NMA: Nonprescription Medicines Academy

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Case Study

HG, a 32 year-old female, presents to the pharmacy complaining that she feels terrible, has a dull, deep, throbbing pain around her eyes, is achy from coughing so much, and can’t fall asleep at night because her cough and sinus pressure kept her up all night. She has difficulty completing her office work due to her symptoms. She has had these symptoms for the past 24 hours. It started with a scratchy throat and has now progressed to a cough, nasal congestion, runny nose and chills. HG says she feels warm at times, but every time she takes her temperature it is normal or even a degree or two below 98.6 degrees Fahrenheit. Her cough has been primarily a dry cough and she would prefer a liquid medication because her throat is sore. She has been drinking about three cups of chamomile tea every day, which helps soothe her throat, but hasn’t done much to relieve her other symptoms. HG informs that she has been drinking a lot of orange juice to get plenty of vitamin C to “boost her immune system.”

PmHx: none significant
ALL: NKDA

Current medications: none

1. Using the QuEST method, quickly and accurately assess HG
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, no fever
• Symptoms present for < 7 days
• Not self-treating to avoid medical care

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

• Since AM needs to be alert at work, avoid medications that can cause drowsiness during the day.
• Appropriate treatment would be to suggest a non-drowsy multi-symptom liquid product for day and a drowsy anti-histamine containing product for night to help HG sleep.
• Active ingredient/symptom management:
  
  • Acetaminophen (pain reliever/fever reducer)
  • Dextromethorphan HBr (cough suppressant)
  • Phenylephrine HCl (nasal decongestant)
  • Doxyalamine succinate (first generation anti-histamine)
• General care measures: Rest and sleep, keep hydrated, use a vaporizer or humidifier, frequently wash hands with soap and warm water

If recommending self care, talk with HG with a few counseling points (QuEST):

1. DayQuil Cold and Flu is a non-drowsy formulation that contains three active ingredients to treat all of your symptoms.
2. Take 2 tablespoonfuls (30ml) every 4 hours, do not exceed 6 doses in 24 hours
   • use the provided measuring cup to ensure accurate dosing
3. Replace nighttime dose of Dayquil with 2 tablespoonfuls (30 ml) of NyQuil
   • Replaces phenylephrine, which can keep you awake, with doxyalamine succinate, which causes drowsiness
4. Do not drink alcohol with either product.
5. Store in a safe place inaccessible to children.

When can the patient expect relief from symptoms?

• Should see some relief of symptoms within 30-60 minutes.

When should HG seek her primary care provider?

• If her symptoms get worse or last more than 7 days.
• Fever that gets worse or lasts more than 3 days.
• If she experiences
  • Redness, swelling, or a rash
  • New symptoms such as diarrhea and/or vomiting
  • A sore throat that occurs with a fever, headache, rash, nausea, or vomiting that lasts longer than 2 days.

Miscellaneous

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