She later stopped in again to tell us how grateful she was that we had taken the time to explain all of her medication changes and how big of a help that was to her.
It was a pleasure to be involved in the care of a patient who was so appreciative and confident in the care that a pharmacy team can provide. As a student about to enter the field of pharmacy, it was an extremely fulfilling experience to be able to help a patient to the extent that we were able to.
Written by: Allie Peet, PharmD Candidate 2022
Community APPE Rotation at Weis Markets in Schnecksville, PA with Nicole Pezzino