Friday, July 25, 2014

Dear Pharmacists

It's no secret that we veterinarians are starting to interact with human pharmacies more and more.  We are MORE than willing to work with human pharmacists in order to find better pricing for our clients and patients to make sure that they get the proper care they need.

In fact, there is a sign on my wall telling my clients to please ask for a written Rx if they would like one.  I'm more than happy to oblige.

However, since Target and Wal-Mart and all those places now feel the need to "get in on the veterinary action" of selling drugs to our clients, allow me to put forth some suggestions for them to help... uh...  facilitate things.

1.)  Animals often require higher doses of many drugs than humans.  Please get used to this.  Because drugs have different pharmacokinetics in different species, and because you only learn about ONE species in pharmacy school, you're not aware of the doses used in our patients. Either go ahead and take a class in veterinary pharmacology, or get a formulary and use it EVERY TIME, but please for the love of all that is holy stop changing my drug doses while making snide remarks to the clients about how I don't know what I'm doing. If you're really concerned that I'm screwing up, go ahead and give me a call. I'll set you straight. But I'm not free to talk to pharmacists all day, so, you may be on hold for a while.

2.)  It is YOUR responsibility to learn the difference between the human world and the veterinary world, when it comes to sigs.  YOU must know that if I sign a DVM after my name and I put SID or whatthefuckever, YOU must know what that means.  Filling it wrong because you are ONLY trained in human medicine is unacceptable.  It is not my job to do your job for you. 

3.)  Please oh for the love of god teach yourself and your staff that 15 mg/5 ml is really the same as 3 mg/ml.   I do not have the time to sit there and explain this to you all every. single. time.

4.)  Please do not panic when I prescribe Alprazolam to my patients.  It really is effective for them.

5.)  Please also do not panic when I prescribe Trazadone to my patients, and especially do not tell my client "I can't give you that!  That vet doesn't know what she is talking about!  It's not USED for that!" until you've spoken to me and I've educated you on your own ignorance.

6.)  Please NEVER, EVER, substitute drugs.  EVER.  Yes I realize it can be done in the human world.  But remember, you are now in a world in which you were never trained, yet you are responsible!  So educate yourself about veterinary drugs OR DON'T SELL THEM OR FILL THE PRESCRIPTIONS IN ANY MANNER OTHER THAN HOW WE PRESCRIBE IT.  And, by the way, Tramadol is NOT a substitute for Trazodone. 

7.)  Stop questioning if I know what I am doing or not.  I do know what I am doing.  You do not know what I am doing.  See how this works?

8.)  Please stop asking for an NPI number.

9.)  No, not all insulin is the same.  No you may not send home a generic when I did not prescribe that.  See how this works?

10.)  The fact that I prescribed prednisolone to my feline patient means something.  It obviously means nothing to you because you keep sending home prednisone.  Please just follow directions.  It's really very easy.

11.)  Invest in a veterinary formulary.  PLEASE FOR THE LOVE OF GOD AGAIN, DO THIS.

12.)  Lastly, simply establish a relationship with us.  Respect us.  Treat us like doctors when we call and do not dismiss our questions for your pharmacy, such as how much something costs.  My clients will be paying you cash for those drugs, which is really really good for your business.  So stop busting my chops over it, realize we are colleagues and you better get used to having us around.

After all, it is your profession who asked for it.



43 comments:

  1. Just had a pharmacist tell a client that I overdosed her dog on Alprazolam and she should give only a 1/4 of the dose. The owner called panicked and scared to give the drug. I called the pharmacy and spoke with the pharmacist... after 10 minutes she still didn't think she did anything wrong and kept saying "well I didn't know how it would affect the dog but I'd be passed out." I finally just told her to call us before she scares the shit out of my clients again.

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  2. Had a pharmacist argue with me that there is no such thing as a long acting insulin...Uh, dumbass, Ultra-Lente insulin acts longer than regular insulin. A drug that has effects for 8 hours compared to its regular counterpart that has to be given every 2 hours IS long acting.

    Oh, and you (along with your MD/DO/PA buddies) absolutely must STOP telling my pregnant clients that they ABSOLUTELY HAVE to get rid of their cats because they will cause abortions. My education in parasitology far exceeds your own, which makes me the expert, not you.

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    1. Wait, what?! Really?!?! >.<

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    2. Completely ignoring the fact that if you've had cats for more than a few years, you've almost certainly already had toxo, won't get it again, and the kids will be fine.

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  3. Actually, SID doesn't exist as correct terminology, technically it should be q. 24h. BID, TID, QID are all ok.

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    1. First of all, obviously it exists because if it didn't we wouldn't be having this conversation. Second, not only does it exist but it is in wide use at veterinary teaching hospitals. Third, it stands for "semel in die," Latin for "once a day." You're welcome.

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    2. Again, the FDA states it is not a proper sig. Just because you use something doesn't mean it is correct. The vet schools need to change that. Sure I came to pharmacy school knowing what it meant since I had been practicing for years, but you are not sending your pet owners to another veterinarian. You are sending it to a human pharmacy. We are not allowed to have SID, QID, QD or many other normally used sigs. You are on here acting crazy, but don't take the time to research what you are complaining about! No YOU are welcome!

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  4. I'm a Canadian pharmacist and quite upset that you're having these sorts of interactions with the pharmacists near you. This is how I practice:

    1. I know that companion animals require different and often much higher doses than people do. I respect that the DVM knows what they're doing and because I have no training in vet med I do not call to question the doses. So I rely on DVMs to really know their stuff because, unlike MDs, they can't rely on me to fix any scew-ups.

    2.) I have seen many rxs from DVMs and understand that they use different sig abbreviations. Since most of our DVMs here use a very good computer system that prints out the species, weight etc as well as spelling out the sig, I seldom have to go look up an abbreviation (which I would, because s.i.d. is new to me)

    3.) Anyone who doesn't understand that 250mg/5ml=50mg/ml doesn't need to be working in a pharmacy. Simple math skills are a basic requirement.

    4.) I do not panic when I see your rx for alprazolam, but it does raise my antennae and I do consider what I know about the owner, and this is because you, the DVM, may not know what I know about the owner, and because all benzos are prime targets of abuse in the human population.

    5.) trazodone? See #1.

    6.) I never substitute anything that is written as DNS. If you write the generic drug name, I will fill with whatever brand of that I have on hand. I expect the DVM to specify a particular brand if that's what they want. I never, ever change the drug. Period. If you have specified a brand name, and we don't have it, I will call you to discuss options. Similarly, when the DVM rxs theophylline and te have only an SR product. I trust you to know whether that will be OK, or if we need to try something else. When you prescribe doxycycline for a rat, I will call you to discuss what liquid base we will put it in, because I know that not all components are suitable for particular animals.

    7.) I don't know enough about vet med to know if you know what you're doing. So I trust that you do.

    8.) I don't know exactly what an NPI number is, but if it is required in the US for prescribing controlled drugs, it is probably only required for MDs. However, with the climate in the US around controlled/narcotic drugs right now, your pharmacy may be running software that requires an NPI to be entered, and the pharmacy/pharmacists do not want to risk their license by making up a number so that they can process the rx. Please have some understanding and compassion for your colleagues.

    9.) We know that not all insulin is the same. There are no generic insulins in Canada. We do not even substitute brands for insulin. Period.

    10.) The only oral prednisolone we have is a liquid. In humans, prednisolone is converted mg for mg by the body into prednisone. I know that this may not be the same in other animals, but I will always call to check that the excipients in our liquid preparation are suitable for the animal.

    11.) We don't have a Veterinary formulary. Is there one that you could recommend? Or an online resource?

    12.) We do not disrespect you.We know you are our colleagues, and that we are woking together in the best interests of your patients and their owners. Do you respect us?

    I spend a lot of time answering questions from people who want to know if they can give such-and-such an OTC product to their pet. I always tell them that I can't make recommendations about non-humans, as it is beyond my scope of practice, and that they should contact the vet. Many of them have no vet to contact, as their pets never see a vet from year to year. I try to encourage them to take care of their pet's health as they would take care of their own. For a small city of close to 30,000 people, we have 3 vet clinics and no one has to go without a vet to take care of their animal.

    We are not trying to bust your balls. Please don't do that to us.

    A Northern Pharmacist.

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    1. Hi! Plumb's Veterinary drug Handbook 7th Ed is available at amazon.ca (I checked) & would be my recommendation for a good general-purpose formulary! Thanks for your interest.

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    2. I'm another vet that would strongly recommend Plumb's as an excellent reference. It is my "go to" drug formluary.

      You sound like a pharmacist that would be very pleasant to work with and I wish there were a lot more like you. Unfortunately, everything that VBB wrote is not only true, but very common (at least here in S. Florida). I've been a vet for 16 years and I have lost count of the times I personally have had to deal with #3, 6, and 10. If I am one single vet that has experienced this with multiple pharmacies over the years, you can only imagine how rampant the problem is.

      I've seen cats changed from Lantus insulin to NPH insulin BY THE PHARMACIST because it's "much cheaper" and then the cat ends up in the hospital with a huge bill to get it's diabets back under control. (This seems to happen more commonly since the price of Lantus increased so much) Was the vet ever called to check that it was ok? NO! When you call the pharmacist to question them, in all of the cases I'm familiar with, the pharmacist has acted like they did nothing wrong and can't understand why they should be at fault.

      It's gotten really frightening, to the point that I have to warn clients about all these possiblities before the fill their prescriptions. It's really sad...

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    3. It's=it is
      Its= used to indicate possession
      At least the pharmacists I know are able to write sentences utilizing proper grammar.

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    4. Animaldoc98, I'm really shocked to hear your story about the Lantus and the NPH. I can't imagine that happenning with a human patient, where a pharmacist could be expected to know the pharmacodynamics, half-lives, etc involved, let alone with a veterinary one. I don't know why these things would be considered acceptable in the pharmacy, so I don't have any solution to offer. I would hope such a thing would never happen in my pharmacy. In Canada, insulin does not require a prescription and pet owners just buy it OTC. I wonder if that played a role. In any case, just unacceptable.

      On another note, thanks for all the recommendations for Plumbs. I have ordered one for the store.

      And 3a72e9f6-153b-11e4-98b7-cf468574db71 : what's your comment about? It's=it has as well, but how is that relevant here?.

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  5. Replies
    1. And at least both the vet and the pharmacist have figured out how to keep replying to the same thread. It's not hard to do. Quit being a troll, it's not becoming at all.

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    1. Excuse me but an NPI is actually not allowed BY LAW to be issued to a veterinarian and we are told by the authorities that even applying for one can get us in trouble. SO STOP FUCKING ASKING US FOR ONE!

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    2. Did I say it is required by law FOR VETERINARIANS??? NO, I said for us to complete an rx it is required by law...but we can get around it WITH YOUR DEA OR LICENSE # (RIF). Most (99%) of our patients are human and human doctors, NP, PA, dentist etc have to have an NPI. Simple is that. Instead of fusing just make sure you have your DEA or license on the rx and we won't have to ask you. Again, do your research or ask someone about policies before getting on here complaining. Then when someone tries to enlighten you, you want to start cursing (GROW UP 2nd GRADER). I know both sides...so I know what we as vets don't know and I know what we as pharmacist don't know. Why do you all try working together instead of not getting better educated???

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    3. I appreciate your suggestion about the DEA and license # options, however I have had multiple pharmacies deny me prescriptions altogether due to a lack of NPI# (despite the alternative options). Additionally, when I suggest the use of my license # some will require my DEA#, and honestly I just refuse to give that out for any prescription that isn't a controlled substance. The DEA website actually states NOT to use it for non-controlled meds. Yet I still receive countless phone calls for my DEA# to approve a prescription of Cephalexin. I have had pharmacists refuse my client the medication when I've refused to give my DEA, despite offering my license # as an appropriate alternative.

      Straight from the DEA website:
      Question: Is it appropriate to provide a DEA registration number on prescriptions written for medications other than controlled substances?

      Answer: DEA strongly opposes the use of a DEA registration number for any purpose other than the one for which it was intended, to provide certification of DEA registration in transactions involving controlled substances. The use of DEA registration numbers as an identification number is not an appropriate use and could lead to a weakening of the registration system. Although DEA has repeatedly made its position known to industries such as insurance providers and pharmacy benefit managers, there is currently no legal basis for DEA to prevent or preclude companies from requiring or requesting a practitioner’s DEA registration number.

      While the NPI number was devised to avoid the use of the DEA for non-controlled substances, you cannot expect veterinarians to be forced to use ours just because we don't fall under the NPI category. Please use our license #!

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    4. Sas, I have never had a problem with just filling in my scripts with the DEA line filled in with "call as needed" - never had a pharmacist call back unless it was for a controlled substance, though they will ask if I call the rx in. It's just a cataloging system, and I feel there is a pretty good amount of us just nitpicking and being recalcitrant because we feel forced into a system we don't want to be in. If we don't have an NPI number, what choice does the pharmacist have? I'm sure the local CVS and Walgreens would love to use your license number as an alternative (not being sarcastic here), but it's not like that choice is up to them. No use getting mad and spitting on them for something they, and we, can't control. Just make sure you're giving it where it belongs.

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  7. I will try to keep this short. As a veterinarian and pharmacist I understand and was pissed with this article. Seems the pot was calling the kettle black throughout this blog.
    1. If a pharmacist doesn't know something...answer their question. They didn't ask for your business, their corporate office did. They went to school for humans.
    2. SID is not a legal sig in the US. DON'T LIKE IT...contact those who made the FEDERAL LAWS!! So yes, I may know what it means, but it is not taught in pharmacy school as IT IS NOT A LEGAL SIG IN THE US! Seems the vet schools need to catch up to federal law.
    3. Xanax is an abused drug (and most of you know it because most of you are on it). If your client is diverting their pets controls and we don't question it, your license could POSSIBLY be questioned, but ours will DEFINITELY be pulled! I don't care about your feelings over my license and well being.
    4. Seeing as we were required to take our pharmacy wet boards WITHOUT A CALCULATOR (yeah you try that) we do know how to do math. But, since we are all very busy why not just write 3mg/ml. Why do we need to do your job for you?? That's too much like right though isn't it!
    5.I get calls from my pharmacy colleagues all the time. Why, because they know they won't get the rude response as above. Again they didn't ask for your business personally, so if they call with a question just answer it! Otherwise you look real childish!
    6. BY LAW YOU MUST WRITE BRAND NECESSARY ON ANY RX IF YOU DO NOT WANT GENERIC...THAT IS THE LAW!!! DON'T LIKE IT...SEE #2!!!!!
    7. An NPI is required by law (see #2). We can use your license or DEA #, but most of you don't have that on your rxs so we would have to call you anyhow.
    8. If someone is giving tramadol for trazadone that is a misfill not a substitution. We clearly know what the uses are for that medication. Now, if you are using trazadone for an off label use, then we must ask that use and document your name on the rx. We do it all day for MDs. It is a for the protection of our license. Again...your feelings<<<my license.
    9. Stop generalizing the pharmacy community (POT MEET KETTLE)

    As a pharmanarian (as my sister calls me) I know both sides of this coin. I went to 4 years of vet school and 4 years of pharmacy school. We only learn one species, but that just shows you how much we have to learn about medications...AND ONLY FOR HUMANS!! I love being a vet and like being a pharmacist (much better pay, but customers and other health care professionals are EXTREMELY RUDE AND MAKE THE JOB HARD TO LOVE). Respect is received where it is given. We are all PRACTICING medicine, so if they ask...tell them. They will learn something new and be able to better help YOUR clients!!

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    1. Hi, "Me". As a Canadian pharmacist, I'm curious about the whole NPI problem. I suspect you are required by your software to enter an NPI in order to process an rx, and you can't complete an rx without one. Is it a software problem? What do you do with dentists, Nurse Practitioners, etc? Is it your State or Federal legislation that requires the NPI for every rx? If so, it seems that the vets and pharmacists could get together to deal with this legislative problem. If you can lose your license (are you licensed by our state or the federal government?) over it, and yet vets don't have one, you're in quite a state of conflict. What about your state pharmacy professional association? Seems like there's a problem here that was not envisioned when the legislation was being drawn up, and that everyone could be working together to solve it. It would be in the interests of both the veterinarians and the pharmacists to do so, wouldn't it?

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    2. Yes, it is a system requirement to fulfill the federal laws of having to verify prescribers. NP, PA, dentists...they all have them. I as a relief vet and therefore do not have an NPI or DEA, so I use my license #, but instead of vets just asking is this possible they go on rants. Yes, that helps their patients/clients and gains respect of other professionals!

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    3. Thank you, Me for your thoughtful reply.
      I know pharmacokinetics are different with many species and I trust my DVMs, but I still call the DVM if something looks odd; everyone makes mistakes and it is my job to make sure that doesn't happen. I have helped catch errors that would have been life-threatening for the patient. I do this for MDs and i will do this for DVMs too. Let's work together for the benifet of our patients and not tear each other down.
      As for NPI, or National Prescriber Identifier, this is messed up. All practitioners who prescribe or order meds or procedures are required to have one. I have one. NPs, PAs and all other providers I work with have one. Software requires it and it is all for tracking and billing purposes. Once again it comes down to $. Of course, CMS doesn't feel that DVMs are health care providers to their definition, so they make you ineligible to get one. Fancier pharmacy software will allow us to put you in as DVM and not require it, but other software does not have this feature and many in my field do not know this.
      Also, this reminds me how jealous I am of DVMs that you do not have to deal with insurance companies like we do. This is slowly destroying my profession and I hope you do not let it creep in and do the same.
      Thank you for your time.

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    4. It sounds like you are a good pharmacist and know what you are doing but you have to realize this article was written because veterinarians deal with these issues daily. You may know better, but I have discussed several times with pharmacists to not change my script and to not scare my clients into not giving the drug but they don't listen. Yes, the article is generalizing, and I'm glad you are good at your job, but you have to realize that these complaints don't just come out of thin air. It happens a lot. Veterinarians are happy to discuss any questions pharmacists have on a drug we are dispensing, just call us before questioning us in front of the client.

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    5. The DEA number is supposed to be used when prescribing scheduled drugs. It is not intended to be used as an id number. I and my staff have been verbally abused by pharmacy staff when I explain to them that I will happily give them my license number but not my DEA for that Amoxicillin Rx. We pay a lot of money to get our DEA numbers. Why are we forced to compromise them for the sake of an inadequate software program??

      "The National Council for Prescription Drug Programs (NCPDP), a not-for-profit organization that develops industry standards and guidance related to medications, supplies and services within the U.S. health care system. Approved by NCPDP members during a Nov. 6-8 meeting in Portland, Ore., the guidance adopts veterinary license numbers as a new way for pharmacies and third-party processors to identify prescribing veterinarians in their databases." quoted from this article: http://www.vin.com/members/news/default.aspx?pId=210&id=6027624

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    6. Sorry, this is the link I meant:

      http://news.vin.com/VINNews.aspx?articleId=29802&callshare=1

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    7. Great info, Jen. Thanks for sharing it. Perhaps more will see this info now and get the word out.

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  8. Don't get me wrong...My vet school classmates have that complaint as well. I haven't had to deal with that because my pharmacy colleagues always call me! Heck when I was working as a pharmacy student intern they would make me do the consultations with the pet owners. So there are plenty who do respect us and know they know nothing about animals. I will say this, changing a script without talking to the prescriber IS against the law! So if a pharmacist does that let them know you will report them to corporate and the board. BTW as far as them "scaring them" about their medications. We are also required by law to counsel everyone. If what we tells them scares them, that is up to them speak to their vet for further information. What we tell them is from published literature and should be general information pertaining to that medication. of course they should not counsel on what they don't know (pred, phenobarb, antibiotics etc are straightfoward). If your patients uses their regular pharmacy for their pets prescriptions, build a relationship with them that lets them know if your patients come there and they have ANY questions about an rx then they should call you. I've actually been asked to start a liaison consulting business between pharmacies and vet clinics for this reason. Hope this helps!

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    1. So where ya at, Me? I've challenged you below. If you're starting some "liaison" company consulting business, then you probably will need some help with this. Let's see how we can solve this problem - haven't heard a peep from you yet.

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    2. Hey...sorry. I haven't been on here. I'm all ears for suggestions. I know I would need to build a relationship between local vets and mainly independents (add they do a lot of compounding). I could do retail on as needed basis for fielding questions when vets are busy or closed. Your thoughts?

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  9. A few years ago, a whole group of DVMs got together and tried to form a communication channel between Pharms and DVMs because we saw this problem coming down the pipes. We tried to open the dialogue and start discussing these problems because, hey, let's face it... this is ALL about the corporations wanting to "get in on the profits" or however you want to define it.

    Unfortunately, not one pharmacist called us back. Not one showed any interest in talking with us about the problems we knew we were going to face. So the project got canned.

    This blog entry has done exactly what I was hoping it would do: re-open the conversation and -hopefully- get DVMs and Pharms to talk about things and maybe figure out a way around this so that we all help our patients. Sometimes you gotta piss people off in order to get them to start talking.

    I am very aware that this was thrust onto a lot of very good people who don't deserve it. Perhaps this is what we needed to make us all start talking and solve this huge, growing problem.

    Me, put your money where your mouth is. Shoot us an email over here at VBB and let's figure out how to make this better. Or do you just want to keep ranting and spouting off and calling names (like a 2nd grader? Really?) because you needed to be in a spotlight here?

    None of us want to fight. We do want to communicate. This entry was born out of a lack of communication therefore the only way to solve this problem IS to make that better.

    So what's your answer? You're in a unique position with being a DVM and a Pharm so you should have ideas on how to make this better, right? Or do you just want to fight?

    Shoot me an email and we can start working on something together, if you're game.

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  10. This whole conversation can really be summed up as follows:

    Pharmacists: Please respect that veterinarians have training in species you have not been trained in and may therefore make requests that seem unusual to you. If you have concerns, please call the veterinarian who wrote the script directly and politely inquire with them about the nature of your concerns before making any assumptions.

    Veterinarians: Please treat your pharmacists with respect and realize that they are trying to do everything in their power to protect their clients and themselves and that they operate under a different set of rulings than we do. Please ensure you write out your scripts as accurately as possible using the most widely accepted directives (q12h, etc) and call the pharmacist directly if you have questions about what your options are.

    Thank you very much and have a nice day.

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  11. I guess I am just extremely lucky to be surrounded by an entire community of pharmacists who are not only not terrible, but actually very helpful. They answer all my questions when I call and say "What do you have that's like triple ophthalmic" or "what medications do you give for cheap?". They answer pricing questions. They answer sizing questions. They even bear with me when I have to dig up a pet's birthday so they can enter it into their system for no real reason.

    The closest I have ever come to having a problem with a prescription is when I have written a 750mg cephalexin script and been told that all they carry is 250s..... they are SO committed to not filling my medications wrong that they won't even change dosing without talking to me. Crazy how that works.

    I never yell at my pharmacists, swear at them, fuss when they ask me for an identifier to link me to me, get angry when they question my dosing, or get upset about their protection of their clients and their practice. It's shocking how that respect seems to be reflected back to me.

    I'm sure there are bad eggs everywhere, and I know this blog isn't named Vets Behaving Reasonably Well Given The Stress They're Under..... but damn. Roll back. Take a minute to calm down and consider that there are always 2 players in a bad communication and bad interaction. If you're consistently having issues with (not the same) pharmacists, maybe you need to take a small step back and realize it MIGHT not be the pharmacist at fault. If everyone else is always out ot get you... it probably isn't everyone else.

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  12. All of you vets, I'm asking this because I'm a pharmacist (and a pet owner). If you were to make a mistake on one of your prescriptions and somehow overdose and kill someone's beloved cat/dog/whatever, would you accept blame? Or would you blame the pharmacist because they didn't double check the dosing? I feel like a lot of people doctors are so careless nowadays with their prescriptions as they assume someone else will catch their error. And if the error is made and the patient suffers as a result of that error, it is the dispensing pharmacist's fault. So, as vets, do you expect the pharmacist to double check the dosing for the intended species of pet?

    I've worked in multiples states as a pharmacy intern and pharmacist. No pharmacist should change a medication or sig without calling a vet and documenting the interaction. If a pharmacist is doing this, I would definitely recommend that you report it to your state's board of pharmacy.

    Of course, if a a vet wrote for valium, I wouldn't think twice about substituting the generically equivalent medication diazepam and dispensing it to the owner. Of course, if you signed, checked,, or otherwise indicated "brand medically necessary" I would definitely dispense valium. Most competent pharmacists will substitute brand name drugs with generically equivalent drugs. No pharmacist should dispense a therapeutically equivalent drug without checking with the vet first.


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    1. Very interesting question, Unknown. I can't speak for others, but I can tell you that as a profession, we are incredibly hard on ourselves. If I made a mistake on a prescription and knew it was my mistake, I would own up to it and tell the owner. I wouldn't blame the pharmacist at all. The only time I would blame a pharmacist would be if my instructions were not followed.

      Have you seen this happening with regards to veterinarians? I agree it's a problem in the human field - just recently I was prescribed Doxy by my doctor, and when I got the Rx, it said "take 1 tab once daily for 20 days". No one thought that was odd. I called the office, the staff dismissed my concern and said "of course that's how she meant to write it!". Saw the doctor again a few months later and told her and she was appalled. Not sure where the mistake occurred, but it occurred, and no one seemed to believe me when I pointed it out. (it was supposed to be twice daily for 10 days for anyone wondering)

      I think all sides make mistakes. Part of the reason for this post is to maybe open up some communication on this subject. We aren't going to stop the momentum of the situation, and we all have to work together to make sure our patients and clients are taken care of, and the only way to solve that is to try to talk about it.

      I still haven't heard from Me, btw.

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    2. I would blame myself. I don't expect pharmacists to check for me. I don't mind if they call with a question and I appreciate their concern, as long as it is respectful, though.

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    3. Doctor Sarcasm- the issue I believe is more and more non-licensed care givers are involved in human physician offices and they are entering rx's into a EMR. The physician is required to approve them before sending, but I know this may not always happen or the physican my not have caught the error.

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  13. To be sure, I was taught never to use any abbreviations (not SID or QID or any of them) on a script because they can be misread or misunderstood, not just by pharmacists, but by owners (Is twice a day every 12 hours or can I just give another one at lunch time since I have a minute then or could I just go ahead and give 2 at once to save time?). I write "every 8/12/24 hours" and our prescription pad has a "no substitutions" check box. Most of our pharmacists are pretty considerate too so I don't have many issues, thankfully.

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  16. As a vet, I have had a few of the mentioned problems before. I get SID isn't a real thing, but I use it everyday (can't break the habit). If you call and ask, then I will definitely answer any question anyone at a pharmacy asks. My big problem was when I wrote a prescription for hycodan syrup only and the pharmacy filled hydrocodone with acetaminophen in it. Luckily, my client called and asked because she knew Tylenol was toxic to animals. So now, I don't script that out as a general rule.

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  17. I'm glad I stumbled on this. I had no idea this was problem with pharmacies, as I have not had to give my kitties meds in a long time. I now know that I need to double check the scrips if I get them filled at a pharmacy. Thanks!

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