We bring the FAST and laughs to pharmacy.

Thursday, February 21, 2008


I could not stop laughing this morning for about 30 minutes.

I had an elderly gentleman call because he was afraid we gave him the wrong medicine. He usually got the "roundish" Quinapril 10mg but this one looked different so he was wanting to know if it was the right med.

I asked him to describe it to me. He said it was a brownish color. I asked him if it was shaped like a long slender OTC Ibuprofen tablet. He said it looked like a turd. Yes, he actually said the tablet looked like a miniature version of his morning constitutional. Mind you it does kind of resemble something that came out of a rat with serious intestinal problems (small, reddish brown, elongated, thin, yeah--rat turd)

You can't make this stuff up. It really happens... A special thanks to the person(s) at Apotex that designed this tablet. You have given me a great laugh and I know some of you will open a bottle and muse at its fecal resemblance....sick little monkeys....

Tuesday, February 19, 2008

The High Price of Perfect Skin

Retin-A used to be the magic cure for acne until it was found to help with wrinkles. That means people over a certain age would have to pay cash for it. Some insurances limited it to age 18, some to age 25, and after that the lengthy and unpleasant prior authorization process is necessary. I have seen many requests for authorization denied. So pony-up and break out a credit card or cash and get your wrinkle cream... I harken back to my acne filled days of youth when insurance gave me the 45gm tube for $3. It was a steal!

Other costly methods for perfect skin include but are not limited to laser resurfacing, chemical skin peels, repeated facials, photo facials, specialty OTC creams, etc. What happened to staying out of the sun and moisturizing? It has worked great for me so far. I am going to be 33 and got carded for cigarettes last year before I quit smoking. Thank you kind gas station attendant for the compliment! I have even been carded at liquor stores and bars...woohoo!

The allegedly greatest product for acne is Accutane. This wonder cure has serious problems if given to pregnant women. For those of you not in the know, there was the SMART system for prescribing that told women all the horrible things that happen with this drug especially if you get pregnant. It didn't work. So the iPledge system was introduced.

A study done by the Slone Epidemiology Center at Boston University followed about 500,000 female patients on Accutane for a 140 day course. Only 447,679 completed the study requirements. The results were not reassuring. The study found a rate of 2.5 per 1000 of the 447,679 that completed the study got pregnant while on Accutane. This is even after enrollment in the iPledge program, the pregnancy tests prior to each prescription, agreeing they would use 2 forms of birth control, and answering all the surveys. They were even told of the birth defects.

Let me put this into perspective. That means that out of 447,679 women about 1,119 of them showed a blatant disregard for their baby's health. They were told this can cause miscarriage or birth defects. End of story. This is category X which means it causes damage EVERY time, hence the iPledge precautions and requirements.

Even more disturbing was the first year of iPledge which was supposed to prevent the shortcomings of the SMART prescribing system before it. There were 122 reported pregnancies. Ten of them were pregnant prior to starting Accutane. Um hello, who's doctor forged a pregnancy test.....that is unethical, immoral, and disgusts me that a healthcare practitioner would sink so low to make a buck. A warning to all healthcare practitioners: These systems are put in place to prevent imminent harm! Bypassing them means you don't care and have no right to call yourself "doctor"... The first rule of medicine is to knowingly do no harm or put a patient in a position of harm unnecessarily. Bypassing these safeguards also means you are going to get sued, big time, because the manufacturer is not liable for practitioner negligence and willingness to disregard FDA sanctioned safeguards. There are thousands of lawyers waiting to profit from your carelessness. Do a Google search. I found pages and pages of them...

Even more disturbing are the number of online "pharmacies" that sell Accutane without a prescription. Sure they print the warnings on the web page but there is NO system in place there to prevent a person from taking it and harming themselves or an unborn child. Because the iPledge system is apparently only enforced in the U.S. there are sure to be many more medical misadventures with Accutane. I wonder where the liability lies there. I guarantee if something goes wrong your lawyer is going to have a damned hard time locating someone from that "pharmacy" when the shit hits the fan.

But wait, there is more! By December 2000 there were 66 documented suicides of Accutane patients and another 1,373 cases of severe psychiatric problems. It was reported that these psychiatric manifestations happen approximately 6 weeks into treatment and were not gradual. It would be like the kid is okay at 2PM but started acting weird and was in the basement building a noose and dead by the next morning. It has been correlated with a severe depletion of serotonin levels in the brain. This sh*t should be pulled from the market. I wouldn't recommend it to ANYONE and recommend to patients that they try topical treatments like Proactive instead. It has shown good results, even with cystic acne.

Just remember kids: Safety First!!! Acne is not the end of the world. I still get it and I am over 30.

Sunday, February 17, 2008

The Set Schedule

This is why I love having a set schedule, but you have to remember I work overnights 7 on/7 off with 15 paid vacation days on top of that. So keep that in mind cuz this is what it gets you!

The Joys of a Set Schedule

1. I always know my schedule, including major holidays, a year in advance. I have ample time to be up to no good.....idle hands do the devil's work....

2. I always know where I am supposed to be without Mapquest or Google, which is a good thing because I am terrible with directions...

3. It is easy to plan your life out in a little black planner....

4. I know where everything is in the pharmacy so I don't feel like a moron when a patient asks for something and I scramble around to figure out where that Easter egg has been hidden.

5. I know most of my customers and for the most part they like me better than the other staff and frequently remind me so I am all warm and fuzzy without alcohol.

6. My night staff is fun (they all work up front and serenade me along with the easy listening selections...and gossip, lots of gossip and tabloid talk...we could work for E!)

7. Super HOT police officers frequently drop in to check on us because I have had a gun in my face at McDruggie's...it is like I have died and gone to sexy police heaven...or a Playgirl calendar shoot...

8. I get minimal phone calls!!!!! I can't stand the constant ringing. Even with 6 people standing there answering them during the day, the ringing never stops...

9. TIVO always has a great selection of time-wasting programming for me to flip through when I get home. God forbid I miss a new episode of Reno 911...

10. It is okay to have a cocktail before noon if you have been at work all night!

Reasons to not like a set schedule:

1. Your boss is a pompous douche-bag...(not all bosses are created equal)

2. Your techs are incompetant (mine are great but some pharmacists are not so lucky)

3. Your job is repetitive and tedious...all work and no play makes Jack a dull boy...

4. The schizpohrenic patient that wants you to answer the same 20 questions also wants financial, dietary, and American Idol advice and no matter what your answers he keeps calling and calling and calling and calling and calling and calling and calling...(You get the picture, right?)

5. Your co-workers conversational skills and listenbility resemble dry white toast, a blob of Jell-O and a cocktail shrimp with its head cut off...not very appealing or entertaining when you are exposed to it for 8 or so hours per day...(my staff is crazy so there is always some drama going on...)

6. One sick co-worker has coughed and mucused on every surface of the pharmacy and you didn't know it until it was too late....hand sanitizer can only accomplish so much. It would be more productive to wipe everything down with everclear and light it on fire than to work sick....and the keyboards harbor mold and bacteria..ew..not to mention the restroom that someone artistically sprayed fecal matter all over..ew..maybe that should be burned also...

7. You haved planned out your entire life in a little black planner...how pathetic to see your meaningless existence splayed out like an overeager lover waiting to be experienced..."Let me pencil you in."...

8. Responsibility and accountability. I hate getting yelled at. When you float it doesn't matter because you won't see that person ever again and if the pharmacy manager has a problem with you because he/she doesn't like the fact that you didn't fill the prescriptions in the computer but read the entire magazine rack there ain't sh*t they can do about it...

9. I babysit machines all night long and work when they tell me to....beep beep beep (printer out of paper), ring ring ring (phone), blink blink blink (parata vial filling machine out of pills), ding ding ding (god damned drive-thru again), gggrrrrr (labels printing, time to fill), beep (scanned label), beep (scanned pill stick bottle), beep beep (okay to fill), bink (scanned for verification)....b.o.r.i.n.g.

10. Holy crap, does he ever sleep? Now he wants to know if he forgot to take a Nexium and took another one would it hurt him? AAAAAAAAAGGGGGGGGHHHHHHHHHHH!!!!!! I just want to tell him where else he can stick his Nexium and rip the phone out of the wall!

Yes, a set schedule is good if you can deal with the rediculous. Some days I wonder if I accidentally landed on the set of the Twilight Zone. Anyway, I don't at all feel bad about this week. I work Tuesday and Wednesday then abuse some vacation time so I have the next 25 (yeppers 25) days after that before I next set foot at McDruggie's. Woo Hoo!!!

Monday, February 11, 2008

Let Me Have It

I do not get enough e-mail to fill up my free time... Send me your thoughts of love, send me your thoughts of hate, send me things you want to hear my jumbled crazy thoughts on...


Seriously, lots and lots of free time.....

Another Letdown in Pharmaceutical Development

The promise of needle-free insulin dosing was supposed to give diabetics a new sense of freedom. No more painful injections. No more refrigeration for specialty insulins. No more hassle...

Out comes the Exubera inhaler. This bulky "advance" in insulin delivery fell flat. I had one patient try it and he never got a refill. He chose to go back to the handy dandy needle. Apparently the bulky inhaler was the fatal flaw. He didn't like having to haul the device to use right before eating, especially in public. It made him feel like people were staring at him like he had a plague.

The stigma from a big inhaler was apparently greater than giving yourself an injection.

Beyond bulk is cost. The large box of blister packs is expensive. Many times the copay would be double that of insulin, if it was covered at all. Perhaps this device needs to be redesigned. I am not sure if the design was based on the "No CFC's in inhalers by the end of 2010" or not.

It was so bad that ALL of our Exubera stock has expired. As I send it back for salvage credit my only thought is "Wow, what a disappointment."