There is one prescription that I know makes every pharmacist get a little bout of acid reflux in their lives:
1 mg of folic acid vs the 220mcg (or something) that the OTC ones have (folic acid has been shown to prevent spinal defects, so this one has some merit)
Some voodoo magical iron prep thats supposed to be gentle on the stomach of the pregnant woman who spends all day consuming dirt, pickles, and other wierd ass cravings.
Little hearts on the pills that make you feel all squishy as you pay $4/tablet
A bullshit name
10000000% of your daily allowance of the B+C vitamins, knowing full well your body will just pee out 99.999% of it
3.457mg difference in every other ingrediant thats present in all prenatal vitamins
An Rx for some new funky-sounding prenatal vitamin with the big DAW-1 box checked. You know their insurance company isnt going to pay for it. Plus if they do, the’ll only cover a month supply so you’ll be stuck with the other 70 tablets making your prenatal section look like the warfarin /levoxyl sections (tons of bottles, all different strengths/colors).
Are OB-Gyn’s retarded? Does sticking your fingers into vaginas for a living rot your brain? Do they realize that there is NO significant difference between the bazillion of prenatal vitamins out there, and the drug companies are just exploiting pregant womens drive to have a healthy baby? With the exception of Folic Acid, there is really no research showing that one brand of prenatal vitamin is better than any other one. Its such an inexact science (since women can take nothing and 99.9% of the time have a healthy baby) that it boarderlines voodoo!
However to the uninformed: most prenatal vitamins have one of the following that make them “special”.
One woman claimed that she tried out 20 different brands of prenatal vitamins before she found one that “worked”. Now what the fuck is that supposed to mean? They all have the same shit in them! How can a prenatal vitamin “work” and more importantly, how can you tell its “working?” Does the fetus say “Yup, i feel it working better! Thanks mom! *thumbs up*”.
Now dont make a mistake and bring up logic and reasoning in front of the poor pregnant gal. She’ll give you both barrels of hormone induced insanity all over your front counter in front of your entire staff (because its HER body and she knows exactly what the baby needs). Heaven forbid you’re a male, because you “dont know how it feels to be pregnant and taking inferior prenatal vitamins”. Reasoning with a pregnant woman is like reasoning with a turd, it just makes you feel stupid for wasting the time. Bad turd!
OB-Gyn’s are partially to blame. The’ll write for whatever hot blonde walks in the front door with a low cut blouse and a bag full of samples. I can just see their fingers twiching wanting to give her a pelvic exam. They have been so brainwashed that they dont realize that an Rx for Folic Acid 1mg plus a super econo-size barrel of cheap generic centrum will do the exact same thing than StuartNatal.
Just thinking about it gives me heartburn, must be those generic prenatal vitamins I take. 🙂
We all get those uppity patients once in a while who think they know it all. Give a patient an inch of information thats somewhat techincal and the’ll run a mile with it. Show one www.webmd.com and they think they know as much as a pharmacist. Suggest something and you’ll get 15 printed out pages from message boards from ‘medical professionals’ (we all know doctors just sit around on message boards all day) saying how wrong you are. Sometimes I hate the internet, and wish all the patients were dumb, compliant, and happy.
One class of patient though really really bug me. Ex-Nurses. Thats right, nurses. Especially older nurses that have long since been retired. We all know that once you become an RN, it doesnt matter how long you’ve been out of practice, you must know 1000x more than my dumb-PharmD ass about the latest treatments. You’ll argue me to death about therapies and shit that you cant even prounounce let alone know whats its MOA is. I want to tell these people:
“Bitch please! When you were a nurse you only had morphine, aspirin and digoxin! You’re so dumb that you still thing MAO-I’s are first line for depression! ”
(i can hear all the pharmacists laughing at the MAO-I joke, if you’re not a pharmacist you wont get it.)
But what gets me, is that now i’m seeing not RN’s getting uppity, but like Nursing Assistants and Medical Assistants. Just because you call in prescriptions doesnt mean that you know more about the medication as I do, or can belittle me with the “Yeah, i know, im an Medical Assistant” bit.
But ya know what, these people are quick to belittle you, but are the first ones to call up with a stupid question that they should know because “They are/were a nurse”.
Actual conversation between a pharmacist and a nurse.
RPh – “Hello, this is the pharmacy.”
RN – “Yes, hello. I am calling to inquire about Mr. Xs medication.”
RPh – “OK, what’s going on?”
RN – “Well, the problem is this: He’s supposed to get 20 mg of this medication, but you guys sent me a 40 mg tablet.”
Rph – “OK, so what’s the problem?”
RN – “Well now, that’s not the correct dosage.”
Rph – heavy sigh…. “Here’s what you do… Take the tablet, break it in half across the score in the middle and give half the tablet to the patient.”
RN – long pause…. “Which half?”
This is the type of crap that scares the hell outta me.
Its common knowledge that a prescription can only get to a pharmacy to be filled 3 different ways:
Now lets focus on the third one, telephone.
State law allows prescriptions to be phoned in by a doctor or a doctor’s agent. “Doctors Agent” pretty much means anyone with a pulse. It does not specify the education needed, nor any requirements short of working with the Doctor.
State law only allows pharmacists to recieve the verbal prescription over the phone. Tech’s cant do it, clerks cant do it, janitors cant do it. Only a licensed pharmacist can accept a verbal from the phone.
Whoever wrote this law must either hate pharmacists, or have not stepped one foot in a pharmacy in their life; because now every doctor’s office has some minimum wage making minority who can barely speak english calling in medications for YOUR mother. Thats right! Someone who has zero medical knowledge and has no clue what they are saying are calling in medication for YOUR LOVED ONES! HU-FUCKING-ZZA!
Bah, so they got hydralazine and hydroxyzine mixed up, or Lamictal and Lamisil confused. Or Lamictal and lomotil, no biggie! Your loved one only ended up in the hospital, and a big fat lawsuit pending on yours truly.
Now dont get me wrong, there are lots of doctors offices out there who employ nurses and other very qualified (meaning they speak english) personel to call in prescriptions. Its just that one cheap-ass doctor who gets some phillipino or chinese fresh off of the boat for $4.50/hr to phone in prescriptions to pharmacies which are blaring loud already, they cant pronounce the drug, and to make it worse they speak super super quietly on the phone!
It just pisses me off to no end as well when they get offended when you ask them to repeat it about 10 times, then spell the damn drug. Its not my fault you cant speak english clearly. Its not my fault you cant pronounce the drug. Its not my fault you dont know any medical shorthand so you have to waste my time and ask what ‘po tid uf’ means.
So please, for the sake of your patients, your liability insurance, and my sanity get someone who can speak clear english on the line when you need prescriptons called in. Your pharmacist will <3 you for it.
Its amazing how the medical community has ‘evolved’ in the past few years. Back when I started this profession, only Doctors (MD/DO/DDS/DVM/etc) and Nurse Practioners/PA’s could write prescriptions. Everyone was happy, and the world was at peace.
Well some idiot decides to allow Certified Nurse Midwifes and Holistic Medicine (or some bullshit like that) to write prescriptions. Head, meet table.
When is the madness going to stop? Are janitors going to be the next ones to have prescriptive authority?
I went to college for 7 years, and I only have the ability to prescribe the morning after pill. Some idiot goes to a Career College, pops out a CNM in 5 months, and can write for anything (yes, I know they are under protocol, but thats not my point).
It makes my blood boil when I see these idiots churn out Rx’s that look like this:
Amoxicillin suspension, 234.3 mg three times a day for 10 days.
Now that may look good to you, but any pharmacist will say “Hey! Amoxicillin suspension only comes in 125mg/tsp, 250mg/tsp and 400mg/tsp!”.. Are we to have some mother who can barely wipe her own ass (but can pop out a kid) measure out 4.7372143 mL’s? Hell no! Its fucking amoxicillin! You round up to the nearest strength! Its not rocket science! You could give the kid 2 grams of this shit three times a day and nothing will happen.
If you dont work in the profession, you may wonder where im going with this. Well its a fact of book learning vs common sense. Obvously a “real” doctor would use common sense and just dose said amoxicillin 250mg/tsp three times a day for 10 days and make it easy for everyone. However some CNM looks up in her little drug book (which is probably wrong) and uses her little calculator to do 20mg/kg/day (or something like that) and just blindly writes for whatever number appears as the result. Use your fucking head!
It doesnt end there, oh no!
I’ve seen them write Hydralazine for itching (supposed to be Hydroxyzine, whoops, you just killed someone). As well as give strengths for drugs that they obvously pulled out of their ass (Ultram 100mg when it only comes in 50’s) as well as write for the latest and greatest shit not knowing that it costs 1000 bucks (Zyvox)..
Blah is all I have to say.. But of course because of them us pharmacists can never be replaced by machines.