Question

Case:

A 27 year old female patient requests counseling from her pharmacist. She approaches the counter with her hands full of dietary supplements with labelling that includes lowering blood pressure. She tells the pharmacist that the has gained over 20 pounds since March when the quarantine was imposed in Chicago. She complains of frequent headaches and sometimes her face is unusually red that started about 2 months ago. There isn’t anything that makes the headaches worse. She’s tried taking Tylenol for her headaches, but when the Tylenol wares off, the headaches are still there. She says her home blood pressure cuff says that her blood pressure has been going up but she cannot remember the numbers. The pharmacist has the equipment in the pharmacy to obtain the patient’s blood pressure which is slightly elevated (128/80). The pharmacist advises the patient to see her primary doctor. After a few minutes of hesitation, the patient says that she and her live in boyfriend have been unemployed without health insurance for almost six months and their savings is reserved to pay the rent and her current prescriptions. She does not remember their names but she gets them from this pharmacy. The patient gives the pharmacist permission to access her records. She tells the pharmacist that she would prefer to take OTC dietary supplements to lower her blood pressure until she can obtain an appointment at the free medical clinic. She asks the pharmacist which one of the products in front of her would be OK to try: Gingko, Fenugreek, Coenzyme Q10, Chromiun, Melatonin, Echinacea, Omega 3-6-9, Red Yeast Rice, Fish Oil.

Medications: Loestrin FE 1/20 po daily, Paroxetine 10 mg po daily

Allergies: None

Past Medical History: Self-reported weight gain.

Past Surgical History: None reported

Family History: Mother-none Father- unknown

Social History: (-) for alcohol, illicit drugs and tobacco Lives with her boyfriend. She also conveys that they have been primarily eating processed foods high in salt content like ramen and macaroni and cheese because they are inexpensive.

Education/Employment: Unemployed, without health insurance.

Case Analysis

1) Please write your group’s SCHOLAR-MAC response below

2) Consider the dietary supplements (DS) the patient brings to the pharmacist for discussion. Are these DSs marketed for the use for lowering blood pressure? Which would be eliminated?

3) Do the DSs being discussed have drug interactions or side effects that the patient needs to be aware of? What are these side effects?

4) Using the information from questions 1 and 2, which of these products would you recommend as safe for the patient? Explain your reasoning.

5) What lifestyle and dietary changes can you recommend to the patient to help bring down her blood pressure?

Additional References Accessed beyond the lecture material.

Answer 1

1. You need to write scholor mac response of your group

2. Coenzyme Q10, chromium, melatonin, omega 3, 6, 9, fish oil helps to reduce BP

Gingko, fenugreek, echinacea,red yeast rice can be eliminated

3. The side effects and drug interactions of dietary supplements are:

• Coenzyme Q10: side effects include stomach upset, loss of appetite, nausea vomiting diarrhoea. The drug interacts with warfarin, atorvastatin, lovastatin and diabetic drugs
• Chromium: side effects are redness, swelling and scaling of skin and drug interaction with levothyroxine
• Melatonin: side effects are sleepiness and drowsiness, drug interactions with diazepam, clonazepam, lorazepam
• Omega 3,6,9: the side effects are skin rash,burping, diarrhoea, indigestion, nausea, taste impairment. this interacts with amlodipine, aspirin, atorvostatin
• Fish oil: the side effects include belching, bad breath, heartburn, nau6,loose stools, rash and nose bleeds. It interacts with anticoagulants and anti platelet medications

4. The safe medicines for this patient are:

Coenzyme Q10: res8have shown that taking coenzyme Q10 for 3 months can decrease BP in hypertensive patients

Chromium: chromium especially niacin bound chromium can reduce BP and cardiovascular diseases

Melatonin: 2-3mg of controlled released melatonin bedtime can be taken for 4 weeks to reduce BP

Omega 3,6,9: apart from managing high BP it also have other important functions like improving heart health, managing cholesterol and triglyceride level

Fish oil: fish oil contains omega 3 fatty acids which are known to promote heart health and maintaining systolic and diastolic pressure

5. The life style changes and dietary modifications that I recommend for this patient is to stop eating processed food and have low salt diet. To do activity and exercises to maintain ideal weight, educate stress management strategies.