Brown Bag Consult: Managing Chronic Conditions With Pneumonia

SEPTEMBER 18, 2018

In this series, Jill Drury, PharmD, a clinical pharmacy specialist, provides patients with "Brown Bag" consultations. Patients bring to the pharmacy their current medications and over-the-counter products, giving the pharmacist an additional resource for pharmaceutical counsel. In this video, a patient with pneumonia is taking over-the-counter medications, as well as prescription drugs.

Jill Drury, PharmD: Next up, is Laurie, a relatively new customer to the pharmacy. She stopped in the pharmacy to pick up her late refill prescription for atorvastatin. I let her know about the potential misuse, and explained the concept behind brown bag sessions. ... Hi, Laurie.

Laurie, patient: Hi, Dr. Drury.

Jill Drury, PharmD: How are you today? 

Laurie, patient: (coughs and looks a little confused)

Jill Drury, PharmD: Oh, Laurie, is everything OK?

Laurie, patient: (hesitating) I thought I had the flu, but it turns out it is pneumonia. I was prescribed an antibiotic and an inhaler. But I’d still be interested in knowing about any OTC products that might help me.

Jill Drury, PharmD: Well, let's take a look at your medication profile and the medications your brought in for me today, in your brown bag, ... Great. So, let's go over the medications that I have listed for you on the computer first, and then we'll see what's in your brown bag. Sound like a plan?

Laurie, patient: Yes.

Jill Drury, PharmD: Great.
  • enalapril 40 mg daily
  • furosemide 20 mg daily, every morning
  • atorvastatin 40 mg daily, every evening
  • esomeprazole 40 mg daily
  • and metformin 500 mg twice daily
OK. Now let’s see what’s in your brown bag.

Laurie, patient: Here you go (hands the bag over).

Jill Drury, PharmD: OK. I see:
  • adult multivitamin daily
  • calcium carbonate 1000 mg daily
  • expired albuterol inhaler
  • expired clopidogrel 75 mg daily, last filled at a competitor pharmacy 2 years prior
OK. The azithromycin dosing is correct. When was the last time you had your cholesterol and glucose checked?

Laurie, patient: I can’t remember the last time I had laboratory work performed to check my cholesterol or glucose levels. But I will ask to have those checked when I go for my follow-up. I have been monitoring my blood pressure more frequently at the pharmacy, and I have questions about diet and goals. Also, I have a cardiac stent, I smoke a few cigarettes each day, and I’m not seeing a cardiologist right now.

Jill Drury, PharmD: Well, hearing that concerns me. I'd like to sit down with you and possibly explore more counseling and more frequent interactions between us. Would you be interested in a medication therapy management session?

Laurie, patient: Yes, I'd like that.

This is a way that I can teach you how to take a reliable blood pressure reading at home and help you follow up with a cardiologist, and we can talk about some of those expired medications that you gave me in your brown bag. Does that sound like a good plan?

Laurie, patient: Yes, thank you.

Jill Drury, PharmD: Why don't we work to set up some more time together, where we can talk about a heart-friendly diet, in addition to going over your medications and some of those expired medications that I noticed in your brown bag. Is that a plan?

Laurie, patient: That sounds great. Thank you!

Jill Drury, PharmD: My pleasure!

Click to watch Brown Bag Consult: Managing a Patient with Pneumonia

Click to read Understanding the Importance of Pnuemococcal Disease Prevention in Patients with Diabetes.