Find a Good Pharmacist

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.pharmacist

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.

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About Ronald Lavine, D.C.

Dr. Lavine has more than thirty years' experience helping patients alleviate pain and restore health using diverse, scientifically-based manual therapy and therapeutic exercise and alignment methods.

His website, askdrlavine.com, provides more information about his approach.

Please contact him at drlavine@yourbodyofknowledge.com or at 212-400-9663.

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