Filling rx for holly trinity

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mona2004

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Just have a question. If MD (not a pain management )writing soma norco Xanax combination (with diagnose code pain and anxiety ) in a daily bases for some pts what would be the best practice for pharmacist?
 
mona2004 said:
Just have a question. If MD (not a pain management )writing soma norco Xanax combination (with diagnose code pain and anxiety ) in a daily bases for some pts what would be the best practice for pharmacist?
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Refuse to fill if you have suspicion that it is not for legitimate purposes.
 
Dred Pirate said:
nope, it is zithromax 1 gram, rocephin 250 IM, and flagyl 2 grams
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OK I'm stumped. What's the indication for this trifecta? Trying to cover gonorrhea and other stuff at the same time?
 
Swishers said:
OK I'm stumped. What's the indication for this trifecta? Trying to cover gonorrhea and other stuff at the same time?
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gonorhea, tric, and chlamydia
 
When I was working in pharmacy 7 years ago we flat out refused to fill those triple cocktails. We were always "out of stock" or "on backorder" considering those people shot a pharmacist in our area.
 
Might want to give your local DEA office a tip about this MD.
 
Leaving all the STD discussion aside,

Are we really assuming that no patient in the united states actually has a medical need for these three drugs in combination? I am all for refusing anything you truly suspect to be illegitimate, but we also should be careful not to put up unnecessary barriers for patients with real needs.
 
KidPharmD said:
Leaving all the STD discussion aside,

Are we really assuming that no patient in the united states actually has a medical need for these three drugs in combination? I am all for refusing anything you truly suspect to be illegitimate, but we also should be careful not to put up unnecessary barriers for patients with real needs.
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How many patients need:

  • Norco 10/325 or Percocet 10/325 120 1 qid
  • Fkexeril 10 1 tid
  • Xanax 1 mg qid
The answer is not many. You should consider any patient that comes with the Holy Trinity, The Trilogy or the Trifecta to be suspect until proven otherwise.
 
KidPharmD said:
Leaving all the STD discussion aside,

Are we really assuming that no patient in the united states actually has a medical need for these three drugs in combination? I am all for refusing anything you truly suspect to be illegitimate, but we also should be careful not to put up unnecessary barriers for patients with real needs.
Click to expand...


When it's not from a pain management office? Absolutely.
 
Old Timer said:
How many patients need:

  • Norco 10/325 or Percocet 10/325 120 1 qid
  • Fkexeril 10 1 tid
  • Xanax 1 mg qid
The answer is not many. You should consider any patient that comes with the Holy Trinity, The Trilogy or the Trifecta to be suspect until proven otherwise.
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When I see a holy trinity it's oxy 30, soma 350, Xanax 2mg.
 
KidPharmD said:
Leaving all the STD discussion aside,

Are we really assuming that no patient in the united states actually has a medical need for these three drugs in combination? I am all for refusing anything you truly suspect to be illegitimate, but we also should be careful not to put up unnecessary barriers for patients with real needs.
Click to expand...
If there is a doctor who writes for this combo exclusively, the appropriateness of the therapy in those instances would be entirely coincidental.
 
If the issue is that the physician is writing this a lot then, yes I would consider this suspect by default. However, if the combo is of a low proportion to the number of normal prescriptions you get from this doctor then you would be hard pressed to refuse solely base on the fact that the prescribing doctor is not a pain management specialist. We have so many "pain" doctors that do only that but don't have any special certification that I would suspect them just as much.
 
Old Timer said:
Whatever you call it, it is:

  1. A Narcotic Analgesic
  2. A Muscle Relaxant
  3. A Benzodiazepine
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Agreed, at recent district discussion in 2014, a Pharmacy District Manager stated the same idea: as pharmacist, we should watch out for classes of med, we watch out for people looking for having fun with B.A.R.
B = Benzodiazepine: Alprazolam, Clonazepam, Diazepam (Valium)...
A = Analgesic (Narcotic Analgesic)...Oxy, Oxy-combo (Oxycodone+Acetaminophen), Hydrocodone...
R = Relaxer (Muscle Relaxer): Carisoprodol, Methocarbamol...
 
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