Thursday, June 17, 2010

Why I Hate $4 Prescriptions

Yeah, they steal my business. Yeah, they cheapen my profession. Blah, blah, blah. The real reason I hate them is that they undermine patient safety by promoting the use of multiple pharmacies. I got a call from a woman whose husband was "out of it" and "running into the walls." She wanted to know if the new antibiotic he had started could cause that. I start asking questions. He gets all his prescriptions with us, but he decided to get this new prescription for an antibiotic filled at a grocery store chain that charged him only $4. I check his profile. He happens to be on Tegretol, an anti-seizure medication. He has been stable on it for several years. The antibiotic that was prescribed? Erythromycin. Which dramatically reduces his body's ability to process the Tegretol, essentially causing a Tegretol overdose. Which causes things guessed it...acting "out of it" and having difficulty with coordination...AKA "running into walls." Even if this patient had filled this at another pharmacy and used his insurance, the interaction would likely have been caught through a message from his insurance company. But the $4 prescriptions are promoted as the "usual and customary" price, and are given to everyone without billing insurance. Erythromycin is cheap as hell, and he probably wouldn't have paid more than $10 for it anyway...was it worth it?

I wonder sometimes how the pharmacists who work for these $4 companies feel? Does it change their practice? Are they more careful about asking what other meds the patient may be taking? Or is it "not my problem"? I would love to hear your point of view. I can only hope that the prescriber inquired about other medications the patient was taking, but that doesn't guarantee that the interaction would have been caught. I advised that the patient should stop the antibiotic and contact his doctor. And to call and ask us if there would be an interaction if they chose to go the $4 route again. People, I don't care if you fill it at my pharmacy or not...I just want you to be safe.

Tuesday, June 15, 2010

Does This Look Like Athlete's Foot to You?

As a pharmacist, at least once a year, usually on the most sweltering day of the summer, I have the unique pleasure of having someone standing before my consultation window, bracing their weight on the counter as they wiggle out of their shoe, bending down to remove their sock, then placing their nasty, sweaty, naked-ass foot RIGHT ON THE COUNTER and saying, in a Deliverance-esque accent..."Does this look like athelete's foot to you?" And believe me, it does, and I don't need to see it. I can help you just fine by asking you about your symptoms and recommending an OTC treatment. I don't need the fungus-among-us cultivating on my counter. I am armed with Isopropyl Alcohol and Lysol, and I am just waiting for your ass to hurry up and pay for that Lamisil so I can sanitize that counter all the way into next week. I actually prefer the ample bosomed ladies lifting up eight pounds of braless tit to show me the fungal rash they've got going on under there. Why? BECAUSE IT DOESN'T TOUCH MY COUNTER!

Sunday, June 13, 2010

I Just Put Pills in a Bottle

Welcome to my blog. I hope to share some funny retail pharmacy stories, as well as educate the public a little bit about what pharmacists really do. I know a lot of people think that all we do is put pills in a bottle, and I will often get interrupted with questions like, "Hey, where are the shoelaces?" My first story will be the educational sort...

Your pharmacist is a safety net against erroneous or inappropriate prescribing from your doctor. I will not doctor-bash on this blog, as I have much respect for physicians, but they are human. They make mistakes. Heck, we all do. My "catch" last week was a new prescription for Levothyroxine, written as "Synthroid 0.25mg." This is a drug used to replace thyroid hormone when your body isn't making enough of it. I checked the patient's profile, as I always do with a new one, because Levothyroxine is one of those drugs that some patients prefer to be dispensed as the brand. Patients can be very sensitive to changes in manufacturers because the drug is dosed in micrograms, which are thousandths of milligrams. So any minute change in the amount absorbed into the patient's system can result in clinical changes in efficacy. Therefore, I like to check. This patient had never had this drug before. Now, when starting Levothyroxine, it is usually dosed low and adjusted up to the patient's response. We are talking 25 to 50 micrograms here. My gut instinct told me that the doctor meant 0.025mg (25 micrograms), NOT 0.25mg (250 micrograms)! Doctor verified that he intended to write for 0.025mg, and the prescription was dispensed with the correct and appropriate dose. Now let me point out here that 250 micrograms CAN BE an appropriate dose...for someone who has been on the drug and needed a higher dose for the proper response. But it would have a new patient climbing the walls. It's knowing those little nuances that make us an integral and vital part of the health care team. And I can tell you where the shoelaces are...