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?

@lady can I ask if you think it's necessary to give a 6 year old child an antihistamine when they go to a house that has cats? Cat owner says the child has allergies but the child is fine around other cats when visiting other houses - seems unnecessary to me but would like your opinion please. Thank you

Thank you OP, such a great thread!

@Ladyofthenuvarings . Great thread, thanks.
My questions are
How much of a jump is Naproxen from Ibruprofen?
I have sciatica but it doesn't seem to work any better.

What do you do to maintain good health, considering you must think about illness a lot?

@pinkgloves there are no studies that prove direct causation between PPI use and cancer. There are some studies that suggest correlation the problem with this is I would say 90% of patients I see on more than 5 medications are on a PPI so in this cohort there is huge polypharmacy and co-morbidities also numerous genetic, epigenetic and environmental factors. So yes there may be an increased rate of cancer in patients on long term PPI treatment but does the PPI cause this the answer is we don't know. In terms of alzheimers that evidence has been disproven several times including in a BMJ article in 2017 and subsequently in NEJM last year. Bottom line is medication use is a risk-benefit are the potential risks worth the potential benefit to the patient in most patients with GORD the answer is yes.

@MariaWaria it's difficult to know without a diagnosis but I would agree that tinnitus normally presents with more of a ringing that is very strong and disorientating. Steroids can take while to be effective and sinuses may be very inflamed, I would usually say six weeks for an effect. Maybe if you're still struggling after that return to the GP you may need a referral to an ENT or may need otic steroids.

@OhTheRoses so fluoxetine comes in two licensed forms 20mg capsules and a suspension which is 20mg/5ml as you cannot half a capsule so this means flexible dosing is limited. The 10mg capsules are an unlicensed medicine so are usually imported from a different supplier and take longer to get. They go in and out of stock constantly. I would say boots may have had a supplier issue, certain chains have contracts with wholesalers and have restrictions on who they can buy from. I would say that your local pharmacy has many patients on this and have a usual supplier through a specific wholesaler etc. I do seem to remember there was a licensed 10mg tablet theoretically available and licensed by has been out of stock for years.

I wholeheartedly agree that prescription charges are poorly distributed on the NHS. I think people who can pay should make a contribution towards there medicals costs and students should get medicines at a reduced rate.

I take 5mg Bisoprolol.( Usually Sandoz)
One one particular brand packet ( Milpharm) it states 5mg Bisoprolol Fumerate equivalent of 4.25g Bisoprolol.
It makes me feel uneasy and like I'm not getting correct dose.
Pharmacist was stumped when I asked about it and didn't reassure me.

What’s the best non-prescription care for asthmatics? My test appointments fell through, have been given a reliever inhaler before but new GP won’t take me seriously. My DM smoked heavily around me from birth. Desperately need some breathing relief!

I have two please

Do you think that a cup of coffee and a paracetomol is as effective as lemsip style drinks?

Does the annual flu vaccine also prevent pneumonia?

thanks.

Thank you for responding. We cd always get the tablets btw but they were more expensive and dd said they imparted the same flavour as the liquid suspension.

How much pre-reg training do pharmacists get in medications and breastfeeding? (Do you get any?).

Also, once qualified, where do you get your info from on what mothers can and can't take while breastfeeding?

@Imupallnightto this would concern me very much the chances of you regaining a normal sleep pattern are slim and this will pose problems for you later in life. I would guess you are taking diphenhydramine. As times goes on bodies tolerance goes up and the dose would need to be increased even more to cause the same effect. At higher doses could cause cardiac problems, confusion hallucinations even. However, these side effects are only really seen at very high doses. I don't want this to be deleted but it will be far easier to address this issue now than to let it go on. A few nights of insomnia and headaches will be worth it in the long run. The bigger danger with relying on antihistamines is not being able to regain a normal sleep pattern.

@STARE2016 duloxetine is an SNRI and inhibits the reuptake of serotonin(and noradrenaline) they way tramadol works is two-fold so it is a partial opioid and partial serotonin reuptake inhibitor(In terms of amitriptyline it does affect serotonin but your dose is low ish and isn't implicated in the same way that duloxetine would be). With duloxetine alone, there is a small risk of serotonin syndrome but in reality, this is very rare. Adding tramadol to this does increase your theoretical risk of developing serotinin syndrome but it is very commonly used in combination and I have never seen a case of serotonin syndrome. Do some research and familiarise yourself with the symptoms of serotonin syndrome and just keep an eye on things. Try not to worry it is very commonly used the thing about medicines is there are so many interactions and cautions. We have to decide which ones have clinical relevance and which might be worth the small risk for an increased benefit. This is the decision your consultant makes when selecting a medication for you. I hope I have answered your question to some sort of satisfaction if your worried ask your pharmacist and they will be able to advise you further on warning signs etc

@NaBiAgOl There is not I'm afraid Antabuse is available on prescription. Is absolutely no use if the person doesn't actively want to quit alcoholics (or those dependant on alcohol ) will drink even while taking this and make themselves very sick.

@nilcarborundum There is a cream you can get over the counter called Eurax which contains an antipruritic which is great for the itch, take a lukewarm bath or use ice chips to numb the itching skin. There are products you can buy to soothe the itch during chickenpox which cools the skin they are expensive but if you are in a bind they might help like virasoothe.Some antihistamines (the older ones) are more effective than others for the itch I won't recommend one but ask your GP or pharmacist as this might help. Also, just a note La roche possay do an anti-pyretic line which is indicated by products with an AP which is cooling and soothing on the skin..

Wanted to say a big Thank you to you and your colleagues, it's a hard job and having to constantly on the ball.

My meds are done weekly by the local chemist in a dossette, it takes quite a while to sort out as I am on 40+ meds a day as a basic.

I know my local chemist gives a damn and will work with me to make sure I get the best out of them as I can. He has also caught interactions and unusual dosages which have saved me from a lot of illness had they not been caught and questioned.

Thank you for your answer @Ladyofthenuvarings that is very helpful!

ah just pondering really! Thanks for clarifying though OP.

@GrandmaSharksDentures I prescribe several times a day usually and more on days I hold a clinic in a specialist area. However, my role is not typical and I think it would be very difficult to find the time to perceive in a typical community pharmacist role. My patients will often ask me for things when they come to collect prescriptions, for minor things mainly skin conditions, skin infections, UTIs but I don't prescribe antibiotics for chest infections or any kind of mental health medication I don't have the time or resources to do so. I can dispense my own prescriptions yes

If on 100mg of Amitriptyline why don't I sleep 😭

@34plus4 do you mean medications for the parents or for the baby??

Ladyofthenuvarings, 34plus4 almost certainly means the guidelines for sleeping more safely next to your baby, for families who cosleep.

One of the "rules" is not to cosleep if you've had medication that makes you sleepy.

Here are some safe sleep guidelines, for example:

www.laleche.org.uk/safe-sleep-the-breastfed-baby/

and

www.nct.org.uk/baby-toddler/sleep/co-sleeping-or-bed-sharing-your-baby-risks-and-benefits

@theblinkow @34plus4 yes of course.No I do not advise patients about this unless asked for a number of reasons. Firstly I often won't know if a patient has children especially in the case of men and I would never assume. Secondly, even if I was aware someone was a new parent I wouldn't know if they were co-sleeping or what the arrangement was and I would not ask. Those are very personal decisions and people can become very defensive of there choices and I do not feel it is my place. Lastly, as a healthcare professional, I cannot advocate for co-sleeping no matter how I may feel personally at it puts baby at increased risk. If a parent asked me regarding it I would always advise against, but I respect any parents right to choose. In theory, it would be great to inform parents of this but in practice, it is not possible. I always advise if a medication makes you drowsy about not driving etc.

@domton the pharmacist in me wants to tell you that all generics are the same they have to be but I do understand that people can react differently to them for reasons we cannot predict. When you visit your consultant specify the brand you want if they write no generic substitution on the prescription that should stop the switching of generic. Get them to include in their letter to the GP and perhaps take a copy yourself. Your GP will be hesitant to write no substitution on the prescription as it is more expensive but inform them that you have experienced severe side effects and as a result have not been able to take your medicine and they should. Most pharmacies have odering systems where they will buy the cheapest generic available at that time. If the issues with getting that specific generic is a supplier issue and the pharmacy cannot get it in then there is no way of getting it, but doing the above will stop it being swapped for the cheaper one if it is available.I'm very curious to know what you mean by well documented as normally if any variability was seen in a generics therapeutic effect that would be an issue as the basis for a generic is that is the same as the innovator product. But anyway hope this helps