Name: Caitlyn Wegner

Community Pharmacy Project Part 1

Date: 02/16/2020

1. Patient’s initials, race, gender, and age: BR, Caucasian, Female, 23

2. List of patient’s medical problems:
 Chronic back pain
 Chronic tension headaches and migraines
 Endometriosis
 Scoliosis
3. List of Medications:
a. Leuprolide Acetate for Depot suspension IM Injections 11.25mg – Every three
months (pg. 922)
i. Directions: Administered by a healthcare provider
ii. MOA: A luteinizing hormone-releasing and GnRH agonist, acts as a
potent inhibitor of gonadotropin secretion when given continuously in
therapeutic doses
iii. SE: injection site reaction/pain, hot flashes/sweats, decreased libido,
nausea, constipation, headache, weight gain, bone pain,
fatigue/weakness.
iv. AE: pulmonary embolism, MI, bone loss, osteoporosis
b. Norethindrone Acetate Tablets 5mg orally– QD – nightly ~ 2300 (pg. 1156)
i. Directions: Take one pill orally once a day – used for add-back therapy
in conjunction with leuprolide acetate for depot suspension.
ii. MOA: Synthetic progestation hormone with androgenic, anabolic, and
estrogenic properties. Progestin-only contraceptives alter cervical
mucous, exert progestational effect on endometrium, interfere with
implantation, and, in some cases, suppress ovulation.
iii. SE: weight changes, breast tenderness, abnormal bleeding.
iv. AE: cerebral thrombosis or hemorrhage, pulmonary embolism.
c. Methenamine Hippurate 1g tablet orally – BID 0800/2300 (pg. 1021)
i. Directions: Take one tablet orally twice a day.
ii. MOA: Tertiary amine that liberates formaldehyde in an acid medium,
which is a nonspecific antibiotic agent with bactericidal activity.
iii. SE: Nausea, upset stomach, diarrhea, abdominal cramps.
iv. AE: N/A
d. Amitriptyline Hydrochloride 10 mg tablets orally – QD 2300 (pg. 80)
i. Directions: Take on tablet orally at bedtime.
ii. MOA: Inhibits the reuptake of serotonin (5-HT) and norepinephrine
from the synaptic gap, also inhibits norepinephrine uptake to a moderate
 degree. Restoration of the levels of these neurotransmitters is a proposed
mechanism of its antidepressant action.
iii. SE: drowsiness, sedation, dizziness, orthostatic hypotension, dry mouth,
constipation, urinary retention
iv. AE: Bone marrow depression
e. Cyclobenzaprine Hydrochloride 5 mg tablets orally – 2 tablets QD 2300 (pg. 410)
i. Directions: Take two tablets orally at bedtime.
ii. MOA: Relieves skeletal muscle spasm of local origin without
interfering with muscle function. Believed to act primarily within CNS
at brainstem. Depresses tonic somatic motor activity, although both
gamma and alpha motor neurons are affected.
iii. SE: dry mouth, drowsiness.
iv. AE: edema of the tongue
f. Rizatriptan 10mg tablet – 1 tablet PRN no more than 2/week sublingually
g. Aspirin-acetaminophen-caffeine 250-250-65 mg tablets – 2 tablets QD PRN
orally
h. Meloxicam 15mg orally– QD PRN
4. Upon review of this list of medications and considering the age and current circumstance
of you patient, are there any medication interactions that concern you?
a. Due to this patient’s age I am worrisome about some of these medications that can
have interactions with alcohol (cyclobenzaprine hydrochloride, amitriptyline
hydrochloride). Alcohol mixed with suppressants and antidepressants can enhance
the CNS depression. I would advise the patient to not drink alcohol or at least
drink less alcohol and drink plenty of water prior to taking the medications or
advise them to hold the medications when they are drinking heavily. In addition,
the common side effect of urinary retention from amitriptyline hydrochloride
while the patient is also on methenamine hippurate. The therapeutic use of
methenamine hippurate is to help prevent recurrent urinary tract infections (UTI)
and urinary retention can cause a UTI. I would advise the patient to carefully
watch any changes with their urinary help and possibly talk to their doctor about
alternative medications. Lastly, I would question the patient about the length of
time they would be on the leuprolide acetate with depot suspension due to the
possible adverse effects of bone loss and osteoporosis. At her age, that is not
something that one would want to acquire.
5. Source:
Shields, K. M., Fox, K. L., & Liebrecht, C. (2019). Pearson Nurses Drug Guide 2019. New
York: Pearson.