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?

@JasperSIn oh what a great question. I would say ketamine even through prescriptions are increasing for it. I have only seen one cocaine prescriptions and near fainted when it came in. Some other odd things would be dapsone a drug that is used to treat leprosy but nowadays more used for odd infections that HIV patients acquire.

I'm intrigued, what's Ketamine prescribed for, for home use?!

I can only think of something to do with addiction to ketamine due to illegal use of it? Why would anyone be prescribed such a strong anaesthetic to use at home?

My mother had ketamine when she was terminally ill.

Lady please could you clear up a question about codeine linctus.
I had bowel cancer and had a third of my bowel removed which means sometimes I need a loo quickly.
Codeine linctus works brilliantly if I’ve got a long journey or anything when a loo may not be available at short notice and the oncologist gave me a prescription for it. The pharmacist at the hospital where the medicine was prescribed told me that in future if I need a bottle of codeine linctus if I show a copy of the prescription then any pharmacy will give me some.
So before I went on holiday I did just that but the pharmacist at the chemist I went to was quite rude to me and said of course he wouldn’t give me a bottle without a proper prescription and no, a copy wouldn’t do and how did he know that I hadn’t walked around every chemist in town getting it.
I left the chemist feeling quite humiliated and I wondered who was right, the pharmacist at the hospital or the one in the chemist shop?

Hi OP, I’d firstly like to say I think that pharmacists are a very much under used resource that a lot of people don’t consider. Also there are instances where they know more about certain drugs than GPs.

Can I ask, how do you keep up with all the new drugs coming out? Or do you learn as they are prescribed and read up then? This is in relation to how they are metabolised (which enzymes used etc) and potential interactions with other drugs the patient is currently taking - even down to common things like calcium, iron etc. This had got to be such a massive amount of info to remember!

Also, in relation to generics, I know you said above that they are the same as the original, in that the same drugs are used, but do you see many adverse reactions when someone moves to a generic version? With HIV meds this is sometimes the case, say because of the different salts used

Lastly, HRT patches- is it true that if you use heat, as in from a hairdryer, to help them stick, it does a hormone dump all at once? Same with putting one on after a shower when the skin is hot (friends have reported getting a bit of a rush when doing that). If so, would sunbathing have the same reaction?

champagnebrain I'm sorry for your loss

Ketemine is a dissociative anesthetic. It's not uncommon in medical settings. I've not heard of it at home though. Was your mother prescribed it for use at home?

Is there anyone we can but over the counter that's like the old Syndol - the relaxing part of it really helped tension headaches.

Also are there really any significant risks in using out of date meds? At what stage past their use by date are they dangerous?

Do you have any idea when the Epipen Jr shortage issue might get better? It’s causing me a lot of worry at the moment trying to fill my child’s prescription and every pharmacy I have contacted say they don’t know what’s happening, when they will be in stock or what I can do to get them - this is life saving medication and it’s so frightening not to be able to get it.

Howmanyleftfeet - Yes, at home. It was over 20 years ago. Maybe rules are different. I can't remember if it was her GP or through MacMillan ? I remember a hospice being consulted but she wanted to die in her own bed.

@Bamchic The IP course is for pharmacists only, I would imagine it is similar to the nursing one but it doesn't really focus on pharmacology, effects etc its more about the principles of prescribing.
I'm slightly confused by your mirtazapine question, mirtazapine is sedating at all doses due to its weak 5-HT1. It is possible it is being used at a 15mg dose primarily to treat insomnia and not depression though this would be off-label. Patients on a higher dose for longer-term might become resistant to its sedative effects or be resistant due to previous hypnotic use but in the general population doses 15-45mg are sedating.

*weak 5-HT1 antagonism

howmanyleftfeet-ketamine is primarily an anaesthetic. At lower doses, it is used in pain management, often in palliative care but also in the treatment of severe intractable pain that cannot be managed by opioids. An example of where it is commonly used is in sickle cell disease but the pain in the bone marrow cannot be anaesthetized by opioids. Its very effective in neuropathic pain that is opioid resistant also. In palliative care, people can develop opioid toxicity and this can be an option for pain that cannot be treated with high doses of opioids. Very specialist though

@LaLaLamp No they do not it would be considered unethical as patients have to give informed consent to treatment. The only time placebos are used is in clinical trials but this is now being phased out as trials become more complex.

No question but I wanted to say that you as a pharmacist are wonderful!
Pharmacists are under appreciated, under-utilised and quietly just get on with doing an amazing and crucial job.
You are very much appreciated and help so many people.

@Ladyofthenuvarings is Naproxen a better ( stronger) anti inflammatory than ibuprofen or does it just last longer?
I'm having a sciatica flare up. So keen on any opinions

@Ladyofthenuvarings, if you come back. I have thought of another one!
What do you think of GPs surgeries who use receptionists as dispensers? It occurred to me I hadn't actually seen a pharmacist in ages as my surgery has its own dispensary.

@Ladyofthenuvarings, I take 25mg of Amitrptlyene at night for sleep, as when I was going through menopause I would not be able to get back to sleep after I woke up during the night. This has worked really well but it's been a quite a few years now and perhaps I don't need it now I'm through menopause. I believe it's not advised to go cold turkey so can you please suggest a reducing regime? Many thanks

@AmIbeingTreasonable you're so lucky 25mg helps you sleep, I'm on 100mg and still don't sleep all night

@Lady why does Paramol go out of stock everywhere for long periods then come back the same as it was before? Is it too addictive for OTC?

Also another question - I use the melatonin gummies to help me sleep and they are amazing but I have to order them from overseas. I’m having a very intense menopause following cancer surgeries and they’re the only thing that has helped me sleep. I don’t take them every night. Are they very bad for me?

Hello. I recently had surgery to remove cancer in my colon. I had an epidural which worked brilliantly until it became disconnected.
It was 11pm and when I told the nursing staff, they called the anaesthetist who was in theatre but he offered me ora morph until he could get to me.
About 15 minutes after having it, my lungs/ribs began to hurt and I felt as if I was being squashed. This is the only way I can describe the discomfort. After an hour or so, it began to wear off, I was prescribed Oxycodone and the iv paracetamol and both those were fine. I have very little pain/ discomfort at All, and I was soon home and am doing extremely well.
So - my question is, does this sound like a reaction to oramorph/morphine and should I try to avoid it I the future?
Thanks x

Hiya i was just wondering if i could have a little advice on my 2 year old daughter shes gonna be 3 in a months time latley shes been waking up in the middle of the night upset and farting alot and she points to her belly ive giving her some infacol as its always helped her since shes was a new born but i crnt help but think im doing somthing wrong as she might be okay one day but then she could have it again the following day surely somthing wrong if shes getting alot of trapped wind all the time

Appreciate any help that might be given as i feel so sorry for her many thanks..

@Ladyofthenuvarings another question from me! Getting ready to send my migraine prone son on camp. We've managed to get to the stage where he needs only paracetamol and ibuprofen. School aware, all forms correct.

I want to give him a cooling roller ball thing as part of his first aid kit. It says not for children under 13. He's 12 (13 in a few months)

He could use it couldn't he? He's taller and heavier than many adults...

Why the age restriction. It's this stuff

School know it's dehydration and tiredness that set him off, as does he.

Hi OP, I've always wanted to be able to ask a pharmacist this, do you treat people on Methadone/Subutex differently to those on a 'normal' green script? As you might have guessed I'm a recovering addict and have collected my script from lots of different pharmacy's in the past having lived all over the country. Some places I have been treated very badly- pharmacist tutting and shaking his head saying I should 'know better', being followed round the shop everyday despite being a daily customer for 6 months, staff refusing to speak to me. However I've also met some brilliant one's who never made me feel any different to another customer (rightly so) what training are you given around this? Do you see a lot of this kind of behaviour and if you did would you pull up your colleagues on it? Thanks