Emergency supply

[peacewalker]

Where do you draw the line in determining what is defined as a "chronic maintenance drug"? I am curious of other people's opinions on this.

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[npage148]

Where do you draw the line in determining what is defined as a "chronic maintenance drug"? I am curious of other people's opinions on this.

I kinda go on gut. If they look like they are pretty regular then they get some. If it's been a 2 months since their last refill they don't get any. Plus I only do Chronic maintenance meds, so no NSAIDS, albuterol or any prn stuff. and NEVER on and controls regardless

 

[charfdorn]

Where do you draw the line in determining what is defined as a "chronic maintenance drug"? I am curious of other people's opinions on this.

I pretty much agree with the previous reply. I mean, obviously, that's not my call at this point, but if it's something the patient actually refills chronically and recently, then clearly they should get what they need. Things happen. But if it's a narc and they forgot to call their doc for refills, or if they just realized they were out three months after the last fill, then it's not a chronic maintenance med for this patient.

 

[Sparda29]

I think topical antibiotics and retinoids being refilled every week for acne would also constitute as a chronic maintenance drug. However, I'm not gonna just give them a tube of that expensive **** for free. I'd write out an emergency Rx, fill it, and then call the physician ASAP for a verbal Rx and file the emergency Rx with the verbal Rx and try to get as many refills as the dermatologist is willing to go with.

Sometimes they don't wanna give refills until they see the patient to determine whether they are gonna be altering therapies or not.

 

[npage148]

I think topical antibiotics and retinoids being refilled every week for acne would also constitute as a chronic maintenance drug. However, I'm not gonna just give them a tube of that expensive **** for free. I'd write out an emergency Rx, fill it, and then call the physician ASAP for a verbal Rx and file the emergency Rx with the verbal Rx and try to get as many refills as the dermatologist is willing to go with.

Sometimes they don't wanna give refills until they see the patient to determine whether they are gonna be altering therapies or not.

Nope, you are not getting an emergency RX for a topical cream. I don't care if you might break out, call your doctor and get some concealer. Plus if you're getting it refilled qweek then you are using too much or you need something else if it's not working.

 

[All4MyDaughter]

Nope, you are not getting an emergency RX for a topical cream. I don't care if you might break out, call your doctor and get some concealer. Plus if you're getting it refilled qweek then you are using too much or you need something else if it's not working.

Agree. It's not an essential med. When I think of "emergency supply" I think BP meds, DM meds, heart meds, and basically anything that might have serious health consequences if the patient runs out abruptly. Not acne meds, not BCP, not HRT, not Viagra, etc.

 

[owlegrad]

Agree. It's not an essential med. When I think of "emergency supply" I think BP meds, DM meds, heart meds, and basically anything that might have serious health consequences if the patient runs out abruptly. Not acne meds, not BCP, not HRT, not Viagra, etc.

Harsh, although now that I think about it, I don't recall anyone ever needing an emergency fill. By which I mean that I don't recall any of my patients ever allowing themselves to run out of refills. I mean levothyroxine sure, but Viagra? No way Jose.

This is embaressing but I don't recognise BCP or HRT. Can you give me a clue?

 

[cycloketocaine]

Harsh, although now that I think about it, I don't recall anyone ever needing an emergency fill. By which I mean that I don't recall any of my patients ever allowing themselves to run out of refills. I mean levothyroxine sure, but Viagra? No way Jose.

This is embaressing but I don't recognise BCP or HRT. Can you give me a clue?

Birth control pills and hormone replacement therapy

 

[rph3664]

I'd do an emergency fill on Viagra etc. if I knew the person was using it for PPH. Otherwise, no, I wouldn't do that.

 

[Sparda29]

Nope, you are not getting an emergency RX for a topical cream. I don't care if you might break out, call your doctor and get some concealer. Plus if you're getting it refilled qweek then you are using too much or you need something else if it's not working.

Ever think the reason the patient runs out of it so fast is because they are using it on not just their face, but over larger areas of the body such as arms, legs, chest, etc? Acne doesn't only exist on the face.

 

[cycloketocaine]

Ever think the reason the patient runs out of it so fast is because they are using it on not just their face, but over larger areas of the body such as arms, legs, chest, etc? Acne doesn't only exist on the face.

Point is that acne isn't life threatening. Hell, it doesn't even threaten physical health. At all.

 

[PharmDstudent]

Point is that acne isn't life threatening. Hell, it doesn't even threaten physical health. At all.

...not until it turns into a cyst

 

[owlegrad]

Birth control pills and hormone replacement therapy

Hell of a clue. Thanks!

I'd do an emergency fill on Viagra etc. if I knew the person was using it for PPH. Otherwise, no, I wouldn't do that.

Primary Pulmonary Hypertension?

 

[All4MyDaughter]

Primary Pulmonary Hypertension?

Yes.

 

[Praziquantel86]

I'd do an emergency fill on Viagra etc. if I knew the person was using it for PPH. Otherwise, no, I wouldn't do that.

They would be using Revatio for that...not Viagra. Same drug, much different dose (and cost).

 

[SomeGuy]

I kinda go on gut. If they look like they are pretty regular then they get some. If it's been a 2 months since their last refill they don't get any. Plus I only do Chronic maintenance meds, so no NSAIDS, albuterol or any prn stuff. and NEVER on and controls regardless

I can think of a number of situations where I'd "advance" an albuterol inhaler. At least around here, they're only $6, not a huge loss if I never get the script.

 

[All4MyDaughter]

I can think of a number of situations where I'd "advance" an albuterol inhaler. At least around here, they're only $6, not a huge loss if I never get the script.

Yeah, I've done that before. Don't really want someone to be without their rescue inhaler if they need it. They have to show proof that they have or have had a valid RX for it at some point, though.

 

[rph3664]

They would be using Revatio for that...not Viagra. Same drug, much different dose (and cost).

Not necessarily. I've seen Levitra and Cialis used for PPH too. Revatio was created to circumvent insurance issues.

I have also compounded Viagra suspension for a child with PPH.

When I was in retail, one of my colleagues advanced some Nitrostat to a customer he had never seen before, then got the doctor's information from his wife and called on Monday. Nobody takes Nitrostat for fun either.

 

[npage148]

When I was in retail, one of my colleagues advanced some Nitrostat to a customer he had never seen before, then got the doctor's information from his wife and called on Monday. Nobody takes Nitrostat for fun either.

How did that conversation go?

Pt: "Hi, I've never been to your store before but I've got some crushing chest pain and my doc have me some nitro pills one time and they seemed to work. I know it's Saturday night and my doctor is sleeping but could I have a bottle?

Rph "Sure thing"

 

[Quiksilver]

I can think of a number of situations where I'd "advance" an albuterol inhaler. At least around here, they're only $6, not a huge loss if I never get the script.

I was thinking that too. And some people unknowingly use it as a maintenance drug

 

[rph3664]

How did that conversation go?

Pt: "Hi, I've never been to your store before but I've got some crushing chest pain and my doc have me some nitro pills one time and they seemed to work. I know it's Saturday night and my doctor is sleeping but could I have a bottle?

Rph "Sure thing"

The man was in the store with his wife and had an acute angina attack and no nitro, so the pharmacist gave him one and called an ambulance.

 

[All4MyDaughter]

How did that conversation go?

Pt: "Hi, I've never been to your store before but I've got some crushing chest pain and my doc have me some nitro pills one time and they seemed to work. I know it's Saturday night and my doctor is sleeping but could I have a bottle?

Rph "Sure thing"

The man was in the store with his wife and had an acute angina attack and no nitro, so the pharmacist gave him one and called an ambulance.

I believe I'd have stuck to just dialing 911.

 

[rph3664]

My colleague who gave out the Nitrostat had over 20 years of experience (30 by now) and it was a judgment call. I would probably have done the same thing, but so far haven't had to. We all agreed that he did the right thing.

 

[All4MyDaughter]

My colleague who gave out the Nitrostat had over 20 years of experience (30 by now) and it was a judgment call. I would probably have done the same thing, but so far haven't had to. We all agreed that he did the right thing.

It's great that it worked out well, but if something untoward had happened to the patient, the pharmacist would surely have faced consequences. An action against his license or a charge of practicing medicine without a license are both possibilities.

 

[rxlea]

So who would do an emergency fill for mental health medication (for bipolar/schizophrenia especially)?

 

[npage148]

So who would do an emergency fill for mental health medication (for bipolar/schizophrenia especially)?

OMG, I will never let one of my mental health patients run out of meds. They need haldol, prolixin, seroquel, or lithium and they got it! They have enough issues without having to worry about going cold turkey plus most of them are pretty nice and pleasant to deal with

 

[All4MyDaughter]

OMG, I will never let one of my mental health patients run out of meds. They need haldol, prolixin, seroquel, or lithium and they got it! They have enough issues without having to worry about going cold turkey plus most of them are pretty nice and pleasant to deal with

No it's ok. Just give them a quick Invega Sustenna injection (or Risperidol Consta if you're cheap) and call the doctor for an RX later. It's fine!

Just kidding. I agree with you and I'd do emergency fills on psych meds. There are many legit medical (not to mention public health and safety) reasons not to let patients run out of these meds.

 

[Carboxide]

No it's ok. Just give them a quick Invega Sustenna injection (or Risperidol Consta if you're cheap) and call the doctor for an RX later. It's fine!

Just kidding. I agree with you and I'd do emergency fills on psych meds. There are many legit medical (not to mention public health and safety) reasons not to let patients run out of these meds.

Agreed, especially because a lot of psych meds (paroxetine comes to mind) have extremely bad withdrawal symptoms. If it's a non-control that the patient has been on for a sustained time, then I would definitely.

 

[SomeGuy]

It's great that it worked out well, but if something untoward had happened to the patient, the pharmacist would surely have faced consequences. An action against his license or a charge of practicing medicine without a license are both possibilities.

In Ontario, you're exempt from most health professional legislation if you are "rendering first aid or temporary assistance in an emergency".
It's intended for AEDs, epi-pens and the like, but it is very broadly written.
Check what your jurisdiction's regs actually say about this sort of thing.

 

[All4MyDaughter]

In Ontario, you're exempt from most health professional legislation if you are "rendering first aid or temporary assistance in an emergency".
It's intended for AEDs, epi-pens and the like, but it is very broadly written.
Check what your jurisdiction's regs actually say about this sort of thing.

Here it's called a "Good Samaritan" law and it protects people from liability ONLY if they are acting within their scope of training/practice. So for pharmacists, it's basically CPR, First Aid, OTC meds, maybe a few more things, etc. Pharmacists in this state can't prescribe (outside of collaborative care agreements) so dispensing medications absent evidence of a valid prescription wouldn't be covered. There's a difference between advancing someone a refill or emergency supply of something and just giving a patient a medication off the shelf. That's how I interpret the law in my jurisdiction.

 

[SomeGuy]

There's a gigantic difference between protection from professional liability and legal/criminal/civil liability, just to be clear.

I should add that I meant that you were exempt from the most important bits of health professional legislation in the situation I described, not most of the legislation itself.

 

[All4MyDaughter]

There's a gigantic difference between protection from professional liability and legal/criminal/civil liability, just to be clear.

I should add that I meant that you were exempt from the most important bits of health professional legislation in the situation I described, not most of the legislation itself.

Sory, now I really don't understand. What do you mean by "bits of health professional legislation?"