DURs

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I recently became a pharmacist, and I just started verifying orders. Oftentimes, DURs come up during verification, but they don't seem signficant. I'm not sure which interactions require talking to the patient or doctor. On which specific DURs do you always make sure that you consult with the patient or doctor?

 

[Old Timer]

I recently became a pharmacist, and I just started verifying orders. Oftentimes, DURs come up during verification, but they don't seem signficant. I'm not sure which interactions require talking to the patient or doctor. On which specific DURs do you always make sure that you consult with the patient or doctor?

You have to post the ones you have questions about.

 

[therxist]

I recently became a pharmacist, and I just started verifying orders. Oftentimes, DURs come up during verification, but they don't seem signficant. I'm not sure which interactions require talking to the patient or doctor. On which specific DURs do you always make sure that you consult with the patient or doctor?

As a new grad myself, I understand your anxiety. Here are some of my approaches to DUR's. Hope to hear feedback from you and others so we can better ourselves.

I basically rank DUR's according to their severity from lowest to highest (which is also what most computer software does).

1. General warnings. For instance: computer tells your tretinoin has no use in pediatric population when you try to fill it for an 8-year-old boy. You know you can override it without much worry.

2. Additive effects. Patient's on Lexapro and drops off a new RX for Vicodin. Computer warns of additional CNS depression. You know he'll be on Vicodin for only 5 days PRN. Override you should.

3. Drug interaction BUT can be managed. Young girl on Trinessa is picking up a new RX for Augmentin. You consult her and that should be enough.

4. More serious drug interaction but benefit outweighs risk. 70-year-old man is taking Coumadin and Synthroid. You know he cannot stop either one PLUS Coumadin level can be titrated depending on Synthroid dose. You override and give him a quick talk.

5. More serious drug interaction and must be avoided. Middle-aged man who is on Imdur now drops off a new RX for Cialis. You call MD and advise not to put him on both.

5.5. Potentially serious drug interaction but so rare (gray area). Female patient on Prozac now uses Imitrex for new onset of migraines. Computer warns of seretonin syndrome, which is a theoretically serious serious consequence yet so so rare. You call MD (which mostly like says "huh?") and document it on RX if he agrees with the fill.

Hope someone else can also share their approach. Thanks!

 

[Sparda29]

As a new grad myself, I understand your anxiety. Here are some of my approaches to DUR's. Hope to hear feedback from you and others so we can better ourselves.

I basically rank DUR's according to their severity from lowest to highest (which is also what most computer software does).

1. General warnings. For instance: computer tells your tretinoin has no use in pediatric population when you try to fill it for an 8-year-old boy. You know you can override it without much worry.

2. Additive effects. Patient's on Lexapro and drops off a new RX for Vicodin. Computer warns of additional CNS depression. You know he'll be on Vicodin for only 5 days PRN. Override you should.

3. Drug interaction BUT can be managed. Young girl on Trinessa is picking up a new RX for Augmentin. You consult her and that should be enough.

4. More serious drug interaction but benefit outweighs risk. 70-year-old man is taking Coumadin and Synthroid. You know he cannot stop either one PLUS Coumadin level can be titrated depending on Synthroid dose. You override and give him a quick talk.

5. More serious drug interaction and must be avoided. Middle-aged man who is on Imdur now drops off a new RX for Cialis. You call MD and advise not to put him on both.

5.5. Potentially serious drug interaction but so rare (gray area). Female patient on Prozac now uses Imitrex for new onset of migraines. Computer warns of seretonin syndrome, which is a theoretically serious serious consequence yet so so rare. You call MD (which mostly like says "huh?") and document it on RX if he agrees with the fill.

Hope someone else can also share their approach. Thanks!

Yep, pretty much what most of the pharmacists I've worked with taught me. You'll probably never be able to memorize all the interactions.

 

[Old Timer]

1. General warnings. For instance: computer tells your tretinoin has no use in pediatric population when you try to fill it for an 8-year-old boy. You know you can override it without much worry.
OK

2. Additive effects. Patient's on Lexapro and drops off a new RX for Vicodin. Computer warns of additional CNS depression. You know he'll be on Vicodin for only 5 days PRN. Override you should.
Not, OK, this require a consultation or warning as the patient can fall and break his neck.

3. Drug interaction BUT can be managed. Young girl on Trinessa is picking up a new RX for Augmentin. You consult her and that should be enough.
I consult on these, but it probably doesn't matter as most patients are not rapid metabolizers and this interaction does not apply.

4. More serious drug interaction but benefit outweighs risk. 70-year-old man is taking Coumadin and Synthroid. You know he cannot stop either one PLUS Coumadin level can be titrated depending on Synthroid dose. You override and give him a quick talk
. Maybe. You only intervene if the dose changes. Once stable it requires no intervention.

5. More serious drug interaction and must be avoided. Middle-aged man who is on Imdur now drops off a new RX for Cialis. You call MD and advise not to put him on both.
This is a fake interaction. Warn him of the signs of hypotension, especially postural hyoptension and be on your way.

5.5. Potentially serious drug interaction but so rare (gray area). Female patient on Prozac now uses Imitrex for new onset of migraines. Computer warns of seretonin syndrome, which is a theoretically serious serious consequence yet so so rare. You call MD (which mostly like says "huh?") and document it on RX if he agrees with the fill.
Explain the signs & symptoms of SS, but especially if this is from a nerurologist or a headache center there is no way I am calling. The number of people with migraines that take SSRI's is legion and I would never get off the phone.