Title sums it up well. I'm a pharmacist. I'm bored out of my mind today (oddly slow day). I just saw an AMA by a pharmacy student who did nothing but snap at people who asked questions.

While at work here, I'll be happy to answer the same questions asked of her or others. I'll even pretend your Seinfeld jokes are serious questions and not just trolling.

EDIT: I'm wrapping up my day at work soon. Thanks to everyone for the big response helping me pass my day by quickly! I'll try to hit a few more questions if I can.

Comments: 2866 • Responses: 39  • Date: 

drukus274 karma

When is it important to avoid the generic drugs?

andillformthehead363 karma

For the most part, it is rare that I ever tell someone to avoid something generic. There are a few instances where people seem to react differently to generics that I am a little more cautious with. The biggest would be converting someone from brand Coumadin to generic warfarin. However, if they are a new patient and have never been on either brand or generic... go for the generic.

Also, be sure that the generic drug is actually AB rated for the brand. This is the case 99% of the time, but occasionally you see a generic come out that hasnt yet met that rating. An example of this would be when venlafexine ER tabs came out, some people were using them in place of the Effexor XR caps... which they shouldn't have been.

Long winded for my first response. I'm sure there have been other instances, but thats what came to my mind.

DJasko232 karma

As a pharmacist myself I must say that there are 2 illnesses/diseases where you should avoid generic, if you already have used the original brand.

In epilepsy and when a patient has hypothyroidism they should avoid generic, if they already used the original. Why? Well because a generic can become generic if it has 100% +- 15% equal pharmacokinetic profile f.example bio-availability to the original. But in epilepsy and hypothyroidism 15% can be very bad. If you have 85% serumconcentration instead of the 100% of the original you may get epileptic seizures which is not good. And 115% may give unwanted adverse effects.

I myself also never tell someone to avoid generic, unless they have epilepsy or Hypothyroidism and are using the original atm.

Great AMA btw. :) Keep it up. (I just graduaded pharmacy studies today! Yey me!)

EDIT: Some of you said the variability might be so high as 80-125 %. In Norway (where I am) I think I read that it could be 85-115 %. How much it can vary in the US I really don't know. I will most surely check this out and come back to you here with a new edit!! :)

andillformthehead24 karma

Both of those diseas states came to mind as well when I gave my coumadin example... but I can only type so much! good answer and thanks! Its making my day go quick for sure.

Mredjr239 karma

Have you had to deal with a angry customer who was going from Dr to Dr trying to get narcotic medication?

andillformthehead337 karma

Constantly! It is a much more common occurence than I would have thought before being out and working. After while you become good at spotting those people, and you know what you are in for.

My favorites are the people who try and make you feel bad for "accusing" them of being drug seekers, and they have legitimate pain... until you present the evidence of their behaviors to them. Its too bad, because some people really are in need of those medications and at times seekers can give everyone a bad name.

justbecausewhynot271 karma

Work at a ER. I can confirm this happens to you. ( and me) Its also very surprising how oblivious drug seekers are at how easy they are to spot. For instance we had this one person go to her doctors office, doctor gave her a narcotic drug prescription that she filled at walgreens, then the next day she presents into the er, er doc prescribes the same drug for her pain, and she takes the prescription to the same walgreens. Needless to say the pharmacy called the ER to let them know she just had this same prescription filled, and the doctor told them to not fill it. She ends up calling non stop yelling at anyone who answered the phone. Guess whos now on the no drug list?

waterlogged191 karma

I worked at an office where the Doc would give 1 refill and the patient would change it to 4. We even had one crafty bastard change it to a 7. After that, the Docs started writing 1 (one). Drug seekers are the worst.

andillformthehead235 karma

I recently had a patient who tried to rip to scripts in half and change around the bottoms to give herself refills. She did a fine job too! She didn't realize though you can't have refills on oxycontin... so... that was a big tip-off for me.

I never ceases to amaze me the new ways old tricks are played.

Moregunsthanpatience101 karma

We fixed that with printed prescriptions. Now the MD's on the floor are too used to them and go bat shit when the printer fails and they have to send out search parties for prescription pads.

andillformthehead109 karma

Its a step in the right direction, but too often I see mistakes because nurses or doctors are not familiar with the program yet. Its simple things that they would never put on a prescription if it was hand written... but because they are selecting from drop down menus or boxes or whatever, they make a misguided click and i end up with some funky stuff.

maxdisk938 karma

I had a case where a nurse (of all people) was getting all sorts of different prescriptions written for Fioricet, with multiple prescriptions from different docs being filled in the same week even, and was getting even more from the Rite-Aid down the road. I guess she thought since it was exempt from the Federal CSA nobody would care, not realizing that it was still considered a CS by the state. Last I heard she lost her license for a long while.

andillformthehead78 karma

People who have some medical knowledge and access can unfortunately find ways to abuse it. I had a nurse I caught who was calling in scripts for herself. She wouldn't use her name when she called, so it sounded pretty legit since she knew terms and language typically used. I never questioned it. I can't even remember why I called the office when I found it all out.

imreallyadoctor308 karma

I got called by a pharmacist for a script that was written for "4 kilos of mofene"

seemed pretty legit

andillformthehead73 karma

Damn this took me a minute to figure out but was worth a good laugh. My tech enjoyed it for sure

friendlyintruder197 karma

When I have a prescription for a prepackaged product such as the Z-pack, why do you still make me wait roughly 20 minutes? Can you not just turn around and hand it to me?

I understand when the counting of pills and putting them into bottles is necessary, but what really goes on in this 10-40 minute waiting period?

andillformthehead874 karma

Nicker had a good response, but here is someones attempt at humour in explaining it... I cant remember who to give credit to (maybe www.theangrypharmacist.com) i'm not sure:

For over a year and a half now, the first thing anyone visiting my little blog garden has seen under the headline at the top of the page is the promise that the question of “why does my prescription take so damn long to fill” will be answered. Tonight I looked over this blogs archives and realized it was a promise not kept. While many topics have been covered here, and you have been provided with ample evidence of how drugstore workday life does indeed warp the mind, the question of why it took 2 hours for you to get 20 Vicodin has remained unanswered. I can’t help but to think there may be someone out there who has been logging on every day for the last 18 months hoping in vain for this mystery to be solved. Should such a person exist, I offer my humble apologies. To everyone else, I offer the following prescription scenario:

You come to the counter, I am on the phone with a drunk dude who wants the phone number to the grocery store next door. After I instruct him on the virtues of 411, you tell me your doctor was to phone in your prescription to me Your Doctor hasn’t, and you’re unwilling to wait until he does Being in a generous mood, I call you doctors office and am put on hold for 5 minutes, then informed that your prescription was phoned in to my competitor on the other side of town. Phoning the competitor, I am immediately put on hold for 5 minutes before speaking to a clerk, who puts me back on hold to wait for the pharmacist. Your prescription is then transferred to me, and now I have to get the 2 phone calls that have been put on hold while this was being done. Now I return to the counter to ask if we’ve ever filled prescriptions for you before. For some reason, you think that “for you” means “for your cousin” and you answer my question with a “yes”, whereupon I go to the computer and see you are not on file.

The phone rings.

You have left to do something very important, such as browse through the monster truck magazines, and do not hear the three PA announcements requesting that you return to the pharmacy. You return eventually, expecting to pick up the finished prescription…..

The phone rings.

…….only to find out that I need to ask your address, phone number, date of birth, if you have any allergies and insurance coverage. You tell me you’re allergic to codeine. Since the prescription is for Vicodin I ask you what codeine did to you when you took it. You say it made your stomach hurt and I roll my eyes and write down “ no known allergies” You tell me……

The phone rings.

……you have insurance and spend the next 5 minutes looking for your card. You give up and expect me to be able to file your claim anyway. I call my competitor and am immediately put on hold. Upon reaching a human, I ask them what insurance they have on file for you. I get the information and file your claim, which is rejected because you changed jobs 6 months ago. An asshole barges his way to the counter to ask where the bread is.

The phone rings.

I inform you that the insurance the other pharmacy has on file for you isn’t working. You produce a card in under 10 seconds that you seemed to be unable to find before. What you were really doing was hoping your old insurance would still work because it had a lower copay. Your new card prominently displays the logo of Nebraska Blue Cross, and although Nebraska Blue cross does in face handle millions of prescription claims every day, for the group you belong to, the claim should go to a company called Caremark, whose logo is nowhere on the card.

The phone rings.

A lady comes to the counter wanting to know why the cherry flavored antacid works better than the lemon cream flavored antacid. What probably happened is that she had a milder case of heartburn when she took the cherry flavored brand, as they both use the exact same ingredient in the same strength. She will not be satisfies though until I confirm her belief that the cherry flavored brand is the superior product. I file your claim with Caremark, who reject it because you had a 30 day supply of Vicodin filled 15 days ago at another pharmacy. You swear to me on your mother’s….

The phone rings.

……..life that you did not have a Vicodin prescription filled recently. I called Caremark and am immediately placed on hold. The most beautiful woman on the planet walks buy and notices not a thing. She has never talked to a pharmacist and never will. Upon reaching a human at Caremark, I am informed that the Vicodin prescription was indeed filled at another of my competitors. When I tell you this, you say you got hydrocodone there, not Vicodin. Another little part of me dies.

The phone rings.

It turns out that a few days after your doctor wrote your last prescription, he told you to take it more frequently, meaning that what Caremark thought was a 30-day supply is indeed a 15 day supply with the new instruction. I call your docotr’s office to confirm this and am immediately placed on hold. I call Caremark to get an override and am immediately placed on hold. My laser printer has a paper jam. It’s time for my tech to go to lunch. Caremark issues the override and your claim goes through. Your insurance saves you 85 cents off the regular price of the prescription.

The phone rings.

At the cash register you sign….

The phone rings.

…….the acknowledgement that you received a copy of my HIPAA policy and that I offered the required OBRA counseling for the new prescriptions. You remark that you’re glad that your last pharmacist told you you shouldn’t take over the counter Tylenol along with the Vicodin, and that the acetaminophen you’re taking instead seems to be working pretty well. I break the news to you that Tylenol is simply a brand name for acetaminophen and you don’t believe me. You fumble around for 2 minutes looking for your checkbook and spend another 2 minutes making a check for four dollars and sixty seven cents. You ask why the tablets look different than those you got at the other pharmacy. I explain that they are from a different manufacturer. Tomorrow you’ll be back to tell me they don’t work as well.

Now Imagine this wasn’t you at all, but the person who dropped off their prescription three people ahead of you, and you’ll start to have an idea why…..your prescription takes so damn long to fill.

andillformthehead86 karma

Additionally... I may say 10 minutes even if i have nothing else going on because I fear running into an unforseen issue with insurance or interaction... and I may actually have it done in 1 minutes. Just don't stare at me from the window, but if you stay close I will get you out of there ASAP.

Nicker39 karma

  1. There usually is a bunch of people that dropped off scripts before you, we like to work in a system where it is first come first serve (so those people that dropped off scripts before you, are going to get filled before you, and if there is a problem with their script/insurance, it's going to be resolved before we tackle your script).
  2. The medication and outcome to you might seem like nothing to you, but you do not see the ‘behind the scene’ action going on. Your insurance might be expired and we would call the company to get new ID numbers, your script might be missing information and we would have to call the doctor to get it, ect…

friendlyintruder18 karma

I assumed there was some basic line system, makes a lot of sense.

Follow up. Can you just figure out what the script says if the hand writing is too sloppy? I'd imagine that not many names look too much alike, but you obviously can't be wrong with something as serious as medication. Do you just call the doctor?

andillformthehead61 karma

There are some look alike and sound alike drugs to be careful about, and sometimes drugs will change their names because of that. For example, apparently Kapidex looked to close to Kadian and became Dexilant instead.

However, its rare I can't tell what something says. If I am pretty sure but not 100 percent, I will often ask the patient what they are treating... which will often confirm it for me. Never do I let it leave the pharmacy without knowing though, so I'll make that call to a doctor if I am not 100 percent sure what I am dispensing is correct

NerdyExploration158 karma

What is your opinion of religious objection clauses some pharmacists cling to (refusing to dispense plan B, birth control etc.)?

andillformthehead380 karma

good question, and I'm not sure I will do a thorough job explaining my opinion here, but I will try... and I'm sure this will spark a good thought provoking discussion so maybe someone can change my opinion.

I don't think anyone should be forced to do something they dont want to, be it because of religious reasons or other. So, if a pharmacist doesn't want to dispense a medication, be it because or religious reasons, medical reasons, or what-have-you, they shouldn't. HOWEVER, I also don't believe that they should then be protected in their job. If my employer wants to carry Plan B and wants it dispensed, and I refuse, they should have every right to fire my ass right there.

If I own the pharmacy, and I decide I don't want to carry a medication or provide a service, no one should try and make me either. I know the discussion gets emotionally charged when we start talking reproductive rights... but there are plenty of examples of other medications we don't carry for various reasons, and noone should be able to make me carry it.

Disclaimer: While I may have used the term "I" in the previous paragraphs, that doesn't necessarily reflect my personal beliefs about said drug. Its just easier to type that way. I don't own the pharmacy I work at, and in fact I float between pharmacies, so I don't have much control over whether or not the pharmacy has it.

None o

[deleted]109 karma

No offense intended by this question - I have always genuinely wondered:

Why do you spend a bunch of time in school and then get a job that pays pretty well for just... you know... putting pills in bottles and giving them to people.

andillformthehead85 karma

I hope the question was somewhat answered previously. But also, consider there are different settings. The knoweledge base used in a retail is way different from when I was in a hospital or long term care.

As far as moving pills around, i try to let my techs do all that if I can while i lurk on reddit (as you can see this is my first post).

MyUsrNameWasTaken104 karma

Do you ever get grossed out/judge people because of the medicine they're on?

andillformthehead350 karma

Rarely. There are a few things that give me the chills still... like when I see meds come through for worms, or for scabies.... oooh scabies... i just want to throw the med from a distance :) But usually we are pretty immune to it.

However... I have worked close to my hometown before and have seen some girls from high school get the whore's coctail, which is Valtrex and birthcontrol together... always makes me happy i dodged a bullet there.

maxdisk9146 karma

No, the "whore's cocktail" is Valtrex, Birth Control, and Aldara (Med for genital warts).

I had a guy come in for Aldara and wonder if his accident insurance policy covered it, My boss said to him "not unless you were in a car crash and it ejected you, ripped off your pants, and you landed on top of the woman!" He got a laugh out of that.

Another case, a man came in for aldara and he was in clear discomfort, shifting around his pants and such. I felt bad for him and made a special effort to get it done quickly so he could go home and treat his itchy warts.

andillformthehead141 karma

I had an intern who was trying to counsel a patient on Aldara. He was elderly, probably mid 70s... so my intern felt a little awkward. Afterwards, the patient kindly explained the doctor was using it for a spot on his bald head instead. And we all had a good laugh...

Uncle-Dads-Whistle46 karma

That's one thing I never understood about why pharmacists or their techs need to counsel the patient when they don't even have the patient's chart or medical history. Isn't it kind of presumptuous considering the multitudes of alternate or off-label uses for medications?

andillformthehead31 karma

Which is why I teach my interns that if a patient is starting a med with multiple uses, the first question should be what they are using it for. Lesson learned for her. On the other hand, its sad how many times the answer to "what are you using this for" is "i dont know."

MoonShark63 karma

My mom is a pharmacy tech so I can sort of answer that: Basic professionalism mandates that she treat all customers fairly. She's awfully good about that, and I don't know where she gets the patience. But she would come home at dinner (when I still lived at home) and just have to tell u about ol' granny Gertrude and her festering sores, or Joe Redneck who just knocked out all his teeth in a combination motorcycle/roof accident, or Jane Highstrung who calls every 12.6 minutes to see if her anti-anxiety prescription has been filled yet.

So yeah she judges people in her head (especially ones who are rude, or should be seeing a doctor instead of a pharmacist) but she still gives them the professional courtesy and help they need.

andillformthehead57 karma

This is also a very good answer. Expecially about people who are rude. So yes, i guess I may make some judgement calls but its almost never reflected in my treatement of patients.

realistmom90 karma


andillformthehead131 karma

well "realistmom" if you are a MILF I will lie and say higher than I am.

From my pharmacist job though, its between 140-160 a year. The range is due to some years working some overtime. For my geographical area, I believe that my base salary is on the higher side of what a pharmacist makes. But I haev a good relationship and situation worked out with my boss. I have other means of income but I'm guessing thats not what you were asking

MoonShark89 karma

Why do pharmacies still stock Airborne and Zicam and other homeopathic BS on the shelves? Doesn't it undermine legitimate medicine to bilk customers for placebos?

andillformthehead118 karma

Yes, and I always stear people away from those products. But some people will buy them no matter what I say, because ancedotal evidence seems to sway people more than anything. So, if their neighbor said it worked for them... they have to try it!

In the end, pharmacies want to make money. So if people are going to buy it, they will carry it.

a_typing_kitten78 karma

How common is it for drugs to just go missing? I used to date a nurse whole stole drugs from a nursing home's resident's pill cups (the fun ones like codine etc- I broke up with her about 20 seconds after finding that out).

Also, what is your favorite looking pill?

andillformthehead85 karma

Of any drug that is non controlled, pretty common as we will drop pills or misplace in our inventory, or miscount... etc

Lower controlled drugs (C-III to C-V) a little less common, but still happens. If some pills are missing here or there we think nothing of it as we rarely count our entire inventory. Allot would have to go missing to notice. Also, we end up pretty trusting of people that we work with (though have been burned by that before).

Higher controlled stuff (C-II like your oxycontins, percocets, etc) almost never, as we keep constant inventory on each pill.

I don't think I have a favorite looking pill... never thought of that. I wish companies would make some fun stuff, like flinstone viatmin shaped pills and such for adults.

Comowl53 karma

How do you not have a favorite looking pill! There are so many to choose from. Generic Bentyl 10mg capsules are pretty. Valium have little hearts in them. They always make me think of candy necklaces. Maybe one day I'll may myself a valium necklace.

On another note. Benicar smells delicious. I always want to eat them.

andillformthehead26 karma

noooo! I cant stand that butterscotch smell! Id much rather count spironolactone and smell that.

cowpuncher78 karma

Where do you keep the "good stuff" and how well it's protected?

andillformthehead145 karma

If I told you I would have to kill you.

In reality... a locked cabinet in the pharmacy. Nothing special. When I'm at work I almost always leave the cabinet unlocked as I'm too lazy to lock it between uses.

summa58 karma

Ever been robbed? Some guy was hitting a bunch of pharmacies in my town about a year back, holding them up at gunpoint for oxycontin and fentanyl patches, I think he pulled off about 6 before the cops caught him.

andillformthehead83 karma

I have not, fortunately. However, pharmacies I have worked at have been robbed on days I was not there. Really hoping that is a scenerio I do not have to get in.

eat_pb48 karma

Couldn't you keep a bottle of stuff labeled "Special Oxycontin" or something that only pharmacists would understand, and really fill it with sugar pills or something harmless like that? Then no shooting, and bad guys get no controlled substances. And since the sugar pills are harmless, its not like someone might accidentally think its REAL oxycontin and hurt themselves with it.

andillformthehead55 karma

Back when generics for oxy were available this might have worked as those patients wouldnt know about that specific manufacturer. However, anyone who comes in and is at all familiar wil be able to identify if I gave them the wrong drug or not now.

The thought did cross my mind... however I thought about using some cheap generic like lisinopril (for blood pressure) in replacement. Again, now that probably wouldnt be a successful technique

joeonyoface46 karma

Do you judge me if I come in and purchase a Plan B pill? I'm a white and in my 20's male.

andillformthehead88 karma

I wouldnt straight up judge you, but part of me will wonder if you are buying it for an underage girl... be it a sibling, other relative, or girlfriend. But in the end, i'll just smile and send you on your way.

joeonyoface43 karma

Really it's for my girlfriend. She refuses to buy it. We're just lucky enough to have our protection break several times a year.

I've always wondered. It's not embarrassing for me to buy them, but I've just kinda figured people made their own assumptions.

Jerakeen142 karma

When condoms break it is typically a sign that you are using a size that is too large.

andillformthehead12 karma

I once had a guy ask me for extra small condoms. It took all I could not to at least crack a smile. He said he got them previously on a trip to mexico. Part of me always wonders if he was trolling... but with now nervous and secretive he was I don't think so.

billonmars45 karma

Do you look at people differently that come to you with regular prescriptions for Narcotics? What's the drug most people would be surprised by that is dispensed at the pharmacy?

andillformthehead66 karma

Coming in with regular narcotic scripts is not enough alone for me to look differntly at you. Combine that with other behaviors... and yes. As I mentioned, you become good at spotting people who are seekers versus people who are genuinly needing the medication.

realistmom43 karma


andillformthehead95 karma

It might be hard to quantify well in this format. Certain appearances denote seeking behavior. They way you talk to me. Seekers have a way of wanting to be "best buds" with me while i'm trying to do work. Not leaving the pharmacy window. We both know why. You don't want me making calls checking up on you, and so you think by standing right there looking and trying to listen that I won't. Other things such as multiple doctors on your file, or if you are someone I am not familiar with but you come in with a VERY high dose of certain narcotics... It might put up a little red flag. There are a good deal of little cues that just add up.

MyUsrNameWasTaken44 karma

Do you like your job? My sister is in pharmacy school right now.

andillformthehead78 karma

Like any job, it depends on the day. What type of practice setting is your sister looking at right now? Retail, hospital, and longer term care facilities cover almost everyone, but maybe she is looking for something more non-traditinal? I have some experience in all 3 of those areas in my short career, most of it being in retail. So like any job in a retail setting, it can be made or broken by the customers. I like it more now than I did at first... as I have developed relationships with people. I have become more understanding of where they are in their situation, where they are coming from, and what might be causing them to come off as impolite. It is really what you make of it in the end... and you really have to have patience (no pun intended).

doctorwatsondoctor33 karma

I just finished my first year of pharmacy school, during which time I've had the mindset of "anything but retail," assuming that the spoiled American consumer doesn't understand the distinction between customer and patient, and which of the two is always right. Am I being unfair?

andillformthehead27 karma

No its a legit concern. And you get it from the management side too who don't know the difference between pharmacist and salesman. You learn to pick your battles, push back when you need to, and work to make the atmosphere how it should be

asternemeraldink39 karma

Do you have any interest working in health services or for a pharmaceutical company?

andillformthehead102 karma

When I first got out of school, working for a pharmaceutical company in some capacities seemed tempting. Now, I look at most reps as whores, whores that don't go away. We all know you don't pay a prostitute to stay but to leave afterwards.

I don't have an interest in the research side if that is what you were asking.

Quellman33 karma

Why is it that compounding is such a specialty craft? Does it take additional education? Do you know if most nation-branded pharmacy's (wlagreens, CVS, Publix) will do custom compounding?

andillformthehead44 karma

It depends on what you are compounding. Any reputible pharmacy school should have a fair amount of compounding education in its curriculum. However, it is rarely needed anymore, so many of us get out of the habit and lose allot of that information. Also, many of the base products and tools are not in your every day pharmacy... so we just don't have the capability to do some things. I'm guessing part of that is also the ROI, as it would cost allot to carry everything needed for how little you would use it. So, its easier to focus all that work for all the doctors compounding requests into a few specialty pharmacies.

Simple compounding will be done anywhere.

Jerakeen30 karma

Why do pharmacists always work from a raised platform?

andillformthehead85 karma

to show off our well trimmed nostril hairs

netgamer729 karma

How long can you take ibuprofen without experiencing some odd side effect?

note: i'm talking about a normal dose, and not 24/7... more like 2-3x per day with the prescribed wait between doses.

I've heard of certain drugs causing unsafe buildup even if you take then infrequently (but ALL the time)

andillformthehead34 karma

Odd side effects? I guess it depends on what you consider odd. And what do you consider normal dose? the 400mg a dose as on the OTC packaging, or 800mg a dose as per an rx? I don't know that I would expect anything abnormal, but you are putting yourself at risk for some potential side effects.

Dalimey10029 karma

What is the strangest disease/ symptom you've had to deal with/ give medication for?

MoonShark28 karma

Similarly, what's the weirdest drug you're aware of, and why is it weird?

Also: Got any good suppository jokes? ;)

andillformthehead112 karma

I'll have to think of answers to both of the "strangest" questions.

I don't have a good suppository joke, but I have a good short story. Girl comes in for Cleocin vaginal suppositories. We are reasonably busy but I quickly go over it with her, knowing i mention its a suppository, and what to do. However, she apparently believes texting is more important than giving me her full attention (dont get me started). I send her on her way.

The next day I get a call from the nurse asking what they prescribed. I confirmed cleocin suppositories. Turns out, the patient was treating it as a Cleocin lozenge. I could only feel good at this result :)

derzahla28 karma

Why is pure d-amphetamine used so rarely these days compared to racemic amphetamine(adderall), despite IMO, being a better drug? And on a similar topic, have you ever filled any desoxyephedrine prescriptions? Any idea's why doctors are so reluctant to prescribe it other than the stigma? It IS by all accounts a smoother and more centrally acting stimulant.

andillformthehead47 karma

I'm not sure I have a good answer to that... usually I would suggest cost of eliminating one of the isomers... however, the end cost of each of those drugs really is close to the same.

No I have never dispensed methamphetamine... though maybe to the surprise of many I believe it is a schedule II so legal, like cocaine.

uninvisible21 karma

I gave this a shot on the other AMA

As someone who as clearly never had an opportunity to learn about what pharmacists do, my perception is that it's about moving pills from big bottles to little bottles. I realize that there's more to it than that, but what would you say is the benefit to having pharmacists and doctors as separate professions? From your degree and your training, what do you use on a daily basis to fill prescriptions? Please don't be angry at me.

Also, last summer I had to fill a shit load of prescriptions before I went off to China for a year. My doctor set me up for getting a bunch of xanax in a short period of time since we didn't know how easy it would be to come by in China, and I'd have it at the ready when I had sleep issues. I felt like my pharmacy was treating me like a drug addict and started refusing to fill anything even though my doctor gave instructions for how often to fill a prescription and how many pills to give. Do you regulate people's medications differently than a doctor would?

andillformthehead35 karma

If your question was on the pharmacy students AMA, that was one reason i decided to do mine instead... as it seems instead of giving you an answer she bit your head off. Though the other people that have already answered seem to have done a good job. Its all "checks and balances." Making sure there aren't any glaring issues that are being missed, being first line in many cases to answer medical questions or offer suggestions for tweaking therapy, among other things. People also see multiple doctors, and don't always share everything they are on... so we can catch interactions that the doc may not have even known would be an issue. This also leads to my plea to try to use one pharmacy as well though.

The second portion is more difficult to answer. Some pharmacists may be out on a power trip (there are assholes in every type of work) but for the most part no. There are times where I have refused to fill prescriptions even if the doctor is trying to OK it. I will offer to the patient to transfer it elsewhere, and if I do I explain everythign to the new pharmacist and let them make their professional judgement call. It really is a case by case basis, and there have been some shady doctors I have come across as well. Sorry this probably isnt the succinct answer you want but its hard to give one blanket statement.

derzahla18 karma

One more question, I come from a long line of pharmacists, and being the lazy bastard that I am, decided early on I was going to be either a pharmacist or a sys admin. I ended up going the sys admin route. To be honest, many weeks, only a couple hours out of 40 are spent doing real work. Did I win? How does your work week generally breakdown? 60% standing, 20% counting out pills, 10% computer lookups, 10% answering patient questions?:) No offense, im generally curious and I know that you obviously have to be very knowledgeable to do your job.

andillformthehead36 karma

No reason for me to take offense is there? It really varies from location to location, but if you are working only a few hours you win. Most of my time is spent surfing the interwebs at most of the stores I work at... and often they give me a tech on top of my bored ass already, so I really don't do much. But some stores and some days keep my running all day.

Also, I've become pretty effecient at what I do, so, that really limits how much time I need to work. Honestly I think I spend about 70 percent of my day wasting time. I often wish I could think of something more productive to do during those times.

thebobster143716 karma

I asked this on another pharmacist AMA, and the answer worried me, so I am going to try to get another opinion. . . I am just starting out in school, and I am aiming towards getting my PharmD. Any advise as to what I need to be prepared for? Anything I should start studying up on right away?
Also, the last AMA spoke about how new pharmacists are having trouble finding work once they are out of school. What is your take on the health of the job market for your field?

andillformthehead30 karma

What about the answer worried you previously? With my schooling, the curricullum was pretty well laid out without much wiggle room. However, any exposure to anatomy and physiology you can get early would be good i suppose?

I only graduated a few years ago. When I came out, market was white hot. I could go anywhere, work for anyone, and all I had to do was have a license and a heart beat. Things have definitely tightened up, but work isnt impossible to find. We just hired 3 full time pharmacists (students waiting to get licesned acutally). It is a result of the down economy like any other area. I see pharmacists who are old and should be long retired trying to come back and put some hours in, pharmacists not retiring when they had planned on it, and some companies (like walgreens and cvs) have put a hold on their expansion. So we are getting a little pinched on both ends. I firmly believe once things turn around a bit we will be easily on the winning side again. Especially as babyboomers get older and start taking drugs like crazy (legal ones for disease states this time).

skyqween15 karma

You mentioned that you work at multiple pharmacies. Have you encountered widely varying prices for the same drug? I recently encountered a price discrepancy of over $50 when picking something up. The first place was insanely priced, and the second one was still scary...

Also, do you get 'regulars'? People from the neighborhood who you see over and over for their scrips? Do you form relationships with them?

andillformthehead28 karma

With brand medications, I rarely see much difference in price. There will be some, but usually only a few dollars here or there. With generics though, I would definitely check a few places if you are not billing an insurance company. If its the pharmacy is billing out, usually there is a contracted price with the insurance company so it won't matter where you go.

Yea, I frequent certain places enough that I get to know people. It makes the job on allot of days. Certain people are like clockwork. Tuesday morning, 10am, i'm bound to see "mr smith" and I like that. And they show their appreciation for me as well.... mmm baked goods.