Recently in Drug Trivia and Rants Category

So, it has come to my attention (a few days ago) that Airborne must pay 25 million due to a lawsuit claiming that it didn't work.

Some highlights include:

• Airborne not proven to work
• The "clinical study" was preformed by a couple of random dillholes and probably was just made up
  
• If you purchased airborne, you can get a refund
• Making medical claims without FDA approval

Now, I know that any self-respected pharmacist would never ever suggest airborne to anyone that they cared about.  Why? Because it doesn't work.  We all know this, you all know this.  Its vitamin-C and a bunch of other OTC shit all in a fizzy alka-selzer tablet that makes you feel all warm inside.  Its like donating $0.75 a day (the price of a cup of coffee) to starving African kids when its just going to feed Sally Struthers.  Rich folk do that just so they can get a hard-on by 'helping people' as they bitch at me about their $30 copay.

The only person you would sell Airborne to is that retired teacher who always calls you out front for an OTC recommendation only to tell you how wrong you are and buy something else.  Those fucks you are happy to see waste money because they have no problems wasting your time.

Which brings me to another point.  One of the major selling points of Airborne is that it was "CREATED BY A SCHOOL TEACHER!".  Now just not any teacher, but a 2nd grade teacher.  Someone enlighten me as to why I would trust anything a school-teacher made?  How is that even a half-way valid selling point?  Some of the most ignorant people I know are school teachers (mostly because they think they know everything and are very vocal about it).  If it were made by a pharmacist it might have some basis because at least we know how the body works, but a 2nd grade school teacher?  Is this shit going to work based upon the vast knowledge of social studies? Cursive writing? Multiplication tables? Is this teacher applying their vast knowledge of shit-stupid physical science to prevent my cold?  What qualifications does he/she have (being a 2nd grade teacher and all) that would actually give her some real-world claim to actually know something about medicine?

Victoria Knight-McDowell, please inform us pharmacists what your methods were to determine what does and does not work to prevent colds as well as any relevant research and study data?  What? No I do not wish my name on the chalkboard. What?!? Detention?  Aww!!!  I'm sorry for implying that you are a fraud preying on the stupidity of the uneducated population, can I go to recess now?

I'm confused as to why people waste their money on this shit.  I'm actually shocked that people swear by something that is proven to not work and has every pharmacist in the country saying that it does not work.  Its the "#1 best selling" because people are stupid.  Not because it works, but because people are piss-stupid.

Of course they also buy "Head On" which is chap-stick for your forehead so I guess I should just shut my mouth.

So I've had just about enough of the boo-hoo bantering about the USA Today article about the baby who received 5x the "normal" amount of amoxicillin and would "writhe in pain".  Lets look at this from a purely scientific standpoint.

According to Amoxicillin on RxList.com:

A prospective study of 51 pediatric patients at a poison-control center suggested that overdosages of less than 250 mg/kg of amoxicillin are not associated with significant clinical symptoms and do not require gastric emptying.³

3. Swanson-Biearman B, Dean BS, Lopez G, Krenzelok EP. The effects of penicillin and cephalosporin ingestions in children less than six years of age. Vet Hum Toxicol. 1988;30:66-67.

** DISCLAIMER (I hate doing these, you all should be smarter than this) DISCLAIMER **
Before I go on, the details of what happened are sketchy at best not to mention published by a shitty sensationalist media outlet that just wants ratings and attention.  Like the 14 year old spoiled drama queen playing the rape card after her boyfriend breaks up with her, you have to treat this all with a huge grain of salt and realization that we are making assumptions here about what happened.

Now, assuming that the child is way premature, say it weighs 1 kg or 2.2 lbs.  Amoxicillin comes in your standard 125mg/5cc, 250mg/5cc, or the oddball 400mg/5cc.  Nobody writes for the 400mg/5cc so we'll just assume that the strength doesn't exist for our example.

For a 1 Kg infant (which im sure the child weighed a bit more than 2.2 lbs) to receive 5 times the "normal" dose (which for our assumption the upper limit will be 250mg/kg since thats the upper limit of no clinical symptoms) the parent would have to give the child 5 teaspoonfuls a day.  Thats for a 1kg infant, thats 10 teaspoonfuls a day or 50mL (1/3rd of the bottle) for a 2kg patient (which 4 lbs sounds reasonable for a premature infant).

Now what fucking parent with a fucking premature baby would think that giving 5 teaspoonfuls a day of an antibiotic (or anything) would make sense?  Now don't get me wrong, the mistake shouldn't of been made in the first place, but don't you think common sense would kick in around teaspoon number 3 or 4 of "maybe something isn't right here".  Considering the father is a "assistant professor of biomedical engineering at the University of North Carolina" we aren't dealing with your standard uneducated village idiot here.  How would they know the baby is "writhing in pain" due to the amoxicillin and not just pissed off because its getting over an infection that required IV antibiotics?  Do they have baby brain reading machines?  Hell, have you tasted amoxicillin suspension? It makes me writhe in pain just smelling the dust when I open the bottle.

The /only/ way that I could see this happening is if the doctor wrote 1.5mL and the pharmacist though it meant 1.5 teaspoons.  However 1.5mL's of the 250/5 is what, 75mg of amoxicillin? For a child that was on IV antibiotics, all that's going to do is just make the baby spit pink all over the place.  I mean thats about as retarded as when PA/NP's write for 4.56mL's tid of amoxicillin because their common sense is in their palm pilot and not in their brains were it belongs. 

Who knows, I may be way off base here, but from the looks of it the USA Today just added the whole Amoxicillin story as purely emotional sensationalism.  Why don't they write shit about us catching mistakes and saving people vs publically hanging us.

You will only find this here at "The Angry Pharmacist(tm)".  It is a smuggled document from the headquarters of a training facuilty (the drug company shall remain nameless) about how to train drug-reps.  This is the secret code! Lets take a look:

• Doctor, can I speak with you for a min about a new product?
• Translation: Our patent has ran out on our best selling drug, so I'm going to tell you how much the generic will suck and how our NEWER and BESTER product (which is the same shit just XR after the name) beats the living hoo-hah out of the stuff I was pimping to you as the latest and bestest just 2 weeks prior.
• Here are some studies for you to read.
• Translation: You wont read this shit, and we paid for them so what do you think they'll say you idiot.
• You know that our new product has 500% better bioavailability and the AUC is 15% higher big-word big-word.
  
• Translation: You have no idea what the fuck these numbers mean, and neither do I!  I just memorize them and spit them out to sound smart.
• I'm going to leave some coupons here so you can trial your patients.
• Translation: We're gonna fuck over pharmacies so they'll have to buy a $500 bottle of 100 to get a whole 7 tablets out for the fucking coupon.  The rest will just rot and outdate on them.
  
• All major insurance companies cover this.  Its Tier-4 on their formularies
  
• Translation: Which means its not covered without a prior auth.  I know you're too 'busy' to do PA's so we'll just fuck over your patients by feeding them samples until they run out, then force them to pay $200/month to continue therapy.  Wait, I think the coke dealer did that same thing to me when I was in college.
• Do you have any questions?
• Please don't be an ex-pharmacist.  Please dont be an ex-pharmacist! SHIT! I NEED A DISTRACTION! IT LOOKS LIKE HE'S GOING TO ASK ME SOMETHING!
• Oh, I dropped my pens.  Dont worry, i'll get them.
• Translation: Yes, they are real. I can make them bounce into each other.  Look into my mind control device doctor.. Loooooook.
  
• Here are some pens and notepads for you doctor.  I hope you have a wonderful day!
• Translation: Sucker!!!! HAHAHA!

I really do dislike drug reps.  However I dislike Medicare Part D salesmen even more!  More on that later!

As I have (and we all have) learned in school, a bottle of Humulin R or N is good for 1 month if kept at room temperature or if refrigerated good until the expiration date on the bottle.  Right?

Not according to the Lilly Reps.

They are telling doctors and other retarded janitor-types who can write Rx's that once a bottle of insulin has been opened, it is good for 28 days upon which it must be trashed.  That really great for the cash customer who is on about 10 units a day and gets to shell out the 40+ bucks a month for a new bottle (as they toss out a 3/4 full one).

This bullshit started about 4 years go.  The formula for Humulin R and N have not changed since god was a boy.  What the hell caused this?

Heres the kicker.  There are no studies to back this data up.  Thats straight from the Lilly mothership.  Turns out that Europe (thanks assholes) have this law that states that all injectables must have an expiration date of one month from the time of penetration (har har har).  HOWEVER if the product was made before 1990 this law does not apply.  Thats why Humalog and Lantus have the warning in the package insert to discard after 28 days.  Humulin R and N do not have this warning (also stated directly from the mothership).  The good ole USA just decided to adopt this standard without any studies to show that its even half way legit.  Yeah, lets just do what Europe does, it worked so well for thalomide didn't it?

Does this stop Lilly reps from spreading the gospel of 'discard R & N after 1 month' to every doctor and nurse out there?  Hell no.  Higher sales for Lilly!  Fancier pens!  Lower tops!  Higher heels!

Lilly, you are fucking retarded.  I hope all of you become cash paying diabetics who are forced to sleep in your own shit.

A really frustrating part about retail pharmacy is that everything seems to be "my problem".  Now I went to college for 7 years, got my PharmD, yadda yadda yadda.  I know about drugs.  I am trained in drugs.  Ask me about a drug and I will tell you everything you need to know about it.

However:

• I am not your fucking insurance agent.  I don't know how much your fucking deductible is because ITS NOT MY INSURANCE.  I can guess, but its only that, a guess.  Its YOUR job to know about your insurance, not MINE.  If YOU dont understand something, talk to your insurance company; not your pharmacist.
  
• I am not the keeper of your insurance card.  If you go to the store and want to buy something but don't have your credit card, do you ask the salesperson to call VISA and ask for your credit card number so they can finish the transaction?  NO.  Keep your fucking card on you, and when you get a new one don't make me fucking ask you 100 times for it before you say "Oh! Yeah! I got this new insurance card last month".
  
• I am not the welfare office.  If you bitch about your $3.10 copay and whine how the government hates the poor, let me charge you the fucking cash price of $150 and see how much you fucking whine.  All the welfare programs have done is create a bunch of fucking ungrateful bastards who think the F in Pharmacy stands for FREE.
• I'm not your mother.  If your medication got lost/stolen/etc its YOUR job to call the doctor to explain how you are not a fucking addict, not MINE.  If I call I'm going to say "Yeah, he/she lost his medicine.  He told me a story but to be honest I wasn't paying attention."  Keep your pills where you can find them, and if you lose them expect to pay cash for the replacements.  Insurance companies do not pay the copay on stupidity.
• I am not a drug company rep.  You can whine to me day in and day out how pricey the medication is in this country, then turn right around and ask me to sign something on a class action lawsuit over Avandia or Vioxx or something.  You know why medication costs so much in this country? Stupid bastards who sue over side effects inflicted from taking a controlled poison.  Lets sue Clorox because my kid drank bleach and died.
• And last but not least.  I am not your fucking personal bitch.  I am here to help you, and will do so with a smile on my face, but I am not your bitch.  I am your pharmacist, and if you treat me like your child or someone you think you can just boss around I am going to pee in your promethazine with codeine and shit on your Soma.  Treat me with respect and you will get the same in return.  Treat me like shit and you'll be waiting 4 hours for your Rx's at the Walgreens down the road.
  

Another typical example of the media getting a hold of a medical concept and completely instilling fear and chaos into the unwashed masses.

Everyone is playing chicken little throwing MRSA around and implying that its somehow a death sentence if you get it. This magical strain of staph is resistant to everything short of a blowtorch and will not only kill you, but kill your children and make your minority cousins horribly disfigured.

Lets be realistic here. MRSA is nowhere nearly as bad as people are making it. For those at home living in a box, MRSA stands for Methicillin-resistant Staphylococcus aureus. Yes, it sounds extremely scary. People think that MRSA is resistant to everything, and there is no hope of treatment.

They are wrong. They are in fact extremely wrong.

First off, I have never ever seen a MRSA case that has been resistant to everything under the sun. Yes, MRSA is resistant to all of the penicillins/cephalosporins, but we aren't living in the dark ages here, we have a shitpot more antibiotics than those two classes. Of the dozens and dozens of Culture and Sensitivty reports that I have gotten trying to get Zyvox covered, I have found that in 99% of the cases the "evil" MRSA infection is perfectly suspectible to the Fluroquinolones (Levaquin/Cipro/etc), Tetracycline, Clindamycin, Rifampin, SMZ/TMP, etc. If you want to go IV route, Vancomycin.

Seriously, its not that big of a deal. The problem is that people want to throw Zyvox at everything instead of doing a proper C&S report to determine what else they can use other than the biggest bacteria bazooka that is on the market (at $60/tablet no less). Give them Zyvox, send them home and forget about them. Right, you try to explain that to the insurance company when they are staring at the C&S report that I faxed them showing that clindamycin has exactly the same efficacy as Zyvox in this case. Retarded I tell you, utterly retarded. The PA's that I have gotten for Zyvox involved a ton of confirmed type-1 allergic reactions to what was effective. If you have drug allergies then you start stripping of available agents and things get a bit complicated.

So I blame the media here (as always) for clipping out only choice words that will cause the most fear and panic (read: ratings) and have patients come in to me in a tizzy thinking their life is over because they have a stupid minor MRSA infection.

Once in a while, you'll get a patient handout for a drug that just cant help but make you laugh. Patient handouts are meant so even the village idiot can get their meanings. Lets take a look at Xeloda's patient information sheet and angrypharmacistize(tm) it.

STOP TAKING XELODA IF YOU EXPERIENCE ANY OF THESE SIDE EFFECTS

Some people think that pharmacists are assholes. Funny how these are the same people who want their 30 day supply of Vicodin filled after 10 days. I'll just give you all at home an insight as to why we are the way we are. If you're a pharmacist at home (or play one on TV) comment and help me out. :)

-- What makes us angry --

We're lied to almost all day. My medication got lost/stolen/flushed/eaten/left on vacation/etc. The list goes on and on and on. So when you come and want an early refill for your pain medication and give us that excuse; unless you can prove otherwise (first time its happened, you get 30 other maintenance meds at our place, we /know/ you), we're going to think you are full of shit. Thats just the way it goes. You think we get smoke blown up our asses every day of work and aren't jaded because of it?

We are people to. We like to be talked to, to asked how we are doing. All day I get screamed at because the doctor didn't okay pain pills or soma. You reap what you sow, and if you throw shit in my face then i'm going to throw it right back.

If you /only/ pick up vicodin/soma/valium at my store (like 5 years going back of nothing but vicodin/soma/etc. You all at home know those kind of profiles), we're going to give you looks when you come in. We're also going to have assumptions when this is the 4th month in a row you need them early because of some bizarre excuse. We understand shit happens, but if you're telling us the truth, then I dont want you in the store because a meteor is going to land on you. Oh, did I mention that we also know you pick up your hypertension meds at another pharmacy?

If you are going to sell your fucking vicodin, dont leave it in the fucking bottle you picked it up in for the police to see. We dont like seeing policemen walk in holding our vial saying "Did this person pick this up here? Heres a subpoena, have a nice day."

If you have the balls to pick up your soma, turn around and hand 2 pills to each of your friends IN THE STORE, we're going to boot you. Plain and simple. Diversion is always assumed but extremely hard to prove except if you are a fucking idiot.

When I have to tell you 10 fucking times that your pain pills are EARLY because you are too stupid to divide 90 by 3 to find out WHEN they are due. Then argue with me about it!

Notice a trend here? All deal with narcotics. Think about that. Now:

-- What makes us Happy --

When you bring in that Rx for Vicodin, and you tell US right off the bat "please put this on file, i'll pick it up when its due on the xth".

When you are a true chronic pain patient who comes in on the day that he/she is due (or maybe a few days late) with a new Rx, waits patiently, and never ever asks for anything early. If there is a snag with your insurance/work comp; you are very polite and helpful to get it resolved.

When you treat us like human beings who care for you and not a licensed dope dealer who you can swear at when things go your way.

When you get your pain pills changed, and you bring back THE OLD ONES for destruction and to pick up the new strength.

So really, it boils down to honesty and taking medication how its prescribed.

I know with the latest Oxycontin crap hitting the fan, people are throwing around the word "addiction" like its going out of style. Let me clarify a few points here.

Addiction is NOT the same as Dependence. People associate withdrawal symptoms with addiction. Fact of the matter is, it appears with both. Example:

Patient is on a beta-blocker for years and years. You take away the beta-blocker and guess what, they patient goes through withdrawals (higher heart rate, higher blood pressure, etc).

Patient is on Fentanyl patches for chronic pain. You take away the patch, and bingo, withdrawals.

Patient is on avandia and you take it away because you're dumb and think its going to suddenly kill the patient. Guess what, withdrawals (higher blood sugar).

Withdrawals is the body's natural response to a sudden change in receptor block/activation. If I dump 500mg of atenolol into someone, they are going to have (among other things) a very abrupt reaction. Because I am not withholding medication, its not really withdrawals, but it illustrates the same principle.

Now lets look at Addiction. The basic difference between the two is mostly psychological. Why are they taking it? Are they taking it for a euphoric effect or are they taking it so they can live a decent quality of life with a broken back/cancer pain/whatever.

A person who is addicted will snort oxycontin illegally, and do illegal things to obtain more oxycontin so they can get the same high. If you buy your oxycontin on the street to snort/crush/inject (ie: take it how it was NOT supposed to be taken) you are an addict.

A person who is dependant on oxycontin takes it as prescribed and lives a normal quality of life. They will bitch and moan if the drug is discontinued, but will generally work with you to move to a different agent.

Now the line gets blurred by patients who are on narcs for legit reasons, but their pain is uncontrolled, so they take it upon themselves to go and doctor/pharmacy shop to obtain more to control their pain. Even if it resorts to doing illegal things.

Nothing fries my wires more than having some doctor refuse to prescribe oxycontin or fentanyl to a chronic pain patient because they are afraid they will be "addicted". Sure, and giving them 200 Vicodin ES/month (wtf?) and blowing out their liver is the correct way to go. Theres a reason why these things are C2 narcotics. They have very abrupt and euphoric effects and guess what... THEY ARE REALLY REALLY GOOD FOR CHRONIC PAIN! Of course trying to explain this to a doctor is about as useful as a debating with a turd. They just get all pissy and hang up (so much for "patient care"). Then you have the patient ask the question "Will I become addicted to these?" The answer is "If you are dosed correctly, you will become dependent on them to live a normal quality of life. Its like insulin or any other medication."

Sometimes it just amazes me as to how much fear doctors put in patients that is 100% unwarranted and unneeded. Maybe it's just a CYA move, but it ends up doing tons more harm than good. So there you have it. Be it right or wrong (in your opinion) thats my take on Addiction vs Dependence.

So, it looks like Purdue got dinged like 600 kerzillion dollars because "misleading the public about the painkiller‘s risk of addiction". There are websites cropping up about class action lawsuits against the company, blah blah blah.

AMERICA! THIS IS WHY THE COST OF YOUR MEDICATION IS SO FUCKING HIGH!!! You think a bullshit lawsuit like this would fly in Canada or Mexico? NO! Lets sue God because water could be misused and we could drown in it.

The article is here:

Now I'm not siding with Purdue one bit, but I think the doctors themselves are partially to blame. Purdue got dinged because they were "claiming to doctors that OxyContin was less addictive and less subject to abuse than other pain medications."

One question. If that was the case, why is it a C2 and not a C3 or C4? Doctors, get your head out of your collective asses and start using COMMON SENSE rather than listening to dumbass drug reps. Oxycodone has been out for a bazillion years. Why all of a sudden would it become less addicting/habit forming/etc just because its in an extended release tablet? How can you expect a morphine analog that has a lower first pass clearance than morphine to be LESS addicting/habit-forming/etc? Here, I have this nice drug called Heroin thats a less addictive alternative to morphine (its a joke, if you knew the history of heroin you'd understand) AND I have this wonderful bridge for sale! Gimme a break. When Oxycontin came out I could see a mile away that people were going to be hooked on this stuff. I saw it with MSContin too. Thats why its a C2 people! High potential for abuse! Same class as cocaine!

If I were a doctor, this is how the conversation would go:

HotRep: Doctor, this Oxycontin is a less addictive pain medication.
Me: O RLY? Why is it a C2 then?
HotRep: Well, because it has a high abuse potential, but its less than morphine.
Me: Oh, if its more bioavailable than morphine, then how does it make it less abusive?
HotRep: Dont make me explain this to you *bending over to show her clevage* Have some free pens and pads.
Me: YES! I SHALL WRITE FOR IT FOR ALL MY PATIENTS!
HotRep: I knew you'd see the light.

Heres what gets me:

Attorneys for the three executives said giving them criminal convictions was punishment enough, and noted they were charged because of their job titles, not because they themselves promoted OxyContin as a drug with little addiction potential.

The speakers, many of whose children died after trying the drug only once, disagreed.

Nuss held up a stone urn slightly larger than a pill bottle that she said contained her 18-year-old son‘s ashes.

"By pleading guilty they acknowledged that doing nothing was not good enough," Assistant U.S. Attorney Randy Ramseyer said. "We cannot bring those people back. It‘s not something this case can do."

Oh, I'm sorry. Your child died after he ABUSED A C2 NARCOTIC. Gee, go figure. Maybe you should stop blaming other people for your child's death, and start blaming your CHILD and YOURSELF because you raised an IDIOT who couldn't say no? Lets sue Clorox because little Jimmy drank a bottle of bleach and died. Am I the only one here sane enough to realize that people have a huge problem with taking personal responsibility for their actions here? How could Purdue even remotely be responsible for a child's death after he/she got Oxycontin ILLEGALLY and abused it? Should the drug magically know that its being used in a child and not work? What in holy fucking hell are people thinking here? Has the world gone mad? Do people think that these drugs are safe?

Wait, this gets better:

Survivors of the victims want the Food and Drug Administration to reclassify OxyContin for use only for severe pain. The drug currently can be prescribed for moderate pain.

Arrrrg!! Im dying here! Moderate vs severe pain? How can you tell? If I get my skin ripped off, am I classified as moderate or severe? Now comparing this with getting my nuts slammed in a drawer I would have to say I am in moderately severe pain. Lets put a label on something that is very person specific.

So next time you're bitching as to why your medication costs $300 bucks a month, think of this and all the lawsuits that are going to be flying around. Oh, and when your loved one is dying of cancer pain and your doctor only prescribes him Tylenol #3 or Norco for fear of being sued, this is why.