We bring the FAST and laughs to pharmacy.

Friday, November 28, 2008

Holiday Wish List

The end of the year is nigh. The mad dash for gifts people will return or leave in a closet to re-gift to someone else later is here. It started off with people coming into McDrugggie's ever so often to use the restroom. No purchases, just restroom trips. These nut-jobs had been in line at Best Buy since 4pm on Thanksgiving so that they could get the magic coupon that got special prices on certain items. I hate to break their plates but all of the items in the ad were available on-line at the sale prices without the magic coupon.....could have shopped at home and enjoyed your family instead of sitting in a 200 people line all night long....I will never understand....

A lady that calls all the time called asking if there was a virus going around because she will only take a Xanax but never anything for her allergies because medicine makes her "sick." She always asks me if I am seeing patents with colds or flu symptoms and if I am sick because I sound sick. I told her I had some allergy related congestion and she told me she had the cure for that....a nettie pot. I let her know ever so politely that if I wanted warm saline in my nose I would go to the beach and play in the waves because inevitably a big one comes along, knocks you down, and cleans your sinuses for you. I of course was joking but seriously do not like the sensation of any liquid in my nose, no matter how congested if may be.

The opposite week manager was filling in for the regular manager and was telling me stories of how the other pharmacist refuses to recommend OTC products because "The body makes snot for a reason and if you take OTC meds it just prolongs the illness." She then told me that he always tells people that none of the OTC vitamin products are regulated and each bottle contains a different potency and concoction than the one before so you shouldn't take any of them.

He also told a pregnant lady one night that she shouldn't take Sudafed because it is what junkies use to get high and did she really think that was a good idea for the baby. That was hilarious. I would never say that to a pregnant lady. I would tell her to use saline nasal spray until she talked to her OB/GYN. He also likes to tell people to ask me questions when I am back on duty. I have had several of those patients but in his defense when he went to pharmacy school they had to compound everything and aspirin was the only real drug. On the other hand he is a pharmacist and should be up to date and comfortable with most of the medications on the market and health issues patients have questions about.

So for the rest of the evening I fed the robot with pills, cleaned, and restocked supplies for a lack of anything medical to do. Then I had a patient come in with a prescription for Duragesic 75mcg patches. For those who don't know, this is a powerful pain patch used in patients who don't tolerate opiate pain relievers like morphine or oxycodone. So I ran it and to my surprise he picked up Oxycontin 60mg (twice daily dosing) from CVS a couple of days ago. These DUR notifications are about the only good thing insurance companies do anymore because without them I would have no idea about the other prescription. Now I am concerned because I have NEVER seen or heard of these two medications being used together. So I had to have a serious conversation with the patient.

He said he had been on the combination before but I told him we needed to consult with the physician to make sure the doses had been properly titrated and the physician was aware of complications that could result from the combination. The patient really had no problem with taking both together. Because I have no recent prescription history to prove the doctor was aware of the situation I told the patient they are both powerful meds that are never used together in high doses because of breathing complications that could result in death. He left the prescription for me to call on and still was not concerned about any complications. What I really wanted to say to him was "Sir, I cannot dispense these without talking to your doctor because Murder One is not on my Holiday Wish List." Alas, I could not vocalize but merely ruminate on that which my brain wanted to scream out...

On the bright side the day was easy and over before I was completely bored stupid. On to the next day...

4 comments:

Anonymous said...

I care for a man in his home & he is prescribed one 100 mcg duragesic (change 72 hr) & 30 mg of oxycodone (not extended release) he takes 3 x's daily. This is actually pretty common here in long term chronic pain patients & I've seen it done numerous times in nursing homes. I'm in Oregon so maybe its just more widely known here, I'm not sure. But I've seen it a lot.
I can understand your reservation about it but it is done.

Big 'N Tasty RPH said...

We talked to the doc and they had been titrating over several months so it was all good. I just have that voice in the back of my mind saying "Don't kill anybody today." The day I stop listening to that voice is the day the world goes to hell in a ball of flame...I hope that day never comes...

NotRetailRPhAnyMore said...

Hi, actually fentanyl patches are used in opiod tolerant patients only, who wish/need to have a constant "basal" rate of pain medication delivered into their system. It is also more convenient for some than taking tablets several times a day. In my experience the combination of fentanyl/oxycodone/MSO4/etc. is quite common and if patient is opiod tolerant very useful in treating severe or chronic pain. Actually, your patient would not be able to tolerate the fentanyl had he not been taking an oral opiate such as oxycodone previously. It is a good idea to double check with the doctor though if there are any questions/problems regarding those scripts.

oddharmonic said...

Neti pot proselytizers are everywhere. My husband was chatting with someone online the other night and they asked if I had a Neti pot yet because it 'cured' her sinus troubles. I tried one once and did not enjoy holding my head at that angle.

I am both aghast and amused by other pharmacist's recommendations.