NAPLEX Question of the Week: Patient Counseling

This is a vital component of what pharmacists do. Today's question of the week focuses on patient counseling.

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A 28 year old caucasian female has newly diagnosed hypertension. She has been in otherwise excellent health and is only on Zyrtec 10mg daily for seasonal allergies. She presents her prescription for Micardis 40mg daily. As the counseling pharmacist, which details would be appropriate to discuss with this patient upon picking up the prescription? Select all that apply.

A. Any abrupt facial/lip swelling should prompt the patient to discontinue the agent and call a healthcare provider immediately.

B. Tablets should be stored in an amber bottle away from extreme temperatures to prevent degradation.

C. Doses should be taken with food in order to maximize absorption.

D. Micardis should be discontinued if patient is found to be pregnant to limit potential adverse effects to the fetus.

E. Caution with salt substitutes is warranted as Micardis may increase potassium concentrations. 

Answers with rationale.

The correct answers are A, D, and E. Answer A is essentially describing angioedema, which is a potential side effect of angiotensin receptor blockers. While not as common as in ACE-inhibitors, it would require immediate discontinuation as this is an absolute contraindication. Answer D is correct as ACE-I and ARBs have known teratogenic effects. For this reason, often in females of child bearing age diuretics or calcium channel blockers are often given instead of RAAS agents. Answer E is correct as written due to ARB effects on RAAS especially aldosterone. Aldosterone decreases leads to potassium increases. Answer B is incorrect as Micardis (or Micardis HCT) should be kept in foil package until just before administering due to potential of loss of potency. Answer C is incorrect as Micardis may be taken with or without food. Some medications like posaconzole suspension or Xarelto (treatment dosage of 20mg daily) require food for optimal absorption. 

Have a great weekend as you head into the final home stretch before graduation!

Dr. B

Christopher M. Bland

Clinical Professor, University of Georgia College of Pharmacy

Dr. Christopher M. Bland is a Clinical Professor at the University of Georgia College of Pharmacy at the Southeast GA campus in Savannah, GA. Dr. Bland has over 20 years of academic and clinical experience in a number of clinical areas. He is a Fellow of both the Infectious Diseases Society of America as well as the American College of Clinical Pharmacy. He is co-founder of the Southeastern Research Group Endeavor, SERGE-45, with over 80 practitioners across 14 states involved. Dr. Bland serves as Associate Editor for the NAPLEX Review Guide 4th edition as well as Editor-In-Chief for the Question of the Week. He has provided live, interactive reviews for more than 10 Colleges/Schools of Pharmacy over the course of his career.