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.
Category Archives: Drug Trivia and Rants
The wonderful world of drug handouts
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
Your tech starts giving you lip.
You start to have conversations with your poop.
You decide to only communicate with your tech using the universal pimp-slap.
You decide to take a poop without pulling up your nightgown.
You can only poop in your nightgown under the moonlight.
You kick all the crackheads out of your store.. Literally.
You grow an evil villan mustache
Pharmacists, Narcs, and why you think we’re assholes
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 —
Notice a trend here? All deal with narcotics. Think about that. Now:
— What makes us Happy —
So really, it boils down to honesty and taking medication how its prescribed.
Addiction vs Dependence
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:
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.
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.
Oxycontin, addiction, and general stupidity
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.
Avandia – Oh why are people so stupid.
**WARNING! Avandia and other prescriptions are hazardous to your health, and only should be prescribed and dispensed under the supervision of people who went to a collective of 15+ years of college and who KNOWS what the hell they are doing. This is because Rx drugs are DANGEROUS and require KNOWLEDGE to use effectively****
Duh right? Obviously not.
So Avandia is being tied to causing MI’s and related deaths in their patients. Lets look at some facts shall we. I bet the media isnt picking up on these:
Yeah, does anyone else see something wrong with believing a study that was funded by the COMPETITORS of GSK? Im sure Dr. Nissen doesnt get ANYTHING from these companies. No sir. He probably doesnt get to use their houses in the Bahamas on their corporate jets and eat with the offical Pfizer credit card. Charity my ass.
Yes, Dr. Nissen, I’m talking about you. You and your flawed ‘study’ is causing me, my colleagues, and the doctors (who actually work and see patients) hours upon hours of time explaining to people why your study is no cause for alarm and they should NOT stop their Avandia without talking with someone with a clue (their doctor). You should be ashamed for causing so much useless and pointless panic over something that is (in the scope of things) retarded and unwarranted. I hope someone tears your ‘study’ a new asshole and points out the glaring flaws. I know you probably dont work for a living actually helping people, so i’ll give you a little pointer: Prescription drugs are dangerous, henceforth why doctors can only write them, and I can only dispense them. I know this is a foreign concept to you, but think about it next time you’re on that jet getting lapdances from the Lilly reps.
In short, Americans want to listen to the media, who obviously know a lot more about medicine than their Pharmacist, their Doctor, or Nurse. I say if they dont want to take Avandia, thats fine, they can die an early death. Thin the herd a bit. Sometimes we need to take the warning stickers off of things and let nature run its course.
Sorry this isnt more rantilicious. I’m gearing up for the NPI cutover clusterfuck that I know is going to drive me to an early grave tomorrow.
Albuterol HFA – What the hell?
As you all probably know, good old albuterol (with CFC’s) are no longer being made. No longer can we get an Albuterol MDI by Warrick for 9.95. Now we get “environmental friendly” pieces of shit for $20/each.
I recieved a phone call from a friend of mine who works in the People Republic of California. He told me that the state Mediaid (Medi-Cal) program decided (with their infinite wisdom) to take every albuterol MDI off of formulary. Thats right, he said no Ventolin HFA, no Proventil HVA, no ProAir HFA, nada.
You know whats covered? Xopenex HFA. 29.99 a pop too. What makes it even better? The company cant supply them fast enough to meet up with the demand of California! I laugh at him! Ha Ha! Oh, get this, they wont accept prior auths for albuterol either! Ha Ha^2! Guess patients are screwed there! Ha Ha^3! Who needs ‘clinical data’ or ‘efficacy’ or ‘studies’ when you put on your formulary the product that will give you the biggest kickback, er.. rebate. California (like Camelot) is a looney place!
So the FDA is saying that you cannot switch a patient from a CFC MDI to an HFA MDI without a new Rx. They are not equivalent and require a doctors OK to switch. They also say that all of the different HFA MDI’s arent interchangeable. I laugh at that too! You know how much bitching we would get if we faxed every doctor saying “Is it okay if we switch this CFC MDI to HFA MDI?” They’ll say “Are you retarded?”. I mean think about it; what doctor is going to say “NO! I DEMAND A CFC MDI! I KNOW THEY AREN’T BEING MADE! COMPOUND IT PUNY PHARMACIST!” Pretty retarded if you ask me.
But what do I know, I only have to hear the complaints.
“Medical” Marijuana
Now the last few entries haven’t been very angry. This one is to make up for that.
How many of us have been merrily working along, to have some fucking douchebag come into your store and ask if you stock “medical” marijuana? How many of you have had said douchebag argue with you when you say that marijuana is illegal to have on the basis of “I have a prescription”.
Let me clear the air here. Marijuana is a C-I substance. It is illegal. End of story. Cocaine is a C-II substance, cocaine is legal with an Rx!
I don’t care if you have an Rx from some quack in some hippie-dirt-eating-town like San Francisco or Seattle. I don’t care if you have a letter from God himself saying “Thou Shalt Smoke The Weed”. Its fucking illegal. Let me repeat it again because you were baked the first time I said it; its fucking illegal. Don’t care what your city says, what your county says, what your liberal fruity-motherfucker mayor says, its illegal. State law cannot relax a federal law, get used to it.
Where do people get off arguing with me about this shit? I could care less if there is a clinic down the road that sells it for “medical purposes”. A quick call to the DEA and that clinic wont be around for much longer, why? ITS FUCKING ILLEGAL TO GROW OR SELL MARIJUANA! Is prostitution legal for people with erectile dysfunction (with an Rx of course)? Think about that one for a while.
Now I know that people are going to blow me shit about how you have “glaucoma”,”wasting”, “blah blah chronic pain”, “blah blah you dont know how it feels” that require smoking out three times a day. My response? There are a whole shitpot full of other agents out there that are safer, cheaper, and work a whole lot better than smoking out. Stop using those lame ass cop-out excuses and stop inviting me to your pity party. Go see a “real” doctor and get a “real” Rx for some Soma or Vicodin instead of going to a quack and getting an “Rx” for some pot. I may not know how it feels to need pot, but you obviously don’t know how it feels to be annoyed while you’re trying to work (you know, work? The thing you don’t do. A job? Ring any bells?)
When you’re 24 years old, reek of pot walking in the front door, then stumble over your words saying that you have glaucoma and HIV/AIDS wasting (when you’re a good 260lbs) and you need some marijuana, it makes me want to kick you in the face and give you a real reason to smoke out everyday. Then you hand me your medicaid card which really makes me mad that you’re doing this shit on my tax dime!
And for god sakes, quit arguing with us about the legality of it! You’re a stoner hippie (still living with your mother) arguing with someone who’s not baked, went to college, has use of most of his brain still, can remember things for longer than 3 mins, and legally deals drugs for a living! In fact, you wont remember this conversation 10 min’s from now (but your glaucoma will be excellent!).
God help us if they decide to make pot legal. If you think Americans are fat and lazy now, imagine when a good majority of the population is sitting around eating Big Macs and smoking out all day. Oh wait, thats our welfare system. Sorry about that.
The Gospel according to Me.
I’ve seem to have made a few doctors upset with my last few posts. I want to help clear up some confusion about this blog, and other items of interest. I type at over 40 wpm, so expect grammar and spelling errors (yes, i’m talking about you grammar nazis out there).
This list could go on and on and on. However:
So if I offended any doctors out there reading, my apologies. This blog is like going out for beers after work with your colleagues and bitching about what happened. I had a really angry response to a nasty comment (from a doctor) I received, but I think i’ll just sit on it for now.
Now approve my damn refill requests! Its been a week! 🙂
FDA, What the Hell?
Quinine. Yes, quinine.
Turns out that the FDA is going to pull this oldie-but-goodie off of the market. Why you say?
Uh, hello? Quinine has been out since God was a boy. Its only been dispensed bazillions and bazillions of times to people for nocturnal leg cramps. Obviously it works. Do you see any published studies for aspirin? Of course not, but FDA wont get its panties in a bunch about that.
Deaths with quinine. Since 1969 guess how many deaths there were. 100? No, 1000? No, a billion? No! 93. Thats right, 93 people have died due to quinine since 1969. Hell, pull tylenol off of the market if you’re afraid of killing people. Aspirin has caused more deaths in its lifetime than any drug to this date. But no, the FDA needs to justify its existence by targeting quinine
FDA, if you’re reading this, get a fucking clue and quit getting sucked off by the drug companies. We’re onto your little scheme. It’ll go like this:
1. FDA pulls quinine due to lack of evidence of it working for leg cramps
2. Drug company X does some half-assed study showing it works better than placebo
3. FDA approves NewQuinine.
4. Drug company X charges $10/tablet vs $0.04/capsule for the old generic
5. Profit!
6. America grabs their ankles.
The FDA is ran by a bunch of old doctors who haven’t practiced medicine for 30 years. They have no clue what the hell is going on and approves medications to whoever will give them a dollar and a reach-around. They’ll sit on tons of generics in the pipeline to be approved, but will pull a drug that has been around forever and is still in common use. They need to wake the fuck up. Yes, drugs have side effects. Yes, if you take 100 of drug X you will die. Doesnt mean pulling it off the market will fix it.
Or maybe we just need to slaughter all the lawyers. Hmmmmmmm….