Welcome to
U.S. Pharmacist's
new monthly communication that presents interesting case studies and asks pharmacists for their input. In about 2 weeks, you will receive a follow-up email with selected responses, as well as the author's own answer.

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OTCs for Elderly
Man With Nausea?

JK is an 88-year-old man picking up his monthly prescriptions at your pharmacy with the assistance of his daughter. JK's daughter asks you to make a recommendation for an over-the-counter treatment for nausea for her father.

She explains that JK has been complaining of nausea for the last several months and has lost 8 pounds (currently weighs 134 pounds) due to his recent lack of appetite. Upon review of JK's profile, you find that he is currently receiving the following prescription medications from your pharmacy: carvedilol 6.25 mg BID; lisinopril 10 mg QD; furosemide 20 mg QD; KCl 20 mEq QD; tamsulosin 0.4 mg QD; donepezil 23 mg QD; and citalopram 20 mg QD.

Upon further discussion with JK and his daughter, you verify that JK was diagnosed with heart failure 12 years earlier and has a history of benign prostatic hyperplasia, which is currently well controlled with tamsulosin. JK has been taking citalopram for approximately 4 years, which was initiated shortly after the passing of his wife. According to your records, JK was started on donepezil 3 months prior. JK's daughter explained that he was having difficulty remembering the names of his extended family members and the medication was initiated at the recommendation of his primary care physician. In addition to the list above, JK is currently taking a senior multivitamin daily and fills all of his medications at your pharmacy. JK's daughter also reports that he has an appointment scheduled with his cardiologist next week. JK has had several bouts of syncope lately and his daughter, who is a nurse's aide, noted that his heart rate varies between 40 and 55 beats per minute.

Based on the above information, what recommendations would you have for JK and his daughter?

Joshua J. Neumiller, PharmD, CDE, CGP, FASCP
Assistant Professor
Washington State University

Click here... Send your input to casestudychallenge@uspharmacist.com by April 16, 2012, and include the words "Case Study" and the date of this email in the subject line. Also, please include your last name and first initial along with your pharmacy degrees and city and state. (Or, let us know if you would like to remain anonymous in the event we choose your answer for the follow-up email.)