What does your pharmacy manager hate most about you?

[Sparda29]

To be fair, I'm 25 and take a (CVS generic) Flintstone vitamin every day.

Flintstone vitamins are frikkin awesome. Although, you kinda have to take more than what the label says since you're an adult. I personally like the gummy vitamins.

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[Quiksilver]

Flintstone vitamins are frikkin awesome. Although, you kinda have to take more than what the label says since you're an adult. I personally like the gummy vitamins.

hold it there padawan, i thought this thread would serve as a lesson to be a little more cautious:
http://flintstonesvitamins.com/complete/index.html

In this formulation, there is no need to take more then 1. The formulation has more then enough of most ingredients, in some cases taking more then necessary is as dangerous as a deficiency. In some cases, like vitamin C, taking more then 500 mg at a time is useless because its absorption becomes saturated.

its kind of interesting to see with this label how children are not like "little adults" but still have a lot of similarities in the way the drug is metabolized and eliminated. These properties are important to consider even in OTC recommendations.

 

[Old Timer]

hold it there padawan, i thought this thread would serve as a lesson to be a little more cautious:
http://flintstonesvitamins.com/complete/index.html

In this formulation, there is no need to take more then 1. The formulation has more then enough of most ingredients, in some cases taking more then necessary is as dangerous as a deficiency. In some cases, like vitamin C, taking more then 500 mg at a time is useless because its absorption becomes saturated.

There are several things I disagree with. First, there will be zero harm from taking two of those Flintstone vitamins. Look at something like this and you will see there is no way that's dangerous.

In some cases, like vitamin C, taking more then 500 mg at a time is useless because its absorption becomes saturated.

I don't think that's a true statement. There are pools of Vitamin C in the body that build up with higher doses. You don't just wash out the excess.... In fact to saturate the pools in the average human 120mg (2 Flinstones) would be perfect.....

 

[Doctor M]

hold it there padawan, i thought this thread would serve as a lesson to be a little more cautious:
http://flintstonesvitamins.com/complete/index.html

In this formulation, there is no need to take more then 1. The formulation has more then enough of most ingredients, in some cases taking more then necessary is as dangerous as a deficiency. In some cases, like vitamin C, taking more then 500 mg at a time is useless because its absorption becomes saturated.

its kind of interesting to see with this label how children are not like "little adults" but still have a lot of similarities in the way the drug is metabolized and eliminated. These properties are important to consider even in OTC recommendations.

actually oldtimer, this is taught in the kinetics class at the university at buffalo. I remember learning this in kinetics back in 2002! So unless the kinetics department is totaly wrong and dont know what their talking about then i would have to agree with quicksilver.

 

[Praziquantel86]

I don't think that's a true statement. There are pools of Vitamin C in the body that build up with higher doses. You don't just wash out the excess.... In fact to saturate the pools in the average human 120mg (2 Flinstones) would be perfect.....

I'm not so sure about this. The water-soluble vitamins are eliminated fairly rapidly from the body, and require daily intake to maintain adequate levels. If we were talking about a fat-soluble vitamin, I would definitely agree with you.

 

[Old Timer]

Do some research on Vitamin-C Pools. I agree 500mg is too much. But to maintain saturate the pools of Vitamin C in most people you need 120-140mg per day and that's 2 Flintstone Vitamins.

B-Vitamins get washed right out, but Vitamin C is different it builds up in pools. The pool can be expanded beyond what is considered necessary for optimum health, but there are no studies to back up the claims made mostly (though not exclusively) by the supplement industry....

Look at this the pool can be increased with increasing dose and the half will decrease with increasing dose..... And that's what I remember from taking food & nutrition in 1981.....

 

[Praziquantel86]

Do some research on Vitamin-C Pools. I agree 500mg is too much. But to maintain saturate the pools of Vitamin C in most people you need 120-140mg per day and that's 2 Flintstone Vitamins.

B-Vitamins get washed right out, but Vitamin C is different it builds up in pools. The pool can be expanded beyond what is considered necessary for optimum health, but there are no studies to back up the claims made mostly (though not exclusively) by the supplement industry....

Look at this the pool can be increased with increasing dose and the half will decrease with increasing dose..... And that's what I remember from taking food & nutrition in 1981.....

Very interesting. It looks like you could get away with one Flintstone Vitamin after the body pool has been saturated, the other half should be accounted for in a normal diet.

I've never heard of these Vitamin C pools before, I'm going to have to look into them.

 

[Quiksilver]

There are several things I disagree with. First, there will be zero harm from taking two of those Flintstone vitamins. Look at something like this and you will see there is no way that's dangerous.


I don't think that's a true statement. There are pools of Vitamin C in the body that build up with higher doses. You don't just wash out the excess.... In fact to saturate the pools in the average human 120mg (2 Flinstones) would be perfect.....

you don't like me do you? I guess I need to type a 3 page paper to explain everything.

There is zero harm with taking 2 vitamins yes, I agree. However when you start taking excess and excess of vitamins, they can be harmful as well (this is what I am getting at), do I need to go over overdoses with vitamins? The other point I would like to address is why would you want to take more then 1 flintstone vitamin anyways? Is it clinically relevant to take more then one? Many people's dietary intake is sufficient enough where they don't need 100% of daily requirements from a vitamin. So why bother and worry? Taking 1 daily is sufficient enough for MOST people who may not have the best diet in the world.

Was my response sufficient for your issue with quinolones? I see your not whining about that.

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=39676
click on image 3705

kinetics of vitamin C ABSORPTION: The most that people can absorb at any given time is 500 mg, because it is actively transported from the gut into circulation. Therefore taking any more of it, is useless and there are no larger pools in the body unless you are injecting it like heroin

 

[Old Timer]

you don't like me do you? I guess I need to type a 3 page paper to explain everything.

There is zero harm with taking 2 vitamins yes, I agree. However when you start taking excess and excess of vitamins, they can be harmful as well (this is what I am getting at), do I need to go over overdoses with vitamins? The other point I would like to address is why would you want to take more then 1 flintstone vitamin anyways? Is it clinically relevant to take more then one? Many people's dietary intake is sufficient enough where they don't need 100% of daily requirements from a vitamin. So why bother and worry? Taking 1 daily is sufficient enough for MOST people who may not have the best diet in the world.

Was my response sufficient for your issue with quinolones? I see your not whining about that.

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=39676
click on image 3705

kinetics of vitamin C ABSORPTION: The most that people can absorb at any given time is 500 mg, because it is actively transported from the gut into circulation. Therefore taking any more of it, is useless and there are no larger pools in the body unless you are injecting it like heroin

Stop fixating on the 500mg or the 1 in 1000000 rxs for a flouroquinolone that's for a pediatric patient. Just because you saturate the pools at a certain point does not mean they do not exist. Just because some small subset of pediatric patients should take flouroquinolones does not mean they should be used for most patients...

 

[Praziquantel86]

Was my response sufficient for your issue with quinolones?

There definitely are safer alternatives for the vast majority of indications. It's not worth having tendons popping left and right when Macrodantin would do the trick just fine.

 

[meister]

What the hell is going on ITT?

 

[b*rizzle]

Er... bad example...

I don't think many practicing pharmacists are that miticulous either, unfortunately. Sad, but yeah.

Rules are there for a reason. To help Sparda29 understand this a bit better, I use myself as an example.

To preface the story, I'll give you an idea of how much my pharmacists trust my knowledge: I've earned the nickname "Lexi" at my pharmacy, since I'm very comfortable with my drug knowledge. I know my stuff. My pharmacists will let me do just about anything they do, except check. But here's proof that bad things can happen to the best of us...

We had some lady come in and buy some Mucinex-D for her husband. As the tech was ringing her up, the lady asked the tech if warfarin interacts with pseudoephedrine. The tech comes over to me & asks the question. I come over to the lady and answer the question. Things were a little busy, so I didn't have time to follow up on WHY he was on the warfarin. Besides, I had just spoken to a woman before that weekend who was looking for the "old school" Dayquil, since her husband was on warfarin and it was the only thing the doctor recommended for cold symptoms. So I didn't think too much about it.

A few minutes later, the lady comes back over to the counter where myself and two pharmacists are standing, filling Rxs. She says: "I just got off the phone with my husband's doctor, and he recommended this thing called Coricidin HBP. Do I really need it?" One of the pharmacists was on the phone and didn't hear her question. The other pharmacist said to her: "I'd probably go with the doc on that one." I nodded and said I'd show her where to find it.

I walked out to the cold & allergy aisle, and picked up a box of Coricidin HBP. I explained to her what was in the Coricidin, to which she asked: "Do you think he really needs it? Does it work as well as Mucinex D for sinus congestion?"

I responded, "I'm not as familiar with your husband's medical history as his physician is, so I'd go with his recommendation. And no, it's probably not going to work quite as well as the Mucinex D for sinuses, but you really don't have a choice. You could also do a nasal spray if you're leery of the Coricidin..." The lady shrugged, thanked me, and walked off.

Turns out that the pharmacist who was on the phone that night remembers this lady, and that she's asked about PSE before. TWICE she had been told no, since her husband has heart problems. Naturally, I freaked out and asked the name, and looked up the profile. The husband has heart failure AND A-fib.

Great.

I grabbed the phone, and called the husband at home. He sounded a bit bewildered to hear from me, but I basically told him: "Your wife is bringing a cough/cold product home for you. Don't take it." I told him what could happen, and asked him some follow-up questions about his condition to interpret the risk of what actually could happen if he took it...BP normal to low, HF under control, warfarin dose stable & regularly monitored...

Then you'd better believe I documented the hell out of what happened. I still didn't sleep very well for the next two or three nights.

Turns out a couple of days later, the wife came in screaming and raising Cain because she told the husband's MD about it at his doctor's appointment the following day. The MD then flipped out and told her that she "could have killed him if [she'd] given it to him." She blasted the pharmacist on duty and told her that "she didn't want to speak to an intern, she wanted the pharmacist...serious things like that shouldn't have been left up to someone who didn't know what they were doing..." and so on.

The pharmacist apologized profusely and said she'd talk to all the interns about it, but did take note of the documentation I'd left on his profile in the computer. There were also witnesses to my side of the story.

In any case, I almost had a full-on panic attack when I heard about this. (It didn't help that our worrywort pharmacy manager began talking about liability insurance, etc).

He didn't take any, so no one was hurt and no one was in trouble (legally). People (patients) are going to hear what they want to, and there's nothing you can do about that.

Regardless of how confident you are in your abilities, if you're not supposed to be doing something, don't do it. Someone could lose their job over your good intentions.

Even after one of our four pharmacists tried to console me and said it could have happened to any of the RPhs, I still feel like I have to gain back everyone's trust. And that is one of the worst feelings, second to knowing that someone could have been hurt or lost a job over something that could have potentially been construed as my fault.

It's been one of the most humbling experiences I've had in my five years working in pharmacy.

 

[Quiksilver]

Stop fixating on the 500mg or the 1 in 1000000 rxs for a flouroquinolone that's for a pediatric patient. Just because you saturate the pools at a certain point does not mean they do not exist. Just because some small subset of pediatric patients should take flouroquinolones does not mean they should be used for most patients...

nowhere in what I said talks about the probability of having a fluoroquinolones prescribed to a pediatric patient. Nowhere did I give an indication, your issue is, that they are "too young," implying that they have no use at all. I found uses for the. In fact, I originally didn't say the patient was pediatric in the first place. But a seasoned veteran like yourself should know better to ask before you make a judgement.

I don't know why you keep bringing up pools of Vitamin C. This was never my point to bring up. I'm not talking about the distribution and what happens or how much accumulates in the body at a given time. that is irrelevent to talking about taking 1 or 3 vitamin C (lets just consider vitamin c at this time) tablets at a given time. If you take 3 of them at once, you WILL NOT ABSORB ANY MORE THEN 500 MG OF VITAMIN C AT A GIVEN TIME. I AM NOT TALKING ABOUT ACCUMULATION, I AM TALKING ABOUT HOW MUCH YOU ABSORB. I do not know the kinetics beyond that and its not the point. the original issue was taking more then 1 flintstone vitamin at a time. This is an example of why it is not a good idea.

As for being a role model for the rest of us, you have singled me out this entire thread, while others are acting unprofessionally, illegally and idiotically. You really know who to make an example of. Congratulations for having good judgement. I do not know what your problem is and what I ever did to you. Your vigilante attitude is annoying and childish. Grow up.

 

[njac]

Don't worry Quiksilver, I just don't like you because your school stole one of my favorite professors.

Oh wait, no, that was Albany. Ok, you're cool again.

 

[Quiksilver]

Don't worry Quiksilver, I just don't like you because your school stole one of my favorite professors.

Oh wait, no, that was Albany. Ok, you're cool again.

aww.. shucks, I think your dog is cute.

 

[njac]

aww.. shucks, I think your dog is cute.

thank you! I loves him. I keep asking where he wants to move for residency but he doesn't care. He's a wuss so he might end up being afraid of the ocean... I don't suggest asking dogs where they want to live. They just want cookies.