NMA: Nonprescription Medicines Academy

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Case Study

CL is a 25 year old white female who presents to the pharmacy looking for “something to settle her stomach.” She is complaining of stomach upset that usually begins upon her getting out of bed in the mornings and often persists throughout the day. On some days she suffers from a painful headache also. CL also has constipation on a regular basis. She states that her symptoms occur daily and began about 1 month ago. She doesn’t notice whether food triggers her episodes. Upon further questioning, CL explains to the pharmacist her lower abdomen is where she feels the most discomfort. She discussed her symptoms with her mother a week ago, who advised her to begin Fiber supplements. CL has tried Metamucil® but it did not relieve the persistent bloating or discomfort and the fiber supplement made her symptoms worse. She also tells you she has not had a menses in three months, but she attributed it to her birth control.

PmHx: None
ALL: NKDA

Current medications, including OTC and herbals: Yasmin®, Metamucil

1. Using the QuEST method, quickly and accurately assess CL
2. Using the SCHOLAR-MAC method, classify the pertinent information illustrated in this case

Using the QuEST method, establish if this patient is an appropriate self care candidate. Provide a rationale:

• No severe symptoms
• Not self-treating to avoid medical care

If this patient is a self care candidate, suggest appropriate strategies (QuEST) for CL. Include supportive measures with your recommendations:

• CL is experiencing many symptoms that can be attributed to early pregnancy.
• An appropriate treatment option is a Clearblue easy pregnancy test to determine if she is pregnant.
• Clearblue Easy® works by detecting amounts of human Chorionic Gonadotrophin (HCG) in your urine. HCG is a pregnancy hormone that is produce during early pregnancy, usually reaching its peak around 7-12 weeks of pregnancy.
• General care measures:
  
  • While testing keep the absorbent stick pointed downwards.
  • If testing in your urine stream, be careful not to allow any urine to get on the rest of the stick. You may also test by testing a sample of your urine in a clean dry container.
  • If too much or too little urine was applied you should retest using a new test.

If recommending self care, talk with MB regarding 2-3 counseling points (QuEST)

1. Clearblue® Easy can be taken any time of the day, but I suggest you test first thing in the morning.
2. If your period is overdue, test again in 3 days time. If this test gives you a ‘Not Pregnant’ result and you still have not had your period, I recommend you go see your doctor.
3. Ectopic pregnancy and ovarian cysts can give you misleading results. Also, if you have recently been pregnant, even if you did not conceive, you may get a false “Pregnant” result.

When can the patient expect relief from symptoms?

• The sudden rise of hormones in a body during pregnancy can cause headaches. The headaches may occur throughout the entire pregnancy. There is no finite timeline as to when this symptom will end.

When should MB seek her primary care provider?

• If CL test positive for pregnancy, she should contact her provider immediately and seek further advice.

Miscellaneous