BayPAC Posted September 29, 2018 Share Posted September 29, 2018 Pharmacists are really helpful but some of them are making my life difficult.... really! Case # 1 I prescribed buspirone for a 70 year old female who is already on Klonopin planning to decrease klonopin as buspirone is increased. She has been falling easily lately and we know benzos may increase fall risk in elderly patients. Patient leaves me a message later saying she would not take buspirone because the pharmacist told her there is an interaction between buspirone and klonopin. I called the pharmacist and she tells me "oh there is no interaction but they are both anxiolytics. No kidding!!! I explained my CLINICAL reasoning to the pharmacist... she said would call my patient back. Case # 2 Patient on trazodone 50mg from me and trileptal from neurologist. Patient on this combo for more than a year, doing well, no seizures, sleeping well. Patient coming to the office says she is now not sleeping well because she stopped trazodone 2 weeks ago; says pharmacist told her these two meds "cancel each other." Are you kidding me? Yes, trileptal decreases trazodone levels and trazodone may decrease seizure threshold, but so what??? She has been stable on these two meds for more than a year!! ... and they want to prescribe meds! Link to comment Share on other sites More sharing options...
jmj11 Posted September 29, 2018 Share Posted September 29, 2018 I know this is a struggle. I've lost my temper before with them, and I regret it. I have to do unusual things in treatment (but on the same page of every headache clinic in the country) and the pharmacist will sew disrespect or doubt with my patients by telling them that this is was an outrageous treatment for headache. It is hard for me to win them back after that. That's what pisses me off. We had this discussion at an International Headache Society meeting in Spain. The non-Americans were appalled that a pharmacist would tell a patient that the prescriptions given by the provider were not safe. They suggest that the pharmacist be immediately reported and their license revoked. The American contingency, well, we just laughed and shook our heads, explaining it is a different world here. Link to comment Share on other sites More sharing options...
EndBulbsOfMouse Posted September 29, 2018 Share Posted September 29, 2018 On the other hand, pharmacists have save my ass on the ICU and heme/onc floors on countless occasions. Link to comment Share on other sites More sharing options...
BayPAC Posted September 29, 2018 Author Share Posted September 29, 2018 12 hours ago, EndBulbsOfMouse said: On the other hand, pharmacists have save my ass on the ICU and heme/onc floors on countless occasions. as with all professions, the problem is with "some" of them. "On countless occasions," some of them have also helped a lot. In some occasions I have stopped meds following their recommendation. If they want my patients to stop a med for any reason, call me and I'll be happy to discuss the case, work as a team. Otherwise don't say anything! Link to comment Share on other sites More sharing options...
sas5814 Posted September 29, 2018 Share Posted September 29, 2018 It is, like all professions, a group of individuals with varying skills and personalities. I had a call a few months ago because I weight prescribed amoxicillin for a really obese kid. The pharmacy tech called and said "the pharmacist wants to know what this patient weighs". I was buried in patients and asked why the pharmacist didn't call. I was told "he's busy". I said "me too. Have him call me if he has questions after the patient has arrived." It was a minor annoyance in a busy annoying day but unnecessary and, really, if you are going to have the tech call then ask for the nurse. They didn't need to interrupt me for that. The eternal problem with prescribing anything is there are always drug-drug interactions, risks, hazards, side effects etc etc. I used to keep a copy of the pages from the PDR on Tylenol with the name blanked out. When patients asked about these things I would offer it to them and ask if they would take that med. Almost all said no. Then I would tell them what it was and use it as a teaching point about meds in general. Link to comment Share on other sites More sharing options...
lkth487 Posted September 29, 2018 Share Posted September 29, 2018 24 minutes ago, BayPAC said: as with all professions, the problem is with "some" of them. "On countless occasions," some of them have also helped a lot. In some occasions I have stopped meds following their recommendation. If they want my patients to stop a med for any reason, call me and I'll be happy to discuss the case, work as a team. Otherwise don't say anything! Yeah absolutely. I work mainly in inpatient, and so all orders (except emergencies) go through a pedi pharmacist. It's an amazing backup to have - everything from weird dosing intervals based on GFRs to interactions I've never heard of. If I had to pick three people I'd always want around me in the ICU, I'd pick an experienced nurse, a RT and a pharmacist. Link to comment Share on other sites More sharing options...
sas5814 Posted September 29, 2018 Share Posted September 29, 2018 Oh yea...I took care of nursing home patients for a long time and pharmacist review of those piles of meds on elderly fragile people was worth it's weight in plutonium. Link to comment Share on other sites More sharing options...
jmj11 Posted September 29, 2018 Share Posted September 29, 2018 I just wish that before they tell my patient that they "have never heard of this treatment and it sounds crazy" that they would simply google it. Everything I do is google-able. For example, daily methergine for the initial control of intractable migraine (https://www.ncbi.nlm.nih.gov/pubmed/8376101 ). Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted September 29, 2018 Moderator Share Posted September 29, 2018 I love my ED clinical pharmacist. They are, quite frankly, smarter than me. My local retail walgreen pharmacist? Him/her I can do without. Link to comment Share on other sites More sharing options...
Moderator ventana Posted September 29, 2018 Moderator Share Posted September 29, 2018 In cases where I have known the pharmD would bring up some interaction or something. I have told the patient that 5hey will l8kely bring up xyz and that I am aware of it and comfortable with it. This seemingly totally protects the prescriber reputation while allowing the pharm to say their peace. Link to comment Share on other sites More sharing options...
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