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Liability and Other Legal Issues Affecting Patient Counseling
Published in Harvey M. Rappaport, Kelly S. Straker, Tracy S. Hunter, Joseph F. Roy, The Guidebook for Patient Counseling, 2020
Harvey M. Rappaport, Kelly S. Straker, Tracy S. Hunter, Joseph F. Roy
In two cases from this same period, pharmacists were presented with prescriptions that contained inadequate directions or incorrect dosages; in other words, they were questionable on their faces. In the 1986 Pennsylvania case of Riff v. Morgan Pharmacy, Cafergot® suppositories were prescribed with written instructions to insert one every four hours for headache, with no notations authorizing refills. The pharmacist dispensed as written, typing the same instruction on the label. Not experiencing relief, the patient obtained refills from the pharmacist and used as indicated but greatly exceeded the accepted maximum dosages of two per attack, with a limit of five in any week. The patient suffered permanent injuries to her foot from decreased circulation and nerve damage. The court found the physician and the pharmacist liable; the latter because of breach of duty by “… failing to warn the patient or notify the prescribing physician of the obvious inadequacies appearing on the face of the prescription which created a substantial risk of serious harm to the plaintiff.” Its reasoning emphasized that the pharmacist is a professional who owes a duty to the patient and has more responsibility than to be a “… shipping clerk who must dutifully and unquestionably obey the written orders of omniscient physicians.”
Sympathomimetics
Published in Frank A. Barile, Barile’s Clinical Toxicology, 2019
The predominant CNS stimulant properties of caffeine and the respiratory relaxation produced by theophylline are well documented. Caffeine stimulates cerebral activity, skeletal and cardiac muscle contraction, and general basal metabolic rate, while theophylline has less central stimulation but significant bronchial smooth muscle relaxation properties. Caffeine and theophylline enhance cardiac muscle contraction, induce coronary vasodilation, and promote diuresis. Caffeine is available in combination with ergotamine, belladonna alkaloids, or pentobarbital for the treatment of migraine headaches (Wigraine® tablets, Cafergot® suppositories), for its synergistic action with ephedrine for weight loss, and as an aid to wakefulness and restoring mental alertness. In combination with sodium benzoate (injectable), caffeine is used in the treatment of drug-induced respiratory depression, and as caffeine citrate (injectable) for the short-term treatment of apnea in premature infants. Theophylline (Elixophyllin®, Theolair®, Theo-Dur®, and various others) is employed in the treatment of bronchial asthma and other respiratory-related disorders. The calcium and sodium salicylate salts of theobromine are available for use as mild diuretics, vasodilators, smooth muscle relaxants, and cardiac stimulants.
Migraine: diagnosis and treatment
Published in Stephen D. Silberstein, Richard B. Upton, Peter J. Goadsby, Headache in Clinical Practice, 2018
Stephen D. Silberstein, Richard B. Upton, Peter J. Goadsby
Oral eletriptan was more effective than Cafergot1.79 At 2 hours after treatment, more patients in the eletriptan 40 and 80-mg groups had a headache response than those in the CafergotT group (54–68% vs 33%; p < 0.0001), and more eletriptan patients were completely pain–free (28–38% vs 10%; p < 0.00001).
Long-term Ergotamine Derivative Therapy for Migraine Associated with Pachymeningitis and Sixth Cranial Nerve Palsy
Published in Neuro-Ophthalmology, 2019
Dominique Tynan, Kate Ahmad, Mark Thieben
A 57-year-old man presented with a four-day history of horizontal diplopia worse on right lateral gaze and headaches. He described migraines since a teenager and increasing frequency of headaches in the 2 years preceding this presentation that were worse in the morning and when lying down. He had a significant medical history of long-standing reduced visual acuity in his left eye to 6/12 due to congenital toxoplasmosis infection; however, this is was unchanged from previous ophthalmology records. The patient was initially started on Cafergot S 2/100 mg (ergotamine tartrate/caffeine) suppositories 10 years prior and would use 2–3 per month for acute migraines. He changed pharmacist to a compounding pharmacist where he was able to obtain bulk supply of Cafergot suppositories at a significantly cheaper price. Subsequently, he increased his use of ergotamine suppositories to 3 per week in the 3 months prior to his presentation.