Health & Wellness

Ask A Pharmacist Thread

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[OP]
Newbie
Nov 20, 2015
30 posts
17 upvotes
Surrey, BC

Ask A Pharmacist Thread

The RFD community has helped me a lot and I just want to give back in some way. Not sure how this thread will evolve, if at all, but I will update this post as needed.

Since this is RFD, I forsee questions related to medication expenses, insurance policies (both 3rd party and government) and other health finance related questions which I will try my best to answer. Keep in mind I am based in BC so I only have knowledge of our BC drug plan Pharmacare as well as 3rd party plans (ex. Pacific Blue Cross, SunLife, Greatwest Life, GreenShield, ClaimSecure etc). I will also try to answers related to the profession in general as well.

Having said that...

...I will also do my best to answer medication related questions with the following caveats:

- a lot of seemingly simple questions are actually more complicated and it is best to refer to a medical professional more familiar with your history.

- Pharmacists are "medication experts" and not diagnosticians. Those are doctors. I'm not here to answer "I have symptoms x, y and z, what do I have?", but rather "I have disease x diagnosed by a doctor and I've been offered medication a, b or c. What are their differences?"

- a lot of questions don't have a "right" answer and while I will try to give the best available evidence when I can, I'm sure most of my answers will end in "...see how it goes for a while and if it doesn't improve, see your doctor".

- Finally, and most importantly, I am not responsible for any problems that may arise. It is always better to seek an in person medication professional, including your own pharmacist, for serious issues and personalized advice instead of believing the words of some unknown entity behind a screen.

My goal is to help people, as well as increase awareness of the expertise of pharmacists and will be able to refer you to pharmacists throughout the lower mainland as well as some areas on the island and the interior who I feel exemplify quality patient care. Please PM me for this. If you feel your case is particularly complicated, I recommend the UBC Pharmacists Clinic (http://pharmsci.ubc.ca/pharmacists-clinic)

Some useful links:

BC Pharmacare Website: http://www2.gov.bc.ca/gov/content/healt ... -residents
BC Health Guide: http://www.healthlinkbc.ca/
BC Nurses/Dietician/Pharmacist line: 8-1-1 (BC Only)
BC Drug and Poison Information Centre: http://www.dpic.org/


Disclosures: I am a community pharmacist working in BC for a large chain. I am not being paid for this and will try my best to provide unbiased, evidence-based answers. While I attend continuing education sessions sponsored by drug companies, I am not affiliated nor receive compensation from any of them. I hold stocks in a few companies and will disclose so when related. If you ask me for a referral, while there are many great pharmacists in any chain or independent pharmacy, I am only familiar with pharmacists I have personally worked with within my own chain.
126 replies
Deal Fanatic
Sep 16, 2004
7807 posts
1068 upvotes
Toronto
Why do you take so long to fill a prescription especially counting those pills on a tray.

Then bottling it etc.

Do you ever compound stuff on premises like Chemists did in the old days or is everything readymade from the pharmaceutical company?

The reason I ask is because Chemists in the olden days could concoct something to suit the individual need, while the mass marketing and patents of pharmaceutical giants these days means one product for all.

I see an alternative/ "natural" health section in shoppers drugmart etc.

Many of the products are not the better high end brands of natural products tested for purity,potency etc but rather the cheaper ones that are more likely not to be as effective in tests/trials etc.

I thought scientists were averse to naturopathic treatments as snake oil and phramceutical giants were always in a better position to promote their true and tested products with published clinical trials instead?

Are you allowed as a pharmacist to recommend any of these " imprecise" (potency,purity etc )natural/alternative products vs the precision pharamceutical drugs that may come with a whole lot of side effects?
Sr. Member
Dec 17, 2014
505 posts
85 upvotes
What are your thoughts on powerful corticosteroid drugs such as Prednisone?
[OP]
Newbie
Nov 20, 2015
30 posts
17 upvotes
Surrey, BC
gh05t wrote:
Nov 22nd, 2015 3:01 am
Why do you take so long to fill a prescription especially counting those pills on a tray.

Then bottling it etc.

Do you ever compound stuff on premises like Chemists did in the old days or is everything readymade from the pharmaceutical company?

The reason I ask is because Chemists in the olden days could concoct something to suit the individual need, while the mass marketing and patents of pharmaceutical giants these days means one product for all.

I see an alternative/ "natural" health section in shoppers drugmart etc.

Many of the products are not the better high end brands of natural products tested for purity,potency etc but rather the cheaper ones that are more likely not to be as effective in tests/trials etc.

I thought scientists were averse to naturopathic treatments as snake oil and phramceutical giants were always in a better position to promote their true and tested products with published clinical trials instead?

Are you allowed as a pharmacist to recommend any of these " imprecise" (potency,purity etc )natural/alternative products vs the precision pharamceutical drugs that may come with a whole lot of side effects?
1) I'd say the actual physical preparation of one drug takes about 2 seconds (labeling a box that already has the correct quantity) to 2 minutes (counting out 720 pills). The other 18-28 minutes (depending what wait time you were told) goes towards the following, probably from most time consuming to least depending on a few factors:

A) When you get to the counter, while the pharmacy make look empty, there were patients before you. When you drop off the prescription, the staff are probably in the process of working on 10 other prescriptions, a vaccination, and a couple medication consults on medications.

B) Depending if the medication is new for you, or a refill, the process of actually looking at your prescription and making sure the drug is right for you based on your allergies, your other medications, your age and numerous other factors could take a couple minutes to hours/days if we need to contact the doctor because the answer is no, the drug isn't right for you.

C) Phone calls from doctors above, and patients.

D) Making sure everything is correct on the insurance side.

E) Typing the label up.

2) Yes, our pharmacy does some simple compounding for things like creams and sometimes liquid formulations for children or patients who are unable to swallow tablets. For more complicated creams or capsules we outsource it to a pharmacy who has the equipment and capabilities of making these to the necessary standards. Having said that, we aren't like the Chemists of old who assess you and then do this. The majority of these items are still prescription only and can only be recommended by a physician or naturopathic doctor

3) In terms of over the counter natural health needs, most chain stores only carry the big brand names like Jamieson, Webber etc and maybe their house brand. Because there will never be head to head trials of two brands of the same vitamin/supplement, it's impossible to really say if one brand is better than another. If a patient has tried both and found one made them feel better, then they should continue with the one that works. In terms of whether they work or not, I try my best to focus on whether it's safe for them to take first, as a lot of supplements can interact with conventional medications. Time permitting, or if they ask me, I will go into whether the supplement may or may not benefit them.

4) I can't recommend therapies that don't have good data on them. So while I agree the majority of money is poured into pharmaceuticals and natural therapies probably don't have the data to prove they work, that doesn't mean I can assume they do. Therefore, I focus on making sure it's safe for them if they want to try it. I also try to focus on non-medicinal, non-supplement recommendations like exercise, diet changes, sleep hygiene etc which have evidence they work.

Hope that helps clear things up a bit.
[OP]
Newbie
Nov 20, 2015
30 posts
17 upvotes
Surrey, BC
chrl120 wrote:
Nov 22nd, 2015 6:16 am
What are your thoughts on powerful corticosteroid drugs such as Prednisone?
There is a time and place for corticosteroid drugs as they are one of the most potent anti-inflammatory medications available. Short term use (dexamethasone for 3 days post dental surgery, prednisone for a few days for allergic reactions etc) is generally well tolerated with maybe some nausea, upset stomach, minor fluid retention, trouble sleeping.

Long term use for conditions such as rheumatoid arthritis, coliltis and many other immune-related and inflammation-related diseases can result in increased blood sugar (diabetes), increased blood pressure, osteoporosis, mood changes, wounds that are slow to heal and other things. However, sometimes this is necessary as corticosteroids can provide a great improvement in symptoms for these patients. In general, the strategy is to use corticoteroids to control acute flares of symptoms while other medications are used to manage the disease and decrease the need for corticosteroids. One example is rheumatoid arthritis, where DMARDs (Disease-modifying antirheumatic drugs) like methotrexate or biologics are used to manage the disease, and patients use prednisone to manage flares in symptoms.

TLDR: There's a place for them, they have some bad side effects, use the lowest effective dose.
Deal Addict
Dec 3, 2014
1572 posts
99 upvotes
New Westminster, BC
Which government agency decides which drugs require prescriptions and which don't? My guess is Health Canada. Also, what are the guidelines for such a decision?

My beef is that there are some drugs (albendazole, anti-parasitical, anti-helminth, etc.) that should be over the counter. I say that the benefits of having them prescription free outweigh the risks.
Deal Fanatic
Sep 16, 2004
7807 posts
1068 upvotes
Toronto
AskARxist wrote:
Nov 22nd, 2015 1:27 pm
1) I'd say the actual physical preparation of one drug takes about 2 seconds (labeling a box that already has the correct quantity) to 2 minutes (counting out 720 pills). The other 18-28 minutes (depending what wait time you were told) goes towards the following, probably from most time consuming to least depending on a few factors:

A) When you get to the counter, while the pharmacy make look empty, there were patients before you. When you drop off the prescription, the staff are probably in the process of working on 10 other prescriptions, a vaccination, and a couple medication consults on medications.

B) Depending if the medication is new for you, or a refill, the process of actually looking at your prescription and making sure the drug is right for you based on your allergies, your other medications, your age and numerous other factors could take a couple minutes to hours/days if we need to contact the doctor because the answer is no, the drug isn't right for you.

C) Phone calls from doctors above, and patients.

D) Making sure everything is correct on the insurance side.

E) Typing the label up.

2) Yes, our pharmacy does some simple compounding for things like creams and sometimes liquid formulations for children or patients who are unable to swallow tablets. For more complicated creams or capsules we outsource it to a pharmacy who has the equipment and capabilities of making these to the necessary standards. Having said that, we aren't like the Chemists of old who assess you and then do this. The majority of these items are still prescription only and can only be recommended by a physician or naturopathic doctor

3) In terms of over the counter natural health needs, most chain stores only carry the big brand names like Jamieson, Webber etc and maybe their house brand. Because there will never be head to head trials of two brands of the same vitamin/supplement, it's impossible to really say if one brand is better than another. If a patient has tried both and found one made them feel better, then they should continue with the one that works. In terms of whether they work or not, I try my best to focus on whether it's safe for them to take first, as a lot of supplements can interact with conventional medications. Time permitting, or if they ask me, I will go into whether the supplement may or may not benefit them.

4) I can't recommend therapies that don't have good data on them. So while I agree the majority of money is poured into pharmaceuticals and natural therapies probably don't have the data to prove they work, that doesn't mean I can assume they do. Therefore, I focus on making sure it's safe for them if they want to try it. I also try to focus on non-medicinal, non-supplement recommendations like exercise, diet changes, sleep hygiene etc which have evidence they work.

Hope that helps clear things up a bit.
Yep, it does clear things up a bit. Thanks for taking the time to answer so clearly and eloquently. :)
Deal Addict
May 18, 2009
4883 posts
904 upvotes
Toronto
This may sound silly but knowing most doc like it old school and still writes their prescription by hand, how can you make out what the doc wrote (since they have such horrible hand writing)?
Deal Addict
Dec 3, 2014
1572 posts
99 upvotes
New Westminster, BC
yesstyle wrote:
Nov 22nd, 2015 10:10 pm
This may sound silly but knowing most doc like it old school and still writes their prescription by hand, how can you make out what the doc wrote (since they have such horrible hand writing)?
Most of the time, the doctors are not even writing in English. Most of biology and medical literature use Latin words. Also, symbols are used not words.
[OP]
Newbie
Nov 20, 2015
30 posts
17 upvotes
Surrey, BC
yesstyle wrote:
Nov 22nd, 2015 10:10 pm
This may sound silly but knowing most doc like it old school and still writes their prescription by hand, how can you make out what the doc wrote (since they have such horrible hand writing)?
Haha, a lot of times it requires some info from the patient about what the medication is for, if they've had it before, what the doctor told them. The dose/directions is often a good clue as well. The hardest is usually figuring who the doctor is unless it's pre-printed on the paper since there's a lot less context to go with for that.

Pro-tip: Take a quick look at the prescription before you leave the doctor's office and make sure either the doctor told you what you were getting specifically (ie, not "a blood pressure pill" but "ramipril" or "altace") or you can at least make out the majority of the letters on the paper :P
Deal Addict
Feb 20, 2014
1181 posts
416 upvotes
Toronto
Are painful, throbbing joints after taking Septra a sign of a serious allergic reaction? What causes this reaction and are there any negative long term effects?
[OP]
Newbie
Nov 20, 2015
30 posts
17 upvotes
Surrey, BC
Jenuine wrote:
Nov 22nd, 2015 11:28 pm
Are painful, throbbing joints after taking Septra a sign of a serious allergic reaction? What causes this reaction and are there any negative long term effects?
Hi Jenuine,

Painful, throbbing joints is not a common side effect of Septra. If this isn't something you've experienced before (no history of arthritis etc), then you should seek the advice of a physician. With some research, I found that Septra can potentially cause some lupus flares, where Lupus is a disease where your body's immune system for some reason starts attacking your healthy tissues and joint pain is a common symptom of this. However, this is a very, very rare possibility so it is best to see a physician. Before that, you may consider speaking to your pharmacist to make sure the problem isn't related to any of your other medications or an interaction between them and Septra, though off hand I can't think of any that would cause painful, throbbing joints.

Hope you figure things out!

Source: http://www.hopkinslupus.org/lupus-info/ ... ion/avoid/
Deal Addict
Feb 20, 2014
1181 posts
416 upvotes
Toronto
AskARxist wrote:
Nov 23rd, 2015 12:33 pm
Hi Jenuine,

Painful, throbbing joints is not a common side effect of Septra. If this isn't something you've experienced before (no history of arthritis etc), then you should seek the advice of a physician. With some research, I found that Septra can potentially cause some lupus flares, where Lupus is a disease where your body's immune system for some reason starts attacking your healthy tissues and joint pain is a common symptom of this. However, this is a very, very rare possibility so it is best to see a physician. Before that, you may consider speaking to your pharmacist to make sure the problem isn't related to any of your other medications or an interaction between them and Septra, though off hand I can't think of any that would cause painful, throbbing joints.

Hope you figure things out!

Source: http://www.hopkinslupus.org/lupus-info/ ... ion/avoid/
This happened a while ago (twice, I think). The first time I was prescribed Septra/Bactrim, I had painful joints. They weren't swollen but just random throbbing pain. I don't have arthritis or lupus (that I know of). The second time I had a reaction, I had painful joints again, and days after stopping the medication, I broke out in hives. It's now on my record that I'm allergic to Septra/Bactrim but I always wondered if those reactions would lead to long term negative effects. I wasn't on any other medications both times.

Doing some reading online, it seems like a lot of people have reported severe side effects. It also seemed like my reactions were getting worse the more I took it.

I overheard an ER doctor talking to an intern once about Asians (I'm Asian) not being able to take Septra. I can't remember what he said but I've never been able to find anything online about it.

Thanks!
Deal Fanatic
May 14, 2009
5264 posts
541 upvotes
Why isn't phenazopyridine available in Ontario any more?
Deal Fanatic
May 14, 2009
5264 posts
541 upvotes
Thought of another one: what's the deal with bioidentical doctors and them compounding things that a GP can't perscribe?

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