new job aS INTERN

Discussion in 'Pharmacy' started by pharma1, Dec 9, 2005.

  1. pharma1

    pharma1 Member
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    hi all

    i just got hired as an intern .

    just wanted to know can pharmacist send us to otc section to pick out drugs for patients without any traing..

    in any case can anyone post a few coomon drugs which ill look over b4 starting.

    thx
     
  2. bananaface

    bananaface Pharmacy Supernerd
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    I would think they could ask you to fetch stuff, yes.
     
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  3. usi

    usi
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    Congrats!!
     
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  4. All4MyDaughter

    All4MyDaughter SDN Mommystrator
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    I just got my Kentucky intern card a few weeks ago.

    I won't start pharmacy school until August 06, so I don't know much at this point.

    I can counsel patients only about things I know. For instance, that Augmentin should be taken with food. Or no extra Tylenol with Percocet, Vicodin, Lortab, etc.

    I often go out in the OTC section to help patients pick out products. More often than not its simply a matter of helping them find something. Or explaining that store brand ibuprofen is the same as Advil. More complicated stuff I'll ask the pharmacist.

    I also get to wear a nice white coat instead of an ugly blue smock.
     
  5. gablet

    gablet Senior Member
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    Wow, an intern card before starting pharmacy school. Is that standard? I did not get mine until a week after starting pharmacy school.
     
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  6. All4MyDaughter

    All4MyDaughter SDN Mommystrator
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    In Kentucky you can get your intern card as soon as you have your letter of admission from a pharmacy school. Since I was admitted Early Decision in October, I got my card in November.

    I am also allowed to earn up to 500 hours of my hours required for licensure before I start school.

    I was surprised too.
     
  7. Requiem

    Requiem Senior Member
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    You shouldn't counsel patients regarding any drug information whatsoever if you haven't even begun pharmacy school.

    At this level you are a pharmacy tech, and should refer everything to the pharmacist. Then, listen to what the pharmacist says and how they go about it and learn from it. Even if you know simple little things, refer them to the pharmacist because it may lead into deeper questions which you will be unable to answer.

    You also should always ask if the patient is taking any other medications before you give OTC recommendations, and since you've completed no pharmacology/therapeutics and therefore don't know any interactions, you're not qualified to recommend.

    You may know a random herb is used in the prevention of colds, but it may interact with prescription medication that the patient is on.

    This isn't meant to sound condescending, but it's the truth. Save the conselling for when you actually start pharmacy school.
     
  8. kristakoch

    kristakoch Senior Member
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    THANK YOU for finally saying that!!! There are way way too many pre-pharms and PS-1s who believe they suddenly know everything about pharmacy without ever taking a class! UNDER NO CIRCUMSTANCES should anyone who is a pre-pharm or a PS-1 be counseling, EVER!!! :thumbup: :thumbup:

     
  9. off2skl

    off2skl Senior Member
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    I disagree to an extent. As a PS-1 an intern should be able to counsel on medications that they have learned and/or that the pharmacist has taught them to counsel on. Furthermore, just because you've heard about the medication and side effects in a class doens't mean that you're going to remember it; you need to practice.

    For example, before I learned about antibiotics or the narcotic pain medications in school, I was counseling on them at work because my pharmacy preceptor taught me how. It is not too difficult to learn just by hearing and repetition.In the beginning she would always stand closeby to make sure I told the patient everything they needed to know and would interject if I forgot something. If the patient had a question, then I deferred to her. Even now as a PS-2 I counsel on medications that I have yet to learn in school by the same method and if I don't know anything about a particular medication then I will call the pharmacist over. Granted, I'm sure that there are some interns who feel they know how to counsel on everything and that can be dangerous. However, I've also seen pharmacists who only read the information on the bottle and the auxilary labels (not everything is there so in my opinion that is dangerous as well).

    Although All4myduaghter is not yet in pharmacy school perhaps shehas worked in a pharmacy as a tech and has heard a lot of counseling and otc recommendations. She has a jump on some of her classmates. She said that she only counsels on things she knows and that if it's a more complex question she refers to the pharmacist. I see no problem with that if she knows her limitations. Furthermore, an intern works "under the supervision of a pharmacist" therefore the pharmacist should be listening and making sure that the correct recommendations are made.
     
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  10. bananaface

    bananaface Pharmacy Supernerd
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    It depends on the experience of the individual. You have to start sometime. The best thing to do is to stick to what you know at the beginning and expand your knowledge from there.
     
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  11. All4MyDaughter

    All4MyDaughter SDN Mommystrator
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    I agree, and I do know my limitations.

    Kentucky interns are required to spend at least 2/3 of their time counseling patients and processing prescriptions. No one should counsel above their level of knowledge and/or experience. I have very little of either so I am limited in what I can do.

    One helpful thing is that we get a printed card with each prescription that contains info like: take with food, take on empty stomach, shake well, don't shake, finish all of this antibiotic, use this antibiotic for three days and discard remainder, etc. The techs are not allowed to give instructions at all, but interns are supposed to.

    I can also counsel patients on things about which I have sufficient expertise such as how to use saline nose drops on a young infant, giving medication to infants and toddlers, and stuff like that. There have been two occasions where patients have asked for particular products and I've been the only one who knew what they were: Isomil DF and Astroglide. Heh, heh.

    I enjoy hearing others' opinions, but what I can and can't do is really just between me and my supervising pharmacists. They know what they've trained me to do trust me to act responsbility. In return, I know that they are always just a few feet away to help me make sure the patient gets the information they need. It's a great learning experience.
     
  12. All4MyDaughter

    All4MyDaughter SDN Mommystrator
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    Yes, "under the supervision of a pharmacist" at all times is the key. For instance, I can take new prescriptions over the phone if the pharmacist is listening on the speaker or from the voicemail if I save them and the pharmacist can check my work.

    When I type prescriptions into the computer (techs don't do this at my store) my initials print on the label so the pharmacist doing the final check can indentify my mistakes and show me the correct way.

    Last night I helped a lady who had some nasal drainage that was giving her a sore throat. She had picked out Tylenol Sore Throat and wanted to know if that would help. I told her that this product was really just an expensive form of acetaminophen and she could use regular Tylenol or ibuprofen and some throat lozenges for the pain relief. I also told her that the pharmacist would probably recommend an antihistamine to dry up the drainage but I wasn't sure which one was best. So we went over the window, and I repeated my advice to the pharmacist who agreed with my analgesic advice and recommended Chlor-Trimeton.

    Everyone wins when it works like this. I have more time to spend talking and listening to patients, patients LOVE having someone take the time to talk/listen to them, the pharmacist has a little helper to take care of the easy stuff and I get to learn things and meet nice people.



     
  13. Requiem

    Requiem Senior Member
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    Well, as it turns out the lady you recommended the equivalent of 1000mg Acetaminophen (Standard dose in Tylenol Sore Throat) decides to take a dose in the morning, afternoon and evening.

    That's 3000mg, but oops! Turns out, she has also been prescribed tylenol-1's for chronic back pain, but didn't really bring it up because she didn't really think a sore throat would warrant any 'serious medication'.

    So, perhaps she takes 5 of these tablets. I mean, the total dose allowed is 12 tablets, so hardly anything is going to happen right?

    Well, tylenol-1 contains 500mg acetaminophen + 8mg codeine, so you've essentially put your patient near death. Better get some N-Acetylcysteine fast, she's suffering from acute intoxication.





    This what I mean by you not knowing anything about the other possible medications she's on, and not asking her about it.

    Again, please wait until you at least start school.
     
  14. npage148

    npage148 Senior Member
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    tylenol with codeine is only 300mg of apap and i really doubt acetylcystine is gonna be needed if she is taking ~5000mg a day for a short length of the cold
     
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  15. All4MyDaughter

    All4MyDaughter SDN Mommystrator
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    Maybe you didn't read the entire post.

    I DIDN'T recommend Tylenol Sore Throat. She had it in hand when she approached me. I told her she could just use regular Tylenol + lozenge instead of that expensive product, and then we went to talk to the pharmacist for further clarification.

    The pharmacist reviewed my advice IN FRONT OF THE PATIENT, agreed with me about substituting regular tylenol + throat lozenze for Tylenol sore throat, asked pertinent questions of the patient and recommended an anti-histamine.

    My point is, the pharmacist heard and signed off on my counseling, and added her further input. That's the essence of the intern training model and that is how my supervising pharmacists expect me to conduct myself.

    Your scenario (the patient not revealing that she was already taking Tylenol with Codeine) could happen even if ONLY the pharmacist had spoken with the patient. OR, if she had spoken to neither of us, she could very well have walked out of the store with the Tylenol Sore Throat and OD'ed herself exactly in the manner you describe.


     
  16. dgroulx

    dgroulx Night Pharmacist
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    In Pharmacotherapy IV this semester, we've only focused on OTC products. They didn't want us to learn counseling on OTC's until our 3rd year of pharmacy school because of the many possible drug interactions. We needed to learn everything else first.

    During this class we have 3 minutes to triage the patients. It's important that you know what conditions that are not appropriate for self treatment. You can get this by first asking age, eating habits, health conditions, prescriptions they are taking, OTC's they are taking, any allergies, then finally symptoms they are presenting with. Then you can tell them to see a doctor, recommend a product, or recommend that they don't take anything.

    I was doing patient counseling last summer and now I feel like I didn't know anything.

    I'm glad that you are getting approval from the pharmacist on your recommendations first.
     
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  17. All4MyDaughter

    All4MyDaughter SDN Mommystrator
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    I agree it is very complex. I feel like I don't know what I'm doing ALL the time. I would say 90% of the time I tell the patient I'm not sure and go get the pharmacist right way.

    I've got no illusions about my level of knowledge or lack thereof. I have only been pursuing pharmacy for about a year and a half and haven't even been working in the field that long. We have a sign in our pharmacist work area that says, "NEVER GUESS." If I'm not 100% sure, I ask.

    There are some things that I do know, and some things I have been taught. So I stick to those things and incorporate new information in as the pharmacists teach me things.
     
  18. Sosumi

    Sosumi Senior Member
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    It's so weird how the laws vary in different states. In Maryland, even though I'm a third year and am currently taking classes like therapeutics, pharmacotherapy, patient counseling, and nonprescription meds, we aren't legally allowed to counsel and give OTC recommendations when we're working for money because we're basically just pharmacy technicians (even though my name badge says pharmacy intern). We're only allowed to do that if we're doing our rotations, and only then under supervision of a pharmacist who's standing beside you.

    My pharmacist lets me anyway, and I defer when the questions are more complicated or when she's not busy. It's great practice and experience for when I have to practice counseling in my classes. It's also funny because I keep hearing my pharmacist recommend Claritin for nasal symptoms when the patient probably has the common cold. :scared:
     
  19. kristakoch

    kristakoch Senior Member
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    Basically mine ( and the other person's post against people in their pre-pharm and PS-1 year counseling) comes from experiences where we have seen over-zealous people deciding since they are in school they know everything. Trust me, you really should not be counseling about drugs until you know what they do (in detail) and why they do that and what other effects the patient could have when taking it. I know when I counsel you usually find out one or two things about the patient that may be very important to the med they are taking, and someone who has no idea about the drug would probably not understand that the info was pertanant and they need to have an extra conversation about the drug (there is a lot of info about the drugs that is very important that do not print out on the sheets).
    I say go ahead and counsel about how to use nasal saline, eye drops, ear drops if your pharmacist has had a discussion about the correct technique for that.
    And I still hold to that you should not be counseling on drugs. Maybe it's because I am from WI and no one can counsel until they have passed their PS-2 year. And yes, I understand that learning it in class doesn't mean you know about the drug, but by having it in class you should be able to recognize the drug, and most importantly, you have learned how to use the drug info resources correctly to look it up if need be. I think it is very fair to only let people past their PS-2 year. (2nd year of pharm school)
     
  20. Requiem

    Requiem Senior Member
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    Exactly.

    Also you are SUPPOSED to ask the patient if they're taking any other medications BEFORE you recommend an OTC. It's a very simple procedure, that'd you learn in school.

    I just think that you don't really have a true, realistic view of how people take drugs, and what drugs do. People will not bring up other medications they're taking unless you ask, they will also misuse many of the products you recommend. That's why it's fundamental to have a very broad base of knowledge before you even attempt to inform a patient on an OTC because there are so many extrenous variables that you're really just not even aware of yet. I'm not even referring to the fact you know ibuprofen is an anti-inflammatory, there's just so much else going on besides that - and you're not aware of these things. Not being able to identify these things will harm patients. It's very straightforward.

    And yes, you almost killed that patient. (had she been on the other medication.) You told them to put back the tylenol sore throat, and recommended more acetaminophen in its place. If she had read 1000mg/dose for sore throat, she could just take the equivalence of that dose in regular tylenol pills.
     
  21. Sosumi

    Sosumi Senior Member
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    I agree. I didn't realize how much goes on in recommending a therapy and patient counseling -- triage, agent and patient related variables, medication history, PMH, why certain drugs should be avoided, why certain drugs should be taken a certain way, pharmacoeconomics, efficacy and toxicity monitoring parameters, etc.
     
  22. sdn1977

    sdn1977 Senior Member
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    I've taught in a pharmacy school and a tech school and supervised many interns. The best rule of thumb is to know how much you don't know! Your patient's trust is a fragile thing and you can fall prey to the marketing of OTC's without realizing it. Although I would love to have you just recommend a product and save me time....the better result for your patient is to have the pharmacist interact with him/her and have you learn, then progress to you interacting with the pharmacist watching, then ultimately interacting alone and confidently. At slow times, talk out different scenarios (what if they have hbp, using antidepressants, pregnant...) so you feel comfortable. It takes years to learn to become a pharmacist so use that time to learn wisely when to speak and when to listen. Also, realize, that sometimes the very best medication is no medication at all. Your professional reassurance will go a long way to building trust when they realize you are not about "selling" a drug.
     
  23. All4MyDaughter

    All4MyDaughter SDN Mommystrator
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    No one should counsel beyond their level of experience. My pharmacist feels that is it within mine to tell people to eat food with their Augmentin, to hold the extra Tylenol with their Percocet and to unwrap their suppositories before using them. That's about the extent of my counseling on drugs, since I really don't know much of anything else at this point.

    I do help people pick out OTC, but only in the most basic sense. For example, people come in all the time with Dr.'s orders to get a particular vitamin, supplement, whatever. I go out to the OTC with them, tell them "OK, these are the three brands of fish oil we carry, this one is 100/$10, this one is..., they all have the same amount of active ingredient" (from the label), etc, etc. I know I'm not qualified to do much else.

    Another example, tonight a man came in with runny nose and congestion. All PSE in tablet/capsule form is kept behind the counter in Kentucky pharmacies, so they have to come to us to get stuff like that. He described his symptoms to me because the sole pharmacist was on the phone. I picked out two products that I thought would be appropriate and we waited for the pharmacist to get off the phone. The pharmacist came over, discussed pertinent info with the patient, looked at the two products and then made his recommendation to the patient.

    That's pretty much how it goes. I don't plan or expect to do much more until I get some pharmacy classes under my belt.
     
  24. All4MyDaughter

    All4MyDaughter SDN Mommystrator
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    I agree. I often feel like I am not learning things fast enough, not retaining enough. Then I remember that training for this career is a multi-year journey.

    Every time I get the pharmacist to talk to a patient, I try to stay and listen, and learn. We are so busy that sometimes I can't, but when possible it's a great way to learn.
     
  25. All4MyDaughter

    All4MyDaughter SDN Mommystrator
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    Where did I say that I recommended she take MORE acetaminophen than was in Tylenol Sore Throat? Or less for that matter? I didn't say that because it didn't happen.

    I told her that she could substitute the regular (cheaper) capsules for the expensive liquid form. It's true - the pharmacist agreed with me. The PHARMACIST counseled her on the specifics of how make the substitution. And yes, she asked her if she was on any other medication. She also asked about HBP before recommending an antihistamine/decongestant.

    I didn't almost kill anyone. That's a bit over the top.
     
  26. Requiem

    Requiem Senior Member
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    If you argue this needlessly it's gonna tire anyone coming into contact with you. Your reading comprehension is terrible. Mainly, because of the fact that I said you told her to put back the sore throat stuff, and in its place recommended more acetaminophen anyway. This sentence denotes the fact you told her to take acetaminophen in tablet form, opposed to the liquid. It makes no difference whether or not its in liquid capsule or tablet, the importance is the 1000mg /day.

    You didn't mention the fact the pharmacist asked her about her other medications, you only said that YOU didn't, which was the issue. Because had she simply taken your advice without getting asked about her other medication by the pharmacist, and had been on tylenol - 1's, yeah she'd almost die.

    Overdose level of acetaminophen is 4000mg/day. It's be well over that, (5 tylenol 1-'s is 2500mg, + 3 or 4 doses of 1000mg obtained through caplets.). I wish you'd understand how simple the example was.
    I also wish you'd just stop being so defensive, numerous actual pharmacy students (plus a teacher) have told you that you shouldn't recommend anything period. That's all there is to it.
     
  27. All4MyDaughter

    All4MyDaughter SDN Mommystrator
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    My reading comprehension is fine, thanks. I understand what you are saying, but I think you've misinterpreted and twisted my posts to suit the arguement you are trying to make. It doesn't really matter anyway, because I don't work for you, or you for me. You aren't my preceptor, supervisor, or co-worker. Those are the people about whose opinions on this matter I'm most concerned, along with patients of course.

    I don't know you and you don't know me. Since you feel that you need to resort to insulting me in order to make your point, perhaps it's just best we let it drop. This thread has gotten far afield of what the OP intended anyway.


     
  28. bananaface

    bananaface Pharmacy Supernerd
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    Actually, you are incorrect. 4g/day is not an overdose for short term use patients. However, more than 1g in any 6 hour period is exceeding the recommended short term use standards. It typically takes over a year for most patients at 4g/day to have liver problems, which is why 2.6 g/day is the maximum you should recommend for long term use. At 5g/day the time to damage would typically be 4-6 months, 6g/day, 1-3 months, 7g/day maybe a week, assuming that doses are evenly spaced out. If doses are clustered or there are other risk factors, there is a greater potential for acute overdose and the time to damage would be reduced.

    Please keep the discussion collegial. :)
     
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  29. Sosumi

    Sosumi Senior Member
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    ^^^^
    What Bananaface said. 4g/day is hepatotoxic in chronic users. You need to take 10grams in a dose to get acute toxic effects.
     
  30. bananaface

    bananaface Pharmacy Supernerd
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    That number is lower for some people. I'd leave any potential overdose to poison control. I'd probably refer at around 3g/dose myself, but I'm not willing to set anyone else's standards for them. Let PC tell them what to do. At the very least it'll scare them enough so they won't do it again.
     
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  31. Sosumi

    Sosumi Senior Member
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    Those numbers are what I got from an article in the "Pharmacist's Letter" and from my palliative care therapeutics professor's notes. She recommends no more than 2.6g/day in chronic users.

    What's annoying is my father had his tooth pulled a month ago and I noticed the dentist wrote for Vicodin ES 1 or 2 tabs po q4 hours :eek: I couldn't even make out what the name of the dentist was, nor was there a DEA number. The pharmacist where I picked up the Rx filled it anyway with that same sig and without any questions and used the generic "Dental First" as the prescriber...
     
  32. golf299

    golf299 Member
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    We just had several lectures from the Rocky Mountain Poison Center, one of the most well respected poison centers in the country.

    Their practice with respect to APAP overdose is to treat adults with NAC if >7.5 grams is ingested, while looking at ALT/AST levels and refering to a nomogram that relates time since ingestion and APAP concentration in the patient.
     
  33. pharma1

    pharma1 Member
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    i will certainly appreciate all for my daughter's confidence to counsel .

    i just finshed my first day of work as an intern and the pharmacist expected me to counsel !!!!come on it was my first day!!!!!!i told him i wanted to c him do it first , he refused he said he wants me to go ahead and do it and then he'll be correcting me where i go wrong!!!!!i dont even get a chance to get comfortable with the job .

    i certainly am glad for you , ur pharmacist is around for you and he sure make you feel comfortable . i hope i get same confidence as u ....i got so nervous my mind went blank . :( ....i want to counsel and enjoy it .....
    is there any website where i get can some tips on how to counsel effectively .....
     
  34. Requiem

    Requiem Senior Member
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    Whooooshh. Grammar police.

    Again, I am amazed by these "future pharmacists" of America. You can get some tips on conselling from your school, or your pharmacist.
     
  35. Abilify

    Abilify Membership Revoked
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    Ironic :cool:

    pharma1, what country is your pharmacy school located? Vietnam? Caribbean? Just curious
     
  36. Requiem

    Requiem Senior Member
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    OMFG!!! A TYPO!!!!!!!!!!!!!!!!!!!!

    I'm sure I can just grab a "u" from one of pharma1's posts!
     
  37. Abilify

    Abilify Membership Revoked
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    make sure that's all you grab!
     
  38. microbe hunter

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    That's still early. It's 1 yr in NY.
     
  39. Glycerin

    Glycerin Commercially Unavailable
    Pharmacist Moderator Emeritus 10+ Year Member

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    Please keep things civil and on topic. The topic of this thread is "new job as intern," not "attack other users because of grammar or spelling."
     
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  40. b*rizzle

    b*rizzle Master of Useless Info
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    I don't think that first-year students should counsel on OTC stuff, since it's just not possible for them to know what questions to ask and where to look for answers should they not know.

    However, I think it's very important that the student is familiar with OTCs and is aware of details associated with specific OTC meds, so that they can alert the pharmacist to potential problems. For example, we had a lady come to our counter this afternoon asking for a recommendation on something for a cough, stuffy nose, and sore throat. She had a box of Coricidin HBP in one and a card for Tylenol Cold "Daytime Severe Congestion" in the other. Before she could even ask, "Which should I take?" I asked her about possible BP issues, and found out that she was taking Toprol XL for tachycardia. I then grabbed the pharmacist ASAP.

    Before anyone jumps all over me, I want to stop and point out that whenever a patient stops me and asks a question about an OTC product, I never specify whatever jumps into my head, even if it seems obvious to me after talking to the patient about symptoms/med history. I know better; I know I don't know ANYTHING about how drugs work, and I conduct myself as such because I know that if I say something, and the pharmacist doesn't get to talk to the patient right away, (s)he may walk over to the shelf, grab the item and walk off before the pharmacist gets a chance to even make eye contact with the patient. Generally when the pharmacist makes recommendations to a patient, we're a slow enough pharmacy that it usually becomes a three-way conversation between the patient, the pharmacist, and myself.

    Again, it's all dependent on what you know, how comfortable you are with what you know (and when you can recognize that you're in over your head), and how comfortable your pharmacist is with the idea of you counseling (i.e. recognizing that you know your limits and will come get them when you don't know the answer to the question).

    My pharmacy manager used to teach, and he and I have already had discussions on the counseling thing. He said his experience as a teacher is that because counseling is such a big deal, and very few people rarely feel comfortable at first (especially with lots of new knowledge), it's important to start slow with what you know and gain confidence. He has told me, like All4MyDaughter's pharmacist, that, IF I FEEL COMFORTABLE DOING SO, it is within my scope of experience and knowledge to discuss with patients about basic things, like unwrapping suppositories before use and staying out of the sun when taking doxycycline.

    Also note that the conversation never ends with me talking to the patient; regardless, I still unfailingly ask "Are there any questions about your medication that you'd like to discuss with the pharmacist?"
     
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  41. dgroulx

    dgroulx Night Pharmacist
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    :laugh: :laugh:

    Don't forget to tell them that the pointy end goes in first.
     
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  42. bananaface

    bananaface Pharmacy Supernerd
    Pharmacist Moderator Emeritus Lifetime Donor Classifieds Approved 10+ Year Member

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    And, where to stick it. :cool:
     
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  43. b*rizzle

    b*rizzle Master of Useless Info
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    :laugh:

    Oh, common sense, how I take you for granted. :rolleyes:
     
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