unbelievable rx

[jyw003]

this guy came into my store and wanted us to fill his methadone of a quantity of 1980!!!!!! he said his doctor increased the dose from 1800 and his home store didnt have enough... lol....whats the most you guys have dispensed??? i told him we will not dispense that amount EVER

[lorain]

450 is the most i do from the pain clinic next door

i told all those patients, i slap the label on 4 closed bottles and double count 50 and put it in a vial....pts are ok with it

[J DUB]

I would not have enough either.....I would not touch that amount without calling the prescriber. Sounds like an extra "0" got added on!!

[jawnly211]

send those pts away

let them tell their crazy "accident" stories elsewhere

i turn away pts for oxycontin 80mg all the time...oh, u will pay cash????? please!!!!

i even turn away rx which are for promethazine with codeine 480ml...no sizzurp for you!!!!

i love it when they come with CII with 3 refills...

[DAW2]

i love it when they call for a refill on a c2 and they say WHY and you explain it and they stilllll b***h about it. geez just haul your butt to your dr

[WVUPharm2007]

...and what if they are a legitimate pain patient with a freakish tolerance for opiates? They do exist. Call the physician and ask for the history of their pain maintenance. It could be a druggie...or it could be a person that actually lives every day in pain...

[Pharmavixen]

Highest dose I ever saw was 680 mg/day (liquid in Tang, not pills), but that guy was diverting to his brother, who ended up in jail with horrible WD because we only give methadone if they have a provider in the community.

I'd call and verify, but I'd never fill a script like that without verification.

Personally, I don't like methadone as an analgesic. Half-life > 24 h, and analgesic effect = 6-8 h, so it accumulates, and people OD. But the insurance companies like it because it's so cheap.

[Doctor M]

Originally Posted by jyw003

this guy came into my store and wanted us to fill his methadone of a quantity of 1980!!!!!! he said his doctor increased the dose from 1800 and his home store didnt have enough... lol....whats the most you guys have dispensed??? i told him we will not dispense that amount EVER

verify the rx, and if doctor is legit and there is no reason for you to not fill the rx, then you should honor the rx with all documentation needed. Maybe pt has been on rx for a very long time. You should definitely verify the rx...but not outright deny the pt...Do your investigating first...

[SoonerPharmD]

i have a pt that gets 480 tabs/month. i laughed the 1st time i saw it, but after looking into his profile he'd been getting that much for months.

[PHARMDhope2b]

yeah just call and verify.
some people just have a high tolerance for pain meds.
When i was in the hospital a few months ago, they had me on oxycontin 30mg bid, dilaudid 2mg IV q3h, lyrica 150mg bid, and toradol 10mg q6h...all while i was wide awake and studying for a therapeutics exam.

The docs and nurses were simply amazed that I was awake!

lol i was like, "I told you that stuff doesnt work on me"

[Old Timer]

Still remember getting an Rx from the local cancer center for MS-Contin 100 mg: 18 tablets q 12h. I called the doctor:

ME: Hey doc, are you trying to kill Mr. Smith? That's an awfully high dose.

MD: Mr. Smith is a heroin addict. He has liver cancer with bone mets and 30mg of morphine will not do it for him.

The patient took that for about six months until he passe away, from the cancer, not the morphine.....

[jyw003]

yea...i did call the dr to verify...it was a real script...however, my store does fill that med often and we couldn't let one person get 19 bottles.....so my pharm manager said HECK NO

[Farmercyst]

What are you guys doing for patients that were on generic oxy and whose insurance doesn't pay for brand. I called the MD and they wouldn't switch to MS. Now what?

[Doctor M]

Originally Posted by jyw003

yea...i did call the dr to verify...it was a real script...however, my store does fill that med often and we couldn't let one person get 19 bottles.....so my pharm manager said HECK NO

cant you just order some more??? I dont understand why he would turn away a legal rx and verified rx.

[Aznfarmerboi]

heres the better question... what do you do if you have an abuser who is on a narc for a long time such as oxycontin 80 mg#270. He is always taking more than he is suppose to but at the same time, you know if you dont give it to him... he will go into withdrawal.

[Old Timer]

Originally Posted by Aznfarmerboi

heres the better question... what do you do if you have an abuser who is on a narc for a long time such as oxycontin 80 mg#270. He is always taking more than he is suppose to but at the same time, you know if you dont give it to him... he will go into withdrawal.

In Pennsylvania filling it early is against the law:

§ 27.18. Standards of practice.

(t) A pharmacist may only renew a prescription at a reasonable time prior to the time when the contents of the prescription shall be consumed according to prescriber’s directions.

[Aznfarmerboi]

Originally Posted by Old Timer

In Pennsylvania filling it early is against the law:

§ 27.18. Standards of practice.

(t) A pharmacist may only renew a prescription at a reasonable time prior to the time when the contents of the prescription shall be consumed according to prescriber’s directions.

Against the law in NYS too... but still doesnt change the fact that if I turn him down now (not my fault...), he will end up in the hospital. MD aware of it too but never give him more.

[Old Timer]

Originally Posted by Aznfarmerboi

Against the law in NYS too... but still doesnt change the fact that if I turn him down now (not my fault...), he will end up in the hospital. MD aware of it too but never give him more.

Then he has to go to the hospital to detox.....

[will7678]

Originally Posted by Old Timer

Then he has to go to the hospital to detox.....

Yeah see these patients in the ICU all the time. End up in such bad withdrawal that we have to intubate them for a couple of days at least to get them through. I have had patients on a high enough rate of propofol that we could perform surgery on most people and they still need 4 point restraints to keep them from getting out of bed. This seems to be more common with the people drinking liters of alcohol a day on top of their pain killers but still have seen it with other substance abusers as well.

[MyTalon4U2NV]

verified or not, i wouldnt fill it.

i understand high doses and quantities are need a lot of the time but dang thats a lot of pills.

and whos to say the md isnt in on anything. no one is perfect. just my 2

[Old Timer]

Originally Posted by MyTalon4U2NV

verified or not, i wouldnt fill it.

i understand high doses and quantities are need a lot of the time but dang thats a lot of pills.

and whos to say the md isnt in on anything. no one is perfect. just my 2

So you, God almighty, would refuse medication to a patient for a legitimate medical purpose because you know better than the doctor....

Give me a break...

[MyTalon4U2NV]

oh, in no way am i saying i know better than the md on a pts state however, personally i just wouldnt feel comfortable.

[Old Timer]

Originally Posted by MyTalon4U2NV

oh, in no way am i saying i know better than the md on a pts state however, personally i just wouldnt feel comfortable.

Who gives a **** what you feel. This isn't about feelings and you are not in 4th grade. It's either a legal order or it's not. It's either a medically appropriate order or it's not. Once you verify the order is legal and you have discussed with physician the need for the high dose, see my previous post on the heroin addict with metastatic prostate cancer, you must fill this order.

[StaviZFingerZ]

what is "UNBELIABLE?"

[Doctor M]

Originally Posted by Old Timer

Who gives a **** what you feel. This isn't about feelings and you are not in 4th grade. It's either a legal order or it's not. It's either a medically appropriate order or it's not. Once you verify the order is legal and you have discussed with physician the need for the high dose, see my previous post on the heroin addict with metastatic prostate cancer, you must fill this order.

agreed...

[Doctor M]

Originally Posted by MyTalon4U2NV

oh, in no way am i saying i know better than the md on a pts state however, personally i just wouldnt feel comfortable.

Its not about you...If its a legit rx, and everything is verified and documented, you should fill the rx. leave your personal feelings aside...

[MyTalon4U2NV]

im sorry i thought pharmacists are there for their professional judgement and to serve as the checks and balances... not just verify and fill.

not trying to argue here.

[Doctor M]

Originally Posted by MyTalon4U2NV

im sorry i thought pharmacists are there for their professional judgement and to serve as the checks and balances... not just verify and fill.

not trying to argue here.

dont apologize, you are right that we are there for professional judgment, but use just that, professional judgment, not personal feelings...or comfort level...sometimes pts need higher doses than others...

[Praziquantel86]

Originally Posted by MyTalon4U2NV

im sorry i thought pharmacists are there for their professional judgement and to serve as the checks and balances... not just verify and fill.

not trying to argue here.

So, in your professional judgment, opioid tolerance cannot develop in severe, chronic pain patients?

[MyTalon4U2NV]

Originally Posted by Praziquantel86

So, in your professional judgment, opioid tolerance cannot develop in severe, chronic pain patients?

my judgement is this...

large, multiple daily doses of methadone causes increased risk for QT interval prolongation and torsades de pointes with doses greater than 200 mg/day.

not only that but with peak respiratory depressant effect occuring later than analgesic effect, it may result in overdose.

[Sparda29]

Originally Posted by MyTalon4U2NV

my judgement is this...

large, multiple daily doses of methadone causes increased risk for QT interval prolongation and torsades de pointes with doses greater than 200 mg/day.

not only that but with peak respiratory depressant effect occuring later than analgesic effect, it may result in overdose.

So you think those risks outweigh the benefits of a patient taking it? I don't think so. If they have terminal cancer and are in severe pain, they are going to die anyway. I'd rather them die in comfort from respiratory depression than die in pain.

[MyTalon4U2NV]

and the torsades de pointes? torsades de pointes is a ventricular arrhythmia, it can degenerate into v-fib which will lead to sudden death in the absence of medical intervention.

so much for letting them die in comfort.

hey guys, like i said im not trying to argue. Im stating my professional judgement... this guy wants 1980. plus. just do the math on that, how many tablets is that per day?

[tkim]

Originally Posted by MyTalon4U2NV

and the torsades de pointes? torsades de pointes is a ventricular arrhythmia, it can degenerate into v-fib which will lead to sudden death in the absence of medical intervention.

so much for letting them die in comfort.

hey guys, like i said im not trying to argue. Im stating my professional judgement... this guy wants 1980. plus. just do the math on that, how many tablets is that per day?

Ever see some arrest from torsades? Or arrest *at all* for that matter? I have.

Someone already sedated who develops a non-perfusing rhythm will quickly go unconscious, and not experience what we consider 'pain' or develop a blunted perception of that discomfort. Sounds comfortable to me.

Your 'professional judgement' in matters of end-of-life decisions and palliative care are lacking.

"I don't want to dispense this palliative med to this terminally-ill patient because if they take it for relief of pain they could die."

Sums up your position. Pretty stupid.

[MyTalon4U2NV]

ladies and gentlemen... i have been proven wrong.

lets give him #1980!

[MyTalon4U2NV]

ladies and gentlemen... i have been proven wrong.

lets give him #1980!

it was worth the try

[Old Timer]

Originally Posted by MyTalon4U2NV

ladies and gentlemen... i have been proven wrong.

lets give him #1980!

it was worth the try

It's not just saying uncle. It's understanding how to apply what you learn in school to an actual clinical situation. I would certainly be hesitant to dispense this order. But once I verify the script is legit and the indication is appropriate then I would dispense it.

[eightball]

can someone edit the title of this daggamn thread.......