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Tuesday, September 7, 2010


Behold the glory and magically delicious awesome that are these sixty Skittles. It is in fact the whole small bag minus the one Skittle that I just had to eat because it was looking at me funny. Sixty is a mighty big number of Skittles but it is even bigger when I took this particular pic of sixty Skittles to represent the sixty medications a patient is on.

Let that sink in: S-I-X-T-Y different medications.

Seriously S-I-X-T-Y different medications. Not only is that a Herculean task to keep track of dosing but are you even hungry after eating that many pills?

I happened to be filling in at a non-24 hour pharmacy and a lady came in with two Ziploc bags of medication bottles for us to transfer from another state because her sister moved in with her so they could help take care of her. We transferred about 12 prescriptions that day and the pharmacist at the other pharmacy told us she had 60 medications so we would probably be calling her back sometime soon for more of them.

I have not seen her entire list of Skittles but her sister said she was "real sick" but I just have to ponder how many of those Skittles she really needs. I am just saying when you get in the double digits of Skittles you are in duplicate therapy territory, not to mention ready for a stomach ache. I also wonder how many Red Skittles she takes to counteract side effects of Yellow Skittles and how many Green Skittles are treating the same disease state. The interactions can be limitless.

I also wonder if any of her doctors have seen her list of Skittles from her other doctors. This is where we have a problem with Skittle therapy in general. It is imperative for pharmacists to identify issues of over treatment, duplication, toxicity, etc. I am a firm believer in the minimalist approach to Skittle therapy. For each desired effect of a Skittle there are a possibility of hundreds of undesired effects. Some Skittles are worse than others and it also depends on how well a patient tolerates each Skittle and if the Skittles interact with each other. It is an increasing problem when patients use multiple physicians and multiple pharmacies to treat multiple disease states.

The moral to this story is that every patient should keep a current drug regimen list with them in their wallet or purse at all times. This will help keep drug therapy to a minimum and could save your life in an emergency situation. The other point to this post is that Skittles aren't only the most awesome candy on the planet but it is fun to say and I want the world to use the word Skittle just like those annoying little blue Smurfs overused their name. Don't make me Skittle you in the Skittles!


Anonymous said...

If you have to pick up all your meds in a BIG brown box, you're doin' it wrong! Just saying.


Pharm.Tech. RDC '06

DenaliDriveThruPharmD said...

I love your 'Skittles' analogy! I wonder how many she'll be on after that liver transplant?

C said...

Actually Gummy Bears are my drug of choice, but whatever works.

I think this is an explanation that laypeople can understand, that is..if they truely want to.

Have you tried the Sweet and Sour Skittles? Very good!

thepharmmonster said...

Ya know, the ironic thing is that I've found that the patients with the MOST prescriptions are actually the ones that do the best job at keeping up with them. I can think of two patients off the top of my head who have rx's in the double digits, and they always know when to get them filled, and they always know exactly how many they should be picking up. With NO outside help. And one of them is a psych patient. Impressive!

WarmSocks said...

I had a friend with leukemia get a bone marrow transplant. So many prescription meds that the family bought a huge fishing tackle box to store all those pill bottles. Eight years, and still going strong.

Big 'N Tasty RPH said...

Transplant patients will always have a lot of prescriptions. It is the nature of keeping an organ from rejecting. Most patients should not need more than 5 maintenance medications ever. The point of the post is for patients, especially if they see multiple physicians, to have a current med list and have each prescriber coordinate drug therapy to reduce the potential for toxicity and interactions while allowing the patient to save a little money. Drugs are expensive, especially with copays rising each year. Go Generic!