No, I'm not joking.

[Shalom]

ImPatient wanders in. His doctor was supposed to send a prescription for an antibiotic.

Check the eScript. Sure enough, there's a Zpak in there.

Put it through the insurance. $25.00 copay, of which we are supposed to remit $14.48 to the insurance company, because in their infinite wisdom they think it's only worth $10.52, but since his copay is supposed to be $25.00, well . . .

Screw that noise. Back it out of the insurance, cash it out for $15.00, make it ready, He saves $, I save $, insurance can go take a flying leap. All the while impatient is grousing about how sick he is.

Hand it to the tech, he hands it to the impatient. Explains that I just saved him $10.00. He looks at the Zpak.

Him: "You're joking."

Tech: "No, that's what he prescribed."

Him: "I don't want that. Put it back." He leaves.

Afterward I get the story from the tech. Seems he'd been to the doctor that morning, and already was given a prescription for a Zpak. He didn't want to take that one for some reason, so he called the doctor to send him in something else ... so the doctor sends in another Zpak.

Oh well. I'm leaving that Rx on hold, just in case he decides he wants it after all...

[raudf]

If he'd had an allergy to the Zpak, like I do, he should have said something. If he didn't like the cost, he should have said something. He should have said both things to his doc, as well as letting the pharmacy know if he has an allergy.

I'm allergic to the Zpak and it's cousins. I told my doc, who had a new file system and it apparently didn't register.. or it didn't register with the doc reading it, that I am allergic. Fortunately, I also told my pharmacy, who flagged it and told me, so I could call the doc's office and remind them that I'm allergic. A few minutes later, I got an antibiotic I wasn't allergic to and much cheaper.

[Sapphire Silk]

I went through this with pain medication. I was passing a kidney stone and went to the ER for pain meds. I explain to the nurse I'm allergic to hydrocodone, as in anaphalaxis allergic.

She dutifully notes that on my chart.

Doc writes script for Vicodin. Nurse hands it to me.

Me: I'm allergic to this.

Nurse:

Me: I told you when I was admitted. I'm allergic to anything with hydrocodone in it. Vicodin has hydrocodone in it.

Nurse: Oh!

Comes back with script for Lortab. Lather rinse repeat.

Comes back with script for Norco. Lather rinse repeat.

Me: get that doctor in here!

Doctor comes into the room

Me: I am A-LER-GIC TO HY-DRO-CO-DONE! Any drug with hydrocodone it in will make me swell up like a balloon and my throat swell shut. I need you to prescribe something else.

Doctor (visibly annoyed): Well, what would you suggest then?

Me: Percocet.

Doctor: Fine. <writes script> Here you go.

Dumbass couldn't be bothered to look up the active ingredients of the drugs he was writing for. I should have filed a complaint.

Oh, and I'm now allergic to Percocet (active ingredient oxycodone).

[NecessaryCatharsis]

Dumbass couldn't be bothered to look up the active ingredients of the drugs he was writing for. I should have filed a complaint.

That's scary. I have anaphylactic reaction to morphine, now I'm wondering what else it is in with a different name. I just assume hospitals would know (my drugstore also has that on my file I think).

Touch wood - I haven't needed painkillers often in my life.

[Food Lady]

If ANYONE should know how to prescribe, it's doctors! Was he on drugs?!?

[Sapphire Silk]

That's scary. I have anaphylactic reaction to morphine, now I'm wondering what else it is in with a different name. I just assume hospitals would know (my drugstore also has that on my file I think).

Touch wood - I haven't needed painkillers often in my life.

Well, morphine is the generic name. There are some formulations that have other names, but a pharmacist would pick up on that quick. I often have to explain why I can take codeine when I'm allergic to so many other opioids, but that actually does not bother me: the pharmacist is doing his job by asking me about that.

But opioid prescribing is so damn common that any physician worth his salt should know the generic and brand names, or better yet just prescribe based on the generic name unless the patient does better on the brand name.

If ANYONE should know how to prescribe, it's doctors! Was he on drugs?!?

No, he was just lazy. It's something he should have reasonably known.

[wolfie]

That's scary. I have anaphylactic reaction to morphine, now I'm wondering what else it is in with a different name. I just assume hospitals would know (my drugstore also has that on my file I think).

I'm not in the medical profession in any capacity, but I'd guess that you should avoid codeine as well. My understanding is that codeine is the original "extended release" opiate/opiod, with the extended release being a biochemical effect that converts it into morphine at a restricted rate (some people have a mutated version of the "critical path" for this effect that results in codeine being converted to morphine at roughly 4x the normal rate).

[bacchinalus]

If ANYONE should know how to prescribe, it's doctors! Was he on drugs?!?

Sadly, that is almost never the case with the doctors in my county. I can't tell you how many times we have to call offices because they write for directions that the *manufacturer* says are too much, or to change a medication because of the lack of communication between office staff and the doctor.

Just a few days ago we had a new patient come in to my pharmacy "do you have any medication allergies?" "just amoxicillin" "....then why did the doctor write for augmentin? (amoxicillin is the main ingredient)"

This kind of interaction happens WAY too often. It's quite unsettling, and is also why we have a list of offices that our staff will NEVER go to, even if we are deathly ill.

[Food Lady]

I am so glad I have no medication allergies. But I am one of those for whom some of the pain killers just don't work. Fortunately I've found one that does. Also, upon most visits to my doctor's office I am asked about allergies. They just like to make sure while I'm still there, before I go to the pharmacy. My med group is great. I wish everyone had that; everyone deserves decent care.

[morgana]

If the dude in the OP had said, "I'm allergic to that." I'd have all kinds of sympathy for him.

However, "I don't want that. Put it back." ?!? Is just being an asshat.

[raudf]

When I had my youngest, my inpatient wrist band had the brightest color of RED (Almost glowed during the day it was that bright) with ALLERGY ERYTHROMYCIN and in my records, "DO NOT GIVE THIS PATIENT ANY ANTIBIOTIC OF THE ERYTHROMYCIN GROUP!" It was even listed next to my door in the nurse board.

I asked my first nurse about how the new system worked and she said if I was accidentally prescribed the meds, when they scanned my bracelet, it would ping an alert.. like they needed it, because the nurses always checked my bracelet before scanning and then checked my med list to make sure. I applaud them for such diligence!

[Sapphire Silk]

When I had my youngest, my inpatient wrist band had the brightest color of RED (Almost glowed during the day it was that bright) with ALLERGY ERYTHROMYCIN and in my records, "DO NOT GIVE THIS PATIENT ANY ANTIBIOTIC OF THE ERYTHROMYCIN GROUP!" It was even listed next to my door in the nurse board.

I asked my first nurse about how the new system worked and she said if I was accidentally prescribed the meds, when they scanned my bracelet, it would ping an alert.. like they needed it, because the nurses always checked my bracelet before scanning and then checked my med list to make sure. I applaud them for such diligence!

Those kinds of barcode scan systems are becoming more common in hospitals and the standard practice. You can still make med errors with them, but if you use them properly error rates virtually drop to zero.

[DGoddessChardonnay]

Those kinds of barcode scan systems are becoming more common in hospitals and the standard practice. You can still make med errors with them, but if you use them properly error rates virtually drop to zero.

I noticed that when I was at the local women's hospital 3 weeks ago. I wasn't given any meds during my visit but the phlebotomist (sp?) who came to get a blood sample scanned the bar code on my bracelet before she took the sample.

Guess they wanted to make sure they had the right patient.

[jedimaster91]

Those kinds of barcode scan systems are becoming more common in hospitals and the standard practice. You can still make med errors with them, but if you use them properly error rates virtually drop to zero.

They're only as good as the information put into the system, but I would love to see them in more areas. Between that and computerized charting, there would be so many fewer errors made because that 5 looked like a 2. Of course, the humans involved still have to pay attention to what they're doing.

[mathnerd]

I'm not in the medical profession in any capacity, but I'd guess that you should avoid codeine as well. My understanding is that codeine is the original "extended release" opiate/opiod, with the extended release being a biochemical effect that converts it into morphine at a restricted rate (some people have a mutated version of the "critical path" for this effect that results in codeine being converted to morphine at roughly 4x the normal rate).

Not quite. Morphine and Codeine are two similar molecules, but are different enough that a person can be allergic to one and not the other.

*Stop reading if you don't care about chemistry*

They are both derivatives of the heroine molecule. The heroine molecule is a big hydrocarbon chain we'll call "R" for the purposes of this post. There are several attachments to R that are called functional groups. There are two important ones when distinguishing the difference between Heroine, Morphine, and Codeine. In the Heroine molecule there are two symmetrical Acetyl groups (COCH3). On the Morphine molecule, both acetyl groups are replaced with a Hydroxyl group (OH). On the Codeine molecule, only one of the Acetyl groups is replaced with a Hydroxyl group. That difference, while slight, can make the difference between an allergy or not.