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Old 08-24-2016, 04:59 PM   #21
Flyndaran
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Default Re: [Basic] Skill of the week: Pharmacy and Poisons

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Originally Posted by Celti View Post
...
Anyone who has medical issues that require them to have more than one doctor that they see regularly has learned it is a good idea to cultivate a long-term professional relationship with their local pharmacist more than once I've had one doctor prescribe something that had potentially-lethal drug interactions with someone another doctor had me on, and it didn't get caught until the pharmacist received my prescription to fill.
...
When recovering from surgery, my pharmacist and doctor both dropped the ball failing to understand my issues. Extreme resistance to opiates that I now know may have been increased due to the one medication I was on, meant every pain med they changed too was just as ineffective as the previous.
My GF said I called them up and used rather harsh words that I have no memory of doing as I was in severe pain and altered mentally by otherwise ineffective drugs.
If I'd had a long term working relationship with either doctor or pharmacist, I can only imagine how we could have minimized my torture.
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Old 08-24-2016, 05:22 PM   #22
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Default Re: [Basic] Skill of the week: Pharmacy and Poisons

We have many "big box" style pharmacies in Ontario, which are really a kind of department store that happens to sell a lot of health products and has a little pharmacy counter at the back. This is also the kind of situation with e.g. a Wal-Mart or grocery store that has a pharamcy counter.
These type definitely have a staff of technicians, and a supervising pharmacist. I believe the pharmacist actually has to be in the building, however. Not just "available". There's a bunch of off-the-shelf medications that can only be sold while the pharmacist is in the building - in the case where the pharmacist goes home but the store is a 24 hour store or whatever, they have gates to wall off that section.

We also have dedicated pharmacies here too. These generally don't have technicians at all, and have one to three pharmacists trading off shifts. The customer area of the store is usually a couple of chairs for while you wait, and a few shelves of a limited range of off the shelf drugs like pain killers, allergy medications, etc. or medical devices like joint braces.

Both kinds inevitably have at least a shelf full of vitamins and herbal supplements, and often a rack of the homeopathy sugar pills.

Our pharmacy is the small, dedicated kind. Their chain requires them to have a display of the homeopathy sugar pills, but doesn't dictate store layout. I've noticed that the pharmacist has chosen to shelve them with the candy bars and soda off in a corner, along with that one copper bracelet.

A big-box pharmacy doesn't do recompounding, and won't order things for you. A dedicated pharmacy might be one that does recompounding (which are a vital medical service - if the government tries to make that illegal, they'll be killing people).

The idea that recompounding is "messing about with drugs" is the weirdest idea I've heard, and I think might be suffering from some sort of language or cultural barrier.

A recompounding pharmacist is not pottering about back there mixing random drugs with random media to see what happens, any more than doctors just pick random drugs out of a list to prescribe to you. Both the doctor and the pharmacist are working with a lot of pre-existing literature and processes.

My partner can't swallow pills, or anything else that hasn't been blended or chewed to death - it's a physical problem. Some of his medications have been available with a "standard" liquid alternative. Some simply don't, and then things get exciting.

Simple pills with no delay release nonsense can often be ground and put in a suspension liquid - part of the task there is knowing what suspension to use that won't react with the medication to make it ineffective or just gross-tasting.
With a sustained-release preparation, sometimes the solution is to use an older form of the drug without the fancy sustained-release, and his dosing goes from "once in the morning" to "once every 4 hours, make sure to wake up at midnight for that dose" or something charming like that.
We haven't had to resort to injectables yet, but that's an alternate too.
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Old 08-24-2016, 05:40 PM   #23
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Default Re: [Basic] Skill of the week: Pharmacy and Poisons

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We also have dedicated pharmacies here too. These generally don't have technicians at all, and have one to three pharmacists trading off shifts. The customer area of the store is usually a couple of chairs for while you wait, and a few shelves of a limited range of off the shelf drugs like pain killers, allergy medications, etc. or medical devices like joint braces.

Both kinds inevitably have at least a shelf full of vitamins and herbal supplements, and often a rack of the homeopathy sugar pills.
...
Around here the actual OTC medication is only a shelf or two compared to the pseudoscience "remedies". The lone pharmacist and many technicians and glorified helpers seem the norm here too. Though my GF knows one degreed tech that could only get a job as one of those helpers, so not everyone's working at their level of expertise.
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Old 08-24-2016, 05:44 PM   #24
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Default Re: [Basic] Skill of the week: Pharmacy and Poisons

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The idea that recompounding is "messing about with drugs" is the weirdest idea I've heard, and I think might be suffering from some sort of language or cultural barrier.

A recompounding pharmacist is not pottering about back there mixing random drugs with random media to see what happens, any more than doctors just pick random drugs out of a list to prescribe to you. Both the doctor and the pharmacist are working with a lot of pre-existing literature and processes.
...
I've honestly never heard of "recompounding". Though my first guess would be changing forms and dosages rather than chemical composition. So they would be the ones to ask to gel cap those horrifically tasting meds?
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Old 08-24-2016, 06:11 PM   #25
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Default Re: [Basic] Skill of the week: Pharmacy and Poisons

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I've honestly never heard of "recompounding". Though my first guess would be changing forms and dosages rather than chemical composition. So they would be the ones to ask to gel cap those horrifically tasting meds?
Sometimes you might change a counter ion, or perform an additional purification step or something, and some stuff with a short shelf life might have to be made from components with better stability, but for the most part you're starting with an active form of the drug, and have no good reason to do any chemistry on it. Even if you are making something with a short half life, you'd start with the closest stuff that you could store, so there won't be many steps in the synthesis.
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Old 08-24-2016, 07:40 PM   #26
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Default Re: [Basic] Skill of the week: Pharmacy and Poisons

That still sounds like chemistry. Or in this case, Pharmacy: synthetic with a large bonus.
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Old 08-25-2016, 06:10 AM   #27
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Default Re: [Basic] Skill of the week: Pharmacy and Poisons

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That still sounds like chemistry. Or in this case, Pharmacy: synthetic with a large bonus.
Pharmacy (Synthetic) has a Chemistry default for a reason. It probably has a more generous default to the Biochemistry specialization.

I'd actually put it the other way around: the Chemist gets a large bonus for a rather mundane use of their skills, the Pharmacist is rolling without penalty. This also looks like a good place for a complimentary skill bonus.

Have we talked about Chinese traditional medicine Pharmacy yet? It's pretty much TL/8 Pharmacy (Herbal) - and almost always requires some final steps in preparing the compound before dispensing to the patient.

Herbal preparations, like spices, tea, and coffee, tend to have a short shelf life. Many of the active chemicals are volatile compounds - they evaporate or spoil over time. Starting with an already rather irregular potency (hurray plants!), this makes older herbal preparations (even capsules and pills) a bit of a crapshoot on dosage.
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Old 08-25-2016, 11:06 AM   #28
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Default Re: [Basic] Skill of the week: Pharmacy and Poisons

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I've honestly never heard of "recompounding". Though my first guess would be changing forms and dosages rather than chemical composition. So they would be the ones to ask to gel cap those horrifically tasting meds?
I think she might be refering to what we usually call "compounding", which usually involves doing one of a couple things:

1) crush tablets or the contents of gel caps into a real fine powder and mix thoroughly with a liquid, syrup, or cream vehicle to create an oral suspension, liquid, syrup, or topical from the original tablets. Example (NOT irl): grind ten 5 mg amlodipine tablets and mix with 60 ml of simple syrup.*

2) mix two liquids to forn either a diluted solution or new suspention. Ex (NOT irl): Mix dyphenhydromine, lidocane, mylanta, to form a mouthwash or lactulose and water to create a diluted form of lactulose for use as an enema.*

3) inject a variety of liquid medications into an iv bag of vehicle in a sterile setting. Ex (NOT irl): Inject folic acid, thiamin 100, adult multivitamin and magnesium sulfate into 250 NS in a sterile room for IV administration.*

4) mix a reconstiting vehicle into a powder to create a suspention. Ex: mix 87.5 ml of sterile water into amoxiclav 200 and shake until mixed thoroughly.*

Fwiw, none of these things extend shelflife, and they all usually shorten it (I know preservatives acn probably be added to stuff, but it simply isnt done). While I understand pills can be compounded, I never saw it attempted in the hospital. If a special dose was needed, an oral liquid was simply made or the medication specially ordered for the patient, depending on the urgency (often both if the patient was to be around a while).

* Do NOT try doing these at home or use any compounds that aren't mixed in a compounding pharmacy. Screwing these up will at best result in a loss of efficacy and at worst be downright toxic.
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Old 08-25-2016, 01:13 PM   #29
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Default Re: [Basic] Skill of the week: Pharmacy and Poisons

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While I understand pills can be compounded, I never saw it attempted in the hospital. If a special dose was needed, an oral liquid was simply made or the medication specially ordered for the patient, depending on the urgency (often both if the patient was to be around a while).
My mother gets some of her tablets (not gel caps) made for her at the pharmacy, since she's allergic to a whole range of dyes and binders. They have to special order the powdered form of the drug in, and then blend with the binder and whatever to get a consistent dosage, then it goes into the press to make the tablet. I don't think she needs any of hers coated, and I don't know if the pharmacy has the tools to do it.
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Old 08-25-2016, 10:31 PM   #30
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Default Re: [Basic] Skill of the week: Pharmacy and Poisons

In Australia only pharmacists are allowed to own part or all of a pharmacy so we have more of a community pharmacy vibe than other countries. We do have some pseudo "big box" retailers but they are actually franchises with no corporate ownership.

Every pharmacy in Australia does some basic compounding, for example mixing antibiotics with water and other ingredients to make suspensions for people who can't swallow tablets (like babies and small children). Some of the larger pharmacies make more complex stuff like short shelf life injectables. All of this is strictly regulated, it is very easy for a pharmacist to lose their license.
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