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Case Study

MP, a 67 year-old female, presents to the pharmacy to pick up her simvastatin (Zocor®) prescription. While she is at the check-out counter, she pulls the pharmacist to the side and states that she has been constipated for 2 days. MP suffers from constipation a few days each month and wants to take something to keep her regular, but with all of the different laxatives and supplements, she is left confused in the aisle. She states she wants something safe to use, long-term, and natural. She has daily bowel movements, but they are difficult to void. She informs that she tried to eat more greens but she just can’t stand the taste of them. When MP has been constipated in the past, she’s used Senokot S® (docusate/sennosides). Senokot S® worked but she experienced painful cramping and sudden bowel movements. Her provider informed her using a laxative everyday can be harmful; therefore, MP is looking for a more safer alternative. She wants something that she can use long term for constipation prevention rather than treatment of each episode. MP has discussed this with her provider and they recommended that she eat more leafy greens, high-fiber cereals and prunes. Her provider also said she needed to get more exercise and drink more fluid. She states again, she just wants a treatment that is realistic and easy to use and as she is not ready to extensively change her diet and start an exercise regimen.

PmHx: Hypercholesterolemia
ALL: NKDA

Current medications: simvastatin (Zocor)

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

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

• No severe symptoms
• Wants to use appropriate laxative for long-term use

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

• Since this patient wants something she can use long-term that prevents constipation and maintains regularity, a bulk forming fiber laxative should be used.
• Psyllium husk is the only fiber supplement that lowers total cholesterol and LDL.
• Appropriate treatment would be to suggest psyllium husk (Metamucil)
• General care measures:
• • Drink fluids
  • Incorporate foods high in fiber into your diet
  • Stay active

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

1. Start with one dose per day (to minimize side effects like bloating and diarrhea) and gradually increase doses on a weekly basis to reach 3 doses per day.
2. Mix one rounded teaspoonful in at least 8 ounces of liquid.
3. Take this product at least 2 hours before or 2 hours after you take other oral medicines.

When can the patient expect relief from symptoms?

• It may take up to 3 days to obtain constipation relief.

When should MP seek her primary care provider?

• AM should call her provider if she experiences constipation that lasts longer than 7 days.
• If she develops severe stomach pain, cramping, nausea or vomiting, rectal bleeding or an itchy skin rash she should contact her provider.

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