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Tuesday, December 22, 2020

What A Waste

ME: CP has that look. 
MICE ELF: Someone pissed in the morning Cheerios. 
ME: Something happened that defies logic; that CP just can't compute and I think shortwired the brain. 
MICE ELF: Well let's ask. 
ME: Nicely. 
ME + MICE ELF: CP? Are you okay? It's okay. You can tell us. 
CP: There is a reason other countries have looked at us over the last year, shaken their heads, and felt sorry for us. I could handle if they laughed at us, but they're sorry for us. 
ME + MICE ELF: Elaborate. 
CP: You saw how our Congressional representatives began receiving their COVID vaccines?
ME + MICE ELF: Right. To encourage their constituents to receive the vaccine. 
CP: Sure. But members who are not included in the first wave of qualification also received theirs. Feels as if they should set an example as well that they are healthy and should await their turns. 
ME: Good point. But there seems to be something else.
MICE ELF: Yes. Like the main point of this post. 
CP: I'm not administering the COVID vaccine. I don't have it. However, I have phriends who do have it and are working clinics for their respective pharmacies and here's a little story that I got to tell. . . 
Pfizer's vaccine is good out of its frozen state, in a refrigerator for up to 5 days. 
The clinics require there to be extra vaccine available. Just in case. 
IF the clinic does not use all of the vaccine, the extra can be returned to the fridge to live out the remainder of its 5 days. 
HOWEVER, if another clinic is not scheduled/held during that time, the vaccine is destroyed. 
ME + MICE ELF: Can the pharmacy staff administer it to their employees? Or their employees' families? Or first responders? Or anyone else in the 1A group?
CP: NO. They have been told it is against the law. 
ME: Aren't pharmacists and pharmacy staff and pharmacy store employees considered healthcare workers?
CP: No. 
MICE ELF: Wait. Hold up. You're telling me that the pharmacists administering the vaccines, or working in their pharmacies, waiting on potentially sick people all day, consulting with them in the aisles about how to treat their symptoms do not count as first-line healthcare workers; that they can't receive a vaccine that is in desperate need that is otherwise going to go to waste; and the government employees who don't qualify have already received their vaccine?
CP: Well, those administering the vaccines can get theirs at the end of the clinic, but only those staff who work the clinics can receive the vaccine. Not the rest of their staff still working the bench in the stores. 
ME: And someone in the government signed off on this? 
CP: If there was anything more American Governmental than wasting this precious commodity, I can't think of one. 
MICE ELF: I wonder if this is across the country? Across all states? *
CP: It shouldn't matter. Everyone should be pissed. There are reports of nurses that don't want it. I'm sure there is pharmacy staff who don't. But I do. Many of my pharmacy friends and staff do. If I can get it so it doesn't go to waste, why can't I? Why should I, as a healthcare worker not be allowed, be told it's against the law, to receive it? Why are these vaccines going to go to waste?

*Having checked as of the posting, it is not against any FEDERAL law. It may be state specific or local health department-specific. Check your local/state agencies and inquire about this. Do NOT let these shots go to waste!

Wednesday, December 9, 2020

Problems With Vitamins

From a professional view, I loathe dosing on vitamins/supplements. (This is not about my opinions on vitamins/supplements themselves, for that is another beast altogether.) The current, normal dosing is based on advertising and not ease-of-use for the patient. 
In much the same way as food labels are based on servings, so are supplements. (When is the last time you shared a can of Chunky Soup with someone? You should because a single can is two servings.)

Melatonin 5mg Gummies. It says so right on the front of the bottle. It says it on the sticker at your pharmacy. "5MG". Clear as can be. No way to misinterpret "5MG". 
Except. . . 
When you, as a do-your-due-diligence practitioner, read the back of the label and check "serving size", you notice the serving is actually two (2) gummies. Hmm. That would make each gummy only 2.5mg. Does that make each dose 2.5? 
When I, as a pharmacist, use these to fill a prescription, I will write "Chew 1 gummy once a day" to convey the simple fact that your dose is 2.5mg. 
When you, the patient, grab a bottle off the shelf, and see "5mg", will you only give your child one gummy? This would mean you are underdosing her at 2.5mg, right? Right.
See why I don't like this? 
Can you see what other issues may arise? 
Maybe a patient doubling the dose and actually taking the 5mg dose, (all the while believing they were taking 10mg) then buying a 10mg, thereby unintentionally doubling that dose?
Sound farfetched? Sound cynical? Sound like something I have complained about before? 
It sounds like something that actually happened recently. A mom bought the same bottle OTC that I used to fill her daughters' prescriptions. Had she not come to me for counsel, she would have doubled their dose. 

Fine. It's melatonin. No big deal. 
Okay. What about the Glucosamine-Chondroitin products? They clearly state if they are double- or triple-strength.
Sure. Just like buying paper products, the math here is frustratingly complicated. 
First, you have to know what "Single-Strength" is. And is that in 1 tablet? 2 tablets? 4? 
Then, is the "Double-strength" a single tablet? Or 2? Or 3? 
Don't get me started on the "Triple Strength" where a single dose is 2 tablets. 

It's all marketing. Unless people can do the math or are wise enough to seek counsel with the White Coats in the back, there can be issues with taking too much or too little of many OTC products. 

(Anticipatory Devil's Advocate rebuttal: geesh CP. they're only OTC supplements. who cares? it's not like they can OD or anything. they don't really do anything anyway, right? it's not like they're real medications.)
Right. Except lots of children take melatonin (and other OTC products) and lots of people believe that "if one is good, two is better" and many patients never report their OTC products while giving medication histories. 

Also, it's not just about Melatonin and Osteo-Bi-Flex. There are many OTC products that can be easily under- or overdosed due to unclear labels. 
Shouldn't there be a call for a change to happen? 
If the label says "10mg" then I expect the bottle to contain 10mg doses, not 2.5mg or 5mg "partial servings". 
I wonder how often mistakes are made based on OTC labeling because it's designed on marketing instead of safety?

Tuesday, December 8, 2020

Dear Board Of Pharmacy

I have a question for my BOP.
Perhaps you too will share this question.
CP: Dear BOP, do you have to approve pharmacist license applications?
BOP: Yes.
CP: Do you have to approve companies that do business with the State BOP?
BOP: Yes.
CP: Do you have to certify e-script providers and other vendors that do business with the State BOP?
BOP: Yes.
CP: Okay. Do you suspend licenses of pharmacists in the State?
BOP: Yes.
CP: If a pharmacist was asked to complete something as part of her registration, and told you "NO", could you revoke their license?
BOP: Yes.
CP: If a vendor said "NO", could you do the same thing?
BOP: Nope.
CP: Why not? You know that you have approved over 200 e-rx systems in the State. You know that one of the providers has refused to fix a known issue with their software.

(Here's the background. If an e-rx is sent by a prescriber, it passes from the office system to another processor who passes it on to Emdeon. They in turn pass it to a switch who is responsible for passing it to the pharmacy. IF, at any point it does not make it to Emdeon, whether due to a system outage or a "glitch", the e-rx is routed directly to my fax machine. This comes complete with no signature by the prescriber. My state has mandated that these Rx's are, in fact, not legal. We are required by the State BOP to call on each of these Rx's. They even have a disclaimer at the top that reads "Warning. This is not a valid Rx until called to verify by the pharmacist." What's even better is, we then have to transcribe it as a verbal order instead of an e-rx, thereby circumventing the intent of the e-rx in the first place.)
Still with me? Good. Now, despite repeated conversations between the company and the BOP, the company has refused to take the action that the other two big e-rx players have and that is to change their software to allow signatures to be printed on the faxes. They also contain a disclaimer that essentially reads "this started as an e-rx but due to a system error or glitch, got routed to your fax instead. It is totally valid so feel free to dispense it. Approved per State BOP", or something to the effect.
BOP: What's your question again?
CP: Why can't you just revoke their approval? Like you would a license?
BOP: Because.
CP: Oh. Okay. What do you suggest?
BOP: Call the offices that use this software and speak to their office managers. Explain the situation and why you have to call all the time, even though they get frustrated with you, and have them complain to their software vendor. Maybe, once enough offices complain about all the phone calls, the company will relent.
CP: Or you could just give them 90 days to be in compliance or threaten them with the loss of their license.
BOP: The Board of Medicine wouldn't go for that. Too many doctors would complain.
CP: Gotcha. So you approved a system that basically tells all the pharmacists to piss off, makes more work for us, then you tell us it is OUR responsibility to call on something you could fix, because you, the Board of Phrickin Pharmacy, are afraid of what a group of prescribers will do?
BOP: Yes. Pharmacists have no backbone and won't stand up to us. We only approve the systems.
CP: I got nothing. I need to relocate.

Wednesday, December 2, 2020

O Seltamivir (O Tannenbaum)

Pronounced: O SELT um a VEER

O Seltamivir, O Seltamivir
My how you help my symptoms
O Seltamivir, O Seltamivir
My how you help my symptoms
Your price is high but that's okay
You really don't work anyway
O Seltamivir, O Selatamivir
Nah you don't help my symptoms

O Seltamivir, O Seltamivir
Why are you never in stock
O Seltamivir, O Seltamivir
Why are you never in stock
The same time each and every year
The flu like clock-work reappears
O Seltamivir, O Seltamivir
Why are you never in stock

O Seltamivir, O Seltamivir
It's time to be backordered
O Seltamivir, O Seltamivir
It's time to be backordered
Xofluza's new, competes with you
Though it's not cheap, one dose will do
O Seltamivir, O Seltamivir
It's time to be backordered

O Seltamivir, O Seltamivir
You let us know, flu is near
O Seltamivir, O Seltamivir
You let us know, flu is near
So many scripts, we do receive
Yet out of stock, we can't believe
O Seltamivir, O Seltamivir
You're such a disappointment.