I know specific medical questions aren't allowed here but I hope general questions about drugs are.

Why are the dosages of some drugs such oddly specific amounts? Naproxen sodium is one I've noticed that's 220mg rather than 200 or 250mg. Or pepto bismol tablets are the strangest I've noticed at 262mg.

Is this some weird historical carryover or is there a legitimate reason for it?

I’m a current P2 and I’m interviewing for a 1-2 year clinical pharmacy internship at my university’s children’s hospital in a couple of days. I think I’m generally okay at interviewing but I’m getting nervous for this one because I’ve only ever done one-on-one interviews but this one is a panel of 5-6 people.

Aside from the general STAR questions, is there anything I should be expecting going into this? I have very limited peds experience so I think I’m just worried about not knowing what they want from me during the interview.

Any advice or insight is appreciated! I apologize if this is considered too school-centric or off-topic (I thought I might reach more people who could help than in r/pharmacyschool)

This is the weekly thread to highlight anything new you learned last week!

Links to studies and articles are great, but so are anecdotes and case reports. Anything you learned in the last week you want /r/pharmacy to know goes here!

Do you guys also find that this is still very common at your hospital?

They blame every other unit (including pharmacy), but never own up to it when nursing makes mistakes with medications.

Young(18-24) Adult Male arrived in the ED by EMS this afternoon for anaphylaxis this afternoon after calling 911 for trouble breathing following 0.9 mg(3 doses) im epi administered, 50mg iv diphemhydramine, 2 bags of iv famotodine, 125mg iv solu-medrol) administed by EMS. Pt stable upon arrival in ED, but observered for 3 hours. pharmacy and psych consulted. Upon EMS arrival, they found patient had admininsted 2 epi auto injectors and found bilateral : Increased Respiratory Effort • Stridor •Wheezing - Expiratory • Wheezing - Inspiratory. Skin: urticaria, GI: nasuea w/ vomiting, ENT: swelling in oropharynx. All other systems reviewed and negative unless otherwise noted above. ROS normal upon arrival to ED.

Pt states they were transported to a different ED yesterday by EMS for trouble breathing/hives/anaphylaxis, and only required 0.3 epi, 40mg diphenhydramine, 2 bags pepcid, 125 solu-medrol. Ininitally suspected to be due to oseltimivir(flu B, tolerated fine previously and during first dose) or almonds/honey. (epic care everywhere is great in this situation) all other medications have been tolerated well by pt for months

Pt states that yesterday, ED Staff suspected a food reaction, but pt did not have any food today prior to taking a different generic/bottle of medication(with same ingredients as previous generic per DailyMed), patient only changed from 2x 10mg esciatopram to 20mg escitalopram, so there was no dose change. pt had reaction to blue point generic, but has been fine since 12/2023 on SOLCO generic. Pt has had previous anaphylactic reactions to Augmentin and various mental health reactions to SNRIs, Abilify and Wellbutrin.

Do y‘all have any ideas whether this would be more likely to be a cross contamination reaction from counting something like Augmentin before on the same tray, cross contamination during production, or an allergic reaction. PGY-1 psych resident/EM doc recommended avoiding that generic and switching back to 2 tab qd dosing rather than 1 20mg tab qd dosing.

Decently interesting case, but kinda weird/uncommon. Any other suspicions/how likely cross contamination at the store level would be?

Update:

Unfortunately the patient found out the hard way what he was allergic to. Anaphylactic allergy to escitalopram or filler following flu infection. Called after hours again today due to another reaction(successfully managed at home with 100 po hydroxyzine and 40 po famatodine). Switching to setraline to avoid ssri withdrawal

Recently, the Medical Council in Thailand has taken legal action against the Pharmacy Council, arguing that pharmacists should not be permitted to dispense over-the-counter (OTC) and behind-the-counter (BTC) medications for 16 common ailments. These ailments include conditions such as headache, dizziness, joint pain, muscle pain, fever, cough, sore throat, stomachache, constipation, diarrhea, dysuria, abnormal vaginal discharge, skin rash, wounds, and eye or ear disorders.
The Medical Council argues that only doctors have the necessary diagnostic skills to assess these symptoms accurately, as some of these ailments could indicate underlying serious health conditions that require a physician’s expertise. They believe pharmacists do not have the same level of diagnostic training as doctors, who undergo years of specialized education to interpret symptoms and prescribe treatments safely.

From the legal lawsuit file

The petitioner (Medical Council) argues that the respondents’ regulations permit 16 groups of patients to receive medical services in primary healthcare settings for ailments that could otherwise require specialized medical care. These services can be provided by health professionals in community settings without physician oversight, for conditions such as headache, dizziness, joint pain, muscle pain, fever, cough, sore throat, stomachache, constipation, diarrhea, dysuria, abnormal vaginal discharge, skin rashes, wounds, eye disorders, and ear disorders.
The Medical Council believes that these provisions violate the standards for patient safety, asserting that only physicians have the necessary diagnostic training to ensure safe and accurate care for these conditions. They argue that allowing pharmacists or other non-physician health professionals to handle these cases risks overlooking serious health conditions.
The court has acknowledged this appeal for review.

Do you think this legal action undervalues the training and capabilities of pharmacists, especially in primary care?

This is the post of the doctor that sued https://www.facebook.com/share/p/18DHUKpnwJ/?

In his post, the doctor emphasized that: • Physicians undergo at least 6 to 11 years of education, including hands-on training in diagnosis and patient management, before they are certified to prescribe medications. • Proper diagnosis requires thorough patient history, physical examination, and sometimes additional testing, which he claims pharmacists are not trained to conduct. • He argues that allowing pharmacists to dispense medications without a doctor’s input could put patients at risk, as minor symptoms could be early signs of serious diseases. • The post further suggests that the role of pharmacists should remain supportive and collaborative rather than independent in common illnesses patient care [BTC and OTC].

Have you seen similar challenges to pharmacists’ roles in other countries? Are doctors questioning pharmacists’ ability to provide care independently in your region?

For pharmacists practicing outside Thailand: What is the level of respect and autonomy pharmacists have in your healthcare system? Is there mutual trust with doctors, or do similar tensions exist?

Do you think this attitude is specific to Some doctor in Thailand, or is there a broader trend of healthcare professionals undervaluing pharmacists worldwide?

Hey everyone, I’m a pharmacy intern working in a retail pharmacy in Texas. I understand that regulations vary by state, but I have a couple of questions about handling prescriptions from outside the U.S., specifically Mexico.

In Texas, can prescriptions from Mexican prescribers include refills, or do patients need to purchase the full amount at once? Also, are we allowed to apply GoodRx coupons to these prescriptions? I assume not, since Mexican prescribers don’t have an NPI number, but I wanted to double-check.

My preceptor told me no, for both questions but the patient kept insisting that we are wrong.

Thanks in advance for any insight!

Our current workflow just isn't working. Right now I have a designated cashier and 4 techs, all of whom are expected to run, count, and answer phone calls. I've considered doing a rotation. If you do a rotation, what do you do? Or if you've experienced ineffective workflow and staff, what did you do to remedy it?

For my pharmacists who work at independents as supervising pharmacist, what is your insurance like? How did you get it? Does that insurance cover stuff like being hospitalized or giving birth etc. is maternity leave possible as SP?

Has anybody thought about suing a patient for harassment or something like that?

Just curious to see how it would turn out, the abuse from some of these customers in retail pharmacy is too much

It’s backlogged for weeks in some places, and not available for order in others. Anyone know what’s up?

Can anyone have idea about how much pharmacist associate owner (SDM) make around including profit sharing and salary?

Thank you so much for time to answer

Because how the fuck do you contact them? I’m about to tell the customer to call the MD and get the script sent in here. I’m so angry with their automated system.

Hey everyone! I’ve made a few posts in the past about other jobs etc. Just trying to learn more and more and broaden my opportunities with roles I may enjoy/qualify for.

I wanted to ask about being a prior authorization pharmacist. What’s it like? What’s the day to day? I did a google search and read some stuff, but wanted to hear from pharmacists who actually have this job. Which company is good and which ones not so much? Are quotas strict? How is the pay? I know it depends on which state/area. Any info you can tell me would be greatly appreciated. It does seem like something I’d be good at and enjoy doing more than retail.

I have 2-3 years both hospital and retail experience, and I’m at the point (already which is sad) where I want to leave retail unless I worked for a company like Costco for example (any Costco pharmacists here??? I heard the lay and QOL is actually really good).

Appreciate all feedback and feel free to personally message me as well with pointers and information. Thank you!!

Are there any state laws that forbid it?

??

this is making a conflict with the definition of

1-Passive Facilitated Transport

2-passive Transport Through Protein Channels

This is a more general question for retail/community pharmacists and I’m sure it’s been asked plenty of times before but I don’t feel like searching.

As a lead technician what can I do to help the pharmacist not stress so much and possibly improve our workflow.

We are considered a high volume store and much like others our phones ring non-stop. We have unrealistic metrics so I know there’s pressure coming down on the pharmacist as well.

A few things I’ve tried to do is make the other techs ask each other for help and if they can’t figure it out then to get me. If I can’t then I’ll bring it to the pharmacist. We have two filling stations and I’ll randomly ask them if they know details of the drug they are currently filling such as brand/generic name and a general indication. Trying to help them understand more about the drugs in case any patients have surface level questions they can answer with slightly more confidence. I’ve implemented a different way of scanning our bins which seems to be a slight time saver.

Most of our holdup in our workflow is our adjudication and I’m still having a hard time explaining/ teaching other techs about it because of all the different rejects.

I guess overall what are some things your techs do or could possibly do to make things run efficiently?

What is a LNPID? We can’t figure it out. We have looked it out. And it changes it to no.

Has anyone in medical affairs for PharmD heard back from Lilly? I got the first interview 2-3 weeks ago and haven't heard back. Likewise, does anyone know if second round interviews are currently happening?

Hi, I'm wondering what the typical dose for use of oral estradiol in fertility treatment is? I'm seeing a doctor write for 2 tablets of estradiol 2mg tablets four times daily, so a daily dose of 16mg which is very high to me in even typical on-label uses. Since it's an off-label for uterus thickening, I'm not exactly sure what the max daily dose can be and I'm still awaiting clarification/confirmation from the doctor. Gladly appreciate any response! TYIA.

Actually, since I'm posting this, I might as well ask too: what is a good source for off-label drug used and dosing? Usually Lexi/Micromedex includes common off-label use doses, but in the case of estradiol and some other drugs I can't remember, they don't have any information. Is there an alternative source for off-label meds? Please guide me here too 🙏

is overnight worth it over evening for 20k more per year and 4 weeks vacation vs 3 weeks? its 4 10 hr shifts sun-wed

I have an opportunity to work at the ideal retail company in texas and am not sure what to think of it since I am currently in a specialty pharmacy position that is very relaxed.

Current position:hospital based specialty phamracy. 30 to 5 mon-fri. Very relaxed but lack of communication from management makes things a bit annoying sometimes. Very limited room for growth. Consistent 3% annual raise. 30 to 45 minute drive from home.

Opportunity: variable schedule, but would work 4 days a week. Work weekends. Most desirable retail company. 15% pay increase. Promoted to manager within 1.5 years with a total estimated compensation of 180k to 200k. Drive would be about the same for 1.5 years then it would be a 5 minute drive.

I have young kids that, which could be troublesome to work weekends.

I would enjoy an extra day off during the week but the added stress might make it not worth it. Along with having to work weekends. I think this is the biggest benefit that affects me, being able to have a whole extra day with the kids would be great.

The money is defenitly great but not a tipping point at this stage in my life. Time is more important. Weighing the extra day off vs having every weekend free is the tough decision, as well as the whole going back to retail thing.

Today I got a call from a mom, who picked up rx for her kid at a Walgreens. She has questions on her medications & she is trying to call Walgreens & they are not picking up the phone.

I work for different chain, today being Friday, I was really busy. Walgreens is notorious for not answering phone calls. Even for me, many a times I call them for a copy, they have put me on hold for hours.

I didn’t want to come across as Rude. I am a very pleasant person & I like to help people as much as I can. However I don’t want to encourage people calling me for consultation when they are not even my customer.

In this case I did gave a consultation & answered all the questions . But she was still going on & on, I had to tell her that I really need to go. I did also let her know that, she is not my patient & I am really just doing a 1 time favor.

I do understand I am a healthcare worker & I have a responsibility to the community etc but I also have a job to do.

I am just curious to know from my fellow Pharmacists, how would you handle a situation like this ? I am in California & I don’t know what does the Law says in this regard.

I work at a group home for foster kids and we have an absolutely amazing locally owned pharmacy near by. They have gone above and beyond for us repeatedly by dealing with Medicaid, delivering medications same day for free, and working quickly and being understanding when we have a med issue and need new meds ASAP. I’m planning on doing a gift basket for all of the staff for Christmas, but am completely blank on what to fill it with! I’m going to put some gift cards in, but I don’t know anything about their personal life and would like to give them something career related that would be useful and might help them out some. I don’t have a budget, but don’t want to go crazy overboard. Any ideas from those in the field?

Curious about the profitability of a compounding pharmacy. Can anyone with experience or ownership of a compounding pharmacy provide details on the finances? I know most compounds are cash pay. I’m curious what an independent pharmacy could bring in doing compounds, potentially both sterile and non sterile. Just wanting to know what others have seen in this niche. TIA!

Hi! Im a dietitian who frequently prescribes Ensure for patients that really need it (like the only thing they’re having in a day is multiple ensure/boost due to various cancers/surgeries).

We typically worked with Coram, an infusion pharmacy under CVS, however they recently stopped taking Medicaid insurance. As a result I tried to order through someone’s local CVS and was told CVS doesn’t do any supplements like this. When I questioned it, the tech I spoke to stated all CVSs no longer take these prescriptions, Medicaid or not.

I’m just wondering if this is accurate for all CVSs or he just didn’t want to do it. Does anyone who works at CVS take these prescriptions for any patients or Medicaid patients?

I totally understand the orders are a pain and I bet the reimbursement is not great, however it is only ordered when absolutely necessary.

Thank you so much for any insight!!