Retail question

[Actinomycin]

Over the weekend when you get prescriptions with small errors or if you dont have products available and the doctor is hard to reach, would you just go ahead and fill the following prescriptions?
1) Antibiotic : Sig - TID for 7 days, Dispense 7, No refills (Would you just give 21 without calling the doctor?)
2) Doctor asks for Extended release (maybe cipro or carbamazepine with no refills). Would you fill with immediate release if doctors office is closed, pharmacy is super busy and patient just wants his medication and understands the difference between immediate release and ER?
3) Also if you are a floater, do you dig out the hard copies and write Void and the other information on them when you trasnfer C3-5?
4) Any similar situations that anyone else can bring up?

---

Members don't see this ad.

 

[GamecockPharmD]

Over the weekend when you get prescriptions with small errors or if you dont have products available and the doctor is hard to reach, would you just go ahead and fill the following prescriptions?
1) Antibiotic : Sig - TID for 7 days, Dispense 7, No refills (Would you just give 21 without calling the doctor?)
2) Doctor asks for Extended release (maybe cipro or carbamazepine with no refills). Would you fill with immediate release if doctors office is closed, pharmacy is super busy and patient just wants his medication and understands the difference between immediate release and ER?
3) Also if you are a floater, do you dig out the hard copies and write Void and the other information on them when you trasnfer C3-5?
4) Any similar situations that anyone else can bring up?

1) I would give 21 and not worry about calling the doc. He obviously meant a 7 day supply.
2) No, if the doctor asked for extended release, dispense the extended release. The only time you would dispense the immediate release instead is if you have discussed it with the doctor and you document it on the prescription. If you don't have it, apologize and tell him/her you can either order the drug or he/she can take it somewhere else.
3) Let your computer system take care of that. It shouldn't allow anyone else to fill the prescription if it has been transferred. I've never heard of pharmacists pulling the hard copies of scheduled prescriptions and voiding them after a transfer. However, check your state law requirements.
4) Nah.

 

[Ackj]

Over the weekend when you get prescriptions with small errors or if you dont have products available and the doctor is hard to reach, would you just go ahead and fill the following prescriptions?
1) Antibiotic : Sig - TID for 7 days, Dispense 7, No refills (Would you just give 21 without calling the doctor?)
2) Doctor asks for Extended release (maybe cipro or carbamazepine with no refills). Would you fill with immediate release if doctors office is closed, pharmacy is super busy and patient just wants his medication and understands the difference between immediate release and ER?
3) Also if you are a floater, do you dig out the hard copies and write Void and the other information on them when you trasnfer C3-5?
4) Any similar situations that anyone else can bring up?

1) I would fill for 21 (in this case) because that's clearly what they meant. If it was something else, probably would call. Actually today we had zolpidem dispense 3 rather than 30 we called just because its controlled.
2) Wouldn't mess with er/ir, they picked those for whatever reason so dosing frequency and kinetics would be different.
3) Transfers automatically void on our system, so we don't bother doing that.
4) We had a script a few days ago, Levitra dispense 4, take one qd. Definitely the wrong sig, especially considering the ds, so we just changed to 'as directed'.
Things that are more ambiguous, we'd call on. I forget the drug, but there was something that was like tid x10 days, dispense 20. Hard to say if they meant dispense 30 or if it was bid x10, so we called.

 

[Pharmguy07]

There are very few discrepancies that I don't call on. It's not my job to guess what the doctor meant to prescribe. I'm not about to put anything on the line because the doctor certainly won't have my back if I guess wrong.

 

[crazybob]

Over the weekend when you get prescriptions with small errors or if you dont have products available and the doctor is hard to reach, would you just go ahead and fill the following prescriptions?
1) Antibiotic : Sig - TID for 7 days, Dispense 7, No refills (Would you just give 21 without calling the doctor?)
2) Doctor asks for Extended release (maybe cipro or carbamazepine with no refills). Would you fill with immediate release if doctors office is closed, pharmacy is super busy and patient just wants his medication and understands the difference between immediate release and ER?
3) Also if you are a floater, do you dig out the hard copies and write Void and the other information on them when you trasnfer C3-5?
4) Any similar situations that anyone else can bring up?

With 1), you could just loan them enough to get them through a weekend or a day until you could call the doctor again.

On 2), it may not be best for the patient to go with IR, if the doctor chooses ER over IR.

 

[Old Timer]

Never, ever, ever assume,

You make and ASS out of U and ME

 

[Actinomycin]

Thanks for the responses - that really helps!

For ER vs IR, I am trying to read the following document and it seems to me that a pharmacist can substitute the product if they are equivalent in his/her professional opinion and they dont necessary need to be A, AB rated products in some states like Georgia and Washington -
http://www.pharmacistsletter.com/pl/220901.htm

http://www.pharmacistsletter.com/(S...&fpt=31&dd=220901&pb=PL&cat=2997&segment=1186
I just feel bad about telling NO to patients when I know they would just go without the drug for 3 days till I hear back from the PA or the doctor and am trying to figure out if I can rarely substitute without a physicians approval without putting my license on the line.

For the controls transfer I do know atleast a couple of pharmacists who pull out each hard copy and put VOID on it. They said that while no state law requires it, DEA requires it (although it would be reflected in the automated systems!!!)
http://www.pharmacytimes.com/issue/pharmacy/2007/2007-02/2007-02-6309

http://www.ascp.com/education/meetings/annual/upload/AM09%20-%20The%20Controlled%20Substances%20Act.pdf

Also when you guys get a very fishy looking C2 script, do you say "I would not fill it until I verify with the doctor" or simply "I am sorry we dont have any Roxicodone"

 

[museabuse]

Thanks for the responses - that really helps!



Also when you guys get a very fishy looking C2 script, do you say "I would not fill it until I verify with the doctor" or simply "I am sorry we dont have any Roxicodone"

If its after 5pm or weekend and someone brings in a oxy 15,30, or oxycontin rx for anything over quantity of 60 and they dont regularly get it and/or they are paying cash or using a discount card that is a red flag for me. I usually don't say i don't have it, I usually say I can't fill this rx because it is a high dose and since I can't verify you have been on it before I would have to check with dr first. They usually dont argue with that....

 

[spacecowgirl]

Fishy scripts get a "I'm having trouble understanding the directions so I put a call into your doctor (or doctor's answering service)." That usually solves it.

 

[Ilikechemicals]

Most docs have an on call service. I either contact the on call doc or make them page the doctor that wrote it. No sense in you dispensing incorrectly for another's mistake or ambigous directions.

 

[All4MyDaughter]

For ER vs IR, I am trying to read the following document and it seems to me that a pharmacist can substitute the product if they are equivalent in his/her professional opinion and they dont necessary need to be A, AB rated products in some states like Georgia and Washington -
http://www.pharmacistsletter.com/pl/220901.htm

I don't see anything in that document that implies you can sub IR for ER or vice versa.

To use your example (Georgia):

A pharmacist may substitute a drug with same generic name in the same strength, quantity, dose, and dosage form as the prescribed brand name drug product which is, in the pharmacist's reasonable professional opinion, both pharmaceutically equivalent and therapeutically equivalent

In my opinion (and according to my professors), ER and IR are NOT the same dosage form and are not equivalent. They have different rates of release, different durations of action, etc.

I don't think you can interchange them, and I wouldn't do it without calling the prescriber.

 

[Ackj]

I just feel bad about telling NO to patients when I know they would just go without the drug for 3 days till I hear back from the PA or the doctor and am trying to figure out if I can rarely substitute without a physicians approval without putting my license on the line.

If they've been taking it, there's no harm in giving them a day or two more of the same thing. If they haven't been on it before, there should be no problem going 2 more days without it, considering they've already gone x number of years without. There are obviously exceptions to this though (post-op, abx, etc).

 

[Old Timer]

Thanks for the responses - that really helps!

For ER vs IR, I am trying to read the following document and it seems to me that a pharmacist can substitute the product if they are equivalent in his/her professional opinion and they dont necessary need to be A, AB rated products in some states like Georgia and Washington -
http://www.pharmacistsletter.com/pl/220901.htm

Please read this again very carefully and tell if you still feel that way. This is not a correct interpretation.

A regular release tablet and a sustained release tablet are NOT the same dosage form and they would NEVER get an A rating in the FDA orange book.

 

[rxforlife2004]

Over the weekend when you get prescriptions with small errors or if you dont have products available and the doctor is hard to reach, would you just go ahead and fill the following prescriptions?
1) Antibiotic : Sig - TID for 7 days, Dispense 7, No refills (Would you just give 21 without calling the doctor?)
2) Doctor asks for Extended release (maybe cipro or carbamazepine with no refills). Would you fill with immediate release if doctors office is closed, pharmacy is super busy and patient just wants his medication and understands the difference between immediate release and ER?
3) Also if you are a floater, do you dig out the hard copies and write Void and the other information on them when you trasnfer C3-5?
4) Any similar situations that anyone else can bring up?

1. Fill 21. Period
2. No. Call and verify. Don't be lz.
3 .No. Who gives a shiet.

 

[DAW2]

#1 -- seen this before. sometimes it is #7, because they gave patient samples. I'd ask if they got samples. if not, eh give em 21
#2 -- gotta verify, it's that simple.
#3 -- heck naw