May 16, 2009 - 3:40pm
I'm curious how many pharmacists that we have as members here. I'm getting ready to take the PCAT this fall, and I'm looking for people who have already taken it.
May 29, 2009 - 2:47am
#2
i have a question that you
i have a question that you may be able to answer for me. it is more of an ethical thing though. should suboxune and xanax be rx'ed together to a person who already has an admitted addiction. the reason that i ask is because one of my dr nurses is a self admitted recovering addict from oxy products but she has the doc writing her both. and most days that i am in the office i can catch her nodding for time to time. normally i would not let it bother me but she braggs about how she counsil misled teens and is atempting to get her liscence to run a suboxone clinic out of my dr office. to top that off i recently ruptured 2 more disc in my back and my dr put me on oxycondone 15mg twice a day for break thru pain and it was working ok. then this nurse happened to be browsing through my chart and immediately began to reem my dr out about this. so after about 15 minute of badgering my dr gave in to her own nurse and changed my bt meds. normally i wouldn't be upset but knowing the case it sort of bothers me. just because she got addicted to oxy she thinks that nobody should have it whether they need it or not. and i also have friends with drug problems and have turned to the suboxone clinics and all of them say that none of them will allow them to join the program if they have a legit rx of xanax. one person told me that the clinic said that these were a deadly combination. is this true because i do not know anything about the suboxone treatments. thanks for any comments on this subject.
May 29, 2009 - 8:53am
#3
I am not a pharmacist but am
I am not a pharmacist but am studying medicinal chemistry and pharmacology. I can't beleive that nurse interfered with your prescription , to my knowledge and certaily in my country the prescribing decision is the prerogative of the doctor and it is not within the nurses remit to intefere with the Rx so long as they are not observing any clinical signs that such medication is harming the patient. I would let your doctor know that the oxycodone that was prescribed for you was working well and ask her why she came to the decision to withdraw the oxycodone. Nurses should not be making suggestions to doctors about prescribing unless they ahve observed the medication to be having a counter productive or negative effect. You need to sort that out with your doctor and ask her if she is going to consult with a third party about your Rx you would like to know who that third person is , why they are being consulted , and what are they being asked. That is your right.
As to your first question, I personally can see no reason why xanax cannot be prescribed to someone who has a history of addiction , and can be safely prescribed with suboxone, to my knowledge xanax is prescribed to methadone maintenance patients who pose a higher risk due to methadone being a full opioid agonist and causing respiratory depression, tachycardia e.t.c But to a person who is already dependent on it a miimum maintenance dose should be ok as long as everything is taken as prescribed. The risk should be decreased largely with suboxone because of the antagonist component , but I think the prescribing of xanax and other benzodiazepines with opioid maintenance therapy should mainly be done within the context of patients who have pre - existing dependency on benzodiazepines , and may need minimum maintenance doses of the benzodiazepine. With somebody who is benzodiazepine naive and is suffering from anxiety I think a benzo, and particularly xanax should be a LAST resort, for fear of kick starting yet another dependency, a beta blocker like propanolol can be as effective or GABA in large doses.
But that nurse sounds as if she's pushing her own agenda , do they do random drug screening there ? How is she getting away with working while stoned ? Anyway best of luck to you and good luck with your studies.
All comments are the authors opinion and should not be construed as medical advice.
May 29, 2009 - 8:59am
#4
Oh and forgot to mention that
Oh and forgot to mention that I feel that diazepam or clonazepam may be more appropriate than Xanax ( alprazolam ) for anxiety ,as a last resort for a short period ( no more than 8 - 12 weeks ) in benzodiazepine naive patients.
May 29, 2009 - 10:00pm
#5
Ethically
It is honestly none of her business, and unless she was involved in your medical care, she violated federal HIPAA privacy regulations. People that aren't related to your case should not be making recommendations about your pain management. If something is working or not working, that should be discussed and decided upon by yourself and your doctor. The problem is that this person now has a recovering addict "savior" complex. She feels that because she abused the drug and became addicted, that everyone taking the drug will, when in truth, this is not the case with everyone. She may also be jealous that you are getting the oxycodone and she isn't so she will try to get the doctor to discontinue your oxycodone. Any of these reasons may be true, but in truth, it is not her ethical responsibility to get involved unless you are doing something illegal, or not abiding by the doctor-patient care model. This basically means you are violating the doctors trust by abusing the drugs, doctor shopping, etc. Since it sounds like you are not doing that, this nurse does not have a leg to stand on. My recommendation would be to get your doc alone and let him know that the new meds aren't working, and that you would prefer it if you were on your old breakthrough meds. Try to explain that, although you appreciate the nurses input, you don't think she is an impartial observer in your case. Best of luck
June 2, 2009 - 3:51am
#6
thank you both for your input
thank you both for your input into this matter and i have confronted my dr about the new meds not being as effective as the ir's but then she started to lector me on the downward spiral of drug abuse and that i could be in over my head before i even knew it. it sounded like the same sermon that i got from that nurse so i am afraid that i am just going to have to wait until she gets her counciling liscence and moves on to save the people that actually need saved.
June 2, 2009 - 4:31am
#7
HIPAA privacy
hmmm when i pull up in the drive thou at wallgreens and i hand them my scriptfor 150 perks 10 /325 4/6 come back in a hour and they hand me a clipb0ard with names on it and times ijust have to snap a pic with my celly i have names and drugs takken and times and sometimes phone numbers hmmm now no HIPAA privacy ???? right
June 2, 2009 - 7:10am
#8
No Hippa
Why would you snap a picture of peoples clipboards? Its HIPPA for those who follow the rules only. The way you make it seem is that you would be a good target for the people looking for the bad side of it. Go inside then brother.
June 2, 2009 - 10:03pm
#9
Then they are violating it
Thats not supposed to happen. They should probably find a better system. We have to follow HIPAA regulations, or get fined. It happens, mostly through customer complaints of breaches of privacy
June 3, 2009 - 3:51am
#10
im not the bad guy
i just play one on tv 
i would never snap a pic but if i can think this up so can a bad guy i don't like putting info on a clipboard for all to see and the clip board sits on the counter inside for all to see only people that get the good stuff sign it all so that can lead to muggings and other bad stuff just a thought
June 3, 2009 - 5:18pm
#11
I know Randem
Not placing blame on you, just the pharmacy. HIPAA is well meaning, but not practical and makes things very difficult.
June 5, 2009 - 12:25pm
#12
My doctors office and pharmacy
have sheets where people sign in when waiting for their appt., and at the pharmacy if you have to sign something that are made so you can peel off the previous line, so that no one can see who's signed in or whatever. I think it's a good idea, keeps people honest and from being nosy,
Ray
June 13, 2009 - 2:44pm
#13
hey Milo, obviously the
hey Milo, obviously the nurse is an employee for the dr so maybe she ahs a job to do like going through charts, we don't know. Not sticking up for anyone just saying there are two sides to every story.
And by the way. At the pain dr I go to I see the NP (nurse practioner) every vist, and I prefer it. I don't think I have seen the dr in over a year. I do know that he reviews every chart at the end of the day. I also work in a large hospital where I see that NPs andnurse clinicains are being used more and more. they see the patients and review with the dr at the end of the day.
I am a licensed pharmacist in NJ. Any questions, feel free to shoot me a line