What happens if Triamcinolone Overdose ?

[RxRetailRx]

Received an e-rx from a PA for triamcinolone 0.5% cream qty 454grams .... I called to verify if he mean 0.1% or may adjust qty as there is only 15 grams tube commercially available on 0.5% cream, which means we need to disp. about 30 x15 g tubes to make up the qty.... a MA told me that the PA said ....he prescribe “big jar” all the time , if pharmacy does not have big one, they have to mark it up to whatever the amount to meet that qty.......I told the MA the 0.5% considered “ high potency” , the manufacture only make 15 grams / tube.... she went back to that PA with same answer back ... What are my option now?

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[awval999]

Well I wouldn't dispense 30 tubes of cream.

You're going to have to call back and speak to the PA and explain the "big jar" is 0.1%. And if he wants the "big jar" you're going to change the Rx to 0.1% because the "big jar" doesn't exist in 0.5%.

 

[PA_dud3]

Lol I have this mental image of some MA on the phone just going "NEED BIG JAR, USE BIG JAR ALL TIME"

 

[CetiAlphaFive]

Received an e-rx from a PA for triamcinolone 0.5% cream qty 454grams .... I called to verify if he mean 0.1% or may adjust qty as there is only 15 grams tube commercially available on 0.5% cream, which means we need to disp. about 30 x15 g tubes to make up the qty.... a MA told me that the PA said ....he prescribe “big jar” all the time , if pharmacy does not have big one, they have to mark it up to whatever the amount to meet that qty.......I told the MA the 0.5% considered “ high potency” , the manufacture only make 15 grams / tube.... she went back to that PA with same answer back ... What are my option now?

Is it a pediatric patient?
Is it a healthy adult?

Why are you worried about HPA axis in an adult?

 

[Lnsean]

Received an e-rx from a PA for triamcinolone 0.5% cream qty 454grams .... I called to verify if he mean 0.1% or may adjust qty as there is only 15 grams tube commercially available on 0.5% cream, which means we need to disp. about 30 x15 g tubes to make up the qty.... a MA told me that the PA said ....he prescribe “big jar” all the time , if pharmacy does not have big one, they have to mark it up to whatever the amount to meet that qty.......I told the MA the 0.5% considered “ high potency” , the manufacture only make 15 grams / tube.... she went back to that PA with same answer back ... What are my option now?

Stock size it to the largest tube available and call it a day

 

[lord999]

Transdermal/percutaneous absorption of topical steroids can happen, but you really have to stuff the patient with it or be incredibly stupid when using it. Unless it's a very young pediatric, it's not likely this is a problem except for possibly clobetasol even when used stupidly.

(Sigh, pharmaceutics knowledge in new students...)

 

[pencilandpen]

I would put 450 grams (30 tubes) as the prescribed quantity, and actually dispense 60 grams (4 tubes) and the remaining quality would be refills if the patient still needs it
if I was really concerned I would put a note on the rx and have the tech bring the patient to me when he is done at the register and asked them if they have really bad rash all over their body, counsel them that its high potency, blah blah blah and all that.

I dont think this is even worth wasting your time and calling the doctor for....
I acutally see prescriptions like this all the time, and I use my judgement to dispense what I see fit.

most importantly I leave a note for the patient and ask if they are ok with it, and as long as patient is ok with it, there has never been an issue with the prescriber.

 

[RxRetailRx]

My partner also tried contact the PA yesterday with no luck, end up we disp’d 30 tubes. pt was consulted.., I leaned that pt could use up 2 tubes at once to cover the big area pet pt’s caregiver .

 

[owlegrad]

I am surprised the insurance covered that much. I would be afraid of a clawback on that one, if it was my money anyway.

 

[RxRetailRx]

Is it a pediatric patient?
Is it a healthy adult?

Why are you worried about HPA axis in an adult?

An elderly pt, only concern was if it was a typo , it happens sometimes.

 

[Lnsean]

My partner also tried contact the PA yesterday with no luck, end up we disp’d 30 tubes. pt was consulted.., I leaned that pt could use up 2 tubes at once to cover the big area pet pt’s caregiver .

damn you guys really dispensed 30 tubes? the both of you came up with this solution? lol...come on man...this is ridiculous and so hilarious at the same time.

 

[WVUPharm2007]

I'm more interested in the patient's reaction when they opened up a bag with 30 tubes of cream in it.

 

[CetiAlphaFive]

An elderly pt, only concern was if it was a typo , it happens sometimes.

Oh, I thought your only concern was that there waa risk for can overdose because that's what you wrote.

I guess when you wrote that you were concerned that it's high potency you really meant high quantity.

I'm more interested in the patient's reaction when they opened up a bag with 30 tubes of cream in it.

Hopefully they transfer out