I have noticed over the past several years that there is an increasing frequency of patients wanting refills for Ultram (tramadol) pain pills early. I am concerned that it is the new drug of choice for addiction because it relieves pain, makes you feel good, and is readily obtainable from practically any prescriber.
An extreme case I had was a lady who goes to a different emergency room every 3 or four days to get a prescription for Ultram. It is usually written with a muscle relaxer and naproxen. She always only fills the Ultram. On this particular evening her newest emergency prescription was one day too early for insurance to cover it. It is out policy to never fill pain pills early if the insurance company denies the claim. Our computer systems do not process next day insurance claims until after 3am. She sat in the pharmacy with 3 young children, one in diapers for 3 hours before the youngest kept screaming and fussing because it was way past bedtime for young children. She finally left the pharmacy at 12am with her children when she had planned to stay until she could get her pills as soon as possible because she was getting fidgety and cranky.
Please re-evaluate Ultram for its potential for abuse and addiction. At the least give it a Schedule V so we can try to prevent some of this personal and child abuse.
Thank you for your attention to this matter.
Big N Tasty RPh
Wednesday, January 5, 2011
Tuesday, January 4, 2011
One to One
I had a patient call concerned because she was having the "I'm gonna pass out" light headed feeling as she stands up from a sitting position. I asked her if she was on blood pressure medication and if she had any other changes recently. She was on Norvasc and had lost 60 pounds over the last few months. Bingo! We have a winner!
There is a lack of awareness for patients that significant weight loss will make major decreases in your blood pressure. This is especially important to know if you are on a blood pressure medication. As your weight and blood pressure goes down you will need to communicate with your physician and monitor your blood pressure. When blood pressure goes too low there can be complications far worse than falling down or passing out when standing up from a sitting position. Imagine if this happened while you were working with dangerous machinery or driving a 2000lb death machine, I mean automobile. Imagine if it dropped so low that you died from a chamber of the heart collapsing or got brain damage from lack of blood oxygenating the brain....crap, gonna get hate mail for that alarmist comment...
Reliable studies over several years have proven one significant finding in weight loss:
1kg = 1mmHg
For every 1 kilogram (2.2 pounds) of weight lost your blood pressure will drop approximately 1mmHg or one point on your reading. This correlation means that patients can see measurable results with only a 10 pound weight loss. As weight and blood pressure drop your blood pressure medications will need to be adjusted. Patients on multiple drug therapy can be dropped to single drug therapy and patients on single drug therapy can have their dose reduced. With enough weight loss and a good weight maintenance lifestyle change most patients can be MEDICATION FREE!
The added bonus: with significant weight loss in Type 2 diabetics we also see less insulin resistance and better beta cell function, which allows them to get off insulin and reduce their other medications and in many patients the same MEDICATION FREE status is achievable!
Another added bonus: with significant weight loss and better eating habits the same reductions can be seen in LDL and triglycerides with increases in HDL (the good cholesterol) and the same MEDICATION FREE status can be achieved by most cholesterol patients!
Long gone will be the days of patients bitching and moaning about taking multiple drugs and spending a lot on ever-climbing copays! Oh wait, reality check, this America... The land of high fructose corn syrup, ever present salty & sugary snacks, and a drive thru eatery on every other street corner! Optimism, I lay thee to rest. Say high to Jesus and Budda for me! I hear they throw great parties, I mean seriously, water into wine...How awesome is that?!
Please let your patients know the wonderful benefits of weight loss and healthy eating. Please let them know how to properly monitor their blood pressure at home at least on a weekly basis with any dietary and workout combo so they know to contact you when they are probably going to need that medication change to prevent any complications. And please only use optimism for them because making those changes should be done slowly and permanently. Slow and steady always finishes the race!
There is a lack of awareness for patients that significant weight loss will make major decreases in your blood pressure. This is especially important to know if you are on a blood pressure medication. As your weight and blood pressure goes down you will need to communicate with your physician and monitor your blood pressure. When blood pressure goes too low there can be complications far worse than falling down or passing out when standing up from a sitting position. Imagine if this happened while you were working with dangerous machinery or driving a 2000lb death machine, I mean automobile. Imagine if it dropped so low that you died from a chamber of the heart collapsing or got brain damage from lack of blood oxygenating the brain....crap, gonna get hate mail for that alarmist comment...
Reliable studies over several years have proven one significant finding in weight loss:
1kg = 1mmHg
For every 1 kilogram (2.2 pounds) of weight lost your blood pressure will drop approximately 1mmHg or one point on your reading. This correlation means that patients can see measurable results with only a 10 pound weight loss. As weight and blood pressure drop your blood pressure medications will need to be adjusted. Patients on multiple drug therapy can be dropped to single drug therapy and patients on single drug therapy can have their dose reduced. With enough weight loss and a good weight maintenance lifestyle change most patients can be MEDICATION FREE!
The added bonus: with significant weight loss in Type 2 diabetics we also see less insulin resistance and better beta cell function, which allows them to get off insulin and reduce their other medications and in many patients the same MEDICATION FREE status is achievable!
Another added bonus: with significant weight loss and better eating habits the same reductions can be seen in LDL and triglycerides with increases in HDL (the good cholesterol) and the same MEDICATION FREE status can be achieved by most cholesterol patients!
Long gone will be the days of patients bitching and moaning about taking multiple drugs and spending a lot on ever-climbing copays! Oh wait, reality check, this America... The land of high fructose corn syrup, ever present salty & sugary snacks, and a drive thru eatery on every other street corner! Optimism, I lay thee to rest. Say high to Jesus and Budda for me! I hear they throw great parties, I mean seriously, water into wine...How awesome is that?!
Please let your patients know the wonderful benefits of weight loss and healthy eating. Please let them know how to properly monitor their blood pressure at home at least on a weekly basis with any dietary and workout combo so they know to contact you when they are probably going to need that medication change to prevent any complications. And please only use optimism for them because making those changes should be done slowly and permanently. Slow and steady always finishes the race!
Tuesday, December 28, 2010
Yay Coupons!
You all know those annoying little printouts/shiny papers/cards with a bin number and a happy "this is gonna save you some money on your copay/this is gonna get you a freebie" message that usually have an issue during claim transmission. For the purpose of this blog they will all be referred to as "coupons". The best part is the patient who does not read the fine print and has no idea what the "deal" entails beyond hand me the coupon and get something cheap/free back and getting snotty when something goes wrong or the "deal" is expired.
Things patients need to know about these coupons:
1. You have to have a prescription for the item in the coupon.
2. They all expire at some point in time. The date is printed really tiny but it is on there.
3. They all have some kind of limit. Some are one time use per patient for life, some are two per person per year, some are free for the first fill and a copay reduction for a few fills after, etc.
4. They are not immediate or fast to process. We have to run the prescription then run the coupon based upon its terms. It may take a couple more minutes than you wanted for your prescription to be completed, discount and all.
5. Giving me the "stink eye", cursing, screaming, making the baby cry, threatening to call your lawyer, etc. will not make this process any faster or make the coupon work after the terms expire or are used up.
For example:
You pull up to my drive thru window at 2am to pick up your Relpax that is ready on the shelf and hand me a computer printed coupon. I process the coupon and it gives me the message "plan limits exceeded. one use per coupon." I relay the message that you need a new coupon and you smart off to me. "So I can't get my medicine?" So I replied that you could but it would be at your insurance copay of $35 dollars.
I can see you giving me the "stink face" and rolling your eyes from the passenger side of the car and just smile when you say "So I have to go back home and print out another coupon then come back?" Yes you stupid cunt! I don't have a magic coupon generator or an internet access to the outside world beyond our company website, a handful of specialty authorization websites, and the ever frustrating PAID prescriptions website. You have to expend the exorbitant amount of energy and effort it takes to drive to your house that is a handful of blocks away, log onto your internet service provider, go to the manufacturer's website, answer the super short questionnaire, print out the new coupon, and drive your ungrateful ass back so I can give you the prescription for $15 dollars after the coupon copay discount. Now go home and stop acting like I kicked your puppy or punched your baby in the face, print out the f*cking coupon, and come back here to my "I want to put my size 9 snow boots up your ass" smiling face to get your stupid f*cking discount!
I say "Good day and happy coupon printing!"
Things patients need to know about these coupons:
1. You have to have a prescription for the item in the coupon.
2. They all expire at some point in time. The date is printed really tiny but it is on there.
3. They all have some kind of limit. Some are one time use per patient for life, some are two per person per year, some are free for the first fill and a copay reduction for a few fills after, etc.
4. They are not immediate or fast to process. We have to run the prescription then run the coupon based upon its terms. It may take a couple more minutes than you wanted for your prescription to be completed, discount and all.
5. Giving me the "stink eye", cursing, screaming, making the baby cry, threatening to call your lawyer, etc. will not make this process any faster or make the coupon work after the terms expire or are used up.
For example:
You pull up to my drive thru window at 2am to pick up your Relpax that is ready on the shelf and hand me a computer printed coupon. I process the coupon and it gives me the message "plan limits exceeded. one use per coupon." I relay the message that you need a new coupon and you smart off to me. "So I can't get my medicine?" So I replied that you could but it would be at your insurance copay of $35 dollars.
I can see you giving me the "stink face" and rolling your eyes from the passenger side of the car and just smile when you say "So I have to go back home and print out another coupon then come back?" Yes you stupid cunt! I don't have a magic coupon generator or an internet access to the outside world beyond our company website, a handful of specialty authorization websites, and the ever frustrating PAID prescriptions website. You have to expend the exorbitant amount of energy and effort it takes to drive to your house that is a handful of blocks away, log onto your internet service provider, go to the manufacturer's website, answer the super short questionnaire, print out the new coupon, and drive your ungrateful ass back so I can give you the prescription for $15 dollars after the coupon copay discount. Now go home and stop acting like I kicked your puppy or punched your baby in the face, print out the f*cking coupon, and come back here to my "I want to put my size 9 snow boots up your ass" smiling face to get your stupid f*cking discount!
I say "Good day and happy coupon printing!"
Friday, December 24, 2010
A Ghost of Christmas Past
Last Christmas I was in south Florida and we were in the hype, fear, and reality of an H1N1 flu pandemic. I was compounding Tamiflu suspension in 16 ounce batches each and every day. Roche was killing with the sales numbers as Tamiflu was going so fast we couldn't keep it in stock. Every child that had a sniffle or cough with a fever got Tamiflu suspension just in case it was the sinister and potentially fatal H1N1.
Today I stare at the gallon jugs of cherry syrup patiently waiting for their turn to be useful and the boxes of Tamiflu capsules seldom prescribed. They have been rendered unnecessary for the time being by vaccinations. This isn't a bad thing, although I hope Roche is still making Tamiflu for the next viral pandemic, but it proves the value of vaccinations.
As Novartis, Medimmune, and Sanofi-Pasteur reap the financial reward of flu vaccination I hope people realize the value of vaccination programs in general. We can prevent horrible fatal diseases and not as horrible hospitalizing diseases with vaccinations. As the world becomes more densely packed with people and people live with their farm animals, diseases will make the crossover from infecting animals to infecting people. Add in a huge amount of world travelers to act as carriers and we see it more and more often with many fatalities.
It is through science and technology that we are able to isolate, study, and prevent if not eradicate pathogens so that more people survive pandemics. For those people who refuse to vaccinate their children out of fear and misinformation, I hope your children are never infected with a vaccine preventable disease so they do not have to suffer irreparable physical/mental damage or death due to your stupidity.
Vaccines do not cause autism. The amount of thymersol used as preservative in a very few vaccines would not even kill a parakeet, lab mouse, or a goldfish. Stop beating that stupid dead horse and get with the program! You have probably used more thymersol in over the counter eye drops than you ever got from a vaccine and statistics show that rates of autism have multiplied greatly for years after thymersol was discontinued in childhood vaccinations in the early 90s.
Perhaps autism is happening because people are so ready to pump developing infants full of medications for every little sniffle, sneeze, or cough. "The baby's fussy so lets give it an antibiotic and some Motrin!" I hate dispensing prescriptions and OTC meds for young children. They are still developing and their bodies cannot process these chemicals as effectively as adults. Unless the child has a fever (above 102 you should take them to the ER because they are at risk of seizures and brain damage) or a physician confirmed infection you shouldn't be pumping them full of medications. I also DESPISE people who pump their kids full of antipsychotics, antidepressants, and ADHD medications. Children are hyper and jumpy because they are children. They have lots of energy and have to touch, see, smell and taste everything because it is part of the human condition and how children learn about their environment before they know how to communicate on a speaking level. Stop vegetating them with drugs!!!
Perhaps it is all the fat-free and preservative/additive full crap you feed your kids with and ate during pregnancy. That is where my bet is. Children do need a certain amount of dietary fat for proper neurological development but when your "food" contains a list of barely pronounceable ingredients maybe you shouldn't be eating it or feeding it to your kids. I liken that to drinking or smoking formaldehyde....it preserves dead flesh, so gee whiz, it is gonna do the same thing to yours Johnny smartass. I can't wait for studies to prove that food preservatives are toxic. Go science!
**Apologies, sometimes I go on a idealogical rampage.
Today I stare at the gallon jugs of cherry syrup patiently waiting for their turn to be useful and the boxes of Tamiflu capsules seldom prescribed. They have been rendered unnecessary for the time being by vaccinations. This isn't a bad thing, although I hope Roche is still making Tamiflu for the next viral pandemic, but it proves the value of vaccinations.
As Novartis, Medimmune, and Sanofi-Pasteur reap the financial reward of flu vaccination I hope people realize the value of vaccination programs in general. We can prevent horrible fatal diseases and not as horrible hospitalizing diseases with vaccinations. As the world becomes more densely packed with people and people live with their farm animals, diseases will make the crossover from infecting animals to infecting people. Add in a huge amount of world travelers to act as carriers and we see it more and more often with many fatalities.
It is through science and technology that we are able to isolate, study, and prevent if not eradicate pathogens so that more people survive pandemics. For those people who refuse to vaccinate their children out of fear and misinformation, I hope your children are never infected with a vaccine preventable disease so they do not have to suffer irreparable physical/mental damage or death due to your stupidity.
Vaccines do not cause autism. The amount of thymersol used as preservative in a very few vaccines would not even kill a parakeet, lab mouse, or a goldfish. Stop beating that stupid dead horse and get with the program! You have probably used more thymersol in over the counter eye drops than you ever got from a vaccine and statistics show that rates of autism have multiplied greatly for years after thymersol was discontinued in childhood vaccinations in the early 90s.
Perhaps autism is happening because people are so ready to pump developing infants full of medications for every little sniffle, sneeze, or cough. "The baby's fussy so lets give it an antibiotic and some Motrin!" I hate dispensing prescriptions and OTC meds for young children. They are still developing and their bodies cannot process these chemicals as effectively as adults. Unless the child has a fever (above 102 you should take them to the ER because they are at risk of seizures and brain damage) or a physician confirmed infection you shouldn't be pumping them full of medications. I also DESPISE people who pump their kids full of antipsychotics, antidepressants, and ADHD medications. Children are hyper and jumpy because they are children. They have lots of energy and have to touch, see, smell and taste everything because it is part of the human condition and how children learn about their environment before they know how to communicate on a speaking level. Stop vegetating them with drugs!!!
Perhaps it is all the fat-free and preservative/additive full crap you feed your kids with and ate during pregnancy. That is where my bet is. Children do need a certain amount of dietary fat for proper neurological development but when your "food" contains a list of barely pronounceable ingredients maybe you shouldn't be eating it or feeding it to your kids. I liken that to drinking or smoking formaldehyde....it preserves dead flesh, so gee whiz, it is gonna do the same thing to yours Johnny smartass. I can't wait for studies to prove that food preservatives are toxic. Go science!
**Apologies, sometimes I go on a idealogical rampage.
Monday, December 13, 2010
Last Minute Gift Ideas When Everything Else Is Closed
It's time for those last minute Xmas gifts because you didn't want to shop with the crowds at the mall, you waited too long for Amazon.com to ship Drug Monkey's book before Xmas, or you had an unexpected gift, or you just plain left someone off your shopping list. Here are some ideas from McDruggie's to bring holiday joy to those you love.
*Gift cards for mediocre chain restaurants like Applebee's and Red Lobster
*Cameras that use 35mm film because they are one of the few places that still carry it.
*35mm film for the aforementioned cameras for family members that fear the future of digital photography.
*Cha Cha Cha Chia! Chia pets.
*Clap on! Clap off! The Clapper.
*Digital photo frames for those who embrace technology.
*Sony Blue-ray DVD player for those who don't own a Playstation 3.
*A speaker set or radio to plug an iPhone or iPod into for listening enjoyment. This is also a great gift for pharmacy employees who tire of hearing the same 50 songs and ads over and over and over and over...
*Candy, candy, candy.
*Liquor because "Candy is dandy but liquor is quicker!" (disclaimer: only some stores have an actual liquor department, other stores only carry beer and wine)
*Tons of Toys! (Be sure to buy some extra toys for Toys for Tots! Some kids may not get presents otherwise and what a crappy Xmas morning that would be.)
*Kleenex, hand sanitizer, antimicrobial hand soap, etc for your favorite germaphobes.
*Illicit Drug test kits for nosey/concerned parents of teenagers.
*A breathalyzer for your favorite alcoholic.
*Laser pointers for your cat or squeaky toys for your dog.
*OTC medications for all your sick relatives.
*Flu shot gift cards.
*Shake Weight! You've seen the commercials now own the legacy!
*Anything from the As Seen On TV collection.
and I saved the best for last...
*It's a pillow, it's a pet, it's a pillow pet! (Yes I have been psychologically damaged by hearing that ad on the muzak over and over and over to the point I can't help but make it my greatest and last recommendation!...stupid suggestive selling ads...)
*Gift cards for mediocre chain restaurants like Applebee's and Red Lobster
*Cameras that use 35mm film because they are one of the few places that still carry it.
*35mm film for the aforementioned cameras for family members that fear the future of digital photography.
*Cha Cha Cha Chia! Chia pets.
*Clap on! Clap off! The Clapper.
*Digital photo frames for those who embrace technology.
*Sony Blue-ray DVD player for those who don't own a Playstation 3.
*A speaker set or radio to plug an iPhone or iPod into for listening enjoyment. This is also a great gift for pharmacy employees who tire of hearing the same 50 songs and ads over and over and over and over...
*Candy, candy, candy.
*Liquor because "Candy is dandy but liquor is quicker!" (disclaimer: only some stores have an actual liquor department, other stores only carry beer and wine)
*Tons of Toys! (Be sure to buy some extra toys for Toys for Tots! Some kids may not get presents otherwise and what a crappy Xmas morning that would be.)
*Kleenex, hand sanitizer, antimicrobial hand soap, etc for your favorite germaphobes.
*Illicit Drug test kits for nosey/concerned parents of teenagers.
*A breathalyzer for your favorite alcoholic.
*Laser pointers for your cat or squeaky toys for your dog.
*OTC medications for all your sick relatives.
*Flu shot gift cards.
*Shake Weight! You've seen the commercials now own the legacy!
*Anything from the As Seen On TV collection.
and I saved the best for last...
*It's a pillow, it's a pet, it's a pillow pet! (Yes I have been psychologically damaged by hearing that ad on the muzak over and over and over to the point I can't help but make it my greatest and last recommendation!...stupid suggestive selling ads...)
Shameless Product Endorsement
I had the worst sore throat ever yesterday. I went to see a band and it hurt so bad to scream or sing that I thought I was going to lose my voice. After the show I went to McDruggie's to get some throat spray and there was a wonderful surprise: Chloraseptic Max.
This magical concoction was so much better than the crappy tasting alternatives and previous formulations that it was love at first spray. It has 1.5% phenol for anesthetic/analgesic purposes, 33% glycerin to coat the throat, and a berry flavor that makes phenol tolerable. It has been my new best friend for two days and my throat feels a lot better.
Thank you Chloraseptic Max! You will be one of my new recommendations for sore throat from now on!
This magical concoction was so much better than the crappy tasting alternatives and previous formulations that it was love at first spray. It has 1.5% phenol for anesthetic/analgesic purposes, 33% glycerin to coat the throat, and a berry flavor that makes phenol tolerable. It has been my new best friend for two days and my throat feels a lot better.
Thank you Chloraseptic Max! You will be one of my new recommendations for sore throat from now on!
Friday, December 10, 2010
Holiday Cheer!
I had a lady call to request a refill on her Darvocet-N 100. I explained to her that it had been discontinued so we would need to contact her physician to get a suitable replacement to treat her pain. She was terribly irate and felt the need to make it my fault that she could not get her medication that she so desperately needed, even though her last refill was 6 weeks ago on a thirty count prescription. She made it sound like I was kicking puppies and drowning them in a bathtub for shits and giggles.
She proceeded to whine and complain about how we mistreat our patients and maybe we should take better care of people. I apologized for her inconvenience (which I should not have done) and this Scrooge then had the nerve to say hatefully "Nobody ever apologizes for anything anymore! You should apologize to me!" I then said "I just apologized to you for something completely out of my control and you are the one being hateful about it. We will contact your physician in the morning because they are not in the office at 7pm." She then had the nerve to repeat herself on how nobody apologizes so I just told her we would call her doctor, said good night, and hung up on her.
I was pissed off. We were doing the work of 20 people with 5 staffers and her attitude was not acceptable. Some people are just inconsiderate assholes! I took the high road and faxed her doctor anyway even though my first instinct was to wad up the request and throw it in the DPI box. I am just too committed to the job sometimes.
I bet she is a miserable old hag and has forgotten what it was like to have a happy holiday. I pity her and hope that none of you are insufferably hateful during the holidays no matter how busy it gets!
***DPI boxes are where we put all patient info for destruction.
She proceeded to whine and complain about how we mistreat our patients and maybe we should take better care of people. I apologized for her inconvenience (which I should not have done) and this Scrooge then had the nerve to say hatefully "Nobody ever apologizes for anything anymore! You should apologize to me!" I then said "I just apologized to you for something completely out of my control and you are the one being hateful about it. We will contact your physician in the morning because they are not in the office at 7pm." She then had the nerve to repeat herself on how nobody apologizes so I just told her we would call her doctor, said good night, and hung up on her.
I was pissed off. We were doing the work of 20 people with 5 staffers and her attitude was not acceptable. Some people are just inconsiderate assholes! I took the high road and faxed her doctor anyway even though my first instinct was to wad up the request and throw it in the DPI box. I am just too committed to the job sometimes.
I bet she is a miserable old hag and has forgotten what it was like to have a happy holiday. I pity her and hope that none of you are insufferably hateful during the holidays no matter how busy it gets!
***DPI boxes are where we put all patient info for destruction.
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