Saturday, June 29, 2013

A serious refill request

So I fax off to a doctor for a refill request on a new patient.  Unfortunately, me being beaten to a pulp daily in the pharmacy, I get tired.  I forgot to fill out the form I faxed out with the patient's name and date of birth.  Duh.  I'm always making fun of them, now it's my turn to get it back...

Yep, I deserved it.  But I take my stripes in stride.  I added the patient name and thus made it a serious request:

So they get the joke, and I get a smiley face in return...

Yay!  Refill authorized!

Friday, June 28, 2013

Shut up Justin Bieber with Duck Tape

When I first saw this product, that's what I honestly thought it was for. I thought people would buy this to give to their insane daughters as a prank gift.

No, this is serious tape with the image of Justin Bieber. Why? Why? You have to ask why? Well let's read the advertisement from the seller:

Back in my day when an artist came out with a new tape it was something you could listen to and not do household repairs with. Cross promotional marketing has taken a bizarre and illogical twist with Duck Tape Justin Bieber Print, which features “four black and white images of the teen idol and incorporating hints of his favorite color — purple — the tape is sure to be a number one hit with “Beliebers” everywhere”. You hear that? It’s the sound of Bob Vila rolling his eyes right out of his socket.

Thursday, June 27, 2013

COOL SAFE: Lock Up your Valuables


Lock up your stuff! Feel free to go into the pool or ocean, then come back and find your stuff is still locked up and safe inside this little safe.

Putting your wallet and phone in your shoe at the beach or pool isn’t fooling anyone! Keep your valuables safe while you go in the water this Summer with the Alarm Sounding Beach Safe. This portable safe has a steel cable that you lock around a fixed object (bench, chair, umbrella, etc). If the line is cut, a 110db alarm sounds, alerting you and scaring off any would-be thieves. A flashing light lets you know it’s locked and secure. It’s sliding drawer is big enough to hold an iPad along with jewelry, cameras, wallets, phones, and other valuables.

Wednesday, June 26, 2013

Favorite Comment of the Week

Man: "Is this Pseudofed drowsy or non-drowsy?"

Me: "All Pseudofed is non-drowsy."

Man: "Good, then I can take it at night!"

Tuesday, June 25, 2013

Do You REALLY Need Brand Synthroid?

You people are out there... spending $20 to $30 on brand Synthroid month after month: You're throwing your money away. It's your money to throw away, but you really don't need to do that! 

First a little history...

In 1986, Flint Laboratories, the then-manufacturer of Synthroid, contracted with a researcher at the University of California to conduct a study that they hoped would demonstrate that Synthroid was a better product than the major competitors' products. Unfortunately, when the study was completed in 1990, it clearly showed that all available brands of levothyroxine were, in fact, equal. 

In the intervening years, Flint Laboratories was sold to Boots Pharmaceuticals. When the researchers attempted to publish their results, Boots Pharmaceuticals exercised a clause in the contract that required their approval of the publication. The publication of the results of the study would have theoretically resulted in a switch to less expensive competitor products and a potential loss of the near monopoly Boots had on the thyroid replacement market. Boots Pharmaceuticals was sold to Knoll. Knoll persisted in their opposition to the publication of the study. 

Intervention on the part of the FDA finally broke the impasse. The manuscript was eventually published in 1997 in the Journal of the American Medical Association. With the publication came more than 60 class action suits alleging consumers had paid 2-3 times what they should have paid for levothyroxine as a result of the suppression of the University of California study from 1990 to 1997. Knoll eventually settled the case for $135 million.  LINK

So basically, the study says the generic IS just as effective as the brand.

Just recently, though, some researchers contend that it may be better to just switch to a natural thyroid product:

New Study Shows Natural Thyroid Better than Synthetic

Comparing Synthroid to Natural Thyroid: Their controlled study compared natural thyroid with Synthroid. What they found was that roughly half of the patients (48%) felt better on the natural thyroid, one-third had no preference, and one-fifth (18.6%) felt better on the Synthroid. Clearly the natural thyroid wins the comparison test (48.6% vs. 18.6%).

"At the end of the study, 34 patients (48.6%) preferred Desiccated (Natural Thyroid), 13 (18.6%) preferred Levothyroxine (T4), and 23 (32.9%) had no preference". LINK 

And yet, here's an ALTERNATIVE OPTION: 
All you really need to do is adjust the dose

Suppose for example, my high maintenance patient (let's call her Amy) has an open prescription for 88 mcg of Synthroid. Like a lot of my Goofmart Pharmacy patients, she insists on having brand Synthroid (despite the checkered past of the manufacturer). Amy's doctor wants to make her happy, so he prescribes it DISPENSE AS WRITTEN: Synthroid 88 mcg.

In case you didn't know, all the of the thyroid products come in different strengths. That's because thyroid medication has a "narrow therapeutic index." But what is a narrow therapeutic index?

A narrow Therapeutic Index is defined medically as the ratio between the average effective dose and the average lethal dose. It is an extremely close margin between an effective concentration of a therapeutic drug circulating in the blood and a fatal concentration. LINK

So a drug with a narrow therapeutic index has to be dosed carefully because it can go from being therapeutic to toxic very quickly depending on the patient and his/her needs.

In the past, patient Amy went to her doctor with symptoms of hypothyroidism. Her doctor ordered labs and the results indicated her thyroid function was low and suggested her getting a boost with thyroid medication. So the doctor put her on 88 mcg of Synthroid (based on her labs) and had her back in another 4-6 weeks to check the labs again. It's trial and error... with the error being on the low side of optimal to prevent toxicity. Doctors always start low and gradually increase... better to give too little than too much. We want therapeutic, not toxic.

But does Amy really need to have BRAND Synthroid? Given the history of trouble with the company, is that warranted? Given the suppressed study which shows that the generic is just as effective as the brand, why pay more? Given that the recent study of natural thyroid replacement (or as we call it in the pharmacy.. pig-throid) suggests the natural replacement is more effective, is brand (or generic) still warranted? That's something Amy needs to talk over with her doctor and her kitties.

And yet there is still a another option

Until there are more follow-up studies on natural (pig-throid) versus synthetic levothyroxine (brand Synthroid or generic levothyroxine), there will be those who insist on having BRAND Synthroid and doctors who will continue to prescribe it for them. But... really... is brand medically necessary?

Let's suppose that generic levothyroxine is not as potent as the brand Synthroid. That's not really true, but there's a lot of people who swear by it. Some people think the excipients affect absorption. Other people think the generic is less potent. I've heard all the stories.

Ok... let's pretend it is true... now what?

So let's say, for this example, that generic levothyroxine labeled as "100 mcg" is "therapeutically equivalent" to "88 mcg" of "the real stuff" -- brand Synthroid. (Let's further avoid the philosophical debate as to how a synthetic thyroid product, i.e. SYNTHroid manages to get called "the real stuff" -- that's another blog post entirely). 

Therefore, if 100 mcg of generic levothyroxine is equivalent to 88 mcg of Synthroid:


Run the labs! If the patient does well on 100 mcg of generic levothyroxine there would be no need to prescribe brand! Instead of focusing on brand versus generic, the prescriber should be concerned with how the patient is doing. TREAT THE PATIENT, NOT THE NUMBERS YOU WEASEL. It doesn't matter if the patient is on brand or generic if you're talking about potency. All that is needed is an adjustment in dose based on the labs of the patient. Meow, meow, meow!

Monday, June 24, 2013

Common Clichés Modified for Pharmacy

"Just be yourself" = JUST BE THE PHARMACIST IN CHARGE. Yeah, don't fill that script for Oxy 30 #180 after 5pm when your gut says NO.

"This too shall pass" = THIS 12 or 14 HOUR SHIFT WILL END, eventually. Hell yeah, it's a long day... but after your knees and feet have had more than enough, it will end. Then you'll go home, pass out, and start all over again in the morning.

"When in doubt, throw it out" = NOT sure of the expiration date? No problem. Throw it away. Let corporate sort it out later.

"Life's a bitch" and so are some of your female patients. But then there's a few that make it all worth while.

"Separate the men from the boys" -- see "This too shall pass" above.

"Open your heart" = Try not to think all Oxy 30 #180 scripts after 5pm are fake. Yeah, it ain't easy.

"If the shoe fits, buy it." Whoa! Hold on there, Cowboy! There's a lot more to it when you're going to be standing up for 8 to 14 hours. You need to consider more than whether it fits or not!

"Make out like a bandit" = This simply means you went through your pharmacy day without getting screamed at by someone on Medicaid (there I go again, picking on Medicaid people). 

"A leopard can't change its spots" but people change insurance all the time. No matter how many times you hear the words "Nope, same insurance I've always had" when you get a rejected claim, stay tough in asking for their new card.

"Absence makes the heart grow fonder" -- No, what it does is brings people to the pharmacy asking for us to fill their prescriptions on the fly... and usually that's during the dinner hour on Monday.

"Show me the money" -- Actually, we'd prefer you show us a valid prescription.

"Fake it till you make it" -- Well, we all know a pharmacist or two who missed out on the opportunity to get a PharmD. They usually counsel "take this with food" for everything. They'll retire eventually. Until then, enjoy the fact that they know what Banesin is...

"Save the drama for your mama" Complaining, whining, making excuses for early refill. We've heard them all!

"You are what you eat" --- Really? That mean's I'm comprised entirely of SINGLE bites of various sandwiches.

"Everything in moderation" -- except for Vicodin or Oxy 30. In that case, TWO is always better than ONE. Just ask all your narc patients.

"Love many, trust few, but always paddle your own canoe" --  or in other words, CHECK EVERY PRESCRIPTION no matter how much you trust the technician!

"Money is the root of all evil" -- Ahem! That's why Goofmart Pharmacy is PURE EVIL! Money is the only driving force behind the absolutely STUPID decisions from management at my company. Probably yours too.

"Money makes the world go round" AND pays for a lot of unnecessary projects, software enhancements, flu shot and Shingles advertising, gift cards for transfers... it goes on and on, BUT apparently doesn't cover things like NEEDED TECH HOURS!

"Time is money" --- That explains it then... TECHS require HOURS!

"A fool and his money are easily parted" --- or rather, a CORPORATION and THEIR GREED for all SHINGLES SHOTS and the corporation's money are easily and QUICKLY parted...

"Another day, another dollar" -- but 30 less scripts per week means you lose 25% of your tech hours.

"Love is blind" -- Just ask the Levaquin Lady...

"All's fair in love and war" BUT insurance rules the world.

"Unlucky in cards, lucky in love" -- more like UNLUCKY with your INSURANCE CARD means you're SCREWED...

"Misery loves company" -- this is why preceptors don't tell pharmacy interns the TRUTH. We want you to suffer with us!

"You only hurt the one you love" -- Naw... there's a WHOLE BUNCH of aggravating customers I do NOT love and I'd like to poke them with my finger and say "HEY, WAKE UP, IDIOT!"

"Laughter is the best medicine" -- According to the computer, Percocet is the best medicine.

"A spoon full of sugar helps the medicine go down" -- Unless you can't swallow like a lot of the over-indulged brats in my pharmacy neighborhood. In that case, you need the liquid version of the medication.

"Don't push your luck" -- Just because you filled a fake Oxy 30 with us before doesn't mean we're going to fall for it again!

"If it weren't for bad luck, I'd have no luck at all" = If you're a pharmacist, the only luck you know about is sometimes pouring out a perfect "30" on the counting tray or getting TWO bites of a sandwich before being called away from your lunch. Other than that, luck is limited.

"Diamonds are a girl's best friends" -- Only if they're in the
shape of Viagra!

"We are known by the company we keep" or by the company we work for. Uh oh.

"A friend in need is a friend indeed" especially if that friend is in need of a Vicodin.

"Curiosity killed the cat" -- Pay no attention to the completely illogical thinking of your corporate muckety-mucks. They know all... you are but a peon in the vast scheme of things. No, there's no logic to reduced tech hours when the company has vast reserves of money for other projects. YOU DIDN'T SEE ANYTHING!

"Beauty is in the eye of the beholder" -- And the faster you fill their script, the more beautiful you appear to them!

"Beauty is only skin-deep" but order that expensive face cream for me anyway, Pharm boy... I'll pay CASH!

"One bad apple spoils the barrel" -- and one bad patient can set your mood for the whole day. Don't take it out on other patients.

"An apple a day keeps the doctor away" -- Unless you have Medicare... then the doc will be happy to see you EVERY day...

"There's no such thing as a free lunch" -- In retail pharmacy, there's no such thing as a lunch, period.

"Footloose and fancy free" -- It's kind of like the motto for Medicaid now that I think about it...

"Free as a bird" -- See above...

"If you love something set it free" -- which explains why I'm still at Goofmart Pharmacy.

"... and that's the way the cookie crumbles" -- the explanation why it's two minutes until closing and a mom with a sick baby comes up to the window with an Rx for the baby and she looks at you with those puppy dog eyes and then you hear a little sneeze or cough from the baby and before you know it you're leaving 30 minutes late...