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After being evaluated by his physician, the patient received a handwritten prescription for Rythmol 150 mg, which he had been taking for the previous 3 years. He filled this prescription with the clinic pharmacy and subsequently started to experience nausea, sweating, and an irregular heartbeat.
Most experts see case reports as the first line of evidence in health care, which can sometimes lead to future higher-level studies. Case reports can be a great learning opportunity for both pharmacists and pharmacy students to understand a case progression and the unconventional response and effects of medications.
The case involves a 62-year-old man who was referred to a pharmacist-managed anticoagulation clinic for follow-up post bilateral pulmonary embolism. The patient was advised to continue on the warfarin he initiated in the hospital at a dose of 5 mg daily and return the following week for a repeat INR test.
Rythmol (propafenone) is a class 1C antiarrhythmic drug that was FDA approved in 1989. In 2010, a case report was published documenting a medication error involving a handwritten prescription for Rythmol.
Investigation into the issue revealed that a prescription for Xarelto had been sent to his retail pharmacy to inquire about the cost of the medication with his insurance plan. The retail pharmacy then placed the medication on hold rather than discontinue the order entirely like the clinic staff had requested.
Norvasc (amlodipine) is a dihydropyridine calcium channel blocker indicated for the treatment of hypertension and coronary artery disease. A case report was published in 2016 detailing an alarming and overlooked medication error involving a prescription for Norvasc.
Coumadin (warfarin) and Xarelto (rivaroxaban) are anticoagulants used to reduce the risk of stroke and embolism in patients with atrial fibrillation and for prophylaxis of deep vein thrombosis (DVT). A case report was recently published documenting a patient who unintentionally received both medications concurrently.
Two later patients would require hospitalization for their symptoms, one of which was documented to have a blood glucose level of 23 mg/dL.
These reports are often written to document an unusual clinical presentation, treatment approach, side effect, or response to treatment. Most experts see case reports as the first line of evidence in health care, which can sometimes lead to future higher-level studies.
Officials learned that a school nurse inadvertently administered Humalog U-100 insulin instead of the influenza vaccine. Acute hypoglycemia was reported in all 5 patients who received the insulin with varying degrees of symptoms.