A 40 year-old female, JW, comes into your community pharmacy with complaints of what appears to be tension headaches. She does not take any OTC medications currently. She denies any history of migraines. After further discussion JW shares with you her medical profile.
PMH:
Chronic gastritis
Hypertension
Depression
Medications
Lisinopril 10 mg 1 tab po qd
Sertraline 50 mg 1 tab po qd
Famotidine 20mg po qd prn
She has never had issues with headaches previously and hasn't tried anything yet. Which of the following would be the best recommendation to address her headaches?
A. Magnesium salicylate
B. Naproxen sodium
C. Acetaminophen
D. Excedrin
Rationale:
There are countless over the counter (OTC) medications used for pain and headaches. Headaches are one of the most common ailments that OTC pain relievers are used for. Acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) are the most common OTC pain relievers used.It is important to look at a patient's complete medical profile before making OTC recommendations. Patients view OTC medications as "safe" and therefore will often self-medicate inappropriately putting them at harm due to their various comorbid conditions. Let's evaluate the potential answers to this question and pick the best one for JW.
Answer A is incorrect: Data for magnesium in headache management is primarily for migraine prevention and not treatment of traditional tension headaches. Furthermore, with the salt being salicylate, and due to her history of gastritis, it should be avoided due to a potential increased risk of gastric complications.
Answer B is incorrect: NSAIDs are very effective for treating tension headaches with a number of OTC options available. Naproxen is an NSAID, and due to her gastritis history however, should be avoided due to increased risk of complications. NSAIDs should also be avoided in most patients with heart failure and chronic kidney disease as well as they could cause worsening of these disease states due to their impact on global prostaglandin inhibition.
Answer C is correct: Acetaminophen would be recommended in this patient due to their history of chronic gastritis. It has no contraindications based on her history, has a good safety profile at standard doses, and has good efficacy for headache management. Always evaluate complete medication profiles when recommending acetaminophen as it can be in many different OTC and Rx products which could lead to accidental hepatotoxicity.
Answer D is incorrect: While Excedrin is often used for headache management, it is primarily used for migraine treatment (marketed as Excedrin Migraine) due to containing caffeine. It would not be appropriate for JW as it also contains acetaminophen and more importantly aspirin. Aspirin similar to other NSAIDs would not be appropriate for JW due to their chronic gastritis.
Brand/Generics covered: Lisinopril (Zestril), Sertraline (Zoloft), Acetaminophen/Aspirin/Caffeine (Excedrin), Magnesium salicylate (Doans), Acetaminophen (Tylenol), Naproxen (Naprosyn or Aleve).
NAPLEX Competencies Covered:
Area 1 – Obtain, Interpret, or Assess Data, Medical, or Patient Information
1.4 - From medical records: treatment adherence, or medication-taking behavior; chief complaint, medication history, medical history, family history, social history, lifestyle habits, socioeconomic background
1.5 - Signs or symptoms of of medical conditions, healthy physiology, etiology of diseases, or pathophysiology
1.6 - Risk factors or maintenance of health and wellness
1.7 - Evidence-based literature or studies using primary, secondary, and tertiary references
Area 2 – Identify Drug Characteristics
2.1 - Pharmacology, mechanism of action, or therapeutic class
2.2 - Commercial availability; prescription or non-prescription status; brand, generic, or biosimilar names; physical descriptions; or how supplied
Area 3 – Develop or Manage Treatment Plans
3.4 - Drug dosing or dosing adjustments; duration of therapy
3.5 - Drug route of administration, dosage forms, or delivery systems
3.6 - Drug contraindications, allergies, or precautions
3.7 - Adverse drug effects, toxicology, or overdose
3.11 - Evidence based practice
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