Clonidine scenario, need opinion plz

[icekitsune]

---

Members do not see this ad.

Hi guys,

I was curious about what you guys think egarding this scenario, which my prof told me. A pharmacist got a call from a pt who is sweating ALOT and feels that he has palpitations. He was previously told to put on a 0.1 mg clonidine patch for pain in his knee. 7 hours later, he called the pharmacy describing these symptoms. He did not get any rx of clonidine filled since march and apparently he had a patch somewhere in his house. The patient denied experiencing any of these side effects before. Anywho, the pharmacist told him to remove the patch and call his md. Do you think it was the right thing to do? or is the pharmacist going to be liable?

I have my own opinion but would like input of others. Thanks!!

 

[BidingMyTime]

Hi guys,

I was curious about what you guys think egarding this scenario, which my prof told me. A pharmacist got a call from a pt who is sweating ALOT and feels that he has palpitations. He was previously told to put on a 0.1 mg clonidine patch for pain in his knee. 7 hours later, he called the pharmacy describing these symptoms. He did not get any rx of clonidine filled since march and apparently he had a patch somewhere in his house. The patient denied experiencing any of these side effects before. Anywho, the pharmacist told him to remove the patch and call his md. Do you think it was the right thing to do? or is the pharmacist going to be liable?

I have my own opinion but would like input of others. Thanks!!

This isn't a homework question is it?

Hmmm, well liability is ultimately determined by a fickle jury. It's hard to say without knowing further info (ie heart attack risk factors, like age) Calling the doctor is definitely good, hopefully the pharmacist stressed that meant STAT and/or ER. I wouldn't expect the clonidine patch to cause excessive sweating, so its probably not related, but since the pt is using the patch (off-label) for pain, I don't see any harm in telling the pt to remove it. If the pt feels better by the time they get to the ER, so much the better--but I doubt that would happen. The concern would be if the pt was having a heart attack, and the pharmacist didn't bring up that possibility or led if the pharmacist led him to believe it was the medicine.....so the pt didn't immediately seek medical attention.

Interested in hearing what your professor said about the answer...

 

[Pharmacy Kid]

Similar case I had

Elderly woman calls saying she developed bad acid reflux/chest pain after taking clindamycin. She denies vomiting, fatigue, left arm pain. She wants to know if she can stop taking it. The clinda was for a boil on her leg. I asked her again when the sx started and she said after she took her first dose of clinda. I told her if the chest pain doesn't subside, gets worse, or she develops fatigue or vomiting to go to ER.

I told her she can stop the clinda but to notify her prescriber.

 

[icekitsune]

This isn't a homework question is it?

Hmmm, well liability is ultimately determined by a fickle jury. It's hard to say without knowing further info (ie heart attack risk factors, like age) Calling the doctor is definitely good, hopefully the pharmacist stressed that meant STAT and/or ER. I wouldn't expect the clonidine patch to cause excessive sweating, so its probably not related, but since the pt is using the patch (off-label) for pain, I don't see any harm in telling the pt to remove it. If the pt feels better by the time they get to the ER, so much the better--but I doubt that would happen. The concern would be if the pt was having a heart attack, and the pharmacist didn't bring up that possibility or led if the pharmacist led him to believe it was the medicine.....so the pt didn't immediately seek medical attention.

Interested in hearing what your professor said about the answer...

Thanks for the reply. No this isn't a homework question. He told me it happened to one his previous student before and was wondering what i would do if this situation happens. in a way the prof mentioned that it wasn't within pharmacy's scope of practice to tell the patient like take off the patch and that we're liable of being sued if something happens. Btw, this was in retail setting. Alot of other pharmacist said that they would just have them call the md without saying anything else about removing the patch or anything else. Then i thought, what if you told the patient to call MD vs told to remove the patch then call md. if something happens during the process of calling the MD, will the pharmacist be at fault (for saying something vs saying nothing). I guess, like you said, mostly the jury's decision.

i forgot to mention in the scenario above, at first i didn't it would be the clondine patch. but the pt stated that it never happened before and the only thing that's new that day was adding on that patch. Once again, thanks for the reply!

 

[farmadiazepine]

what's going to happen if they take off the patch after wearing it a day or two? nothing.

so take it off, call your md. or leave it on, call your md. either way, call your md, because you are sweating like crazy and have some problems. no liability to the rph.

 

[BidingMyTime]

Thanks for the reply. No this isn't a homework question. He told me it happened to one his previous student before and was wondering what i would do if this situation happens. in a way the prof mentioned that it wasn't within pharmacy's scope of practice to tell the patient like take off the patch and that we're liable of being sued if something happens.

What farmadiazepine said. For their to be liability, it would have to be proved that direct harm came to the patient because he took off the patch. The clonidine is being used PRN for pain...it's not like the pharmacist told him to stop taking his amiodarone or something. If he were having a heart attack, the clonidine patch isn't going to stop/minimize it. I don't see any liability problems arising from the pharmacist telling him to take off the patch. Granted people can sue over anything, but even for a fickle jury I don't see where any case could be made that the patient came to harm from taking off the clonidine patch (maybe his knee pain came back, and then he had to deal with the psychological stress of the pain in addition to his sweating and heart palpitations!)

Now in a different scenario, say the person was having symptoms he thought was related to his amiodarone, which he'd just been put on after having a heart attack, and the pharmacist told him to stop taking it (not that a pharmacist would, but for the sake of discussion).....then the pharmacist would be liable if the guy stops taking his amiodarone and has a heart attack.

 

[RickRossPharmD]

To the poster above, whether the clonidine was actually being used for pain depends on the sig to serve as proof if it came down to a court of law. BP and heart control is not always simple. There are some unique people who get treated in unorthodox ways.

To the OP, I would tell him to contact his MD office, an on-call doctor, then an urgent care (in that order) due to the severity of the symptoms he was describing. I would give no advice on removing it and defer that liability

 

[BidingMyTime]

To the poster above, whether the clonidine was actually being used for pain depends on the sig to serve as proof if it came down to a court of law. BP and heart control is not always simple. There are some unique people who get treated in unorthodox ways.

Very true. My assumption was that the pharmacist he was consulting with had access to the original script and that it had actually been prescribed PRN for pain-in which case I don't see any liability if the pharmacist told him to remove it. Clonidine patch isn't normally used for pain, so if a patient just told me that was what he used it for, I would assume he was mistaken.

 

[icekitsune]

i guess i thought it was strange. cause my prof told me that during that situation, the pt has not filled the clonidine for several months and on that particular day, the office told the pt to put it on his knee to help relieve pain. I guess the pharmacist told the pt to remove it, fearing the pt has a serious event and did not want the pt to continuously having the drug since according to the pt, the patch was placed on 6hrs prior (for the first time) and when asked, the pt stated the office told him it was for his knee pain (therefore to place it on the knee) and the pharm told the pt to call oncall md.

Idk, to me it kinda seemed to be reasonable thing to do but i don't have alot of experience so..