Are You Kidding Me?

My mouth just dropped open.  It's obvious to me that physicians do NOT read medication reconciliation forms for home meds at all.  The ones that do, kudos, but the ones that don't make my job more interesting and at times really get to me. Case-in-point:  50-something presenting to the hospital with lower GI bleed.

The doctor signed off to CONTINUE HER HOME MED OF PHENTERMINE FOR WEIGHT LOSS.  Are you kidding me?

I guess the nurse could have written "Purina Dog Chow - take one cup by mouth daily" and the physician would have signed off on it.

Way to go Joint Commission on putting in a requirement with no means of adhering to any sort of THINKING for anyone involved.

Except for the pharmacist of course to wade through the BS and find what is really needed.

I really like the one where the physician wanted to continue the patient's viagra while in the hospital.  THAT should keep the nurses on the floor on their toes running from a man who is looking for some fun.  Not good.

Medication reconciliation forms.  The bane of my existence.

Why Does it Take So Long to Fill My Prescription?

The age old question that used to make my toes curl...  why does it take so long to fill my prescription?  If you search around the net, you'll find non medical people discussing, and it's hilarious: Why does it take so long to refill my prescription?  I went there yesterday and it took them 2 hours to refill my medicine.  I wanted to call the manager to complain but thought I'd ask here first.

Yahoo's best answer voted (not kidding):  If they did it in 2 minutes, you wouldn't value them as much. You'd think that they were just technicians putting pills in a bottle.

They have to make you wait to preserve the mystique.

Yeah, that's it baby.  We need more value?  We love mystique.

Basically the bottom line is that there are hundreds ahead of you!

Paternity Testing Available More Discreetly

Friday , February 29, 2008

By Marrecca Fiore

Who needs Maury Povich when paternity tests are now available at Rite Aid, Meijer and other pharmacies for just $29.99?

The Identigene DNA Paternity Test Collection Kit was first rolled out in Washington State, Oregon and California in November last year, according to Rite Aid spokeswoman Ashley Flower. The company continues to evaluate whether it should expand the kits to other states, she said.

According to the Identigene's Web site, the tests compare genetic information obtained from cheek swabs collected from both the child and the father. The swabs are then sent to the company's laboratory along with a $119 lab fee. The results are mailed within five business days.

While the tests are believed to be accurate (the company's Web site says they're 99 percent accurate), there are some reasons why women and couples may want to consult a professional laboratory for paternity tests, said Brad Imler, president of the American Pregnancy Association.

"There's no risk of harm from a medical standpoint," he said. "Although they're not admissible in court. And, from an emotional standpoint, it's a good idea to see a professional. It doesn't have to be a doctor, but someone who is prepared to discuss the result with you if it comes back in a way you were not expecting."

Imler said some people, especially married couples, may find the results of paternity tests traumatic.

"Whatever the circumstances are that bring someone to the point of needing a paternity test, that's irrelevant," he said. "The professionals associated with the laboratories are trained to present the results in a way that doesn't cause panic or in a way that reduces panic."

Both Rite Aid and Identigene representatives say the tests have brought no more controversy than at-home home pregnancy, blood pressure, cholesterol and drug tests did when they were first introduced.

"There was a lot of concern when the home pregnancy test first came out," said Douglas Fogg, chief operating officer for Identigene. "Would people use it correctly? Would people be able to handle the results?

"We have been providing home DNA testing since 1993 and on the rare occasion we'll have a client that has a hard time dealing with the results," he continued. "Most of our clientele are aware of what the results will be. They don't want to involve lawyers or physicians. They just want confirmation in a quick, easy and confidential way."

Fogg said the company’s Web site provides consumers with counseling information

"Some people are devastated by the result of a paternity test," he said. "A paternity test can have a life-changing result. For those that need professional help in dealing with their situation, our Web site offers references to family counseling services that can provide people with the help they need."

Fogg said 60 percent of Identigene's clients are females. Some users are looking to confirm their own paternity. Almost 30 percent of purchasers buy the test for someone other than themselves, according to the company's own surveys.

The tests are sold in 1,000 pharmacies nationwide, Fogg said. He said all pharmacies have reported sales and the company is pleased with the interest. The tests are also marketed online and through resellers.

Is It That Bad?

A potential pharmacist student commented on my blog here asking me if pharmacy was really that bad... he said he was reading blogs about the medical profession and all we do is gripe and complain. Got me to thinking this early morning about that question... "Is it that bad?" For me, no way it's not that bad or I would have already gone back to school to do something else. I believe it's human nature to complain some and especially to complain anonymously. Things about pharmacy that I have loved... This is a list probably needed to be completed to tell you guys and gals the GOOD stuff.

1. If you loved science and you loved biology in high school and college then pharmacy could be the career for you. Not only did I have the opportunity to learn about chemicals, etc..., but I learned the various ways they are changed, metabolized, and excreted by the human body. Not only that, but the different ways they can be broken down by DIFFERENT human bodies - some with renal issues, some with hepatic issues, etc... Everyone can be truly different. Drugs can react differently. I found this one single point of pharmacy to be quite fascinating.

2. If you want to graduate in 6-8 years and start out making six figures (potentially) this may be the job for you. I found in 1999 when I graduated that I was making close to six figures, but a lot of the older pharmacists were really ill about the new guys on the block because they knew we were making the exact same pay. It wasn't pay based on performance but LICENSURE. For the new guy, this is great; for the old guy, it can be disheartening to think that little youngin' next to you is bringing home the same bucks. I'm almost 10 years out of pharmacy school now (unbelievable time flies!) and it STILL DOES NOT BOTHER ME. I don't get wrapped up in petty stuff, and I figure if you really want a dollar more per hour, you could have negotiated up front. BE A SHARK when you negotiate - ASK FOR THE IMPOSSIBLE. If you do not ask, you will NOT RECEIVE. Vacation... they say we'll give you 3 weeks. Tell them that you want 4 weeks. Go up on pay by at least 5-10K per year. Why not? They want you and they will negotiate just like if you are selling a house.

3. Options other than retail. When I tell people I'm a "pharmacist," the majority think retail. What is great about pharmacy is that there are MANY MANY options in different jobs. Of course coming out of school, retail is the most lucrative in pay, but over time other positions can be just as tasty. There are the hospital pharmacists (me), the home infusion pharmacists, the nuclear pharmacists, the retail pharmacists, the professors in a pharmacy school, the long-term care pharmacist, the consultant pharmacist, and the specialty pharmacists within other settings. You can do a residency, make yourself a little different than Joe PharmD next to you, and land a Critical Care Specialty Pharmacist position at a big city hospital, make rounds with a physician that actually respects you if you know your shit and drink Starbucks coffee everyday leaving for home at 5pm like the rest with bankers' hours. The CHOICES ARE ENDLESS really.

I've been out of school, like I said, for 10 years almost. I have tried retail, home infusion, long-term care, and hospital. I love little bits of all of them... but I find hospital to be the most comfortable for me.

I would never tell someone to NOT pursue pharmacy. It's a great career for anyone... BUT you will find some complaining out there... even from me.

Blogs have to be funny after all, right?

What advice I would give students graduating from pharmacy school

Seems others are doing the same, so I'll put in my 2 cents. 1.  Don't assume that all of pharmacy is retail.  Yes, you will make the most bucks in retail and if you have gone the way of borrowing your way into a huge hole, then it may be your only way to make it out and then find something else.  Perhaps retail is your goal, and you love it, but personally, I found 3 years of retail to be enough pharmacy prostituting that I could do.  The bucks WERE nice, but the abuse to my body from standing 14 hours a day, lack of bathroom breaks, treatment from STORE managers who have barely any sort of education, abuse from patients, and abuse from non-caring technicians, I look back now and say RUN -- no I SCREAM RUN!  There are some great jobs out there that don't involve retail at all.

2.  If you DO choose retail know that the longer you stay IN retail, the less likely you'll ever get out.  It's like getting hooked on a drug.  You keep doing it saying you'll quit, but by the time you are ready to leave, it's almost too late, unless you are lucky and some poor sweet manager in a different realm of pharmacy sees the pain you have experienced and wants to throw you a lifeline.  I had one of those - a female pharmacist that I am forever indebted to.... thanks J!

3.  Make pharmacy a hobby somehow.  Read and read and read.  The only difference between you and the girl (since girls are taking over ;)) standing next to you is that you somehow have made yourself marketable... you are reading publications and keeping up.  You are giving a rats ass about pharmacy and all the crap going on...  You know how to find anything FAST...  you can think on your toes.  Who care what you made in Biochem.  No one cares.  But do you know the difference between using Primaxin/Fortaz vs. Tygacil in different situations?  Can you think critically?

My top advice... DO NOT GO INTO RETAIL!!!!!!!!!!!!!!!!!!!!!!!!!!!

Brain Shivers... Brain Zaps... Brain Shocks...

I do not know if many in the medical community are aware of this term that is thrown out there for such offenders as venlafaxine (Effexor), duloxetine (Cymbalta), paroxetine (Paxil), fluoxetine (Prozac), sertraline (Zoloft), fluvoxamine (Luvox), citalopram (Celexa), and escitalopram (Lexapro), but it is a very real phenomenon. Unfortunately, though many in the medical community have not had to rely on any of these meds in their own personal lives, I had a 2-3 year stint with venlafaxine from 2002-03. Basically, I presented with the inability to sleep due to anxiety of some personal issues (which we all have from time to time), and did not want a controlled substance. I tried paroxetine first and absolutely despised the drug. I quit cold turkey. Very smart for a pharmacist, right? (You can't just stop cold turkey and expect to not endure some uncomfortable sensory disturbances.) I found venlafaxine, at 75 mg extended release, to be a very good drug for its purpose of 9 to 12 months. However, what I didn't expect was that weaning from the drug would be so uncomfortable. 75 mg in itself is not even a moderate dose, falling more into the lower dose category. I've seen higher doses much more than the lower doses.

To explain what I felt, I will do my best to try to break down into words the feelings. Initially, there was a sinking feeling in my brain. If you've ever been to the Grand Canyon or a very tall building and looked down, there is a falling feeling that your brain sometimes throws at you though you are not falling at all. That feeling would happen for very short bursts, 2-3 seconds, enough to disrupt my thoughts, my work, and my being. I would just think, "What was that?" If I tapered over the recommended taper schedule (usually a week at a time step down, but keep in mind there's only one strength lower than the 75 mg XR - the 37.5 mg XR. Then where do I go? Literally it didn't matter. The big divide between the 75 mg and the 37.5 mg was enough to cause the "shivers" in my brain - a disorientation, falling, weird, and uncomfortable feeling.

"Brain zaps" are said to defy description for whomever has not experienced them, but the most common themes are of a sudden "jolt," likened to an electric shock, apparently occurring or originating within the brain itself, with associated disorientation for a few seconds. The phenomenon is most often reported as a brief, wave-like electrical pulse that quickly travels across the surface of (or through) the brain. Some people experience these "waves" through the rest of their body, but the sensation dissipates quickly. They are sometimes accompanied by brief tinnitus and vertigo like feelings. Immediately following this shock is a light-headedness that may last for up to ten seconds. The sensation has also be described by many as a flashbulb going off inside the head or brain. Moving one's eyes from side to side quickly while open has also been known to trigger these zaps and sometimes causing them to come in rapid succession. It is thought to be a form of neuro-epileptiform activity.

As withdrawal time increases, the frequency of the shocks decreases. At their peak, brain zaps have been associated with severe headaches. They may last for a period of several weeks after the last dose and usually resolve completely within a month or two. However, anecdotal reports of "zaps" during a protracted withdrawal are known to last a year or longer.

My remedy was to open the capsule and to count the tiny beads and literally make capsules with less and less tapering over a 6 week period rather than the usual 2 - 3 weeks at this dose. It did eliminate the feeling, but it definitely helped. One could go as far as asking the physician for a 37.5 mg immediate release tablet and maybe breaking it up into pieces and tapering at the very end that way. Any way you dice it, venlafaxine was a pain and taught me right away a bigger lesson in remembering the side effects than any package insert ever could.

10/31/12 - update and fitting it is Halloween! Guess what? Add Cymbalta (duloxetine) to the list. It has been given approval for pain, both arthritic lower back and cancer. Withdrawal when you miss a dose.

I did take Vitamin B Complex, and maybe it helped.  Others have mentioned other vitamins.  Would love to hear remedies that worked if you can email me at theblondepharmacist@gmail.com

Walgreens - the Superpower

Walgreens September Sales Increase 9.5 Percent;Opens 6,000^th Store

DEERFIELD, Ill.--(BUSINESS WIRE)--Walgreens (NYSE: WAG)(NASDAQ: WAG) had September sales of $4,413,000,000, an increase of 9.5 percent from $4,031,527,000 for the same month in 2006. Sales in comparable stores (those open at least a year) rose 4.7 percent.

September pharmacy sales increased 8.8 percent, while comparable pharmacy sales increased 3.9 percent. Comparable pharmacy sales were negatively impacted by 3.8 percentage points due to generic drug introductions in the last 12 months.Total prescriptions filled at comparable stores increased 1.6 percent. Pharmacy sales accounted for 66.4 percent of total sales for the month.

Comparable store front-end sales increased 6.3 percent during September.

Calendar day shifts accounted for a negative impact of 1.6 percentage points on comparable pharmacy sales. Patients fill more prescriptions on weekdays compared to weekends, and this year’s September had one additional Sunday and one fewer Friday compared to September 2006.

Calendar year-to-date sales were $40,357,306,000, an increase of 11.9 percent from $36,056,997,000 in 2006.

Walgreens fiscal year began Sept. 1, so fiscal year-to-date sales are the same as the month’s sales.

Walgreens opened 18 stores during September, including two relocations, and acquired one store. The company opened its 6,000th store in New Orleans and will celebrate the grand opening in October.

At Sept. 30, Walgreens operated 6,014 drugstores (including 101 home care division locations, eight specialty pharmacies and three mail service facilities) in 48 states and Puerto Rico, versus 5,475 a year ago. Franchisees of Option Care, Inc., a wholly owned subsidiary of Walgreens, are not included in Walgreens store count.

Please note: Monthly sales numbers are preliminary and unaudited. Comparable stores are defined as those locations open for at least 12 consecutive months without closure for seven or more consecutive days and without a major remodel or a natural disaster in the past 12 months. Relocated and acquired stores are not included as comparable stores for the first 12 months after the relocation or acquisition.

Magic Mouthwash (the vague term for a concoction of ANYTHING)

When I worked in retail pharmacy, a physician would write a prescription for "Magic Mouthwash" and the patient would hand over the prescription with this look of "magic."  This special blend of WHATEVER would be the cureall for their sore mouth and throat caused by thrush or radiation or any other mouth/throat pain condition.  The physician rarely would include what he/she "thought" to be their special recipe.  So, we would have to call and clarify. "What would Dr. Doe like in his magic mouthwash?"  I would ask simply.

"Magic Mouthwash?"  asks the nurse, "I don't know.  What do you normally put in it?"

Sigh.  "Well we could start with diphenhydramine, lidocaine, and nystatin all at a 1:1:1 ratio or we could do tetracycline and throw in some mylanta with the formerly mentioned ingredients at all different ratios.  There are probably a 100 different magic mouthwashes out there.  What is the doctor treating?"

And it would end up that I could pick whatever I wanted.  That made me think... hmmm  placebo effect.

So what exactly should you put in Magic Mouthwash?

The usual concoction contains equal amounts of viscous lidocaine and diphenhydramine for analgesia...and Maalox or a similar antacid to enhance coating of the ingredients in the mouth.  Some also include nystatin to prevent or treat fungal growth...a corticosteroid to reduce inflammation...or tetracycline to prevent secondary bacterial infections.

Who knows if this stuff even works and is worth the money since we pharmacists usually tack on a compounding fee.  I say get a prescription for lidocaine viscous and buy your own benadryl solution and mylanta and make your own... for less.

Teamwork and Positive Attitude!!!

There was this cheery orientation video that we all had to watch with the rest of the newbies during the Human Resources' led introduction. I cannot remember the exact name of it, but it had phrases come across the screen of what staff members should NOT say to other members of the staff or patients in the hospital. Rather than: "No. I don't know." Say: "No... but let me find out for you."

There were twenty or more of them, and oh... what a perfect world it seemed for that 10 minutes of listening to those positive and helpful statements. In the real world, I remember the first three weeks of work. I heard them all.

"No... it's not my job."

"Sorry, I don't know."

Or just ignored me. I felt like the biggest idiot asking question after question but considering there was no real formal training program, I guess I got by after four weeks of it.

Andy gave me a brand-new shiny white notebook filled with a 5 week training schedule, a page to write down all my usernames and passwords... (um... doesn't that defeat the purpose?), and blank pages to write notes. OK.

A few words about the training schedule.

I don't know how many of you pharmacists out there have specialty pharmacists, but it's this new phenomenon of further separating the pharmacists from those with residencies and fellowships. We have a few female specialty pharmacists: critical care, infectious disease, pain management, and a couple of others. And their boss, Ann, who has about a month left before she moves away. Most of the regular staff (non-residency pharmacists) cannot stand Ann because they say she forced more work on them and our boss Andy didn't stand up for them. OK. Whatever. Now we have to calculate creatinine clearances for Vancomycin, etc... Big deal. Doesn't matter to me.

Part of the training schedule included meeting with every single one of the specialty pharmacists, etc... and discussing what they do and taking me up on the floors to see them in action. One of them did her job with that setting up the meeting and showing me what she does, etc... One of them mentioned setting something up in three or four days but never delivered or remembered it later (That would be Jessica, who seems nice enough)... is that MY job to remind her? It's THEIR TRAINING PROGRAM! Another one of them, Kimmie, never mentioned it or anything. Geeze. So I didn't see any of it.

The third week, I saw my boss Andy completely ass out. We have automatic orders that can be ordered in group by physicians and we don't have to see the actual written orders... they are pre-approved orders. They print off all day as the orders are being entered along with the scanned and written images we see. Sometimes we get a little bit behind on the pre-approved orders. Andy waltzes into our little room and asses out one day as we are behind on them but also severly understaffed. I saw the real Andy. He's passive aggressive.

Also the third week was when it was discovered by me that although we are in one department, we are severly divided. Staff vs. Clinical. I'm staff. Ann, Kimmie, Jessica, and management with some others are clinical. They have private celebrations for one another without including the staff and don't have the decency enough to take it off site but rather leaves us out. Like I care... but I remember the terms used in my interview...

"Oh Blonde Pharmacist...." Andy says nicely, "We have the best team attitude and everyone is positive and we are making sure that all new hires fit with us and vice versa."

Um. OK. I see what's going on here. He's hiring one person at a time to try to change the culture.

I don't want to be a part of the revolution!