I am a pharmacist-AMA

[Ladyofthenuvarings]

First off I have NC for this as with my other posts it's very identifying
I am a community pharmacist and independent prescriber working in a primary care center.I really feel there is a huge misconception out there that all pharmacists do is count out tablets and try to rip people off with over priced suncream.But it really is much much more than that.Like any profession there is good and bad and I've met plenty of both variety,but the majority of us are perhaps more knowledgeable and helpful than the public realize.Just trying to clear up any misconceptions really.....so AMA?

Do you ever hoist your judgey pants when handing over medication?

I'm always a little embarrassed to collect my meds (mood stabilisers) because the pharmacist knows exactly what they're for.

@isabellerossignol I see mistakes on a daily basis I'd say probably 5 or six times a day they happen for all types of reasons the doctor might not have all the information,patient may not have been honest or clear with them,miscommunication or just human errors.it really depends on the nature of the error the action I take.If the does is incorrect I will usually speak to the patient and see if they are aware of any changes and if not will contact the doctor.It something is contraindicated or unsuitable I will contact the prescriber and tell them my concerns and recommend an alternative treatment sometimes I really have to hold a hard line on this as they can be gesturing to trust some else's judgment.Then because I'm an independent prescriber if something is bothering a patient be it a side effect or maybe they don't need a medication any more or need a step up treatment I will make those decisions myself.

@cheesenpickles most of the CF I see revolves around abuse of the system I would say.I mean there are always people trying to get tablets without a prescription but I would not really consider them CFs.I see a lot of people taking advantage of the NHS getting medications they don't take and selling them on to make money.Getting medications here and bringing them home to their own countries.Getting things on prescription they should and could afford to buy for much cheaper than it costs the NHS to supply.I see a lot of entitled people and really irritates me.I would never and have never begrudged anyone in need but my team and I (and the NHS )are taken advantage of on a daily basis

@Hefzi
I am an independent prescriber so I can prescribe most drugs in my own right however mostly I use this skill to optimize people's current medications they are on.I do feel I help people in this way I can often reduce medication burden and make hints simpler for them.Doctors are often not aware of interactions or special medication precautions.I would always recommend that anyone with a query about a medication interaction to speak to their pharmacist.I see lots of mistakes with regrading dosages and interactions mostly in these situations I will contact and discuss with the prescriber and recommend a correct treatment.If the mistake is obvious or recurring I will correct it myself.

That's so bad @Ladyofthenuvarings. Reminds me of the calpol post that did the rounds on Facebook.

Thanks, OP - I hadn't realised that existed in the UK: that's brilliant. I find it's mostly pharmacists who have been able to help with things like side effects, interactions and even other possibilities - not dissing GPs at all, but pharmacists are essentially specialists in medication after all.

Very useful and interesting thread - thank you

@GummyGoddess if someone was rude to me and then came and apologized I would take that at face value.As a pharmacist people are often rude to me sometimes is simple frustration which I can understand sometimes it's full on abuse people have thrown things at me,pulled out syringes and on one eventful night a gun.Point is we see frustrations all the time and think very little if it.If someone came and apologized to me I would be delighted and think highly of that person for recognized their rudeness towards me.Don't worry about it chances are your pharmacist understands your frustration and has forgotten all about it

@ImADadButThatsOKIsntIt I funded my IP course myself as I wanted to move into a role in a primary care center and felt this would help and and it definitely does.Without getting too specific I now hold my own clinic one day a week for a specific set of conditions where I do medicine reviews but also predominately monitoring of these patients as they are high risk.My role is slightly different from a standard community pharmacist due to the fact it's encompassed in a primary care center.I do prescribe but it is mostly for the patients I see at my clinic and medicines optimization as I see fit.I saw it as a positive step for career progression and it has been very beneficial and I enjoy it so that's always a bonus

What are your views on the weedkiller glyphosate, also known as Roundup? Is it something to avoid the use of in small quantities in domestic gardens? There are reports of court cases in the USA.

I suffer with migraines and was prescribed Sumatriptan which has been a godsend, I've ran out now and struggle to get Doctors appointments due to work but I do have a card where I can get them OTC but only 2 at a time, why is that?

@TildaKauskumholm this is very specific indeed and impossible to give advice without the full clinical picture.You could have indeed have been sensitized to the tramadol though the reaction does sound a little atypical .Both codeine and tramadol are opiates (although tramadol is slightly different)

My advice to you is you need to discuss this with your consultant before the surgery to develop a pain management strategy.If this isn't possible you need to mention this at pre-op.Most likely they will preform a risk assessment and devise a management plan.True opioid allergies are very rare and and disputed.Anything I say about this would merely be speculation and I don't want to add to your worries so my only advice is to speak to your team as they will be able to help.Good luck

How come when I take my prescription in it's always a 10-15 minute wait?? Even if I'm the only person in there?

@trumpdump acne scars are a difficult one it depends on the nature of the scars if your scars are what are called ice pick scars where the skin is physically indented then these are very difficult to get rid of.As far as I know and I am not a dermatologist the only treatment is laser and micro-needling to not surgery as such.

If however your acne scars are hyper-pigmented which means the skin is darker or red but the texture is intact then these can be approved.Azelaic acid is a treatment which some evidence behind it,it comes on prescription but you would find it very difficult to get it prescribed for this indication.The ordinary do however do a 10% suspension that is worth a try .For fading acne scars I would recommend the ordinary AHA or lactic acid a few times a week and then using azelaic acid and vitamin C on skin on alternate days

Not a miracle cure but does help and also wear sun cream and no sun beds as this will darken the hyperpigmentation

I am under the impression that whilst Pharmacists are hard to recruit generally, and that people seem to prefer community posts. I would like to know if you chose to work in the community specifically, and what might put people off hospital roles?

@ExpletiveDelighted Currently I don't work in a chain but I did for a few years and was store manager also.I graduated at 22 and started my first job and within 6 months I was store Manager so I had a team of 20 people under me which is quite a lot at that age.I learned very quickly how to manage people and conflicts.I definitely struggled with finding my identity as a boss and not just a co-worker at the beginning.Mannagjng a store is very stressful and practice takes a bit of a back seat because your time is take up managing rotas or having target and progression meetings If someone calls in sick that's on you, if you have no pharmacist on a bank holiday Monday that's also you or if the alarm goes off at 4 am that's also your responsibility.This was an aspect of the job I really didn't like and one of the reasons I left

I love my job I live learning about new and better treatments,so for me keeping up to date is a joy and I'm always reading papers and journals and new guidelines.The doctors get a bit annoyed with me sometimes as I'm constantly posting guidelines and memos all over the place which mostly go ignored.However I realize this is not the case for everyone but honestly as a pharmacist you have a duty to your patient to be as knowledgeable and up to date as possible.

How do you feel about medication charges? I take a drug which is exempt from charge (not a contraceptive) and don't pay for any prescription items. I'd be happy to pay for those other items I need but I don't have to.

@DonDadaOnTheDownLow I see people for all walks of life on all types of medication and I can honestly say I don't judge.To me it's just another days work.Its very important that you don't feel your pharmacist is judging you as they shouldn't be and if you feel they are ,move to someone you are more comfortable with.Our job is to support people on medication not judge them for it

Do you think that pharmacists should be able to issue more OTC medications during pregnancy? Things like clotrimazole for thrush. Or do you think it's correct that pregnant patients are redirected to their GP for a prescription?

I was on fluconazole for 4 weeks,(oesophagus Candida) 400mg starting dose first day and 200mg there after. I have since read how bad this drug is for your liver, my GP said it was fine. I did have terrible pain under the ribs the first day of taking it and felt sleepy for a few days after and then felt fine as I continued. What are your views on this drug? And is there anything else you would suggest instead?

@ticketsonsalenow I am not aware of the cases about roundup but I would assume they pertain to the fact that roundup is neurotoxic to some extent ?the thing about herbicides is they kill living things they are toxic but if they weren't they wouldn't kill things.I think anyone who uses they needs to take the necessary safety precautions wear a mask,don't do it in a windy day don't do it when drying laundry etc etc. FWIW I use round up on my garden frequently but only with a sprayer and always wear a mask .I think as consumers we must no the risks of products we use and take responsibility for them,unless of course we have not been informed or mislead that is different

@0hMyDayz the reason for this is between the manufacturer and regulator.Sumatriptan was originally a prescription only medicine and was then approved for OTC sales.The regulator may have stipulated a smaller pack size as they do not want people taking vast quantities of medication OTC similar to restrictions on how many paracetamol you can buy.Also sumatriptan is quite expensive and a larger pack size might not have been commercially viable but it is more likely to have been the former .Just to put this in perspective there are only six tablets in the prescription box of sumatriptan.HTH

@cricketmum84 this something I get a lot and it's the one of the only things that actually frustrates me .I do understand however why as people don't realize what goes on in a dispensary.So if you come in to my shop with your prescription and there's no one else in there.But we have 3 people calling back and then 4 more people having phoned in for the next 30 minutes.I might be on the phone sorting some medication out for another patient or handling a doctor query.Equally I could be dressing a wound or doing a morning after pill consultation .Their is only one of me and nothing can leave the shop without me checking it .So even if your prescription is ready it cant be given out until I am free to check it .Then I have to check is this dose correct for the correct indication and interactions and counseling points I need to speak to you about.Theres so many variables so it's hard to pin point one.You're pharmacist isn't trying to keep you waiting honestly they are trying their best to be as quick as possible .

@NottonightJosepheen in terms of beauty the best kept secret for a moisturizer is silcocks base it comes in a big tub and is cheap as chips,tbh pretty much all other moisturizers are the same formulation just with added skin irritants.Although not something you can buy in a pharmacy there is nothing like the ordinary for skincare.Simple and potent active ingredients with an evidence base I think people are a bit cared because there is not fancy packaging and intense marketing.If you do your research you can find the perfect regimen for you.Lots of "bloggers" theses days are flogging all sorts of vitamins developed for skin apparently.But in reality a lot of these contain random ingredients in sub-therapeutic doses the best thing you can do for your skin is sunscreen, a healthy diet and water (and retinol when the time comes ) but if you are looking for a vitamin for skin health I would just recommend an old fashioned one such as floradix which is quite potent.

Are there more medicines out of stock than usual and if so why?