Selected case reports from the practice of a clinical pharmacist in the field of pneumology

Overview

This article presents three case studies highlighting complex pharmacotherapeutic challenges and the role of a clinical pharmacist in clinical practice. The first case describes the long-term treatment of avian mycobacteriosis (MAC –⁠ Mycobacterium avium complex) in a patient with cystic fibrosis. It details the patient's history of multi-drug resistant MAC infection, numerous antituberculosis regimens, and significant drug intolerances, emphasizing the need for careful consideration of drug interactions, particularly with cystic fibrosis transmembrane conductance regulator (CFTR) modulators. The second case focuses on the management of a drug interaction between rifampicin and levothyroxine. It describes a patient with hypothyroidism whose levothyroxine the­rapy was destabilized by the co-administration of rifampicin, a potent enzyme inducer. This case highlights the critical need for proactive management and careful monitoring of thyroid function in patients receiving both levothyroxine and rifampicin. The third case explores a potential intoxication by menthol and eucalyptus in a patient attempting to quit smoking, who consumed excessive amounts of menthol-eucalyptus lozenges. This case illustrates how seemingly harmless over-the-counter products can lead to adverse effects when consumed in large quantities, underscoring the importance of a detailed dietary history. Overall, these case studies underscore the role of a clinical pharmacist in complex pharmacotherapeutic problems, the importance of interdisciplinary collaboration, and individualized patient care in managing challenging clinical scenarios.

Keywords:

intoxication – Cystic fibrosis – smoking cessation – CFTR modulators – mycobacteriosis – menthol – antituberculosis drugs – rifampicin – drug interaction