Customer scenario
CUSTOMER SCENARIO
49-year-old Faizal has been prescribed an ACE inhibitor (ramipril 2.5mg tablets once daily) to help manage his hypertension. Faizal agreed to be signed up to the New Medicine Service (NMS) before he started the tablets, and you invite him back to the pharmacy for a consultation as it has now been 2 weeks since he started his treatment.
When you ask how Faizal is getting on with his new medication, he confirms that he has been taking them every day as prescribed; however, you notice that Faizal looks tired and has a dry cough.
Faizal tells you that he has been suffering with disrupted sleep for the past week and has also experienced a dry cough that has affected his sleep quality. Not being well-rested, he is struggling to cope in the day, which is causing him stress. He confirms that these issues have only started since he started the ramipril tablets. Faizal has been measuring his blood pressure at home which has improved; however, he is concerned that the additional stress may affect his blood pressure negatively.
YOU REVIEW FAIZAL’S MEDICAL HISTORY AND FIND:
MEDICAL RECORD
He has no known allergies
He regularly takes omeprazole 20mg capsules once in the morning, which has been managing his GORD
He had previously been prescribed co-codamol tablets for a knee injury
He is not taking any OTC medicines but he would like something to help manage his sleep issues
WITH THE KNOWLEDGE THAT YOU HAVE,
WHAT WOULD YOU DO NEXT?
Select correct or incorrect for each answer
Check Faizal’s blood pressure to ensure that his blood pressure is stable and review any readings that he has collected
Common side effects of ACE inhibitors, including ramipril, are sleep disorders and a cough that can cause sleep disturbances. If sleep disturbance and cough continue the medication should be reviewed by Faizal’s GP as an alternative could be prescribed
You reassure him that his sleep issues may be due to the medication, and that his symptoms are likely to improve after his medication is reviewed
Nytol (diphenhydramine) tablets can be used short term to help break the sleep-stress cycle and manage his symptoms. However, you emphasise that the medication should not mask the root cause and that his medication should be reviewed with the GP as soon as possible
Advise Faizal that addiction is unlikely with diphenhydramine; however, he can become dependent or tolerant to it if it is used inappropriately or for long periods of time
Educate Faizal about the sleep and stress link and offer sleep hygiene and lifestyle advice to help improve his sleep habits and relieve his stress
Communicating with other HCPs: After asking Faizal for his consent to do so, you share this information with his GP who confirms that he will review his medication at his upcoming appointment. The GP also confirms that Nytol tablets would be advisable to use short term in this instance as his sleep issues are impacting his day-to-day activities and could in turn worsen his condition.