Three Challenging Drug Questions and How I Handled Them

In my last blog post, I shared a story of how our highly respected pediatrician didn’t know the answer to a question.  As a healthcare professional, I always want to know the answer when someone asks me a question, but I know the reality is that I can’t always do that.  I wanted to share a three challenging drug questions I’ve received where at one point I didn’t instantly know how to respond.

“I’ve got a 9 year old who I’ve diagnosed with frequent migraines, what medication can I use after acetaminophen and NSAIDs have been tried?” – Needless to say I was not confident in any answer I was going to provide in an off the cuff manner.  Guessing is ok for paper exams, but not in real life.  Pediatrics is not my strongest area and this was definitely a really hard question for me to blurt out an answer.  In an adult, I would have been comfortable with the obvious choices of triptans for acute migraine management and migraine prophylaxis agents like topiramate, beta-blocker, etc. What did I do? I did some research on pediatric headaches.  In addition, it is really important to do your research on the patient as well.

“Can you use lisinopril in dialysis?” When I get a question like this, I always want to try to get a lot of patient background.  This is obviously another question that is specific to a case as the majority of questions I get are.  In this situation, I would obviously want to look at what has been tried as well as how at risk the patient is for hyperkalemia.

“Can I use buspirone in ineffective esophageal motility?” I had no idea and I told the provider that.  I had never seen it at that time and honestly haven’t seen it again since.  There is some evidence out there that it might be helpful.  In this situation, buspirone is usually well tolerated and the doses that were being discussed were relatively low in the grand scheme of things.

For those of you who are students/young pharmacists, I just wanted to encourage you to stay curious, continuously learn things, lean on experts in topic areas, and ask questions.  You are not going to know everything and that is ok.  Don’t pretend to be a hero when you don’t know the answer.


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Written By Eric Christianson

February 11, 2018

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