Do I win worst interaction found ever?

[mik30102]

At my rotation today I found someone that was dispensed Nuedexta+amitriptyline+fluoxetine+ziprasidone who to top it off has heart failure. I could not believe that one of the pharmacists actually dispensed a regimen with three separate contraindications... Has anyone else seen something worse?

---

Members don't see this ad.

 

[zelman]

At my rotation today I found someone that was dispensed Nuedexta+amitriptyline+fluoxetine+ziprasidone who to top it off has heart failure. I could not believe that one of the pharmacists actually dispensed a regimen with three separate contraindications... Has anyone else seen something worse?

Did the patient die? I'm assuming not. It doesn't seem bad to me assuming there was aggressive EKG monitoring.

 

[PharmDstudent]

It's psych. Anything goes...

 

[FMLazole]

I once found out we had been dispensing Norco to someone with a codeine allergy on file.... I couldn't sleep for days just thinking about wellness of the patient. I win.

 

[npage148]

Codiene allergy= I want diladid
A true opiate allergy is impossibly rare to the point of irrelevance

I have a patient on Tikosyn. The ER staff love trying to kill her azith or moxi

 

[bacillus1]

I once found out we had been dispensing Norco to someone with a codeine allergy on file.... I couldn't sleep for days just thinking about wellness of the patient. I win.

Most patients with a codeine allergy can take any of the -codones or -morphones. It really depends on what the reaction was. I hope there is a place in retail computer systems to document that it is OK per MD to dispense, instead of calling every time.

 

[Dred Pirate]

Most patients with a codeine allergy can take any of the -codones or -morphones. It really depends on what the reaction was. I hope there is a place in retail computer systems to document that it is OK per MD to dispense, instead of calling every time.

My spidey sense believes he was trying to be sarcastic

 

[Dred Pirate]

At my rotation today I found someone that was dispensed Nuedexta+amitriptyline+fluoxetine+ziprasidone who to top it off has heart failure. I could not believe that one of the pharmacists actually dispensed a regimen with three separate contraindications... Has anyone else seen something worse?

typical student thinking he saved the day - In pysch you can throw the max doses and contraindications out the window

 

[zelman]

Most patients with a codeine allergy can take any of the -codones or -morphones. It really depends on what the reaction was. I hope there is a place in retail computer systems to document that it is OK per MD to dispense, instead of calling every time.

I just see if they got it more than once before. Two exposures with survival = not allergic.

 

[mik30102]

typical student thinking he saved the day - In pysch you can throw the max doses and contraindications out the window

I agree with you on the max doses, but were talking about beyond significant QT prolongation here. In addition for 3/4 of the meds something else could have been chosen without the QT prolongation. (Say sertraline, abilify, ramelteon for insomnia). I also just happened to look at his charts and over the past few months he has had QT prolongation issues BEFORE the nuedexta was added this past month. I stand by my opinion that this should never have been dispensed.

 

[zelman]

I agree with you on the max doses, but were talking about beyond significant QT prolongation here. In addition for 3/4 of the meds something else could have been chosen without the QT prolongation. (Say sertraline, abilify, ramelteon for insomnia). I also just happened to look at his charts and over the past few months he has had QT prolongation issues BEFORE the nuedexta was added this past month. I stand by my opinion that this should never have been dispensed.

Exactly. EKG findings matter more than a list of drugs. A patient on zero drugs with prolonged QTc shouldn't have been put on Nuedexta. The other meds are inconsequential.

 

[anewmanx]

Codiene allergy= I want diladid
A true opiate allergy is impossibly rare to the point of irrelevance

I have a patient on Tikosyn. The ER staff love trying to kill her azith or moxi

sure, because anyone who has a rare allergy is just lying.

I'm allergic to Methylprednisolone; gives me anaphylaxis. The ER staff thought I was just having a panic attack until I turned the color of a lobster from head to toe. That ER trip turned into a three day hospital stay at their expense.

I love it when people ignore scientific reasoning for their own personal opinions.

 

[Dred Pirate]

I agree with you on the max doses, but were talking about beyond significant QT prolongation here. In addition for 3/4 of the meds something else could have been chosen without the QT prolongation. (Say sertraline, abilify, ramelteon for insomnia). I also just happened to look at his charts and over the past few months he has had QT prolongation issues BEFORE the nuedexta was added this past month. I stand by my opinion that this should never have been dispensed.

yes, obviously you need to have all the facts, but just because some book says it interacts, doesn't mean i is clinical significant in every case. So, yes, if there was an issue before hand, what was her Qtc (not QT)

 

[npage148]

sure, because anyone who has a rare allergy is just lying.

I love it when people ignore scientific reasoning for their own personal opinions.

I'm not ignoring science, hypersensitivity opiates is so rare that clinical pharmacology doesn't even list it as a contraindication. Some people may get itchy on opiates but that's non allergic histamine release. But it does list methylpred allergy under its monograph So...

 

[KidPharmD]

I've had patient's on several QTc prolonging agents before. It matters more what their QTc actually is than how many prolonging agents are on their profile. This would be a risk/benefit kind of thing. With psych patients, we often have to push the limit on some of these things just to get the patient some semblance of normal function.

 

[PolarPop]

How long was the QTc??

 

[CynicalIntern]

Not even close. THIS is the worst drug interaction.

 

[Dred Pirate]

Not even close. THIS is the worst drug interaction.

that is nothing, I got a warning about using maalox plus in a 92 year old because of a pregnancy contraindication

 

[npage148]

Nope, these are the worst.

"Imitrex is contraindicated in vascular disease and migraine is a form of vascular disease"

 

[Ackj]

Not even close. THIS is the worst drug interaction.

Seems to be more of "duplicate therapy" than "interaction."

 

[anewmanx]

Hot dogs AND sausage.

 

[sakigt]

There was a great podcast (I think ERCAST) about BBW of droperidol that is relevant to the convo http://onlinelibrary.wiley.com/doi/10.1197/aemj.9.6.615/pdf