I’d like to share with you some highlights of the stimulating interview I recently conducted with Barbara Parrillo, a pharmacist in New Jersey. From first-hand experience, she urges readers to develop a relationship with a local pharmacist they can trust.
Barbara, why is it important to find a good pharmacist to work with regularly?
It’s most important to bring all your prescriptions to the same pharmacy because then they have a record of everything you’re taking. Your pharmacist can counsel you if there are possible interactions or overlaps between the drugs you’re taking. She can consult with your physician when there are any problems.
It’s important that your pharmacy keeps a profile on you that’s current. They need to know the diseases you’ve been diagnosed with and any allergies you have.
It’s a good idea to have your whole family go to the same pharmacy. This gives the pharmacist a chance to get to know all of you, and she has a full medical history to do her job effectively.
It’s common for people to go to many different doctors and they may get similar prescriptions for the same ailment. By using one pharmacy the pharmacist is able to catch this and call the doctor to avoid duplication.
Also, there are times when a patient isn’t following the right dosage schedule for his drugs. When it comes time for a refill, your regular pharmacist can readily see if you’re taking your medication too frequently or not frequently enough.
Sometimes we see a patient (usually a senior, though it could be anyone) who takes a lot of different prescriptions and is on a tight budget. He might try to stretch out his prescriptions — take a pill every other day instead of every day. Or fill one prescription one month and a different one the next month. Your pharmacist can pick up on that when it’s time for a refill and may observe that you’re not feeling well and advise you that it’s because you are not taking your meds correctly.
Also, drugstores can be busy places. If you’re a regular customer they will recognize you at the counter and may find a couple of extra minutes for you.
What are other issues a pharmacist can help you with?
Many people now take a variety of “natural” health products. But not all herbs or supplements are free of potential side effects or interactions with prescriptions you might be taking. Pharmacists can help you with herbal interaction counseling.
Pharmacists can also help you minimize your use of pain medications – give you alternatives and strategies with dosing schedules to help you steer clear of medication dependence.
Your pharmacists can advise you when to call your medical doctor – for example, if your symptoms persist for longer than expected. Also, he can assist you when it’s safe to treat yourself.
Your pharmacist can help you pick out the proper over-the-counter drugs for you and your family. He can look at you drug profile see what meds you are on and what disease states you’re being treated for and then you both can make an educated choice on what to take.
She can also tell you how to use these OTC’s correctly. One major area of misuse is nasal sprays. Patients overuse them and then can have a hard time stopping the medications.
How do you find a good pharmacist?
It’s like anything else — you shop around. You can try more than one. Go into a pharmacy and poke around – you can see if they spend time with their patients. Set up an appointment to talk to one of the pharmacists. You can review your medications with them and ask some questions to see if the pharmacy can provide the services you are looking for.
But don’t go into a pharmacy at their busy times and expect a pharmacist’s undivided attention. (8 am, noon, or 5 pm are usually the busiest times). They can answer a question or two but if you need to have a discussion with them the off hours are better.
The pharmacies that are not as busy will have pharmacists that can spend more time with you than the busier stores. You can usually tell which pharmacies have overworked pharmacists.
Many people are concerned with getting a good price these days, and chain pharmacies want you to think they’re cheaper. They usually are. But be aware — not all their drugs are cheaper. Some pharmacies have specials on a popular diuretic or blood pressure pill to get you in and then you’re their regular customer. You’re led to expect that all your prescriptions will be low-priced. But that’s not always the case.
These bigger stores also want to draw you in with low drug prices so you will shop in the rest of the store, so just make yourself aware of prices. I recommend if you are in the market for a full service pharmacy then pick it for the pharmacist. But if you are also looking for the best price then it’s a little harder to find both in one place, They’re out there — you just need to do your homework before making your decision.
Word of mouth is also a good way to find a good pharmacist. Ask your neighbors, ask your doctor.
What about drug side effects you should talk to your pharmacist about?
Every drug comes with a list of side effects. The pharmacist now gives you a pamphlet of information about the drug you are taking. Use this as a point of reference but remember — not everyone gets these side effects.
You know your body, so if anything seems different after you start a new drug you should call your pharmacist or doctor (depending on the severity). Sometimes a solution could be as simple as changing the time you take the medication or whether you need to take it with food.
Rashes are a common allergic reaction. People are developing frequent allergic reactions to antibiotics – sometimes they’re severe. These should always be reported to your doctor and pharmacist.
Is there a particular class of medications more prone to side effects?
Any drug could potentially have a side effect.
One example of a drug that should be closely monitored is Coumadin. It’s prescribed as a blood thinner. The generic name is warfarin. Warfarin (Coumadin) can have serious side effects if you take too much for your body – you can bleed. Or, if you’re not taking enough it will not be effective.
You need to be aware of foods to avoid while on the medication (your pharmacist can help you here, too) and also pay attention to your body. If your gums start to bleed, or you get a lot of bloody noses or black add blue marks, call your doctor. You may need to follow up with a blood test sooner than usual. Always follow your doctor’s orders and get the blood work on the days your doctor has scheduled. This is the only way to ensure your drug is working correctly.
What about a parent’s concern with teenagers abusing drugs from the medicine cabinet?
Abuse of prescription drugs by teenagers has become a major concern for parents. You have to know your children. Counsel your kids about the risks.
You can hide your medications. But the best solution is to lock your medications up. Especially pain meds.
It is also important to monitor your children’s prescriptions for ADHD. They tend to find their way into other teens’ hands.
It used to be that you could flush unused pills down the toilet, but that isn’t recommended any more. Many pharmacies have a program to dispose of unused drugs – call up your pharmacy and see if they have a drop-off day.
A big problem today is when your kids are visiting grandparents (or the grandparents are visiting you.) Older people have pills everywhere – Xanax, Valium, sleeping pills. Older kids could have a field day.
As a pharmacist, do you get an idea of the prescribing patterns of physicians in your area? Do you ever develop a sense of the particular doctors who patients should be leery of?
Pharmacists usually build up a good relationship with the area doctors, so they are able to help you find a specialist in the area. As a pharmacist, my interaction with physicians and with their patients usually gives me a feeling of how they run their practice. Of course, some good and some bad as in everything.
Is there ever a reason someone should use brand name instead of a generic version of a drug?
Generally, no. Generic products are fine. Formularies – the lists of drugs your health plan will cover — are made up of approved generics. Most hospitals use generics.
But there are a few situations in which it might make a difference – thyroid medication, for instance. Your body adjusts to an exact dose of thyroid medication down to the microgram. So variations in product manufacturing can make a difference.
It’s not even that you have to take the brand name — it’s just that, whatever you’re on, stick with it, whether it’s Synthroid or a generic. The problem would be if you move around with your prescriptions and you get different manufacturers. Then your dosage levels could be off.
The same issue may apply to phenytoin and warfarin , and a few other drugs, too.
What about drugs from Canada or another internet source?
I recommend against getting your medications online or “from Canada.” You don’t really know what you’re getting and you have no recourse.
Some of these drugs are the real thing but there are counterfeits out there too. The pills can even look exactly the same. Sometimes there’s no active ingredient in them at all.
The FDA is working hard to protect us from counterfeit drugs and from generics and brand drugs that do not meet regulations. So by going outside this system there is just no guarantee what you are getting. Here again I would have to say buyer beware.
Thanks so much, Barbara. I’m sure readers will find a lot of value in what you have to say.