Tis the season to get loaded

I hate this time of the year.  No, not because everything is all xmas’d out a whole month before Christmas.  No, not because The Angriest Pharmacist went and became a “ooh clinical pharmacist”. Its because this is the time of the year that everyone either wants 2 months worth for going to Mexico, or an early refill because “My baby daddy died this time 5 years ago and I need more vico-dans and somas for the pain”.

Lets first start with the 2 months going on vacation/mexico shit.  There are 4 types of people who get to go on vacation for 2 to 3 months.

  • Rich
  • Poor
  • Old
  • Teachers

Now the rich don’t have a problem with plopping down $400 for 2 months because they know their insurance wont early fill + dispense an additional month on top of that.  So that leaves you with the welfare peeps (who dont’ work), the old people (who are getting Medicaid benefits even though they are spending 2 months not here), and Teachers (who “deserve” 2 months off).  Now I really do hate doing these early fills because these 3 groups have one thing in common: It should be free.  Thats right, I’m poor/on a fixed income so I cant afford to pay $20 for a 60 day supply of lisinopril but I sure as shit can drop a few hundred to go spend 2 months driving/flying somewhere.  What bugs me the most are the people on welfare (and thereby are not too old to work) who spend 2 months in Mexico.  I’m sorry, but if you are going to suck on the state tit here, then you should have to fucking be here to get your check.  I know that the state tit here is upper-class 19-year-old-nom-nom-nom compared to the old-shriveled-dry-hanging-to-knees Mexico state tit, so fucking decide which side of the big tall fence you are going to be on.  A few weeks is fine in my book, but 2 fucking months?  Teachers obviously know everything (and pay for nothing) and are first to tell you how to bill their insurance, and how wrong you are doing it.

Oh, and I didn’t even bring up how they want this 2 month supply RIGHT NOW because even though they knew about this for months they decide to stop by the pharmacy on their way out of town. Yeah, they learn for next year when you turn them away empty handed (or they have to pay/get reimbursed when they come back).  Also didn’t mention that I’ve advanced a month supply only to have their welfare be terminated and them never come back.  No good geed goes unpunished.

Now, onto the people who take dope to cope(tm).  I realize that the holidays are a tough time for some.  The loss of family or family not being there is hard.  However there comes a point where that becomes an excuse to just get more pain pills.  To be honest, I have heard all of the stories/bullshit over the years to fill up 10 websites from people who lie through their teeth to get their zone-out-candy early to either ride the holidays out via a chemically induced slump or to sell to afford xmas presents (or stuff their turkey with vicodin and soma).  I realize that waiting in line for Walmart at 2am so you can trample someone to death requires a little somethin-somethin to get you going, but please dont bitch at me due to your lack of planning.

Yes, someone did get trampled to death at a Wal-Mart while opening for black friday.   If thats any indication that we have forced-subsizided the breeding of the scummy end of the gene pool I dont know what is.

Confusion with the Vico-Dans

Alright boys and girls.  We have seem to have a bit of confusion in the patient/crackhead/doctor worlds as to the proper strengths and naming of various hydrocodone products.

I’m tired of seeing Rx’s for Vicodin 7.5/500 or Lortab 7.5/750.  Quit making yourself look like an idiot in front of your local pharmacist and heed my words of wisdom.  Here is the chart, print it out and keep it with you (or just write Hydrocodone/APAP <strength> and make it easy on yourself.

First off, Vicodin 5/500 and Lortab 5/500 are THE SAME FUCKING THING.  Don’t give me this bullshit as to Vicodin upsets your stomach while Lortab doesnt.  To be honest, both come from the SAME generic bottle (yes, the Watsons) so that just tells me how full of shit you are.

Now, the breakdown (hydrocodone/APAP):

  • Vicodin
    • 5/500
  • Vicodin ES
    • 7.5/750
  • Vicodin HP
    • 10/660
  • Lortab
    • 5/500
    • 7.5/500
    • 10/500
  • Lorcet
    • 10/650
  • Norco
    • 5/325
    • 7.5/325
    • 10/325

Now, for those at home who actually aren’t on this stuff, you may notice that LORTAB always has 500mg of Tylenol and NORCO always has 325mg of Tylenol.  Amazing!  Learn the rest or print this out so you can get it right on the Rx. 

You may also notice that Lorcet and Vicodin HP only have 10mg difference in Tylenol in them.  If you call me up, and get pissy with me over 10mg of Tylenol for dispensing Vicodin HP vs Lorcet I will drive to your office and kick you square in the teeth.  There is NO point in stocking both over 10 piddly mg of Tylenol.  Thats almost as stupid as getting pissy at me for dispensing Prinivil over Zestril (back in the day when they were both trade name).

This has been a public service announcement from The Angry Pharmacist(tm).  No Doctors or Addicts were harmed in the making of this public service announcement.

The woes of new prescriptions

Lets face it, pharmacists are between a rock and a hard place when it comes to new prescriptions.  To be more blunt like this, we get bent over and the only choice is between what brands of lube we do (or dont) get.

Verbal Call Ins:
Usually from someone who has close to zero medical knowledge, these abortions of our profession are littered with “I think that’s….” or “Does … exist?” by some high-school student who is trying to decipher the same handwriting that took us a college degree to learn.  Add onto the fact that most doctors are notoriously cheap (or foreign) thereby hire the bottom of the barrel staff who either know nothing, don’t speak English clearly, mumble, speak softly or all of these.  Although I thought that having Methotrexate 0.2 mg called in by an OB/GYN was a mistake, it however didn’t take the office staff to say “Well I couldn’t really read it” when I called back to make damn sure they meant Methergine.  Now only an idiot can confuse MTX with Methergine, but the point is still there.

Now there isn’t a good way to handle this short of having the prescriber him/her/itself call in.  However, there are a TON of doctors who I cant understand what the hell they are saying, so we’re back to square one.  The prescriber can however hire people who speak CLEAR and LOUD english on the telephone.  However if their girls misspoke on the phone and someone dies, unless pharmacies have call recording software nothing will happen to the MD and his marble-mouthed liability.  They will just show on the chart it was written correctly, taken verbally by Pharmacist-X and that’ll be the end of their accountability.  Pretty sad to know that your career/livelihood is being held by some idiot who cant point to where her rectum is.

So, solutions?  One is pretty damn good that I came up with all by myself (go me).  If a doctors office has someone call in an Rx that you cant understand what the fuck they are talking about, tell them “Excuse me, but I cant understand a word you are saying.  Is there someone there who can call in the Rx for you?”  Sure you’ll offend the person on the phone, but both herself and the Dr should KNOW BETTER.  If the Dr gets pissed, ask if you would like that person calling in Rx’s for his/her family.  See, Dr’s like to get pissed off about things, but most of the time if you hit them with the logic bat (ie: ITS UNSAFE) then they can be pretty receptive.  I’d rather hurt the feelings of some young “nurse” who cant speak the English than hurt the feelings of an entire family because she called in something incorrectly and killed someone.  If we stand up and address the problem then it won’t be as big of a problem.  If we just accept it and let them vowel-guess us to death then it’s just going to get worse.

Now not to belittle techs, but lets imagine a time when a Tech can get a New-Rx over the phone by one of these marble-mouthed idiots.  Yikes!  That right there is pharmacist double-penetration with no lube.

Because today’s society we are so afraid to say to people that they cant speak clear English. Some company (and computer programmers who have NEVER EVER EVER stepped foot in a pharmacy for more than 20 min) created ePrescribing (such as SureScripts)

I’m not going to go into how absolutely EASY it is for anyone who has ever worked in a doctors office to call in phony Rx’s.  Hell, with how substandard the people calling in Rxs have gotten I would take a new one from an autistic dog for Norco without any suspicion (that’s if they actually called it by Norco, instead of Vicodin 5/325 *sigh*).

Seriously doctors, make your life and mine a whole lot easier (and safer for your patients), hire someone who knows what the fuck they are doing.

ePrescribing:
Touted as the next best thing since prepackaged drugs, the ePrescribing system is going to become mandatory in a couple of years.  All doctors will be able to go to their computers, click away and have their Rx magically zipped to the pharmacy of their choice!

Like taxes and welfare, this is a system that looks better on paper than how it really is.  Take this example to my right. 
erx-levaquin.jpg 

Now I’m not sure about you, but if I were some tech who didn’t know any
better and was just hammering out the Rx’s while my pharmacist sat around and drank coffee, I would fill that as Levaquin 750 #5 – 1 tablet 4 times daily.  Thats what it says right?  Now all of the pharmacists reading at home are giggling, the doctors are sighing, and the dentists are wondering what the problem with this Rx is :).   Now I’ve been out of school for a while, so there might be some indication for 750mg of levaquin 4 times a day.  Wait, there is.  Its called WRONGITITS.  Its called the QD and QID drop-down boxes were so close together that someone clicked the wrong fucking one and the Rx was verified and sent out (by the “Dr”).  If a tech filled that and the pharmacist wasn’t on his game, that would of went out vs having the pharmacist on the phone saying “4 times a day? You’re on crack girl-who-cant-speak-english!”  How would their software even allow that to go out with such a blantant mistake?  This isn’t rocket science folks, certain drugs are commonly taken either once or twice daily.  Its very RARE we see a modern (ie: still trade name only) drug that has to be taken 4 times a day.

Is there a cut and dry solution to this problem? Yeah, give pharmacists prescriptive authority like you’ve given everyone else with letters after their names. 🙂