Prescriptions by Optometrists

[BuckRx]

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Well, they do it their way, we do it our way 🙂 If we detect any signs of these systemic diseases we immediately refer to the primary care Doctor because we aren't specialized in treating systemic diseases, but only detection.

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Also check this out: http://www.diabetespharmacist.com/2...rneal-arcus-eye-condition-linked-to-diabetes/
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Your primary care should be doing a funduscopic exam already, but I guarantee optometrists save their share of patients from blindness as well.

 

[Shnurek]

See that's too late. Optometrists may detect these things, but only after signs of damage have occurred. Yearly checkup would pick it up before you could.

Like I said, I'm not familiar with the time frames but ODs and Ophthos regularly monitor controlled diabetics and controlled hypertensives for any changes in the retina. In case their medication might not be working as well anymore or if they are non-compliant with the dosing regimen.

Optometrists may detect these changes and the patient will most likely never be aware about what is happening to them. They might feel fine. Especially when it is just grade 1 retinopathy. Only once it hits grade 3 or grade 4 do they really start feeling the full body symptoms.

In any case when my professor was a student she had a patient with hypertensive retinopathy so she took his blood pressure and found it to be 220/180 and told the patient to go to the emergency room immediately. He left saying that he was fine and two days later he died from a hemorrhagic stroke.

Your primary care should be doing a funduscopic exam already, but I guarantee optometrists save their share of patients from blindness as well.

Hah, my primary care Doctor doesn't know how to focus an ophthalmoscope correctly. They might see the optic disk and take a brief view of the fundus.

Here's an interesting article about the shift in the role of the traditional Optometrist: http://www.healio.com/optometry/pri...y-care-evaluation-systemic-disease-management

 

[eagles22]

Like I said, I'm not familiar with the time frames but ODs and Ophthos regularly monitor controlled diabetics and controlled hypertensives for any changes in the retina. In case their medication might not be working as well anymore or if they are non-compliant with the dosing regimen.

In any case when my professor was a student she had a patient with hypertensive retinopathy so she took his blood pressure and found it to be 220/180 and told the patient to go to the emergency room immediately. He left saying that he was fine and two days later he died from a hemorrhagic stroke.

Like we said, you'll have a role in monitoring their eyes, but you're not the person who should be evaluating the progress of the disease since there are more effective means to doing so. Even in you example, but the time they noted it in the eye, the patient was close to dying. All that stuff you've shown is cool, but the medical doctor is the guy who is going to really be doing the heavy lifting in all the disease you've mentioned since he has the tools that are more effective for preventive care.

 

[BidingMyTime]

Off-topic, by why do optomotrists (at least in my area) always write DAW-1 for every single prescription? The pt's insurance does not want to pay for brand name Pred-Forte, Tobradex, and I don't think brand name Polytrim is even made any more, so save us both a bunch of time and allow us to make generic substitution.

 

[BidingMyTime]

:. Physicians see them as first-line pain medication. They almost never start with Motrin 600 or Motrin 800 - instead, they write a script for oxycodone 5 mg 1-2t q 4-6h prn. Oxycodone is NOT a first line pain medication. Hydrocodone should not be used for mild pain.

This may be a problem with your prescribers. It's extremely rare that I see oxycodone written as a first-line pain medicine by anyone but a surgeon (and occasionally an ER doctor)

2. They are either suckers or do not care enough to monitor drug usage. I regularly have physicians calling me authorizing an early fill of oxycodone/methadone/morphine FOR THE SAME STRENGTH AND DIRECTIONS.

This is definitely a problem with your prescribers. Most prescribers, at least in my area (granted I don't live in Florida) prescribe quite reasonably and do not give early refills more than once.

3. Some pharmacists do not believe that we are responsible for refusing to dispense prescriptions that we believe are being diverted or misused. This is evident in another recent thread - "Call the pill mill doc, once they authorize it just go ahead." I don't think this is morally, ethically or legally right. If you have good reason to believe that patient is diverting or abusing, it is your JOB to refuse to dispense.

I was not trained to be a police officer, not do I have the training to diagnosis the degree of a patient's pain, nor do I feel any compulsion to morally/ethically tell a patient what they should do. If there is a legitimate concern that a patient is overdosing on a medicine (or selling it), then I would refuse the prescription. If it's just that the patient is running out a week short every month, and I have talked to the physician and they are OK with the patient taking extra doses, than I am not going to refuse to dispense it (although I would encourage the physician to write the prescription to reflect the extra doses that the patient is taking.)

4. Patients have been given the idea that they can and should expect a pain-free life. If you have chronic back pain, you cannot expect to have no pain ever. Your goal should be to increase functionality and allow ADLs to be accomplished without excessive pain, NOT to be pain free. Patients (and family members of mine) frequently do stuff like take multiple pain medications so that they can do things that they should NOT be doing with chronic back pain, such as: planting trees, doing extensive house repairs including ladder work and heavy carrying, and things of that nature.

I totally disagree with this. The goal of pain relief is that the pt can carry on a normal life. Most people do not have good enough disability insurance that they can lay around and be taken care of. Do you want the state to increase the disability rolls and raise your taxes to pay for it? Most people HAVE to work, and many jobs involve at least standing on ones feet, as well as a certain amount of lifting & walking. And they may need strong narcotics in order to get through the day. And who are you to say that treatment goal shouldn't be to be pain-free? If you are or a loved one ever experience chronic pain which could not be cured, you would probably be more understanding. Of course, there will always be flare-ups and such, but the goal for treatment should be to make the patient as pain-free as possible and able to accomplish whatever their job entails.

End story: physicians need to STOP prescribing these medications for the average patient. In my PERSONAL experience, they are pushed on you. Last time I visited the ER, I rated my pain at a 5 of 10 when asked and was offered oxycodone THREE TIMES, despite saying no each time. Seriously, that is out of control.

The medicine the ER would offer you is also going to be based on the extent of your injury/problem, not just how you rate your pain. The ER will also look for other signs to gauge how severe your pain is, like increased BP/pulse. If you go in with a hangnail and rate your pain a 10, you will NOT get oxycodone. ER's are quite aware that many people have an undue fear of narcotics and addiction, and/or that people will downplay their pain because they are "tough." For you to have been offered oxycodone 3 times, undoubtedly there were other reasons why the nurse/doctor was offering you that, besides just your 5 out of 10 pain rating.

 

[Shnurek]

Like we said, you'll have a role in monitoring their eyes, but you're not the person who should be evaluating the progress of the disease since there are more effective means to doing so. Even in you example, but the time they noted it in the eye, the patient was close to dying. All that stuff you've shown is cool, but the medical doctor is the guy who is going to really be doing the heavy lifting in all the disease you've mentioned since he has the tools that are more effective for preventive care.

True, I'm more interested in diseases isolated to the ocular system.

 

[Shnurek]

Off-topic, by why do optomotrists (at least in my area) always write DAW-1 for every single prescription? The pt's insurance does not want to pay for brand name Pred-Forte, Tobradex, and I don't think brand name Polytrim is even made any more, so save us both a bunch of time and allow us to make generic substitution.

Maybe they like the free lunches from the drug reps, who knows lol

 

[BuckRx]

Hah, my primary care Doctor doesn't know how to focus an ophthalmoscope correctly.

Because you would totally know if he didn't.

🙄

 

[All4MyDaughter]

Maybe they like the free lunches from the drug reps, who knows lol

Dude, there ARE no drug reps for those kinds of drugs. They have been off patent so long, no one is marketing them. Which is why it's dumb to write DAW for them.

 

[Carboxide]

This may be a problem with your prescribers. It's extremely rare that I see oxycodone written as a first-line pain medicine by anyone but a surgeon (and occasionally an ER doctor)



This is definitely a problem with your prescribers. Most prescribers, at least in my area (granted I don't live in Florida) prescribe quite reasonably and do not give early refills more than once.



I was not trained to be a police officer, not do I have the training to diagnosis the degree of a patient's pain, nor do I feel any compulsion to morally/ethically tell a patient what they should do. If there is a legitimate concern that a patient is overdosing on a medicine (or selling it), then I would refuse the prescription. If it's just that the patient is running out a week short every month, and I have talked to the physician and they are OK with the patient taking extra doses, than I am not going to refuse to dispense it (although I would encourage the physician to write the prescription to reflect the extra doses that the patient is taking.)



I totally disagree with this. The goal of pain relief is that the pt can carry on a normal life. Most people do not have good enough disability insurance that they can lay around and be taken care of. Do you want the state to increase the disability rolls and raise your taxes to pay for it? Most people HAVE to work, and many jobs involve at least standing on ones feet, as well as a certain amount of lifting & walking. And they may need strong narcotics in order to get through the day. And who are you to say that treatment goal shouldn't be to be pain-free? If you are or a loved one ever experience chronic pain which could not be cured, you would probably be more understanding. Of course, there will always be flare-ups and such, but the goal for treatment should be to make the patient as pain-free as possible and able to accomplish whatever their job entails.



The medicine the ER would offer you is also going to be based on the extent of your injury/problem, not just how you rate your pain. The ER will also look for other signs to gauge how severe your pain is, like increased BP/pulse. If you go in with a hangnail and rate your pain a 10, you will NOT get oxycodone. ER's are quite aware that many people have an undue fear of narcotics and addiction, and/or that people will downplay their pain because they are "tough." For you to have been offered oxycodone 3 times, undoubtedly there were other reasons why the nurse/doctor was offering you that, besides just your 5 out of 10 pain rating.

I don't live in FL either, or anywhere near it. There's nothing on the news about my state or area having a narcotic "problem."

As for my ER visit, I can assure you that there were no issues that would precipitate that need of pain medication. It was not injury-related and I did not receive any procedures that would require premedication of any sort.

 

[Shnurek]

Because you would totally know if he didn't.

🙄

Yes, because I use one all the time? And my fellow students practice on me. So when he spent two seconds looking into each one of my eyes without even moving the focusing dial, I know what's going on, trust me.

Dude, there ARE no drug reps for those kinds of drugs. They have been off patent so long, no one is marketing them. Which is why it's dumb to write DAW for them.

Do they differ at all in active and inactive ingredients?

 

[BidingMyTime]

Do they differ at all in active and inactive ingredients?

There is absolutely no difference in the active ingredients. Inactive ingredients can be different, but we are talking eye drops. There are a limited amount of preservatives & buffers that can be used. If the patient had a document allergy to a certain preservative, then I could see going with the name brand (but lets face it, how many optomatrists have any idea what individual preservatives/buffers are in any specific companies brand of a specific eye drop?)

I see 2 possibilities

1) the optomatrist has a "god-complex" and wants to dictate a specific brand just so he can feel important when the pharmacist calls to get it changed to generic

2) the optomatrist has absolutely no idea that "generic substitute" means and thinks the pharmacist will be doing a therapeutic substitution, instead of a generic substitution, if (s)he checks generic substitute allowed.

 

[All4MyDaughter]

Do they differ at all in active and inactive ingredients?

I was going to instruct you to look this up, but someone already gave you the answer. However. You SHOULD know the significance of generic substitution and what it means in terms of interchangeability etc.

 

[Shnurek]

I was going to instruct you to look this up, but someone already gave you the answer. However. You SHOULD know the significance of generic substitution and what it means in terms of interchangeability etc.

Just started taking Pharm now. Or it could be 3) The Optometrist dislikes the patient and wants them to lose money lols

 

[All4MyDaughter]

Just started taking Pharm now. Or it could be 3) The Optometrist dislikes the patient and wants them to lose money lols

Cool. But I always tell my students that if they are going to talk about something, they should make sure they know what they are discussing. And look things up before asking. Be proactive. 😉

 

[npage148]

Do they differ at all in active and inactive ingredients?

In an equally ignorant question, why is the EXCACT same contact lens labelled for daily wear two week disposable in the USA but labelled for much longer wear and disposable intervals when sold outside the US? Why does my OD get grumpy when I mention this?

 

[VA Hopeful Dr]

In an equally ignorant question, why is the EXCACT same contact lens labelled for daily wear two week disposable in the USA but labelled for much longer wear and disposable intervals when sold outside the US? Why does my OD get grumpy when I mention this?

I'll field this one. Its a combination of the manufacturer's labeling and the legal climate.

If a lens is marketed for 2 weeks in the US, even if its OK'ed for longer in England, you (as an OD in the US) OK someone here to wear them for 4 weeks, they get a corneal ulcer and lose some of their vision then you are going to lose that lawsuit.

 

[npage148]

Figured as much, thanks