Pharmacy Phun

Veterinarians are always getting harassed about drugs. People want us to prescribe drugs for their pets in inappropriate ways (antibiotics for a virus, or pain medicine in the name of the owner instead of the pet so that it can go onto the owner's insurance. as if!). People want us to dispense drugs directly from our office so they don't have to schlep somewhere else and wait for it, or so that they can get the special veterinary-only formulas that aren't available at local pharmacies. At the same time, people think we are evil and greedy for charging "so much" for the medications we dispense, even though our markup is, quite frankly, bupkes - especially for the more expensive drugs. So they ask us to write a prescription for a non-veterinary-only drug that requires one to look up what size/strength of the medicine is available for people and/or to figure out if it's even something most pharmacies carry - but heaven forbid we want to charge any actual money to cover the time spent on that. Dispensing is really lose-lose, except of course for the pet who needs to start on something right away, without waiting for malpracticingvetpharmRus.biz to ship it from Outer Buttlandia... on the whole, I gotta say, I prefer prescribing. What else? Oh right. People want to steal our drugs. Veterinary hospitals get broken into frequently by losers who don't like the Special K you can buy at the grocery store. People abuse our trust by bringing in pets with diseases requiring long-term treatment with opioids or benzodiazepines, and then diverting the drugs we dispense or prescribe either into their own selves or onto the street. And then there are the "friends" who think "yo, so - you can probably get all the Vitamin V you want, right? Can I get some too?" is appropriate cocktail party discussion. So, pardon me for being a little cynical about the whole veterinary pharmacy situation.

This brings me to the issue of prescribing. And please, don't say "prescribing human drugs." Drugs are drugs. There are drugs used in humans and not in animals, drugs used in animals and not in humans, drugs used in humans and dogs but not cats or pigs, drugs used in humans and cows but not horses or sheep, they are all drugs, and none of them are human (last I checked.) Prescribing is fine, I don't mind do it, in fact I sometimes like doing it because often, it teaches me something (I have to do a little research (epocrates FTW!) to find out what strength something comes in, what the vehicle is, how it's absorbed in a given species, etc - a little brain exercise can be nice). But, for some reason, it's really common to run into a problem with the pharmacist.

Don't get me wrong. I generally love pharmacists. I appreciate their education. They aren't just pill-counting techs - they are experts in these medicines and how they work and interact in the human body. Most, however, have little or zero education about the pharmacokinetics of commonly prescribed veterinary drugs in the species for which I am prescribing. This does not seem to stop the ones around here from accusing me of malpractice and/or simply changing the Rx without telling me!

Common pharmacist errors with veterinary prescriptions include:

-dogs getting thyroid hormone supplementation: pharmacists frequently tell the client the vet MUST have made a mistake and is dangerously overdosing the dog. Trust me: we're not overdosing the dog. Humans just happen to require much smaller doses than dogs happen to require.

-telling us they don't have amoxicillin suspension 25 mg/ml, but they can swap it out for 125 mg/5 ml "if that's ok with you!" WTF? This one happens FAR too frequently and no one has ever adequately explained to me why this happens. I always thought this mistake could only be attributed to pharmacy techs, but I have had two licensed pharmacists pull it on me, so, I dunno - there's gotta be some reason, but I don't know what it is. I wonder if the Angriest Pharmacist could maybe drop by and explain why this one error is so common? [side note: I love the Angriest Pharmacist!]

-trying to sub in a timed-release formula for a dog (whose transit time is different enough that this is not good)

-telling the client the insulin we are telling them to get for their cat is too expensive and they should change to some cheaper (inappropriate) stuff.

It can be very frustrating. Some of my colleagues have offered CE classes at pharmacy meetings to try to cut down on some of the more common errors that classically trained pharmacists make with respect to veterinary prescriptions. That's probably a lot more productive than bitching about it on the internet is. I can bitch about it on the internet in my PJs, though, so there is that.