weird phone calls

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tussionex

tussionex

Pharmacist
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  1. Pharmacist
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i don't want to be accused of being a lurker 😀
so i'll throw this one out on the stoop and see if the cats licks it up!

i swear, we get the weirdest phone calls on my shift.

1 - patient started on questran for diverticulosis [severe diarrhea is predominant sx]....can't stand the questran, taste, feel, etc...nursing not sure how to give it? any suggestions for palatability? i suggested plain old water...nothing flavored or hot as the patient will be on this long term after discharge and anything they put that powder in will be ruined as far as taste is concerned....anyone think they should find a compounding pharmacy and have the MD write that the powder be punched into capsules? i'm not sure it would be effective, so i thought i would toss it out onto this forum first


2 - patient is a celiac disease sufferer. this was actually handled by the night shift, but it's got me curious. patient is post op, celiac, and claims by virtue of celiac that she is allergic to corn. post op abx is ancef [premix in d5w]...apparently dextrose is contraindicated in corn allergy? why? {sdn...whaddya got?} soooo...they d/c'd the ancef in entirety. must not have needed it that badly. if it were me, i would have suggested another fluid...NS? LR? give it IM? my other question....all i have understood about celiac, both professionally and through friends with the disease, is that corn is tolerated....so, i dont get the connection.

anyone else got any weirdo scenarios?
 
tussionex said:
i don't want to be accused of being a lurker 😀
so i'll throw this one out on the stoop and see if the cats licks it up!

i swear, we get the weirdest phone calls on my shift.

1 - patient started on questran for diverticulosis [severe diarrhea is predominant sx]....can't stand the questran, taste, feel, etc...nursing not sure how to give it? any suggestions for palatability? i suggested plain old water...nothing flavored or hot as the patient will be on this long term after discharge and anything they put that powder in will be ruined as far as taste is concerned....anyone think they should find a compounding pharmacy and have the MD write that the powder be punched into capsules? i'm not sure it would be effective, so i thought i would toss it out onto this forum first
Click to expand...

I can't help you with number two, but I can offer some suggestions for the Cholestyramine. The first is to mix it in a thick fruit juice such as pineapple juice or pear nectar. They are much better at masking the grit. The next thing is to have the patient drink the slop with a straw. When you use a straw you get less slop all over your mouth and face. This has been helpful to me in the past.
 
Oy boy the Celiac patients are worse than diabetics......We have seveal Celiac patients and they drive us crazy asking about gluten in every edible product in the grocery store......
 
good call, OT...i'm sure we have some kind of nectar kicking around...will have to hit up dietary. a straw sounds like a great idea. i can't imagine what the stuff might taste like....ick!
i've only seen it when we compound the "butt paste" for the nicu babies.
 
we change fluids for people all the time if it's compatible and stable enough. and if it's not stable we just have the nurses call an hour before they want to hang the bag.
 
MountainPharmD said:
Oy boy the Celiac patients are worse than diabetics......We have seveal Celiac patients and they drive us crazy asking about gluten in every edible product in the grocery store......
Click to expand...
New pharmacy business opportunity: Celiac Consultant
 
tussionex said:
i don't want to be accused of being a lurker 😀
so i'll throw this one out on the stoop and see if the cats licks it up!

i swear, we get the weirdest phone calls on my shift.

1 - patient started on questran for diverticulosis [severe diarrhea is predominant sx]....can't stand the questran, taste, feel, etc...nursing not sure how to give it? any suggestions for palatability? i suggested plain old water...nothing flavored or hot as the patient will be on this long term after discharge and anything they put that powder in will be ruined as far as taste is concerned....anyone think they should find a compounding pharmacy and have the MD write that the powder be punched into capsules? i'm not sure it would be effective, so i thought i would toss it out onto this forum first.


2 - patient is a celiac disease sufferer. this was actually handled by the night shift, but it's got me curious. patient is post op, celiac, and claims by virtue of celiac that she is allergic to corn. post op abx is ancef [premix in d5w]...apparently dextrose is contraindicated in corn allergy? why? {sdn...whaddya got?} soooo...they d/c'd the ancef in entirety. must not have needed it that badly. if it were me, i would have suggested another fluid...NS? LR? give it IM? my other question....all i have understood about celiac, both professionally and through friends with the disease, is that corn is tolerated....so, i dont get the connection.

anyone else got any weirdo scenarios?
Click to expand...

Tessalon - I'll start with #2, since you asked. Celiac disease is hard - real hard - for pts & providers. Yes - they are real concerned about their gluten & rightfully so - it makes them sick.

However, I doubt she's "allergic" to corn - which would be a reaction to the protein in corn. Real corn allergies are due to the protein (the protein causes the increase in immunoglobulins), which of course there is none in dextrose.

But - often celiacs are "intolerant" to corn. Corn is comprised of protein, fat, starch & some sugars. Starch is just polymerized glucose, which is just dextrose. They not only can't tolerate it in their bowel (in the form of corn or corn starch), they can't tolerate it metabolically. Its actually a common reason for not giving dextrose in the hospital unless you have no other alternative, but its not an "allergy" (ie stimulating immune globulins). So - its not really a "contraindication" like you & I might think of it (I'd bet if you read the OR record, she got plenty of D5-somthin'), but just not the best fluid to give if you don't have to.

Pts often get the "allergy" & "intolerance" mixed up, but in this case, she has a valid issue, just a different mechanism than that which causes an "allergy".

Ancef IM - ouch! no thanks! Its easily given in NS, but since it was just routine post-op coverage, obviously she could get along without it (if she was completely npo, I'd just give a few doses of cephalexin & call it good).

As for #1 - yeah, Old Timer gave as good a suggestion as could be given for the issue. My question is - why cholestyramine? To increase the viscosity in the bowel & decrease bile acid absorption? Kinda different for diarrheal issues with diverticular disease & will interfere with the antibiotics which are probably being given due to the infected diverticula.

I DEFINITELY wouldn't recommend punching capsules. This is expensive & since its not really the drug of choice - why offer. If the guy's not going to take it in the hospital, you can bet he's not going to take it on d/c. Very few pts tolerate cholestyramine even for lipid disorders, let alone this disease.

Since it was nurses calling, you'd have to go with Old Timer's suggestions, but I'd see if I could track down the MD tomorrow to see if you can change tx to a more pt-friendly option.

Good luck!
 
good morning, sdn...
i knew you would have a good answer....and a long one!

yeah, the corn thing stumped me....and 3 other pharmacists. we all looked at the micromedex, then each other, and said "get the he$$ out of here! no way!"
what confused me the most, though, is that my mom's best friend is a celiac patient and a lot of her gluten substitutes contain corn [or rice]. i guess each patient is different! BTW, aren't most people a little bit intolerant of corn's effects on their bowels🙄. i know i am, but that falls under the heading of too much information.

i think ultimately she got switched to PO something...i don't really know the end of the story. i still like the IM idea! yeah, i know....major ouch! seriously, if it were me on the other end of the phone, i would have just switched to NS.

i've been off for 2 days, so i dont know if the questran dude is still there...i will check when i get there today...i suppose you're right, it's going to be a continued compliance issue, so why not explore something else. i don't have his whole story, either...both of these cases i got as a "consult" from my partner pharmacist as i was doing computer work on my shift.

we go over the allergy vs intolerance issue a lot with nurses. they are catching on and when i call to ask if mr so and so stopped breathing or yakked with his last exposure to codeine, they usually have an answer. the patients almost always don't get the concept, and refuse the drug anyway.

time to haul off to another double. thanks for the tips, everyone!
 
ps - now that my questions are answered...i wanna here everyone else's weirdo questions!

c'mon, i know ya got them!


especially my friends in retail!:hardy:
 
You lost me after your personal corn problem.

Thread closed. 😛
 
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OK - I've got one that stumped the student I was working with, but shouldn't stump any pharmacists, so we'll try it here. Its actually a cross-over & can be either hospital or retail applied, but it keeps Tuss from sharing her own dietary intolerances.....😀

So....little old lady (lets call her lol) comes up to rx counter. She chats with me, asks about drsdn (who she met once, but feels as though she knows him like her own grandson...), anyway shares with me a problem she has.

Now....she's either pulling her O2 tank or has it in her cart, but today, she's sporting a new backpack type thing that has the O2 in it. I ooooh & aaah & agree how smart it looks, but asks how can I help with the problem?? (aah - I've got rxs piling up, a tech that just left for lunch, the intern couldn't solve the problem ..... but, yes - she is a cute girl, I agree with lol:meanie:).

Well - the problem is her nose. Here in CA its dry - real dry - even for our summers. Her nasal prongs (which she must use 24-7) are irritating her nares & the area between her nose & lip. What can she use? Cyclo - you folks down there in the dry heat - Zpak & you should be used to this kind of question.
 
I am going to throw my suggestion out here and someone can tell me what they think. There is now an Ocean Gel that is a mosturizing gel. When I talked to the Drug Reps at APha about it, they suggested it for tenderness after you have had a runny nose. I am not for sure what type of irritation this patient has, but on the website for this gel, it says that it can be used dry and chaffing areas. I personally can say that this works for runny nose irriation.
 
How about K-Y? It's water-based so it won't damage the tubing. It's relatively odorless. And it's pretty inexpensive.
 
sdn1977 said:
Well - the problem is her nose. Here in CA its dry - real dry - even for our summers. Her nasal prongs (which she must use 24-7) are irritating her nares & the area between her nose & lip. What can she use? Cyclo - you folks down there in the dry heat - Zpak & you should be used to this kind of question.
Click to expand...


Glycerine. Humectant.
 
Actually - petroleum based products do indeed damage the tubing (as per her RT company - it makes the nasal prongs "stiff" & degrades them faster).

So - she wanted a non-petroleum based product.

Either Ocean Gel or K-Y would work - I suggested the generic K-Y jelly....took her & her new backpack down the aisle to the feminine hygiene products & showed her what I'd recommend. (Ocean is expensive - only 'cause its new & she's on SSI).

We had a nice "chat" - there are so many new ones, she says......warming and all that.....yes, I agreed & we smiled. I think she'd had some experience with K-Y Jelly in her younger years.😉

A few days later she calls with another question & I ask about her dry nose. All is good - but, she says - K-Y has always been good to her.😀 Gotta love the lol!😉😛
 
you can chat about "warming" jelly with the O2 lady but i can't mention a little corn problem...sheesh!😀

i'm happy your patient found a solution...glad to hear she likes her KY!:hardy:
 
tussionex said:
you can chat about "warming" jelly with the O2 lady but i can't mention a little corn problem...sheesh!😀

i'm happy your patient found a solution...glad to hear she likes her KY!:hardy:
Click to expand...

"Warm and Tingly" is not good for oxygen tubing. 🙂
 
sdn1977 said:
OK - I've got one that stumped the student I was working with, but shouldn't stump any pharmacists, so we'll try it here. Its actually a cross-over & can be either hospital or retail applied, but it keeps Tuss from sharing her own dietary intolerances.....😀

So....little old lady (lets call her lol) comes up to rx counter. She chats with me, asks about drsdn (who she met once, but feels as though she knows him like her own grandson...), anyway shares with me a problem she has.

Now....she's either pulling her O2 tank or has it in her cart, but today, she's sporting a new backpack type thing that has the O2 in it. I ooooh & aaah & agree how smart it looks, but asks how can I help with the problem?? (aah - I've got rxs piling up, a tech that just left for lunch, the intern couldn't solve the problem ..... but, yes - she is a cute girl, I agree with lol:meanie:).

Well - the problem is her nose. Here in CA its dry - real dry - even for our summers. Her nasal prongs (which she must use 24-7) are irritating her nares & the area between her nose & lip. What can she use? Cyclo - you folks down there in the dry heat - Zpak & you should be used to this kind of question.
Click to expand...

Im a little late, but here's my 2 cents: Ayr nasal gel. It's water based. Good stuff. I have lots of patients that love it.
 
MountainPharmD said:
Oy boy the Celiac patients are worse than diabetics......We have seveal Celiac patients and they drive us crazy asking about gluten in every edible product in the grocery store......
Click to expand...

I've called up many a generic manufacturer asking, at the behest of a Celiac patient, if the product is gluten-free and contains a potato starch versus a wheat based one.
 
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i have a website bookmarked at work that list gluten content in tabs/caps and is searchable. i'll have to find it and post it.
 
tussionex said:
i have a website bookmarked at work that list gluten content in tabs/caps and is searchable. i'll have to find it and post it.
Click to expand...

That would be helpful. Thanks.
 
Now if you wanted to be really helpful and assuming she wasn't going to kick the bucket any time soon, you should have offered to order a box (12) tubes of the hospital pack of K-Y. They sell for about 25% of the boxed retail pack.
 
Old Timer said:
Now if you wanted to be really helpful and assuming she wasn't going to kick the bucket any time soon, you should have offered to order a box (12) tubes of the hospital pack of K-Y. They sell for about 25% of the boxed retail pack.
Click to expand...


Good job OT!!!! You're never too old - yeah!😉
 
It does not get any drier than Colorado. We sell AYR nasel gel by the case. Those lungers on oxygen swear by it.....

One of them told me once they were told not to use a petroleum based product because of the flammable enviroment it could create with oxygen. I've never seen vaseline catch on fire but I suppose its possible. I told them a more likely reason was because petroleum based products break down the rubber tubing faster.

I am bored. I think I will go try and set some vaseline on fire....BRB!
 
MountainPharmD said:
It does not get any drier than Colorado. We sell AYR nasel gel by the case. Those lungers on oxygen swear by it.....
Click to expand...

On that - I can agree - now give up a phone call. I'm too tired to remember one (except one which really shouldn't be repeated).

So - Mountain - you've done this a long time - what crazy phone calls have you had???
 
MountainPharmD said:
It does not get any drier than Colorado. We sell AYR nasel gel by the case. Those lungers on oxygen swear by it.....

One of them told me once they were told not to use a petroleum based product because of the flammable enviroment it could create with oxygen. I've never seen vaseline catch on fire but I suppose its possible. I told them a more likely reason was because petroleum based products break down the rubber tubing faster.

I am bored. I think I will go try and set some vaseline on fire....BRB!
Click to expand...

Yeah!! Someone agrees with me! Where's Zpak?????????????????? 😕
 
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tussionex said:
patient is post op, celiac, and claims by virtue of celiac that she is allergic to corn.
Click to expand...

Assuming she does know what she's talking about, she could be both celiac and allergic to corn.

tussionex said:
apparently dextrose is contraindicated in corn allergy? why? ?
Click to expand...

While dextrose, the molecule, is not a problem for corn allergy sufferers, the dextrose that is used in medical applications is not 100% pure. It usually contains residue of the plant it was derived from, and that plant is usually if not always corn. There have been medically documented instances of patients allergic to corn having serious allergic reactions to dextrose drips: see, for instance,

Guharoy, SR and Barajas M. 1991. Probable anaphylactic reaction to corn-derived dextrose solution. Veterinary and Human Toxicology. 33(6):609-610.

You can find out more information about medical excipients and other items that may be problematic for patients with corn allergy at http://www.cornfree.ca

Sincerely,

Cornfree
 
hey cornfree...thanks for the info!🙂
 
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