[AMA] I Am a Community Pharmacist, Ask Me Anything

I have been working in community pharmacies for almost 5 years now. I have probably seen enough of everything.

Ps. I am not allowed to give out any specific health advice.

Comments

  • +5 votes

    Is it true that you keep a log of shifty people that come in thats shared among all pharmacy?
    If you have like 5 repeats, can you get all 5 things at once (instead of monthly)
    Do you need a prescription for asthma puffers?
    Have you ever had to turn someone away that was obviously sus?
    Whats your fav part of working as a pharmacist?

    • +17 votes
      1. Is it true that you keep a log of shifty people that come in thats shared among all pharmacy?
        It is true. Pharmacies do receive notifications of certain group of people from higher authority to keep a look out for + appropriate actions to take if encounter.

      2. If you have like 5 repeats, can you get all 5 things at once (instead of monthly)
        You can but not all the time. IF doctor authorize to supply all repeats, you can ask the pharmacy to dispense them all and the pharmacy will do it for you. On the other hand, a lot of addictive medications or easily overdosed should not be dispensed all at once in case of toxicty. Pharmacist ethically should not do that and they can refuse unless given a valid reason or getting a okay from prescriber.

      3. Do you need a prescription for asthma puffers?
        Ventolin/Asmol/Bricanyl nope. But if you are on Concession card then it will be cheaper for your to get it through scripts. The rest of the puffers you need to get scripts.

      4. Have you ever had to turn someone away that was obviously sus?
        EVERYDAY

      5. Whats your fav part of working as a pharmacist?
        I love helping my patients getting better. You feel really satisfied and good when a patient come back and thank you for your advice. Those compliments really make our day. I spend most of my time talking to patients to understand more about their conditions rather dispensing at the back and it is really fun and rewarding.

      • +2 votes

        Awesome, thank you so much for that! Much appreciated.

      • -6 votes

        Pharmacies do receive notifications of certain group of people from higher authority to keep a look out for + appropriate actions to take if encounter.

        Could we see some examples of what these might be please?

        •  

          Easy - derelicts asking for methadone substitution
          They will even threaten pharmacists due to their addiction.
          Any schedule 8 class drugs, a.k.a. drugs of addiction.
          They will even steal prescription printing paper to forge a fake script.

          Easy way out is: "we're out of stock/we don't sell that here"

          I'm not a community pharmacist but someone very dear to me was.

          •  

            @cwongtech:

            I'm not a community pharmacist but someone very dear to me was.

            What happened to them?

          • +3 votes

            @cwongtech: Am community pharmacist

            A lot of the ones I get are suspected doctor shoppers from the doctor shopper line, other stores who are concerned about patients bouncing around to fill muitlple private scripts for large quantities of drugs of abuse
            Stolen script pads I get a fax regularly from the government of names of DRs who have had their pad stolen (so just have to call them and confirm any drugs that may be abused) and a lot more

            Funnily enough I've had less problems with MOST of my methadone patients (0.01% kinda deal, nearly all my methadone patients were people in a hard spot trying to fix their lives and themselves and I can respect that wholeheartedly)
            Usually the ones that are visibly intoxicated
            I had one lady last week who reaked of alcohol
            Advised her I couldn't safely fill a script for very potent pain killers as it was a risk to her safety

            Insisted she was sober and began throwing things at me (stationary she could teach mainly)
            Assaulting the person who has yoUr full name, address, date of birth, Medicare number and more is a bad idea

      • +7 votes

        Why the hell can't I get all my contraception pills in one go?? I keep only being allowed one frigging box at a time and I think restrictions on contraception should absolutely be lifted.

        •  

          Lucky for you, pharmacist is pushing for prescribing right for the pill with sufficient training supervision. Hopefully things will change soon

          • +6 votes

            @Farmacist: I fundamentally disagree with this. Doctors should be doing the prescribing because they have to do the risk assessments and deal with complications after the fact.

            • +2 votes

              @brokeunikid: Also a pharmacist and agree

              We're there as a double check safety

              Us prescribing bypasses that

              The Overseas model of CONTINUATION prescribing has some merit but also many pitfalls (how do you get them to ever see the doctor again to review their condition if we can prescribe repeats?)
              Most patients think BP 180/110 is okay 😂😂😂

          • +3 votes

            @Farmacist: Don't you think it is a conflict of interest for pharmacists to be prescribing and dispensing at the same time?

            • -2 votes

              @Save Medicare: Is it really a conflict of interest? They aren't commission based.
              A pharmacist's role in treating the patient is also checking whether a medication to be dispensed matches the symptoms described by the patient, that's why they ask you many questions before actually releasing the medication to you.

              Doctors do make mistakes too (they are human).
              Pharmacists are not blindly dispensing medicine because they can make more money, the more you buy.. it doesn't work like that.

              The only way they could make more money is via selling generics

              • +3 votes

                @cwongtech: Hahahahah hahahahahah we are not commission based

                The owners take EVERYTHING the government funds

                We supply a medication review service? Owner gets everything

                We intervene from a potentially life threatening intereaction? Owner gets all the funding from government

                My friends who work in supermarkets get a better hourly wage than us; and they didn't do a 4 year degree, 1 year post grad training nor deal with the stress of killing someone

                The government also has laws about mandatory reporting for health professionals; where if we seek help and that doctor believes we may be a risk at work they are obliged To report us
                For that reason many don't seek help for fear of losing their livelihood

                Tl;dr be nice to your pharmacist; they're probably incredibly stressed/depressed

            • -1 vote

              @Save Medicare: It is a conflict of interest.

              Having said that, I often feel that the pharmacists has greater knowledge than the actual doctor prescribing…

        • +1 vote

          Go to another pharmacy; I dont see a problem with dispensing all the repeats for the pill

          • +1 vote

            @pharm86: Until one day you get high blood pressure then have a heart attack on the pill because you didn't go back to the doctor
            Who do you blame? The pharmacist who doesn't know all the risks?

            https://www.fsrh.org/standards-and-guidance/documents/ukmec-...

            Have a read of all the relative and absolute contraindications to the pill
            Prescribing the pill ain't a simple click

            There's a reason why doctors train for so long and keep training, its to protect the people

            • +2 votes

              @icejester: Why issue repeats on the script then? The patient does not have to go back to their GP while they have repeats left on the script regardless of whether they get it one at a time or all at once, and the OCP is hardly an addictive medication

        • +1 vote

          the crunch of it is… Liberal voters…

        •  

          Because it's to protect you from having adverse events on the pill when your clinical condition changes.

          Here, have a read of all the relative and absolute contraindications to the pill

          https://www.fsrh.org/standards-and-guidance/documents/ukmec-...

  •  

    Is there a way to get vitamins via PBS?

    •  

      Not that I am aware

      • +2 votes

        A friend of mine asked a vet for a prescription for a medication for their pet. The vet apparently provided them with a letter asking for the medication. They then took this to a discount chemist and were sold the prescription medication at PBS price with the pet's name and the owner's family name (eg Paws Smith) on the sticker.

        Is this a legitimate practice?

        Do you know what vets are allowed to prescribe, or could you give us a rough outline of the rules surrounding this?

        • +5 votes

          Yes thats correct practice. Most of the place you will see pet name + owner family name. That's what we have been taught to do.

          They can prescribe anything pretty much.
          https://www.ava.com.au/sites/default/files/documents/Other/G...

          good source if you want to have a read.

        • +3 votes

          Slight clarification as an ex pharmacist

          It may have been pbs price but it wouldn't have been a pbs-subsidised medication unless they were doing something highly dodgy.

          Ie it was probably an antibiotic which cost the pharmacy $2 so they could sell it for $6 "pbs price" (despite not involving the pbs in any way) while still making profit

          • +1 vote

            @jzdhgkd: Thanks, that's the aspect I found most surprising since, to the government, pets are property not people.

            Thankfully the ATO is happy for Paws McDuck to earn less than the tax-free threshold.

            • +1 vote

              @Scrooge McDuck: At chemist warehouse, if you look on their website, the prices of their products are below or on par with PBS price, which is what they would have received. Animals are not able to receive PBS subsidies.

              Vegemite kid, some vitamins are listed on the PBS but only certain people may qualify for some of them. Usually special cases can be granted a PBS authority approval for subsidy of some vitamins.

              DVA patients may have more subsidies allowed depending on their DVA status.

    •  

      If you have a repat gold card some vitamins are fine

  •  

    What is the usual profit margin from a medication that's commonly used for, for example, high blood pressure or diabetes?

    • +6 votes

      It really depends on pharmacy and also different pharmacies have different deals with the pharmaceutical companies. All I can say is we are pretty lucky here in Australia that our medications is at extremely high standard and affordable price compare to many other developed countries. (Ventolin in America is USD 70 from my memory while Australia is only 10 dollar or less)

      • +2 votes

        It can vary from 50%-300% easily

      •  

        How often are there manufacturing faults with medications?

        • +1 vote

          The tga website usually.has a list of recalls. Some involve wrong strength pills inside the box, some include wrong medication inside the box, some include presence of contaminants in the medication.

      • +2 votes

        While antihistamines (Cetirizine, Fexofenadine, Loratadine) in Aus is about $30/50tabs so I import mine from the US for $30/365 tablets.
        I've been taking them daily for the last 15yrs.

        •  

          It's strange, over the counter products in America are ~ 50% cheaper than they are in Australia (eg Rogaine for baldness), but prescription only medications are much more expensive in the world's greatest country.

        • +1 vote

          Where do you get the antihistamines from? Interrested!

        •  

          Would you kindly share the place where your purchase antihistamines? I agree though, I've always buy a crap load whilst on holidays in the states/ euro cause its so damn cheap compared to Aus. I didn't know we could buy them overseas without being put under the microscope!

          • +1 vote

            @vapingwinnieblues: Amazon US.
            With shipping, it usually was about US$20. However, I bought my last batch about 6 months ago before the stupid regulation change and Amazon US stopping shipment to Aus.
            I buy the Costco US brand Cetirizine HCL 10 mg. I used it when I used to live in the US and know it's good.

            There are still sellers on ebay US that ships them here, it is still cheap even if I have to pay double the price I used to.
            Or use something like Shopmate. (US$16+10%GST + AU$30 shipping = AU$55/365 tablets)

            Have 4-5 more months of supply before I have to worry about that.

            EDIT=====

            Still AU$28.01 in ebay

            https://www.ebay.com.au/itm/Kirkland-Allergy-Aller-Tec-10mg-...

      • +1 vote

        Wait what Ventolin puffers are $70 USD in America?! That can't be correct surely?? So many people with asthma need that to not die what the (profanity). I need it from time to time and my asthma isn't that bad at all

        • +1 vote

          It's true

          … the two best-selling combination inhalers, Advair and Symbicort, had global sales of $8 billion and $3 billion last year. Each inhaler, typically lasting a month, retails for $250 to $350 in the United States.

          The price of epipens for people with acute allergies is also another scary expensive commodity in the US.

        •  

          Sadly, it is true. In the US the life saving medications are often the ones that'll get slapped extra expensive price due to the fact there's a definitely market (either buy/use or die), or lack of competition.

          • +1 vote

            @zrmx: Ummm is everyone forgetting that prescription pharmaceuticals dispensed on the PBS here are heavily subsidised (through the taxes we pay)in Australia - The PBS currently sits at around $9 billion per annum! The PBS price we pay at the counter is no where near the actual cost of the drug.

      •  

        *$6 - if a pharmacy was charging 10 for ventolin they'd go out of business pretty quickly

  • +3 votes

    What is really different between a GP prescribed and generic brand medicine that the pharmacy suggests? I really would like to know this. I always buy the GP prescribed brand for my kids medicines but sometimes do buy the generic ones for myself.

    • +5 votes

      The main different is the excipients such as preservatives, bulking agents, binding agents etc… They have the same active ingredients and they are all tested to by TGA so rest assure you get the same therapeutic level in your blood stream. However, I am aware that some patients react better with the original brand. Pick the brand that you like really. Keep in mind, the brand that GP put on the script can be generic, orginal or just the drug name itself. The do not always write down the original brands.

      •  

        Thanks for that.

        • +1 vote

          I believe some original brands have better efficacy due to better absorption than some generics. I give you one example, my mum suffers from glaucoma, when she uses lanatanaprost generic vs xalatan. There was about 20% difference in results, this is important because this difference is enough to not need another eye drop.

          There was also a study about it. https://www.ncbi.nlm.nih.gov/m/pubmed/17322603/?i=2&from=/25...

          I think at the end of the day, if your doctor prescribe certain brands and they actually wrote it down, they probably did this for a reason. It best not using the generic.

          • +2 votes

            @minotaurian:

            I believe some original brands have better efficacy due to better absorption than some generics.

            I always ask who makes the generic
            I believe if the generic version is made by the same manufacturer as original then it is definitely fine.
            I also check whether the product has been around for a long time, i.e. if it's a well-known and researched product that is widely available like paracetamol, then it shouldn't be very hard to do a generic.

            Please see Celestone M Cream and Antroquoril Cream
            Both are made by Merck Sharp & Dohme (MSD).
            These are creams used for the treatment of Eczema.
            Celestone M is the original brand
            Antroquoril is the "generic" brand

            Note: If it has the AUST R XXXXX number, then it has been tested to be effective.

      • +2 votes

        However, I am aware that some patients react better with the original brand.

        So how could that be? Is there a physiological explanation other than the placebo effect?

        The do not always write down the original brands.

        Do you think prescribers should follow a standard (eg drug name only)? How often are mistakes made with prescriptions?

        • +3 votes

          So how could that be? Is there a physiological explanation other than the placebo effect?

          It kinda comes back to that first sentence.

          The main different is the excipients such as preservatives, bulking agents, binding agents etc…

          Whist you get the same dose of the main drug, these can have a bunch of different effects on how you experience the dose. Some excipients are cheaper for a reason… that is they often have (albeit minor, but yet annoying) side effects of their own. Other generics may simply be missing the excipients that make the brand medicine go down better.

          Conversely, you may react poorly to something in the makeup of the expensive brand. A good GP or pharamacist will generally work with you on that.

          The human body is a complex organsim - your dinner tonight may or may not agree with you depending on the band of ingredients used. Drugs are no different.

          •  

            @bobbieb: Can excipients affect oral absorption in non-sustained release medications? That could be another cause.

            • +1 vote

              @Scrooge McDuck: Technically yes. A good example of this would be lactose can inhibit the function/absorption of thyroid medications. Despite this, some of the commercially available through medications use lactose as a filler. One could argue that the filler used is measured in milligrams in these tablets, but it can have a noteworthy effect given that the active ingredients in these tablets are in micrograms.

        • +1 vote

          Yes, sometimes just placebo, sometimes the body may not agree with certain excipient.

          Yes I think so. However, some prescriber tend to write a certain drug/brand name under the deal with a pharmaceutical rep for instance.

          •  

            @Farmacist: I heard that there were laws enacted so that doctors do not that especially if there were conflicts of interest due to kickbacks or gifts received from reps, is this true?

        •  

          Whilst most of us including yourself are well aware of the placebo effect, I don't think many people are aware of just how truly dramatic an effect it has. The placebo effect isn't something you should put in the "grain of salt" box: it should be thought #1. Placebo/nocebo is extremely influential and should always be regarded as the main consideration when examining efficacy differences between non-blinded medications.

          If the patient isn't blinded, you will see placebo.
          If the DOCTOR isn't blinded, you will see placebo.

          I think you would be very hard pressed to find credible research showing any difference between binding agents and additives. Where such evidence may exist, I would then further challenge you to find the study replicated by another source. Meanwhile there are STACKS of studies showing exact same pill: slap different labels on, and different efficacies result.

      •  

        Do pharmacist have greater profit margin with generics?

      • +6 votes

        "However, I am aware that some patients react better with the original brand"

        I, too, am a pharmacist, and that statement maybe should exclude the anecdotal evidence, and be written as "I am aware that some patients react better to any random brand and that there is no evidence "original" drugs work better than "generic" drugs".

        *not really wanting to jump in here as you are replying well, but I dislike the general publics misunderstandings about generic medications, and would like to avoid some confusion.

        • +2 votes

          Very good answer gabbo. Thanks for helping me there. I should use your answer in real life situation too.

      • -4 votes

        Please show proof where TGA tests each individual generic medications. Please give correct and truthful advice, instead of making things up when you don't know the answer.

        If the active ingredient is the same why would some people react better to originals? Generics, do not have to give you 100% bio-equivalence. See what happened when generic digoxin hit the market

    •  

      In the front end, same medication different filler.

      In the back side of things, the only research that generic brands tend to do is to validate that their medication is non-inferior or bioequivalent to their original counterparts. Most of them dont do research for new medications.

      Original brands do cost more, but they are often from companies that invest money into researching new medications. So when you're buying an original brand, you are often funding new medications, treatments, etc.

      •  

        Original brands do cost more, but they are often from companies that invest money into researching new medications.

        They are rewarded for doing so by being given a legal monopoly for a certain time period. Only after they have received their reward are the generics allowed to be produced.

        Big Pharma companies are very profitable and do not plan future R&D expenditure by sales volumes of current patent-expired products (although yes, that is a factor in their cashflow). They do R&D based on projected profits of new drugs (e.g. we think there's a P% chance we can make a better boner pill, it will cost $X to do the R&D, and if it works it will make us $Y).

        • +2 votes

          I think the problem is that big pharma is a business just like any other, and exist to make a profit. Their R&D also fails a lot of the time and there is no rewarding that loss in costs. The average patent on a drug molecule lasts about 25 years, but it takes on average 10-20 years to bring a drug to market (from the time you first patent the molecule). That doesn't leave you a lot of time to recoup the expenses you have outlaid, hence the high prices … it's a bit of a vicious cycle.

  •  

    Which medicine is the biggest rip off that is commonly prescribed, when there's an alternative that has the same effect at a lower cost?

    (Besides Panadol/Panamax)

    • +7 votes

      Mhmm very tough question. Personally I would pick weight management medications. They are expensive for consumer to purchase and pharmacy to get in. Exercise and good diet is a much cheaper alternative.

  • +4 votes

    what the hell is a community pharmacist

  •  

    I’ve been using voltaren gel on a inflamed wrist for 2 weeeks now, and I noticed on the package don’t use for more than two weeks. Should I just take a short break and use it again? Or am I not allowed to use it ever again?

    • +1 vote

      You can still use it. The reason they put that 2 weeks timeline is because if your wrist is not healed by then, you probably should go to see a doctor/physio or get a scan etc to find out what is going on inside there. There must be a reason that your wrist is not healed by 2 weeks.

    • +53 votes

      Try changing hands

    • -2 votes

      If you want the best inflammation relief try this.

      1. Buy some Lectric soda from the chemist
      2. Cut up an old sock or stocking
      3. Put a handful of Lectric soda in the sock
      4. Bandage it to the inflamed area (I prefer overnight)
      5. A couple of nights and the swelling will go down

      Just note that the Lectric soda will go rock hard almost like plaster

    • +1 vote

      Have you tried turning it off and on again?

  • +1 vote

    What is the impact of Discount Chemist Warehouse on the industry?

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