[pharout]

First of all, I agree completely with what Linnear said. At this point, it would be important to first of all explain to the pt why it is important to take the med. If her bp is as elevated as she truely describes, she is at definite risk for stroke sooner rather than later. She is in the htn urgency/emergency category with this bp. The number 1 reason people fall into this is that they are non-adherent to medical therapy. The doctor should have known this and questioned this when he saw her (I'm assuming he had previous bps to compare to). I think it is also important to find out "why" the pt didn't tolerate it (e.g. bp dropped too fast and began having dizziness, had headache, peripheral edema?). It is almost always explainable and cause is usually due to one specific agent. This would lead down the road to making a recommendation for an alternative.
Second, if a pt discloses info to you that was not disclosed to the physician and this new info compromises a pt's risk, you are obliged to let the physician know. You would be doing a great disservice if you didn't. I would also not dispense the prescription. If you know it caused problems, it is important to clarify what these were and let the physician make the decision. If you did dispense, then you are medicolegally liable (not sure the physician is since he didn't know).
Third, since I'm from the U.S., could someone explain to me what an MUR is? Medical Utilization Review???
thanks...