Another clinical question to ponder

[kristakoch]

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To keep going with the clinical questions started recently...here's one with a community spin on it.

A mother comes into your community pharmacy with a prescription for her son Johnny. The prescription reads: clonidine 0.1mg patch take one po everyday.

When you talk to the mother you find out that Johnny is a 7 year old boy with autism and she wants the med to keep him calm during the day.

What do you think? Do you fill? Do you call the MD? What do you do?

AND to keep it interesting, make sure you are writing all of your steps so everyone can see your thought process thru this one (ie just don't say fill it when you mean you called the MD, etc)

Good luck, I will come back in a few days to tell you what happened and what shoudl have been done. And yes, this is a real scenario, this really happened!

 

[Moxxie]

To keep going with the clinical questions started recently...here's one with a community spin on it.

A mother comes into your community pharmacy with a prescription for her son Johnny. The prescription reads: clonidine 0.1mg patch take one po everyday.

When you talk to the mother you find out that Johnny is a 7 year old boy with autism and she wants the med to keep him calm during the day.

What do you think? Do you fill? Do you call the MD? What do you do?

AND to keep it interesting, make sure you are writing all of your steps so everyone can see your thought process thru this one (ie just don't say fill it when you mean you called the MD, etc)

Good luck, I will come back in a few days to tell you what happened and what shoudl have been done. And yes, this is a real scenario, this really happened!

Just curious - did the rx really say "0.1mg patch take one po everyday? What type of doctor did this rx come from? (i.e. family practice, psychiatrist, another specialist).

 

[alwaystired]

I am a newbie (P1) but I wouldn't fill it because it said po for a patch. Right then and there I have a red flag that maybe the doctor wanted a different drug to calm down the kid.....I would check the profile and see if they were on any other drugs in the past to see if the doctor just wrote for the wrong thing and then call the doc. (that way when I call the doctor, I am armed with the patien'ts history of rx and then I can ask him what he really meant to write).

 

[WSU2007]

I would get in contact with the physician before filling this Rx. I think that PO dosing would be more appropriate for a child this age. I also would recommend possibly lowering the dose to .05mg depending on the childs weight. Increasing to the desired 0.1mg after 7 days.

 

[npage148]

maybe he wants the 0.1mg/24h patch but looked at the chart and got distraacted by an old po dosing

 

[bananaface]

I am curious to know if the kid has taken clonidine before. It is dosed orally (off label) for autism. But, 0.1mg/24h is too high for a starting dose. I want to know his weight, too.

Oral dosing should start at 0.05mg/day divided between 3-4 doses, and going up from there to a weight based limit. The Rx is going to get seriously revised before dispensing.

 

[WSU2007]

May not have to divide the doses for a 7 year old maybe?? I have seen children not much older go with QD dosing. Epocrates tells me divided doses as well under peds dosing, but that may be for very young children.

 

[kristakoch]

Ok good catches, yes the RX did say to take a patch PO, which obviously is not correct. SO calling the physician for clarification would be good.

Also, the patient has not ever been on clonidine (tablet or patch).

So you call the physician and talk to him and he says to just change the PO to applying the patch daily.

What do you do now? Fill it?

Some things to think of, first child has never been on clonidine before, the child is autistic (this may play big into the choice of the patch), ADRs of clonidine and what can happen with abrupt starting/stopping of clonidine.

 

[ultracet]

while all of your questions regarding ADRs and withdrawal/ tapering are fantastic, appropriate, etc...

i'll let some of first/second years for it....

now for the indication.
http://www.ncbi.nlm.nih.gov/entrez/...t_uids=1548248&query_hl=3&itool=pubmed_docsum

now no i didn't evaluate the article however i do believe a lit search is appropriate in this matter...

 

[npage148]

its a weekly patch, not a daily one so thats wrong if thats what the doctor said