The longer I typed on this, the more I RAGED

Posted by The *Angriest* Pharmacist as Disgusting, Drug Companies, Education, Me being a dick, Patient Education, Stupid People

Imitrex (Sumatriptan) 100mg Tablets #9  —- $250.84
-Exclusivity Patent runs out Feb 6, 2009
Treximet (Sumatriptan/NAPROXEN) 85/500mg Tablets #9 —- $222.72
-Approved April 15, 2008 - Exclusive for 3 more years on combo.

Well, Imitrex is going off patent, and Dr. Reddy’s is itching to get into that generic migraine therapy market that is currently absolutely DOMINATED by ridiculously expensive name brand medications. As you can see above, these fucking things are $27 PER TABLET. As you might have expected, now that Imitrex is going to have an AB-rated generic equivalent, it is complete junk and no longer efficacious for migraine headaches (with or without aura).

So, what comes to mind when you see what GlaxoSmithKline is doing here? To me, I think of the assraping of American citizens that are already struggling to make ends meet in a time of economic hardship. I think of GSK playing tricks on Americans that may not have as much education as their local pharmacist. I see that GSK knows that people who are suffering from migraines will pay anything to no longer be suffering from migraines. They are banking on that fact. Now, they are hoping that maybe just once, Imitrex didn’t provide you full relief — just enough of a chance to get you to call up your doctor and ask for a prescription for that new drug, Treximet, that you just saw on television. [I've seen Treximet ads on 5 different channels today.]

Ya know, I wouldn’t be surprised in the fucking LEAST if GSK hasn’t been slowly dropping the potency of Imitrex tablets over the last few months — in hopes that their migraines won’t clear up and they’ll seek out a new therapy.

But TAestP, WHAT IF TREXIMET REALLY IS BETTER????

I don’t doubt the efficacy of Treximet. But, I have a few insights here. Does Naproxen alleviate your migraine symptoms? I’m sure you tried it initially as it’s in every major migraine algorithm after Acetaminophen and Ibuprofen. If you’re taking Imitrex, that probably means you failed Naproxen therapy. So, why are we adding it back on board now?

Does anyone know how much Sumatriptan tablets are going to cost? It doesn’t really matter exactly how much they are going to cost — we know that the generic is going to be cheaper. We also know that NAPROXEN IS DIRT FUCKING CHEAP. So, once again, big pharma has taken two seemingly inexpensive drugs, combined them, called them gold, and made them just as expensive.

Here’s a few notes I’d like to share:
- Clinical Pharmacology lists “Krymchantowski AV. Naproxen sodium decreases migraine recurrence when administered with sumatriptan. Arq Neuropsiquiatr 2000;58:428—30.” as a source for why the combination is better. What’s wrong with this study? Well, how about the fact it was tested in 67 (56 women) people by ONE researched in RIO DE JANEIRO. It’s way too brief. The methods are weak. It is a poorly done study.

- Also listed as a reference is: “Brandes JL, Kudrow D, Stark SR, et al. Sumatriptan-naproxen for the acute treatment of migraine: a randomized trial. JAMA 2007;297:1443—54.” — This one is cited because it shows that ‘more patients had sustained pain free responses 2-24hrs after the dose with decreased recurrance rate in combo vs either drug as monotherapy or placebo. I didn’t even read this study — I flipped to the back page, as I always do, and saw all that I needed to see.

Funding/Support: The 2 clinical trials (MT-400:301 and MT-400:302) described in this article were funded by GlaxoSmithKline in partnership with POZEN, the IND sponsor of the investigational drug MT-400 (sumatriptan–naproxen sodium).

Role of the Sponsors: GlaxoSmithKline and Pozen Inc provided financial and material support, monitoring, data collection and management, and data analysis to the authors and study investigators.

In case you were wondering, POZEN INC is a puppet company of GlaxoSmithKline. And, as you can see, they performed the ENTIRE FUCKING STUDY.

Also of note regarding this filth of a study fabricated to bilk money from the American people, of the 10 ‘researchers,’ two admitted to working for ‘Pozen’ and two for GSK — all of which work in Chapel Hill, NC.

-The final study listed in ClinPharm boasting this drug is merely a safety and tolerability study. Well, fucking duh this drug is tolerable. How often do you think people need to take Sumatriptan? Once every other day? Once a week? Heck, the max daily dose is 2 tablets. So, the most Naproxen you could get is 1000mg — a normal daily dose — which wouldn’t be ingested that often. Of course it’s safe.

Of course it’s non-inferior. Of course it’s safe. But, is it cost effective? No. It’s not. Because you motherfuckers at GSK have no fucking morals. You’re soul-less pieces of deep fried pig shit, and I hope all of you get the pleasure of having Alzheimer’s as you age. You all deserve to be beheaded on Al-Jazeera. You’re nothing. You’re wastes. I wouldn’t shit on you if I got paid a million dollars to fill “2Guys1Face.” I hate you more than I hate everything else combined. I just wish that there was some way I could just remove the money from you via osmosis and have you thank me for it — much like the unsuspecting public is doing now.

You may give them a $20 coupon or even a few free pills, but I’m hip to your game GSK. I’m not gonna play. My pharmacy will NOT carry your product. My pharmacy will NOT dispense your product. If someone brings me a script for this bullshit, I’m going to be having a conversation with a doctor. I’ll end up filling two prescriptions and having a little education session. I just pray that you don’t send some fucking big-tittied Treximet Drug Rep to me. That bitch will leave in tears…

Lots to address

Posted by The *Angriest* Pharmacist as Education, Hospital Pharmacy, Patient Education, True Story

Hello world! Buckle up, we’ve got a bunch of issues we’re going to cover today. The first relates back to a recent post about how to bust a fraudulent prescription. Watch this video about the prescription drug problem in Michigan. Turns out, they have an awesome system tracking prescriptions. They can view in real time all the patients that are doctor shopping, track the number of pills they’ve received, and even access all of their information. This is, of course, not a public database. Yet, the agency charged with tracking this data and generating the reports has no ground to stand on — as it’s not illegal in Michigan to “doctor shop,” and the state prosecutor doesn’t want to waste his time on these cases — he just wants the big dogs…for the glory of the big bust and getting his face on the evening news…What a crock of shit.

The funniest thing about the video is the very last sentence the reporter speaks. The lady they had all but busted doctor shopping refused an interview and said she was merely seeing all those doctors because she was going out of town and she needed to make sure she had enough Vicodin to last her. I just fucking wonder who paid for those prescriptions — it sure as shit wasn’t her, and I’d bet anything she made a good amount of money selling them on the skreeet. It’s a dollar a milligram in my area for hydrocodone and oxycodone (yes, they are considered the same per street rules). Xanax usually runs 10 bucks for 2 milligrams. Anyway…

If one breaks the law, regardless of how big of an issue it may be, it is the job of the prosecutors to see the case to fruition whether it be court, plea, or otherwise. Hopefully, you guys can get this changed! I’d really like to hear from some of our Michigan pharmacists — you guys have access to this program, Michigan Automated Prescription Service (MAPS), do you use it? Is it accurate and trustworthy? Do you use it to check sketchy patients and subsequently use it to deny them service?

-=+=-

I’m sure most of you have noticed that my number of posts has recently gone from 5/wk to 0/wk. I’ve gotten about 20 emails asking me where I’ve been! Have I gone on vacation? Did my dog die? Did my dox get dropped? Make no mistake - if I go on vacation or something happens to me, it’ll get on the website somehow. My last will and testament has direction for how to notify readers of my untimely, but all to expected, death…:-)

I feel awkward announcing this to the world. I’ve gained all my steam on this website because of my job. I am a community/retail pharmacist in Anytown, USA! Well, starting last Wednesday I’ve been working in a highly clinical role.

The clinical pharmacist at my local area hospital decided he wanted to get drunk in Hawaii for two weeks. Last year, they paid tons of cash to bring in a replacement for the two weeks. This year, the approached me about a month ago to see if I could do it. I’ve known the clinical guy there for quite some time. I spent the weekend prior to his vacation with him getting trained on my duties, their computer system (which is sweet), and pretty much everything a new employee would need. And yes, I had to watch that stupid fucking HIPAA video with the red headed lady that eavesdrops all over the hospital.

So, I arrive there at about 6am. There are three teams right now, and I am on two of them (the third team has a Pharm.D., MD on it…showoff!). Rounds for Team 1 start at 7:00am, and rounds for team 2 start at 8:30am. I do Vanc/Gent for the entire hospital. I also modify TPNs. Physicians set the initial TPN, and I modify them based on patient needs and expenditures (This was the HARDEST thing to remember for me because of the chemistry/equations I hadn’t touched in 5 years - at least Vanc/Gent is plug and chug)  I also narrow therapies based on C&S and patient needs. I’m also seeing that everyone gets normal health maintenance stuff while in house (stress ulcer prophylaxis, DVT prophylaxis, vitamins, vaccinations) - this was an initiative initiated by the normal clinical guy. I also do all discharge education (obviously).

I’m not a BCPS (Board Certified Pharmacotherapy Specialist) like he is, but I think I’m getting along just fine. Apparently, I’m eligible to take the exam — it’s 3 years after you graduate or immediately after you complete a residency…I’m not sure if that’s true or not. Anywho, the physicians all respected him immensely — and rightfully so. He is the smartest fucker I’ve ever met. I shit you not, I never asked him a question he didn’t know. He’s like a walking Koda-Kimble-Dipiro Database. That has been good and bad for me. Good in the sense that the physicians all believe in the importance of me being on the team because of the asset he is but bad because I don’t know everything he does, and I have to use the ole idiot-student-reply, “I’m not quite sure. I’ll research that and get back to you as soon as possible.” Needless to say, I look up quite a few things.

I’ve answered a lot of questions on rounds. I feel like I’m really an asset. They all appreciate and respect me, and it makes me feel all tingly inside. I was even asked to be the ‘leader’ of Grand Rounds this week. Essentially, I presented a current patient case then educated on a disease state. I chose my favorite because I already know a lot about it — Cirrhosis and associate complications. I talked about it all: portal hypertension, varices, acute management of variceal bleeds (including some preparation guidelines that I created for the hospital so that they had shit ready to go in case a cirrhosis patient pops a bleed - somatostatin, rapid infuser, plasma, platelets, blood typing/Rh factor early and blood stocked closely), hepatic encephalopathy, Child-Pugh classification….everything.

I got a good reception. I think it went very well, and I didn’t sound retarded.

And, of course, some dickhead doctor asked me a trick question — trying to throw me in front of the train, and I caught it and fired back.

“What are normal ammonia levels?”
“This institution considers 10-75 micrograms per deciliter within normal limits.”
“And, based on your clinical experience, at what level of hyperammonemia do you initiate treatment?” [Yeah...he was being a dick here. This was only like my 7th day there...ever...I have no clinical experience, but I knew the answer.]
“Actually, that’s a common misconception. You do not initiate treatment in cirrhosis based on ammonia levels. Ammonia levels alone do not dictate the presence of hepatic encephalopathy. Some patients could have a level of 80 and have severe symptoms, and another could have a level of 100 and be asymptomatic. Ideally, we would treat as symptoms emerge such as asterixis primarily, impaired cognition, confusion, agitation, euphoria, insomnia, and reversal of day-night sleeping pattern.” [I had them written down.]
“Oh. I see…” [He knew it. He just wanted me to fail.]

A few minutes later, he asked me about hepatorenal syndrome. I omitted it from my presentation because there really isn’t much to say, and we don’t have a hepatologist or a transplant team. I mean, there’s two types. In type one, you die within a month. In type two, you die within 6 months. He asked me what the cure was…

“The cure? Well, you can try an extensive fluid challenge to unlock the renal vasoconstriction — something like 2 liters with a rapid infuser. It won’t work, but you should try it. Most likely, your patients with this have advanced cirrhosis and will be on the liver transplant list if eligible. If they develop hepatorenal, you’d need to move their name up on the list quite a bit…”

Well, that’s about it.

I don’t really like the sound of, The Angriest Clinical Pharmacist. They’ve offered me the position on a semi permanent basis. Just a few days a week. Since winter is approaching they are going to expand to 4 teams. However, if I took it, I could no longer be the PIC at my pharmacy…so no deal…

Retail is what I am…I haven’t had my fill yet…:-)

Daily frustrations

Posted by The *Angriest* Pharmacist as Drive-Thru, GUEST CONTRIBUTOR, Lazy People, Patient Education, Stupid People, True Story, Work Sucks

The following post was written by a reader of TheAngriestPharmacist. She posted a couple of comments that were right on point and impressed me tremendously. So, I invited her to write a guest post. She is taking some pharmacy-related classes and currently works in a pharmacy. Her pseudonym is ALIGIRL CphT. While I’m not into the whole “waz up guuurl!” fad, I enjoy her perspective and rants.

-=+=-

After working 4 years in a pharmacy one would think you get used to all the crazy and impatient people we see everyday. I, unfortunately, get slapped in the face with these people everyday, and everyday I see something new. My little rant and rave today has to do with the drive-thru. First of all, whoever invented it for the pharmacy was either a lazy person that didn’t want to walk the twenty steps to the pharmacy inside the building or a person that claims they have five kids and did not want to take them out of the car today.

So, when you drive into the first lane (nearest the window where I am standing) in a drive thru and see that there is already a car in the second lane (furthest from the window), does that not tell you that I am already helping them and you must wait your turn? Or, does it simply tell you they are there, and I am here so somebody better help me too? Perhaps an additional, magic fairy person?

Obviously, you see me standing there at the big 10×10 window already talking to the person in the second lane. You saw them send money or a prescription which means they are still being assisted. So, please explain to me why you feel the goddamn need to still push the ringer. Did you think that I did not see your big Expedition drive directly in front of me blocking my view of the second lane? — the person I am already helping! Do you really think I do not see your face staring at me like I am wasting your time because I am helping someone who was there before you?

Now, I have to turn off the ringer and tell you I will be right with you, which I do very calmly. I continue speaking to the second lane and notice you reach out your hand to push the ringer AGAIN! Okay, are you freaking kidding me — or are you just severely retarded? I just told you I would be right with you. So, now I just turn the damn ringer off and don’t say anything to you because, obviously, you do not understand English.

As I am finally finishing up with the second lane, after all your interruptions, you start beeping your horn. Really? WHAT THE FUCK!! Now I am freaking pissed. The freaking President of the United States could drive into the drive thru, and he would still have to wait his turn — so hold the fuck up. I thank the second lane, send them on their way, and ask you how I can help you. This is when you have the balls to say, “Didn’t you see me here?” Yes, I saw you there. I told you I would be right with you. Then you pushed the ringer again, and I ignored it. Next you decided to start honking your damn horn.

I can only help one person at a time and you, my friend, were after them. Now, you start complaining that in a drive-thru you shouldn’t have to wait at all, and that you should just be able to drive up, grab your shit, and go. Um, excuse me, but last time I checked we had to get all your information as well as enter insurance info and type in the prescription. If you are picking up a prescription, we have to confirm that we have the right patient as well as take your payment. And this also may take a few minutes. It may take a little longer if the patient has any questions or concerns about their medications or if they need to be educated on something.

So, no, a drive-thru is not to just drive up and go, it is a convenience for people like you that do not wish to get off their lazy asses and walk inside. This, my friend (wait, you’re not my friend — I hate you!), is a pharmacy, not Mcdonalds. We take time in what we do, and we try to do things right. We are not making burgers and fries. We are filling medications, checking for potentially dangerous drug interactions,billing insurances, and about a million other things.

If we take an extra few minutes with a customer that actually cares about their health, then yes you must wait an extra few minutes — wouldn’t you expect the same courtesy of the person behind you? That’s how the drive-thru works, ya don’t like it then you can go down the street to the pharmacy that has no drive-thru and walk your fat ass inside.

So, when you approach a drive-thru pharmacy, please wait to be attended to…especially if there is already someone else in the lane next to you being helped. Don’t push the buzzer a hundred times — or even once. And don’t you dare toot your little horn. We do see you there, and we did hear you the first time you unnecessarily rang the buzzer. Just freaking wait a few minutes. You are sitting in a car, directly in front of me, not standing in the cold!

What is important

Posted by The *Angriest* Pharmacist as Just a question, Patient Education, Salutations

Who are you?

It’s a very pertinent question. It can be answered in a plethora of different ways. The way each person answers the question tells us a lot about them. It tells us where the priorities lie, what they think about themselves, their career, what they’ve done with their life, and perhaps even where they are going.

One could answer this question several ways:
I’m a pharmacist. — Tells us about a person’s career or career path.
I’m a man/woman. — Tells us of their gender role (obviously). They also think their manliness/femininity personifies them.
I’m a husband/wife. — Tells us the most important thing in their life is their relationship with their S.O.
I’m a (insert religion). — Tells us that their relationship with a higher power is important to them.
I’m a son/daughter. — Tells us they value family. They probably have a good relationship with their parents.
I’m a father/mother. — Tells us they have children and they are one of the most important things in their life.
I’m a brother/sister. — Again, tells us they value family and probably have a close relationship with their siblings.
I’m a Brother/Sister. — This one could tell us they were involved in a Fraternity and valued it and the relationships they forged from it.
I’m a [pharmacy] student. — Tells us where they want to go with their life. Their aspirations.

You see, we can learn a lot about someone with just a few words — with some assumptions and clever associations. But, what’s the most important thing about someone? That’s very easy. Do you know it?

THEIR NAME! A person’s name epitomizes who they are. If you know someone’s name, you may not know everything about them the statements above can tell us, but you have a way to get that information — an ‘in’ so-to-speak. Not knowing someone’s name — or forgetting it — can be a very embarrassing situation. I do all I can to remember the name of every person that comes into my pharmacy. I think every Pharmacist and Technician should. Not only does it help us ensure the right person gets the medicine, it lets the person know that you care WHO they are and not just WHAT they are buying or HOW much they are spending.

Do whatever you need to do to remember everyone’s name. Write it down. Say it ten times in your head while looking right at them. Take a mental picture. Do whatever works! Simply by announcing someone’s name as they enter the pharmacy pretty much guarantees you a customer/patient for life. (”Hey James [or Mr. Smith]! What’re you up to today?” — or — “Hey John! How is that new Blood Pressure medicine working?” [with respect to patient privacy, of course])  It also ensures that you will probably get the benefit of the doubt should you ever make a mistake or screw the person over by accident. That personal relationship will help make sure that cool heads prevail, and it also will assure that angry patients see you as a human, with a name, that can make mistakes. But, as a human, you are allowed to be remorseful of those mistakes and apologize….all from knowing something as simple as someone’s name.

So, readers, I ask you this, WHO ARE YOU?

Jabberheads

Posted by The *Angriest* Pharmacist as Cellphone, Engrish, Patient Education, Rude, Stupid People, True Story, Work Sucks

Check out the pharmacy blog aggregators — All your pharmacy blog goodness compiled and listed on one page for you: http://dumbmedicine.com/?p=144


At about 2:30pm today, a lady brought a prescription to the counter. I approached her, said hello, and immediately glared at the cellphone, which is now synonymous with American Culture, smashed against her ear. When cellphone talkers approach my counter, they get no sympathy from me. I’m not courteous of their conversation because they are on MY time. Anyway, I asked this lady her birthday, as she turned away and started to scamper off and chatter some more, and she had the nerve to turn, roll her eyes at me, and say, “12-15-67″ in a tone of voice that would lead me to believe that I was bothering her…can you imagine that…me…bothering her…

I have a sign at my pickup window that says, “For your safety and other patient’s privacy, please finish all cell phone calls before approaching the counter.” Some people completely ignore it. Some of my techs have the guts to call people on it, others don’t — some don’t give a shit either way. Most guests will close their phone as they read the sign.

This woman continued her conversation the entire time I filled her Metronidazole 500mg po TID #24. That usually doesn’t bother me in any way. Had the woman came in with another person and they had a conversation outside the pharmacy I wouldn’t give a shit — what’s the difference? However, it does irritate me that I can only hear one side of the conversation — the human brain wants to know both sides. If it only hears one, it gets confused and either tries to fabricate the other half of the conversation OR the person gets angry…like most people when someone is loudly talking on a cell phone in a public place.

As I finished the prescription, I walked to the register to ring the woman out. She continued the conversation. I glanced back at the sign — making it pretty obvious that she should hang up. She continued the conversation.

“Do you have any questions?”
“Hol’ on jus’ a minute…” (Into the cellphone)
“Do the directions be on the bottle?”
“Yes, ma’am — it’s three times a day. There’s also a handout in there for you to read if you want to learn some more about the medicine. There is one other thing we need to talk about…”
“Nuh uh…no she din’t…are you fo’ reaaaal? Ohh my wooooorrrrrrrrrrrddd……” (Obviously into the cellphone)
“What? Huh? You say sumdin to me?”
“Yes, ma’am. There’s something important I need to tell you about your medicine.”
“Aww…okay”
“Girl lemme hit you back in a minute. Bye…” (Into the cellphone)
“This medicine has a pretty severe interaction with alcohol. Even just a small amount of alcohol could make you very sick. I cannot emphasize enough that you should avoid alcohol for the entire time you are taking this medication and even a few days after you are finished with the last dose.”
“S.O.S. please some one help me. It’s not healthy for me to feel this way. Y-O-U are making this hard, I can’t take it, see it don’t feel right,” blared from the woman’s phone (a song by current hip-hop artist Rihanna).
“Hello…girl, I’m talkin’ to dis pharmacisss. Lem me call you back afta while…Bye.”
“Okay, what?”
“Don’t drink any alcohol while your taking this medicine.”
“Ohh. I don’t drank…”
“Okay. Good. Do you have any other questions? [No] Okay then. Thank you. Come see us again…”

Does this story infuriate you all as much as it did me? I mean, what if I had to tell her something REALLY important. She may have not caught any of it…But, she was 100% aware of something scandalous the caller was talking about…

I didn’t have my jammer with me today, otherwise her phone service would have magically started to fail as I was talking to her. I took it home as I was off for two days. I don’t want to leave it at work in case there’s a raid or something…:-)

Now, before I get any hateful comments about it — this lady spoke exactly like I wrote her words…in ebonics. I’m not trying to be racist, ethnicist, or any other time of -cist you all can dream up. I hate it when people butcher the English language — regardless of who they are. I try and speak perfect English. While I type in a very odd manor — as if I’m keeping everything as one continuous thought (using dashes and ellipses) — I speak very well. Hearing the language butchered irritates me…