Ok....I've got another clinical situation that happened to me a month or so ago.....A young woman came to the pharmacy with a male with two new Rxs. I was on the phone - actually, multiple phone calls....and my tech took her Rx's, got info, etc. Well...it was busy...she gave out a couple of other Rx's, took a couple of more new ones (get the idea? there's just two of us and yeah - she's a good tech - can multitask well). Anyway...after my phone calls, I go over and get a couple of new ones from my tech to do myself and notice these two for the same woman written by an OB/Gyn: Prenatal vitamins (I can't remember which right now - doesn't matter) & misoprostol 200mcg - take as directed prn. Now...what would you do?.....I'll tell you later what I did......
Another how would you handle.....
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sdn1977 said:
Fill the Vitamins but not the Misoprostol...it is contraindicated in pregnancy. Do I pass the exam? I'm only a P1, so I doubt it!!!
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sdn1977 said:
call the MD.
GaPharmGirl09 said:Fill the Vitamins but not the Misoprostol...it is contraindicated in pregnancy. Do I pass the exam? I'm only a P1, so I doubt it!!!
hmmm....welll....now, why is it contraindicated??? You can look this up. But, as a P1.....what do you perceive is your most valuable role??? And no - you're not out of the exam yet. Here in CA the exam is two days (or used to be anyway) so you've got more time to think about it. Perhaps some of your 3rd or 4th year colleagues can assist? Good first attempt!
alwaystired said:
Some might choose this route, but that's not my style. Plus....where I practice, a call to the MD might be returned a day later or worse yet...if it was Kaiser it would be the next week. I can't remember the detail of this one, but what if the Rx was written two days ago? Our local clinics couldn't find the chart faster than a day or so. Not a bad answer though...just not what I did.
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sdn1977 said:
According to Micromedix, two of the non-FDA labeled indications is abortion and labor inducement(cervical ripening).
sdn1977 said:
Patient safety and well being first, always. My role, as I see it, is to counsel patients to the best of my ability and to give them the best information possible so that they can make well informed decisions about their healthcare.
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You talk to the patient. She might not be preg or trying to get preg. A prenatal vit is an easy and cheap way to get the pt a multi vit if she needs one. I know a few people going this route. Perhaps she is having an abortion and asking her would clear all the mystery
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Would you ask her if she is pregnant and how far along? Could she be using it to ripen the cervix in the last month or so of pregnancy?
I used an herbal product for this purpose during the last month of my pregnancy (it was recommended by a certified nurse-midwife) while continuing my regimen of prenatal vitamins.
I also received cervical administration of misoprostol in the hospital to induce labor one week before my due date. My water broke within two hours of the first dose. Good times...
I used an herbal product for this purpose during the last month of my pregnancy (it was recommended by a certified nurse-midwife) while continuing my regimen of prenatal vitamins.
I also received cervical administration of misoprostol in the hospital to induce labor one week before my due date. My water broke within two hours of the first dose. Good times...
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Or maybe she has miscarried but the dead fetus did not spontaneously abort. Misoprostol can be used for this as well I think. The prenatal vitamins were recommended because she may try to get pregnant again after the physician-suggested waiting period.
Really good answers....and no - there is no "correct" answer. However, I will stand behind the one wrong answer - "fill it", IMO, is not the answer here! But...back to the many, many correct answers - that is one of the lessons you'll learn over 4 years of pharmacy school. Yes - an off-label use of misoprostol is to induce a miscarriage or ripen the cervix. I've actually dispensed the drug for this purpose and counseled the woman when she had questions about it. However, in this case, I think the point I really wanted to get across was you had to TALK TO THE PATIENT and find out what was going on with her. Now, in this actual case....no she was not pregnant, but as was mentioned earlier, she knew vitamins were important prior to and during the early weeks of conception. She wanted to become pregnant, so asked her gynecologist to prescribe a prenatal vitamin. She also told her physician she had gastric issues (not sure if it was due to NSAIDS or not) and had used misoprostol when she lived in another country. After I had determined her purposes, I educated her about misoprostol use in pregnancy, gave her specific info on that (just in case she had some at home), gave her suggestions for OTC alternatives for immediate relief, filled her prenatal vitamins, gave her misoprostol back to her and suggested she have another conversation with her gynecologist about her potential GI problems and how they might relate to a healthy preganancy. Its just my opinion that although I need to fill Rxs in a timely, accurate and complete fashion, I also have a bigger role in educating patients about their health and whatever therapy is prescribed to maintain that health. This young woman went away very grateful for the vitamins, and info about the medications in question, confident she can go back to her MD and have a further discussion and best of all, she knows she can come back to ask me anything! There were lots of ways to have handled this, all equally successful (or correct.....), this was just one........have fun!
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loo said:
Thank you! 🙂
I also want to give a big thumbs up to this thread and the discussion. I'd love to see more like it! 👍
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Please get over yourself, sdn1977.
OF COURSE no RPh would just fill something WITHOUT talking to the patient, MD, whatever--especially if the patient is pregnant. Let me rephrase my answer. YES, I would FILL IT after double checking with the patient or MD.
Maybe you should think before you jump down somebody's throat.
OF COURSE no RPh would just fill something WITHOUT talking to the patient, MD, whatever--especially if the patient is pregnant. Let me rephrase my answer. YES, I would FILL IT after double checking with the patient or MD.
Maybe you should think before you jump down somebody's throat.
loo said:
hmmm....troubles???? the point is...you would NOT fill it - there is no medical justification for it in this situation after discussing it with the patient. This is a very typical board question - they want to know your thought process....so..your amended response needs to show you have really evaluated all related medical/pharmacologic reasoning. Sorry if I've offended....just sharing professional experiences as they do on so many of the medical forums.......
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sdn1977 said:
As a P1, I very much appreciate this kind of post. It is great to learn from older, more experienced pharmacists and it is also nice to learn new, practical ways to handle new situations. They do not specifically teach you this stuff in text books.
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No, no troubles at all...except for your tired pedantic style. My point is, you would fill it if the scenario YOU described was NOT the case, as others have so eloquently pointed out. There is more than one correct response and after talking with the patient/MD you have choices. You pick the right one based on your findings. I would have filled it if it WAS NOT the sceneario YOU described. Sorry I wasn't able to stroke your ego.sdn1977 said:
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No apology necessary...but thanks all the same.sdn1977 said:
I think what you're doing is great---making folks think with real-world examples. Keep it up! The discussion is stimulating.
