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Monday, February 27, 2017

The Debate

1. "Take one tablet by mouth every day."
2. "Take one tablet by mouth once a day."

Both directions say the same thing...or do they? According to some pharmacists, they are not entirely the same in their instructiveness. Let us examine a little closer.
CP's Partner and I conducted a very scientific poll. We asked our Phamilies, Phriends, Kids of Phriends, Random Strangers, and our Bartender to explain to us how they would take medication if they were given Option 1 or Option 2 on their bottles.

Conversation #1:
CP: How many tablets would you take if I told you to "take 1 tablet every day"?
People We Polled: <incredulous looks on faces> One.
CPP: And on how many days would you take one?
PWP: <still looking dumbfounded> Every day.

Conversation #2:
CP: How many tablets would you take if I told you to "take 1 tablet once a day"?
PWP: Seriously?
CP: Yes.
PWP: One.
CPP: Okay. Now the tricky question: On how many days would you take one?
PWP: Every day.
CPP: But it doesn't say "every day". It says "once A day". Couldn't this be interpreted to mean you get to select "A" day on which to take it?
PWP: You're arguing semantics with me.
CPP: Precisely!

PWP: Why are you asking me this, again?
CP: We were having a debate. At work, we noticed a number of prescriptions, prescriptions we personally typed, getting sent back for correction.
CPP: We wondered why until we noticed that the same pharmacists were sending them back for the same reason...
CP: ...The two directions listed above. I believe that both are a fine option. Personally, I prefer Option #1.
CPP: Personally, I don't care, but Option #1 works fine for me. I just wanted to try to learn why some pharmacists were stuck on Option #2 being the ONLY correct option. Hence, my reply in Conversation #2.
CP: Unless they are insisting that the medication be taken at "the same time once a day"?
CPP: Okay, but they are still taking only one tablet every day. If they were really that hung up on "at the same time" then could they not amend Option #1 to "at the same time every day"?
CP: True.
PWP: You are both really weird.
CP: But we yearn to know. To understand our fellow colleagues. To boldly go where no one has gone before. To...
CPP: They get it.

*For the record, we know "ONCE' means "eleven" in Spanish and that can be confusing but that is not the gist of this debate.
*Second, there is a HUGE difference between "Take 2 tablets once a day" and "Take 2 tablets every day". While the patient will take a total of 2 tablets either way, the timing is different. It's either 2 at the same time, or 2 throughout the day which could be taken 19 minutes or 16 hours and 11 minutes apart.
*By adding a simple "prn" or "as needed" to either of these changes them as well. Again, not the point.

What say you?

Tuesday, February 21, 2017

Demo Time

The next time someone asks why it takes so long to fill your prescription, I'm going to send over one of my highly trained, cynical representatives to perform a demonstration.
We will have a demo cart set up with the following items: empty vials, safety lids, non-safety lids, a blank label, a completed "test" label, random tabs/caps we found under the counter (or M&M's), a counting tray, a spatula, and the most illegible, poorly written or typed prescription we have seen in our pharmacy. 
Then, in our tone most snarky, we shall commence the lesson.

See this blank label? Uh-huh. This is the before. Yep. See this completed one, the one with all the writing on it? Yep. We put that on there. But how does it get there? First you have to read the prescription. See this one? I can't give you XXXXXXXXXXX the way that it is written. It would either kill you, or it doesn't exist. See, your prescriber is just making it up as he goes along. Must have been the 5pm special, scribbling as he and his colleagues exeunt. Now we have to call the prescriber...

Fast forward to receiving a new, clean prescription. This could take seconds to weeks, depending on your office. Now we type it all in the computer. What we type in here (motions to computer) comes out there (waves hand over completed label). This is how we know what, and what quantity, to count. Now we have a big bottle of medication. Somehow, we have to make sure it is the right one. Uh-huh. Yeah. We can't just grab random medication off the shelf. That would be bad, m'kay? So we pull it. Then we scan it. THEN we count it. Let me demonstrate it for you.

<exhibits flawless, machine-like skills while wielding a CP 5000 model spatula and effortlessly sliding the chosen little doses across the smooth surface of the tray>

Then we have to select the appropriate size vessel for your medication. Easy with tablets as there is a graduated marking system on the side here <waves hand over the tray demonstrably>, but less easy with capsules. It takes experience and know-how to gauge the size. We then bust a cap on it. THEN, and this is every patients' favourite part, we professionally apply a label to the bottle, delicately rolling it so as not to impart creases or wrinkles (okay, we slap that bitch on there, but it's lovingly applied to appear straight and elegant). THEN...

...we hand it off to the pharmacist. Her job is to verify that what I put in there is what is supposed to be in there. I performed this demonstration for you in an aseptic, controlled environment. Normally, I would perform this task under duress; I would be answering phones, taking your drop off, fielding questions about the location of cotton balls, the bathrooms, and the sale item of the week and slinging pills like a short-order cook slinging hash. The pharmacist, once she is satisfied I didn't mislabel or misfill your bottle, will bag your order so you can go wait in line to retrieve it.
[Note: I skipped the part about the drug interactions, profile check, etc because that is the pharmacist's advance class (#WhyYouPrescriptionTakesSoLong II) which is available only on weekends and evenings for a nominal fee.]
Assuming no one in front of you decides to present a new insurance or discount card, it is quite likely you can proceed through checkout in a matter of minutes.

Hello? Sir? Wake up. Your prescription is ready. Sir? 

Monday, February 20, 2017

Patient Know-It-Alls

Don't you just hate it when someone is so convinced they are correct and you know they are wrong but can't change their belief? It's like every post on Facebook this past election season. Or going down the rabbit hole of Flat-Earthers thanks to Kyrie Irving...Or an average day at work in the pharmacy.

Just Convinced He's Right In Some Thinking: I need my diabetes medication refilled.
CP: Okay. <scanning profile> I see we have Metformin on your profile. Would you like me to...
JCHRIST: Nope. That's not it. It's for something else.
CP: It is for diabetes.
JCHRIST: No. No, It's not. I said it's something else.
CP: O...kay. Any idea what it...?
JCHRIST: What about my blood pressure medication?
CP: You mean the one to lower it?
JCHRIST: Of course to lower it! What a stupid question.
CP: Just making sure. <scanning...scanning...> Aha. I see Lisinopril.
JCHRIST: Nope. Wrong again.
CP: Well, it IS for High Blood Pressure. The way this conversation is going, I suggest you at least fill that.
JCHRIST: Did that replace my Lipitor?
CP: No. That would be for cholesterol.
JCHRIST: No it isn't.
CP: Um...Yes. Yes, it is! It's right there in the name "lipid".
JCHRIST: No. It isn't. Don't they teach you about drugs in school?
CP: In fact, they do. I'm just curious where you obtained your education.
JCHRIST: School of hard knocks. I've been taking these for years. That's why, when your people ask if I "have any questions for the pharmacist", I always answer "Nope. Been taking them since before you were born".

...That moment when you realise you are arguing with an idiot...which makes you an idiot...which makes you wonder who is the bigger idiot...

CP: I see. Well, since my advice is always free, let me offer this to you. You can give a man an education, but you can't make him take it. Since you are so convinced you are taking the correct medications for the correct conditions, there is nothing I can do to help you. The next time you pick up your medications, I will have a new waiver for you to sign:

"I, the undersigned, have refused the most valiant attempts at counseling by my pharmacist. Even though she is trained in the ways of the phorce, and I am but a patient, I prefer to put all my faith in my uninformed alternative facts. Nothing she can tell me shall persuade me otherwise and I shall live and die by my own ignorance, exculpating the pharmacist from any blame."


Thursday, February 16, 2017

A CP Guide to OTC Products

In any pharmacy or grocery store or place that sells oral cough and cold products, there are rows and rows and shelves upon shelves with products "begging for your filthy dirty dollar. Shut up and buy!" How does one decide what product is correct for their particular symptom(s)? Simple, ask the pharmacist...Then ignore her advice and go with your friend's sister's hairdresser's customer's second cousin's recommendation.
The next time you are overwhelmed, simply break down the aisle into these categories:

1. Pain Reliever/Fever Reducer. Almost always Acetaminophen (Tylenol) but sometimes Ibuprofen (Advil or Motrin--same thing and you can't argue one works better than the other.)
2. Antihistamine: Usually diphenhydramine (Benadryl), sometimes chlorpheniramine or brompheniramine.
3. Nasal Decongestant: always phenylephrine if you don't see the Rx staff for it. Pretty worthless.
4. Cough Suppressant: Always Dextromethorphan.
5. Mucolytic: Always Guaifenesin.

That's it. Nothing more to it. The only reason there are so many products is that there are so many manufacturers and brands marketing themselves to you. Basically, the only thing you need to look at is will the product you buy alleviate the symptoms you have? If you remove the pain reliever from the equation, then the job is easier. Most people have either or both of these at home.

Forget the "Sinus", "Allergy", "Cold", or "Flu" designations placed on the boxes. They are as worthless as they box on which they are printed. "Words are wind."

Do I have pain? A headache? Then a pain reliever is right for you.

Do I have a runny nose? Itchy, watery eyes? Drainage? A cough? (Basically, if it's leaking and it shouldn't, you want an antihistamine.)

Is my nose stuffy? My head congested? (Basically if it's not running and it should, you want the good stuff-the pseudoephedrine from behind the pharmacy counter.)

Am I coughing? Is it dry? Seriously, get an antihistamine. Forget the DM. Doesn't work.

Am I coughing up bits from my lungs? Get the Guaifenesin. Best bet is Plain Mucinex. Blue Box. And drink lots of water.

In all seriousness, buy individual products where able. Combination products will almost always have you taking something you don't need for a symptom you don't have. Worse yet, you could be taking a combination that does not include a medication to treat the symptom you DO have. It is easier (I did not say more convenient) to add or subtract single ingredients as symptoms come or go than it is to take multiple combination ingredients that won't work.

When in doubt, ask your pharmacist.
Then take her advice.

I thinking we should make a survey sheet of symptoms.
These could be available at the pharmacy counter or online.
The patient could check the box or circle the symptoms of each family member when they get to the pharmacy or from home (especially before sending their husband or kids).
The pharmacy staff would then hand the appropriate product(s) to the patient after reviewing the list.
Someone should make this for me so I can post it.

Tuesday, February 14, 2017

Lame Pharmacy Pickup Lines

1.  "I'm easily administered, like Lactulose. I can be take orally or rectally."
2.  "Single this Valentine's Day? Come to the pharmacy where we can treat your VD ... blues."
3.  "Call me Proair because you can use me every 4 hours as needed."
4.  "You must be a 5-alpha reductase inhibitor because that is one Finasteride."
5.  "You can always get it over the counter at the pharmacy. Just ask."
6.  "Pharmacists come in prescribed doses."
7.  "Are you here to pick up a bottle of insulin because you are extra sweet."
8.  "I need to keep Amiodarone on hand because every time I see you, my heart skips a beat."
9.  "A pharmacist's love is like Nystatin Suspension-you have to swish before you swallow."
10. "If you're looking for a short-term fling, I've got just this thing. Call me Medrol and I'll be all over you the first day before slowly slipping away."

Monday, February 13, 2017


Welcome to CP's Pharmacy where we are always at the phorephront oph phun and ephphiciency. Today's discussion is "Bring a Phriend to the Pharmacy".
Always looking at ways to revolutionize the practice of pharmacy and stay one step ahead of the competitors out there, CP has once again developed a growth strategy that will be a real game-changer. We will initially celebrate with a monthly program with the goal of this becoming a weekly, or even daily, program in certain markets. 

Bring A Phriend To The Pharmacy is a simple concept.
Chains have invested a lot of time and money into med synchronization programs that simply don't work. The idea is that the patient will be contacted when her refills are automatically filled on a predetermined schedule. The problem with this idea is the patient herself. It's the human factor. (Patients often forget to take their medications as prescribed; forget to pick up the refills; or otherwise miss doses or generate stockpiles of certain prescriptions.)

As I got to thinking about this and how we could improve the idea I asked myself, "CP, who are the most compliant patients in the pharmacy world?". After about 3 milliseconds of brainwork, I responded with "Controlled Substance Patients (CSP)". That's when it hit me. If we partnered the MOST compliant patients (CSP) with the lesser compliant patients, Other Disease-State Patients (ODSP), we could really affect compliance. Think about it...

Controlled Substance Patients
-are always on time (even early).
-never miss an appointment.
-know exactly when their refills are due.
-know exactly when their next dose is due.
-never miss doses (and sometimes take an extra, just in case).
-take even "as needed" medications on a strict schedule.
-know the hours of operation of every pharmacy.

CP, what does this have to do with "Bring A Phriend To The Pharmacy"?
I'm getting to that. Patience. I mean, Patients.

This program will join a CSP with an ODSP. It will be like a life coach knocking on your door every morning at 5am for your workout ... except, we'd encourage the ODSP to drive.

CSP: Time to pick me up!
ODSP: It's 5am.
CSP: It's Refill Day!!
ODSP: But they don't open for 4 more hours.
CSP: We have to be first in line.
ODSP: The pharmacist said our prescriptions wouldn't be ready until 10am. They don't actually work on them until they open.
CSP: Right. But they hate it when we stare at them. Makes them feel pressured and they just want to get rid of us. They speed ours through and we can have them by 9:30.
ODSP: <click>
<<10 minutes later>>
ODSP: Hello?
CSP: Where. ARE. You? Let's go.
ODSP: Ugh. Being healthy is tiring.

Eventually we can expand the program to pair up patients who are on a similar dosing schedule. This way, the patients will always take their meds together, thereby increasing compliance. I'm working on the name, but "Let's Do Drugs Together" will be the working title.