New Pharmacist... Random Question?

[sunnyscripts17]

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Hi - I graduated pharmacy school this year and have just been licensed a few weeks. I started working for Walgreens about a month ago as a grad intern. Before that I worked for a small chain while in school. I'm hoping someone can give me some advice on how to handle a situation I have run into twice in the past two weeks. Today and a day last week there was a CAP put on the Rx's dealing with oral contraceptives and other drugs (abx and topamax). In the first instance it was the mother picking up the abx; second instance it was the Grandma picking up. What is the most appropriate way to handle this since you have to counsel, but the mom or grandma obviously may not be aware the daughter is on the OC and the daughter is not present? Advice on how to handle this from those of you who have encountered this before would be VERY much appreciated. 😀 Thanks

 

[lorain]

this is my worst scenario...i try to get a # to get a hold of the person whose taking the medication

 

[MountainPharmD]

this is my worst scenario...i try to get a # to get a hold of the person whose taking the medication

Why is this your worst scenario?

To sunnyscripts17, when did the pharmacists at Walgreens start counseling patients?

 

[johnep34]

Have frequently had Grandma picking up her 15 year old grandaughter's script for OC. We do not normally counsel on OC as expect this to have been done by prescriber. Most OCs prescribed by Nurses in UK.
johnep

 

[WVUPharm2007]

In the US, there have been cases where pharmacists have had to pay child support for not counseling patients that have taken oral antibiotics with oral contraceptives.

This isn't an issue for you, because people in the UK have at least an appreciable level of common ****ing sense. In the US, you can get sued for just about anything. I'm actually rather shocked I've never been sued by anyone. I'm not joking.

 

[MountainPharmD]

In the US, there have been cases where pharmacists have had to pay child support for not counseling patients that have taken oral antibiotics with oral contraceptives.

Urban legend man....the data suggests that the interaction is only with Rifampin from case report 40 years ago.

 

[johnep34]

I seem to remember there was a case where a chain was being sued because pt not counselled re penicillin. I always try to counsel, but difficult if mother picking up script for young daughter. Case law has shown right of children to data protection, even from their parents.
johnep

 

[type b pharmD]

To sunnyscripts17, when did the pharmacists at Walgreens start counseling patients?

Sunnyscripts just graduated pharmacy school

 

[npage148]

I assume that someone picking up an Rx for someone has been designated a caregiver by the patient so I will counsel them. Don't send your mom to get your meds if you don't want her knowing what you are taking.

And I've done the call kid at home thing and most of the time I get "why didn't you just tell my mom?"

 

[Kirbypuff]

I assume that someone picking up an Rx for someone has been designated a caregiver by the patient so I will counsel them. Don't send your mom to get your meds if you don't want her knowing what you are taking.

What if mom volunteers because it's on her way to pick up some of dad's Rx's anyway?

 

[npage148]

What if mom volunteers because it's on her way to pick up some of dad's Rx's anyway?

How would the mom know the kid's got an RX? If she's hiding the fact she's getting BC and doesn't want her mom to know, she'd also be discrete getting anything filled which may blow her cover. And I'd rather deal with a privacy issue than a baby issue

 

[Kirbypuff]

How would the mom know the kid's got an RX? If she's hiding the fact she's getting BC and doesn't want her mom to know, she'd also be discrete getting anything filled which may blow her cover. And I'd rather deal with a privacy issue than a baby issue

Sometimes mom will know about the topamax but not the birth control. I'm just saying it's possible so we have to be careful about disclosing private information.

 

[sunnyscripts17]

Thanks lorain I really appreciate your advice on how to handle this situation!

npage148 - I share your opinion too about considering someone who is picking up the medication a designated caretaker, and likewise a person who can be counseled about the daughter's meds. At the same time Kirbypuff you brought up another point I was thinking about in that the mom/grandma might know about the topamax but not the BC - and when the daughter asked grandma to pick up the topamax she probably figured the BC would never come up. So what does this leave you to do? I think lorain brought up a good idea to get a number and call, but I have tried this before with other counseling issues and the person picking up will just get upset and want to know why you can't just tell them. (and in this case it would raise suspicion with grandma that the grandaughter is hiding something and the issue might come up at home anyways). These are all the things that went through my mind yesterday as Grandma sat in the drive thru! 😕 So npage148 and lorain I know what you do.. What would everyone else do? I really appreciate your thoughts/advice!

 

[WVUPharm2007]

Urban legend man....the data suggests that the interaction is only with Rifampin from case report 40 years ago.

****, that doesn't matter. Lawyers will sue you for anything. And I'm talking like 2 degrees of separation here...a dude I work with has a dude he knew from Rx school who actually got sued because of that ****...it was back in the 90s. **** it, I just put the dumb little pink sticker on the bottle...

 

[ForcedEntry]

Counsel the caregiver.

The Rx label stapled to the outside of the bag has enough private information to constitute a HIPAA violation.

 

[BustyPharmD]

If she's over 18 then I would be more inclined to call the pt... but if she's under 18 then its more important that the pt know's the effects of the medication. As another SDNer posted... I'd rather have someone mad at me for hippa than an unplanned preg....

And besides, the parents might already know about the BC.

good luck!

 

[Brixius]

Urban legend man....the data suggests that the interaction is only with Rifampin from case report 40 years ago.

I'm glad somebody finally had the stones to say it ...

I have also read griseofulvin can have an actual interaction ... rifampin and griseofulvin are the only two I tell patients to be really careful with.

 

[npage148]

I'm glad somebody finally had the stones to say it ...

I have also read griseofulvin can have an actual interaction ... rifampin and griseofulvin are the only two I tell patients to be really careful with.

Sure, we all know it's some ******ed legand but I'm still telling people about it. Just as Reye syndrome being caused by ASA. The rates are they same for ASA and APAP but i'm not telling people to give their kids ASA becasue I know the truth.

 

[pharmdinfl]

You can provide written counseling and enclose the information sheet in the patient's bag - stapled shut. Include the statement to please call if there are any further questions. There are quite a few interactions that come up frequently and it doesn't hurt to have a small statement typed up on strips of paper - a sort of "frequently asked questions" kind of thing.

 

[Brixius]

Sure, we all know it's some ******ed legand but I'm still telling people about it. Just as Reye syndrome being caused by ASA. The rates are they same for ASA and APAP but i'm not telling people to give their kids ASA becasue I know the truth.

There is more reason than Reye syndrome not to give children ASA.

If people ask about the BC-antibiotic issue I tell them there is no evidence to support such a reaction, but if it makes them feel better to use alternative method of contraception, go for it. One thing I will not do is give misinformation just to cover my ass. Who knows ... maybe it'll get me in trouble someday.

 

[Vitamin K]

Why not: Counsel on it, but "hypothetically". i.e. something along the lines of: "This medication may decrease the effectiveness of birth control pills. IF she is taking any oral contraceptives, either for pregnancy or to control her cycle, she should be aware of it and will need to use a second method of contraception if this is the case."

 

[RxMarine]

How many pharmacists have been fined for violating hipaa???

Are u all talking about hypothetial what if's or the real world?

Here's a little tidbit from the idaho BOP:

One easy tip to help you use patient
information appropriately is to apply the “Mom
Rule.” How would you want your mother’s PHI
handled? Use your patients’ PHI much like you
would the health information of someone you care
a lot about. Help patients get the best care
possible while protecting their health information​

from inappropriate use or disclosure.

I doubt it's going to help the government to waste time investigating a pharmacist who told phi to someone picking up a script for someone else. In fact the only major HIPAA fine so far (that I know of and read about) was aginast CVS and Walgreens for leaving phi in dumpsters outside the pharmacy.

That's the kind of sstupid **** ppl get fined for....not when you're trying to help people...of course don't leave some stupid message on an answering machine about that antibiotic for the STD they have...they don't want their spouse to know about that...and u can bet u'll get sued in the divorce!

like the lady who picked up her two tabs of 500mg azithromycin...i just hoped her husband already had his dose.

 

[Old Timer]

Sure, we all know it's some ******ed legand but I'm still telling people about it. Just as Reye syndrome being caused by ASA. The rates are they same for ASA and APAP but i'm not telling people to give their kids ASA becasue I know the truth.

Do you have something to back this up? Every single national and international organization recommends not to give ASA to treat febrile illness in people 19 years of age or younger. ASA does not cause Reye's syndrome, it increases the incidence.

 

[MountainPharmD]

How many pharmacists have been fined for violating hipaa???

Are u all talking about hypothetial what if's or the real world?

Your status says pharmacist. If you haven't learned the concept of CYA then you are in deep ****. Its someone like you who will be the first pharmacist to be fined under HIPPA.

I do know a pharmacist who was fired for disclosing a patients PHI. To think it won't happen is stupid and naive.

 

[npage148]

Do you have something to back this up? Every single national and international organization recommends not to give ASA to treat febrile illness in people 19 years of age or younger. ASA does not cause Reye's syndrome, it increases the incidence.

1: Paediatr Drugs. 2007;9(3):195-204.Links

Schrör K.


Reye syndrome is an extremely rare but severe and often fatal disease. Death occurs in about 30-40% of cases from brainstem dysfunction. The disease typically is preceded by a viral infection with an intermediate disease-free interval of 3-5 days. The biochemical explanation for Reye-like symptoms is a generalized disturbance in mitochondrial metabolism, eventually resulting in metabolic failure in the liver and other tissues.The etiology of 'classical' Reye syndrome is unknown. Hypothetically, the syndrome may result from an unusual response to the preceding viral infection, which is determined by host genetic factors but can be modified by a variety of exogenous agents. Thus, several infections and diseases might present clinically with Reye-like symptoms. Exogenous agents involve a number of toxins, drugs (including aspirin [acetylsalicylic acid]), and other chemicals.The 'rise and fall' in the incidence of Reye syndrome is still poorly understood and unexplained. With a few exceptions, there were probably no new Reye-like diseases reported during the last 10 years that could not be explained by an inherited disorder of metabolism or a misdiagnosis. This may reflect scientific progress in the better understanding of cellular and molecular dysfunctions as disease-determining factors. Alternatively, the immune response to and the virulence of a virus might have changed by alteration of its genetic code.The suggestion of a defined cause-effect relationship between aspirin intake and Reye syndrome in children is not supported by sufficient facts. Clearly, no drug treatment is without side effects. Thus, a balanced view of whether treatment with a certain drug is justified in terms of the benefit/risk ratio is always necessary. Aspirin is no exception.

 

[Old Timer]

1: Paediatr Drugs. 2007;9(3):195-204.Links

Schrör K.


Reye syndrome is an extremely rare but severe and often fatal disease. Death occurs in about 30-40% of cases from brainstem dysfunction. The disease typically is preceded by a viral infection with an intermediate disease-free interval of 3-5 days. The biochemical explanation for Reye-like symptoms is a generalized disturbance in mitochondrial metabolism, eventually resulting in metabolic failure in the liver and other tissues.The etiology of 'classical' Reye syndrome is unknown. Hypothetically, the syndrome may result from an unusual response to the preceding viral infection, which is determined by host genetic factors but can be modified by a variety of exogenous agents. Thus, several infections and diseases might present clinically with Reye-like symptoms. Exogenous agents involve a number of toxins, drugs (including aspirin [acetylsalicylic acid]), and other chemicals.The 'rise and fall' in the incidence of Reye syndrome is still poorly understood and unexplained. With a few exceptions, there were probably no new Reye-like diseases reported during the last 10 years that could not be explained by an inherited disorder of metabolism or a misdiagnosis. This may reflect scientific progress in the better understanding of cellular and molecular dysfunctions as disease-determining factors. Alternatively, the immune response to and the virulence of a virus might have changed by alteration of its genetic code.The suggestion of a defined cause-effect relationship between aspirin intake and Reye syndrome in children is not supported by sufficient facts. Clearly, no drug treatment is without side effects. Thus, a balanced view of whether treatment with a certain drug is justified in terms of the benefit/risk ratio is always necessary. Aspirin is no exception.

Not enough info to back up your claims. Every national organization argues against this. Aspirin does not cause Reyes Syndrome, but it appears to increase the likelihood and there is no similar proof for acetaminophen. When major guidelines change, I'll change my recommendation,

 

[npage148]

Set up a randomized control trial if need further proof. I don't recommend and warn against it for the same reason that I warn against the BC and antibiotics. God forbid some kid gets Reye's or someone gets preggers, I'm screwed regardless of what the data does or does not suggest.

 

[Old Timer]

That one article you site is on the Aspirin Foundation Web Page. While the American Academy of Pediatrics says:

[FONT=Arial, Helvetica, sans-serif]Do not give aspirin to your child because it has been associated with Reye syndrome, a rare but very serious illness that affects the liver and the brain..

http://www.aap.org/publiced/BR_Infections.htm

While the CDC says:

Aspirin or aspirin-containing products (e.g. bismuth subsalicylate – Pepto Bismol) should not be administered to any confirmed or suspected ill case of novel influenza H1N1 virus infection aged 18 years old and younger due to the risk of Reye syndrome. For relief of fever, other anti-pyretic medications such as acetaminophen or non- steroidal anti-inflammatory drugs are recommended.

http://www.cdc.gov/h1n1flu/childrentreatment.htm