This entry is part of an ongoing series where pharmacists describe inspiring patient interventions. Have a story you wish to share? Send it to vwood@ensembleiq.I had a return visit from a patient I had last seen about 5 months ago. We had discussed her different comorbidities at the time, and when we had reviewed systems she expressed concerns at the time about her memory. We did a MOCA and the score suggested there was some memory impairment. I had sent a recommendation to her primary care provider and they had prescribed donepezil for her. As it was our last issue she was to follow up with primary care. I was called on a consult earlier this week because she was still working with the dietitian and wanted to know if her constipation problem was from metformin.When she attended and I reviewed all of her therapies she said she was not longer on donepezil because of nausea and cramps. She had taken the medication for 3 days. I reviewed the possible reasons these problems happened as part of the drug action, but also talked about this effect usually wearing off with continued use. We had discussed this before recommending it, but of course she does have memory issues. We discussed different options including a patch form of a similar treatment, but she agreed to re-try the medication.The unfortunate thing is we are almost a half-year later in maintaining treatment that could have preserved some memory function to this point. It is fair to say that her pharmacists were in a position to prevent that, both myself had I insisted on an adherence follow-up should primary care not follow up on it and her community pharmacist for not picking up that she was not refilling her medication. Patients with dementia often stop these kinds of medications because of side effects, and the potential impact of pharmacists watching for this cannot be overstated as once the memory is deteriorated it won’t likely be recovered.
