Mary met with her local pharmacist for a yearly medication review

Mary, a 67-year-old female retiree, met with her local pharmacist for a yearly medication review. Mary is currently seeing multiple providers for chronic conditions including diabetes, osteoporosis, and hypertension. Accordingly, Mary takes glyburide (2.5 mg daily), alendronate (10 mg daily), and metoprolol (100 mg/day). During her review, Mary stated that over the last 6-8 weeks she had been experiencing severe heartburn every couple of days, along with stomach and chest pains, as well as difficulty swallowing. After further discussion of her history, it was revealed that Mary had gastric ulcers when she was in her 50’s, which were resolved following treatment with cimetidine. In addition, she had recently started taking naproxen for pain and stiffness in her hands, as suggested by her PCP.

The pharmacist suspected that the combination of alendronate and naproxen might have been causing Mary’s symptoms and contacted her PCP for a consultation. An endoscopy was ordered which showed ulcerative lesions in the mid-esophagus. Biopsy showed hyperplastic cells, and esophagitis was diagnosed. Both alendronate and naproxen were discontinued and a 4-week regimen of omeprazole was initiated. Once the esophagitis was controlled, Mary was placed on a lower dose of alendronate and advised to refrain from taking naproxen.

Discuss Coordination of Care Through a Medication Therapy Management Program (MTMP)

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