Monday, June 14, 2010

What did your pharmacist do?

The other day we encountered a patient who was taking birth control and came into the pharmacy with a new prescription for belladonna/phenobarbital and tells us it is for irritable bowel syndrome.

First, phenobarbital can decrease the efficacy of birth control drastically. Second, belladonna/phenobarbital is not a first line treatment for irritable bowel syndrome, at least according to the American Journal of Gastroenterology...I think they might know. So, I called the physician's office to discuss it with him and I had to leave a message. About 2 hours later, the medical tech(person who does your blood pressure) calls me back and I tell her about the issue. There are 3 options to fix this issue: stop the belladonna/phenobarb, wait to see if she has breakthrough bleeding(in this case indicates birth control may not be working) and if she does increase the strength of birth control or just go to the higher dose of birth control (didn't count physical barrier or abstinence, because she said no to both). Taking the increased dose of birth control may sound like the best option, but high dose birth control greatly increases the incidence of DVT and pulmonary embolism(basically a clot that can kill you). The fact that one of the drugs is a bad choice of treatment for IBS is enough for me to recommend picking a different agent that doesn't interact with birth control and is first line for treating IBS. Anyway, back to the medical tech on the phone, I inform her of these options and she says "just tell whoever wrote the birth control to increase it, don't change what we wrote". So, I ask her if the physician was aware she was making this recommendation and if was he aware of the interaction. She said no to both, so I proceeded to tell her about the potentially serious increase in risk of life threatening side effects with the recommendation made. Needless to say, she is going to check with the physician to get his opinion. Additionally, this physician is an internal medicine practitioner, which is fine, but he is not specialized in GI, so should not be writing prescriptions off-label(basically no one knows if its safe or effective) for a GI disease. This lady should have been referred to a specialist or treated with safe and effective treatments. Phenobarbital comes with a list of nasty side effects as well, so she would benefit on several levels by receiving different treatment. So, the scary occurrence is medical techs making recommendations they have no qualifications or training to make and the assumption that whatever the physician wrote is ALWAYS correct. It is amazing how many receptionists and medical techs pass their opinion of "the doctor wrote it, so he knows, don't change it" on to pharmacists, who then have to decide whether to call again and demand to speak to the doctor, which may or may not get him on the phone, or fill it as is...what did your pharmacist do?

Saturday, June 12, 2010

"Over 770,000 patients are estimated to be injured because of medication errors every year." This may explain

I cannot believe it is legal for drug companies to produce products that look practically identical. The pills shown are in no way similar, propranolol slows your heart and lowers blood pressure, while haloperidol is a very potent anti-psychotic medication that can cause Parkinson's like symptoms, yet they are practically identical. The eye drops have similar mechanisms of action, however, they are NOT the same drug and cannot be used interchangeably. These were just 2 I came across today at work, you would be amazed how prevalent this is. This type of problem is what led to the tragic event with Dennis Quaid's children, only that drug was heparin, a powerful blood thinner. Hardly any progress has been made to change these practices, most of the time we put a small sticker that says high alert. However, this does not always happen. It's easy to see how a nurse, pharmacist, tech, etc. could grab the wrong drug, especially when they are taking care of multiple people at the same time and everyone wants attention immediately. Think about this the next time you are picking up a prescription or your nurse is giving you a medication, be proactive and protect yourself! Five-mornings-after pill coming soon?

If the woman chooses to ask for the pill, why would this hurt the pharmacist's morals, we only gave her the pill, she made the decision to take it. I don't think you should insert yourself in the equation. While this is an extreme exaggeration, following this logic, a clerk at walmart could refuse to sell rat poison, because they believe ALL life is sacred, even that of animals. This logic can set up chaos, we can't allow refusal based on beliefs. Why couldn't I refuse to dispense morphine, on the premise that I think it is immoral to help someone to alter their mental state even though it is an accepted effect of the medication to help treat pain? This is a tricky topic and should be interesting to see the results of this attempt....No offense to either side of this issue intended, everyone has the right to their opinion, I just think we will be hearing more about this as the approval process proceeds

Five-mornings-after pill coming soon?
A French drug company is hoping to offer American women something their European counterparts already have: a pill that works long after "the morning after."

Thursday, June 10, 2010

Stuck Behind the Counter

It has been very interesting being in an independent pharmacy and seeing how community pharmacy should be practiced. My previous experiences with community pharmacy have been with major chain stores, where the pharmacist is often so busy that talking with patients is often impossible. Why have we allowed pharmacy to take this path? Pharmacists were the most trusted profession for a long time, however, we have lost that rank. I would love to see medication therapy management take a strong hold in community pharmacy. There is an enormous need for this type of service, which has become even more evident while I've been on rotation. The computer systems at large chain pharmacies are very advanced and typically show a picture of the pill and the computer does the rest. It seems that the pharmacist could address interactions, DUR and the other parts of dispensing that require a pharmacist and let the tech's do the rest. I think they also need to counsel a majority of the patients.Obviously, you don't need to be counseled every month on medications you've been taking forever, but today on rotation a 22 year old was prescribed a drug that would have made her birth control ineffective, so counseling pays off in situation like that.Why don't pharmacists have a consult room? It doesn't require more than 2 chairs and a space slightly bigger than a closet. This would allow for us to provide patients with services that we have been trained to provide, but are practically impossible without a private area. Personally, I am not comfortable discussing my medications in the "counseling area" provided by most pharmacies. Anyone who has been in a pharmacy knows what I mean, a small divider doesn't do much to control who hears the conversation. Additionally, I think typical consumers don't realize the danger of the current routine health care practices. For example, many family physicians receive education about new drugs from the people who sell them. This is evident when you see a spike in prescriptions for extremely expensive versions of older drugs after a drug rep has made his/her way through local physicians' offices. For example, when Prevacid's patent expired, almost immediately Kapidex(extended release version) was released.. The next issue has to do with medical records. Most physicians in the community don't communicate well or at all with each other. Therefore they don't know all of the medications their patients take, so they don't know if the new prescription they wrote interacts with the prescription the patient received from the ER last week. However, if the pharmacist met with the patients, we are excellent(I'm a little biased) at taking detailed medication histories and the larger pharmacies all have a database to see all the prescriptions a patient has had at any of their stores. These are just a few of the benefits that would come from bringing the pharmacist out from behind the counter and encouraging people to take 5 or 10 minutes out of their day to talk with their pharmacist. After all, it's free and you spend that long in the waiting room at the physician's office. Next time you go into your pharmacy, talk with your pharmacist, it could save you money, an uneeded headache or even your life.

Unreported complaints gets Pfizer warning: Read more by clicking the link below

Those extremely ethical and honest drug companies care about every single one of us!

Unreported complaints gets Pfizer warning - More health news-

Stop drinking your lotion, people!

"Stop drinking your lotion, people! JoNel Aleccia writes:Here's a warning you probably thought you'd never need: The federal Food and Drug Administration is urging consumers not to swallow Benadryl Extra-Strength Itch-Stopping Gel after receiving reports of people chugging the lotion that's meant to be used only on the skin.At least 121 people have reported gulping the gel, which they confused with other over-the-counter Benadryl products that are actually intended to be swallowed, between 2001 and 2009. FDA officials said they had received reports of serious side effects from drinking the lotion. In large amounts, the active ingredient in the gel, diphenhydramine, can cause numb lips, unconsciousness, hallucinations and confusion. One man reported that he simply grabbed the wrong medicine from the kitchen cabinet where he stored the cough medicine. "One small swig and he knew he had made a mistake," reported the patient safety site"

Stop drinking your lotion, people!

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Wednesday, June 9, 2010

Top Ten Dogs

My wife, Jessi, and I were discussing tonight what we thought were the dog breeds that were most likely to attack humans. She is a veterinary technician and sees many different breeds on a daily basis. On a few occasions, she has ended up at the urgent care clinic getting stitches for dog bites. In an attempt to find an answer to our question, we turned to the most reliable source available, google(that was an attempt at humor). It was interesting to see so many differing and passionate opinions on what the answer was. However, ALL of them were opinions with no reference as to how they determined the answer nor information about where they collected data. So, Jessi and I decided we are going to find an answer that is hopefully accurate and at a minimum will explain how we reached our conclusion. Assuming someone reads this, does anyone have any suggestions for an approach to answer this question? I would also like to know what anyone who reads this thinks is the #1 breed that is most likely to attack/bite a human is, so please leave comments!

Maryland Poison Center's ToxTidbits

NSAIDs increase heart problems


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Tuesday, June 8, 2010

A Pharmacist's Education

This is my first blog that I have EVER composed, so I'm not sure what exactly makes up a good post. I want to start off with a topic I am particularly passionate about, PHARMACY.

What does it take to be a pharmacist?
Based on my experiences the general public has a wide range of ideas concerning the pharmacist's role in their health care. Prior to researching and then attending pharmacy school, I thought a pharmacist basically handed out drugs like a bank teller hands out cash. I had no idea that as of 1990 to be licenced as a pharmacist it was required to receive a doctor of pharmacy degree(Pharm. D.)  In addition, I didn't know that a growing number of pharmacists have received training similar in length and intensity to that of a physician, only in a slightly different area of study. Over 75% of students enrolled in my pharmacy school have earned a bachelor's degree or higher prior to applying to pharmacy school (minimum requirement of 2 years of prerequisite coursework). Students then spend 4 years studying topics such as  pathophysiology, pharmacology and pharmacotherapeutics among others. After graduation, students sit for their licencing exam(NAPLEX) and a state specific law exam.They then have the option to begin entry level practice or continue on to a residency(similar to those completed by physicians). Students who choose to apply for a residency are required to begin with a year-long residency in general practice known as a  PGY1. After completing a PGY1 the pharmacist can choose to begin practicing or continue on to a specialty residency, which is called PGY2. After completion of a PGY2 the pharmacist can sit for the boards to become certified in their specialty. Currently, residencies are not required to practice, however, several pharmacy organizations are pushing to require a PGY1 residency in order to provide patient care. This would most likely include pharmacists at your local chain pharmacy. With the rapidly increasing number of medications on the market and the increasing number of elderly patients requiring complex medication therapy, the pharmacist is an essential member of the team responsible for managing the health of our population.

Have a medication or general pharmacy question? Ask me! Comments and feedback are welcome too!