Pseudoephedrine sucks big, floppy donkey dick

Posted by The *Angriest* Pharmacist as Drug Companies, Just a question, PSE

I absolutely hate PSE. If I could fake a study and say it causes cancer and heart attacks, I wouldn’t hesitate a second. Here’s the most enlightening thing you’ll hear all day, I know how to fix the problem.

PSE cannot be sold anymore in it’s pure salt form.

Done.

Combo drugs are okay. People cooking meth will have a hell of a time trying to extract loratadine, acetaminophen, ibuprofen, or a -pheniramine from the pseudoephedrine. I would doubt it could be done…if it’s possible, it wouldn’t be easy or cost-effective.

You want pure PSE? Get a script. Make it a legend drug…it doesn’t need to be controlled - then all the NP and FNPs wouldn’t be able to prescribe it.

Seriously - how hard is that solution?

Why isn’t it done yet?

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More Trials and Tribulations…A New Analogy!

Posted by The *Angriest* Pharmacist as Drug Companies, Me being a dick, Stupid People, True Story, Work Sucks

Today I received three calls that went pretty much as follows:

“I’ve got this Elidel cream that expired in May 2007. Can I still use it?”

Ugh…I always tell people that yes they can use it, but it of course will not be effective. Listen up, people. Expiration dates are not merely suggestions…Do you feel the urge to drink milk that is “just a few days past the expiration date” ????? Of course not…idiots.

-=+=-

Why do I get 50 calls a day asking me, “How much is 30 Effexor XR 150mg?” or some other random drug? Yet, I never see these magical cash patients come in…I know, some of you might say I’m getting shopped by other pharmacies. But, I never call other pharmacies for prices. I figure out what the correct price is based on my cost, and that is what I tell people. If they tell me that Walgreens or someone is selling it for $XX.XX, and it is within reason, I just switch it. Also, I know how most Wag’s operate, they don’t have time to be shopping prices. I also know how they charge…it is insane…they charge more than double what I do for most things. They *don’t* check prices.

-=+=-

I’m open from 9am - 9pm. I close from 1:30pm - 2:00pm. Why do I fill ten prescriptions from 1:15pm -1:30pm? That’s more than any other 15 minutes of the day! By those numbers, I should be filling 480 scripts a day…That’s not even close to the 200 or so I do…blah! Why 1:15pm — I just don’t FUCKING GET IT! All I want to do is eat a turkey sandwich, and I can’t do it. And I don’t even want to think what would happen if I stayed closed a little bit longer. Imagine me closing at 1:45pm and staying closed until 2:15pm to make sure I get my 30 minute lunch (which I am required by law to get). I’d have 20 people at my drop off window swearing like a drunkin’ George Carlin when I got back…not an option…

I won’t even speak of the 2-15 minute breaks I’m supposed to get that I’ve never gotten in all my years of pharmacy…

-=+=-

Stop spilling shit in my pharmacy. Lotion is *not* easy to clean up…

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Does anyone have an Teva-Brand or Sandoz-Brand Amlodipine/Benazepril? Anyone notice what the pill says on it? IT FUCKING SAYS LOTREL

Talk about a scam — man, this could really make pharmacy look bad. How do you explain that away if someone notices? I know that the name-brand manufacturers make the generic after the patent runs out for about 6 months until the actual generic manufacturers get their research, patents, and studies done and applications submitted…At least, that’s what I’ve always thought. But DAMN, change the appearance of the freaking capsule…

-=+=-

If your kid cries, screams, shits, or acts like a terror, kindly remove him from my pharmacy. If I had kids, and they were brave enough to act out in public, I promise you they will be taken to my car, scared shitless, and I will return — leaving them locked in the car with the windows up sans air conditioner as punishment.

-=+=-

“Why does it take 20 minutes to fill my prescription? Last time it only took you two minutes!”

“Last time you got this filled, you came in at two minutes til closing. I had everything locked up, and I was on my way out the door. Everything was done. I was all caught up. Today, you dropped off your prescription behind 10 other people that also want their prescriptions in two minutes…”

Here’s something I wish people would consider. Ever go to Red Lobster, Applebees, Chili’s, TGI Fridays, or some other steakhouse for dinner? Ever get directly taken to a table, handed a menu, given a drink, ordered, and had your food placed directly in front of you? Fuck no. You wait an hour for a table. You get to the table and are given the menu. Your drink orders are taken and 5-10 mins later you get your drinks and order your meal. Depending on the order and the amount of business, you get your meal in 15-30 minutes. Do you bitch on the amount of time? No! In most cases, you enjoy your drink and talk to your date/friends. (Granted. In some cases, things get screwed up and you say something after you’ve waited forever if your waitress doesn’t notice) THEN, after you finish eating, the waitress clears the plates and offers
you dessert. You wait 5-10 more minutes for that. If you don’t get dessert, you wait a few minutes for your bill. You get out your credit card and set it on the table. Five minutes later, she takes the credit card and charges you. You leave a generous tip.

Total time at the restaurant: 2+ hours

You could’ve had Easy Mac in 10 minutes and for less than 2 bucks. But, you wanted a steak…way to go…

Compare this to my pharmacy. I am steak. I take a little bit of time, but it’s delicious. Plus, you get the joy of looking at me work while waiting. But, it will be correct, cheap, and just as ordered…

You don’t have to tip me. I wouldn’t accept it if you tried. And I’m not feeding you. I’m dishing out complex medications designed to attach themselves to specific receptors located all over your body. What separates what I’m dishing out from poison? Merely the amount I give to you and how much I tell you to take…

Paracelsus says,

“Alle Ding’ sind Gift und nichts ohn’ Gift; allein die Dosis macht, dass ein Ding kein Gift ist.”

Translation:

“All things are poison and nothing is without poison, only the dose permits something not to be poisonous.”

Next time, ask the cook or waitress at Red Lobster about the rash under your tit.

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Omacor - maybe it is not a bad idea

Posted by The *Angriest* Pharmacist as Drug Companies, Me being a dick, True Story

For the first time in my life, I am rather glad I listened to a drug rep today. She was pushing Omacor (which is being renamed Lovaza in the coming weeks/months). She was telling my how it’s $20 on BCBS, $30 on this plan, etc etc. I butted in with, “Why should my customers pay $115 a month for this when it’s on the OTC shelf for $20?” — She had dealt with my kind before. She offered to go grab a few off the shelf for comparison. I’d never really cared enough to compare the various Omega-3’s.

Coming sooner or later: Me tearing a drug rep a new one for not being quick enough on his feet! — Just to prove I am NOT pro-drugrep

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In steps the pharmacist

Posted by The *Angriest* Pharmacist as Drug Companies, True Story

Okay, I’m not an MD….not even close. Occasionally, I feel that I do have the knowledge (albeit basic) to suggest some therapeutic substitutions to a doctor, however. Today, I had to listen to a poor (monetarily), 85-year old man tell me how much his medicines cost him each month. I felt bad for him. He had never even filled at my pharmacy. He merely wanted some prices to save a few dollars. He had Part-D, but was in his donut hole. He couldn’t meet the out of pocket expense. It was drugs or food in his mind. I reviewed his drugs and jotted the following note:

Eplerenone —> Spironolactone (he’s 85, he can deal with gynocomastia)

Tiotropium —> Ipratropium (Tio breaks the BBB anyway)

Xopenex —> ProAir HFA (Is that inactive isomer really that freaking dangerous?)

Flomax —> Doxazosin (Seriously…come on…)

Toprol XL —> Metoprolol (BID dosing though)

Revatio —> Warfarin, Diuretics, Beta Blockers, ACE-I, Digoxin, O2 Therapy (these aren’t going to decrease M/M, but they will help with QOL. He was already on some of them…of course) - I couldn’t even fathom this one. The SE’s alone would kind of suck…I thought it was just used for PAH in women. BTW, it’s 900 bucks a month. Way to go Pfizer….eat it.

If the above changes were made/considered, it could potentially save this person THOUSANDS of dollars a year…and TONS each month. The substitutions are not lesser therapies. They are equivalent. They are generic. They are cheaper.

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Earth to consumers. GET A CLUE!

Posted by The *Angriest* Pharmacist as Drug Companies, Stupid People, True Story

I want to tell everyone about this drug. It’s a great drug. It’s called Ambien. It’s an isomer of benzodiazepines. It’s not exactly the same, but it’s similar. It’s got a pretty quick onset and a relatively short duration of action. This means it will put you to sleep quickly and wear off before you wake up. This keeps you from having a hangover the next day. Remember, not all sleep is equal. If you don’t get enough REM sleep (which you are in 25% of the night), you wake up groggy and in bad shape.

So, what happened to Ambien? It went generic. Damn says Drug Company X. What are we going to do? The drugs not got one isomer that’s more active than another (levo vs dextro) so we can’t split off the inactive one. Ohh, I got it! Let’s coat it with 2 layers and allow a little drug to be released immediately and a little to be released later. Let’s call it Ambien CR, YEAH! That’ll get us 17 more years of patent protection. In the meantime, jack up the prices on Ambien before Teva can get it on the shelves.

So, people of earth. Answer a few questions for me:

How many times a night do you take Ambien? 1

How many times a night do you take Ambien CR? 1

Will Ambien CR keep you more asleep than Ambien? No.

All this technology into making this better drug, and who’s paying out the ass? Not me.

-=+=-

Other Examples:

Paxil 10mg taken once daily ====> Paxil CR 12.5 mg taken once daily

Can this be understood by anyone? No. The half life of Paxil is 21 hours. The half life of Paxil CR is 15. How much more extended can you get? It still takes 2 weeks to a month to reach steady state. Once you get there…it’s the same drug…With pizza, donuts, and applebees on the side.

-=+=-

Metoprolol 25mg BID ===> Toprol XL 25mg qd

In essence: tartrate ===> succinate Big whoop.

Screw this. We’re talking the difference of 40 bucks a month. It’s gotten better as the years have gone by, but come one. Taking a drug once a day is worth that over twice a day? Bullshit.

-=+=-

My personal favorite:

Doxycycline 100mg =======> Doryx ER 100mg

I had a drug rep from these jackasses call me and ask me if I had any on the shelf. I said no. She inquired about me ordering. I told her I’d ordered if I got an RX for it, the doctor was too stupid to let me change it, and the patient was willing to pay the unpreferred copay. She hung up on me.

3 hours later she called again…posing as a doctors office. I remembered her southern belle accent. She told me to order some because this doctors office was going to start using it and calling the scripts in to my pharmacy. I told her I would order it pending the criteria I told her earlier in the day. Then I hung up.

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