My Music ParadiseLet the music spice up our lives

I was happily signing into my email to see if my PDA has replied regarding my extra shifts and holiday in Feb. So holiday is not a problem. Working extra shifts not a problem either as my PDDM was happy for me to work 6 days a week, but he did jokingly said ‘ you are not planning to work 7 days a week are you?’ lol!!! So my PDDM came by the store to have a chat with me yesterday, and offered me the store based position. Right, he gave me a few days to think about it.

Then today, I was logging onto Pharmacy Planner to print off my next few weeks rota. Boy I was shocked to see that they have put me down to work in the same store for the next few months!! Since when I became a store based pharmacist?? I then emailed my PDA to express my frustrations and told her I havn’t agreed on being a store based pharmacist. Ha-ha, she replied instantly as I titled the email ’Urgent’. she apologized, as she had the impression I was going to be a store based pharmacist. Well, the good thing is it is sorted now, and she will try to arrange a mixture of stores and areas for me. Pheww….Thinking about the travelling makes me sick.

One thing I have achieved through this is – learn to say yes to NO.

So today as usual, I travelled to Brixham for work. By car, it is only 35 minutes from where I live. If I take the bus, including walking to the bus stop and waiting time etc, it takes about 1.5 hours. I have to wake up at 6.45am too! By the time I get home it would be 7pm. However the good thing about this pharmacy is, it is fairly quiet, with about 150 items a day, only 1 addict. But store is quite messy, disorganized. If I were to take up the offer, I will have to do a lot more work to improve the store’s current condition. There is only 1 dispenser, when she is off, I will be on my own, doing the goods, dispensing, and checking. I guess I would most likely say No for now.. and carry on being a relief pharmacist.. going around to different stores, is more exciting for a newly qualified pharmacist! Meeting more people, new faces, different working environment etc.

Today was my 2nd day back to work, also my 1st time working with addicts. Such an overwhelming day! I can feel the adrenaline rush, literally! Those who know me, would know I have never had training for MDA (substance misuser)services before. I was so thankful for the regular pharmacist there, who prepared the whole week’s methadone in advance. I only had 1 coming for collection, and 4 supervised+collect today. The only thing I keep reminding myself is to fill in the back of the prescription, the CD (control drug) register, and the monitoring sheet. Because it was my 1st time, I had another staff going into the consultation room with me during supervision.

Apart from that, it was all quite good. The staff in this store really knows how to enjoy!! At 10am sharp, they started taking orders for sandwiches! After sandwiches, it was chocolates and peanuts and they have ribena too!  my oh my. If only all branches I go to do that!

I just remembered the other day, I saw a prescription for Maxalt Melt (Rizatriptan) for migraine. It was 5mg. One of my collegues brought up the issue to me that patient recently had 6 Maxalt on 26th July, Frovatriptan on 29th July, and 6 Maxalt again on 2nd Aug. This issue was definately worth looking into.

Anyone should not take 2 different anti-migraine treatments at the same time. However, bearing in mind the dates she had these tablets, they were 3days apart. With the Maxalt, maximum daily dose is 20mg, and for frovatriptan, up to 2 tablets a day. So she probably had several episodes within the last 7 days.

When the carer came, I managed to find out what was actually going on. So, patient had 6 episodes of migraine in the last 10 days. She started off with maxalt, then frovatriptan, now back to maxalt, maxalt melts in the tongue, thus work faster, I guess thats why she is given these instead of frovatriptan. The doctor has also started patient on Amitriptyline, which can be used as prophylactic treatment for migraine.

I did give out the maxalt melt this time, but I made sure carer was aware that she shouldnt take 2 treatments at the same time, and not exceed stated dose. If 1st tablet doesnt give any improvement, a second dose shouldnt be taken. Hopefully the amitriptyline will help to reduce the frequency of migraine in the future. One point to remember, overdosing on anti-migraine drugs ie. Triptans, can cause drug related headaches.

So today I was working near the harbour, where most tour busses stop. Because of its location, there were so many queries, especially from the visitors. The good thing is we were so quiet with prescriptions, we did only 52 items. It is the least I have ever seen so far. But that was really good, it gave me time to sort out all the queries Over the counter.

I think  I covered almost all conditions on the counter today! You name it. Lol.. Another very happy day for me.. Let me tell you what I’ve seen today, Im so proud! Iv never seen so many conditions in a day!

• Ring worm – I sold canestan 1% cream
• Atheletes foot – I didnt think it was atheletes foot, so I didnt sell the anti-fungal cream, just sold E-45 cream instead
• Injured palm/wrist – I measured her wrist, sold Tubigrip , and ask her to take paracetamol
• Coldsore/sore mouth – Only a tiny blister near the mouth, didn’t think it was coldsore, I sold blistex instead of zovirax, because it has been there for 3 days, zovirax wont help much.
• Migraine – Sold co-codamol effervescent tablets (I regretted this, because apparently codeine can slow down the movement in the gut, so may slow down absorption of the drug, I would sell soluble aspirin or soluble paracetamol the next time, I sold it to them because I knew Yellow Migraleve contains paracetamol + codeine, but now I think its not a good choice)
• Corns – Put on corn plasters for several customers
• Travel sickness tablets for a lady on baclofen and dihydrocodeine – sold boots hyoscine hydrobromide, mentioned about constipation to her
• Contact dermatitis due to new washing powder – sold hydrocortisone 1% cream, advised him to apply thinly once or twice daily, no longer than 7 days.
• Head lice for asthmatic and high blood pressure – sold malathion – Derbac-M
• Had several queries on wasp stings, bites etc..
• Had a lady coming in with a deep cut on her finger, that hasnt stop bleeding since 5 hours ago!!! Blood was still gushing out, and dripping everywhere, had to sit her down, got the 1st aid kit, bandage it up for her, and referred her to the nearest surgery. The cut was so DEEP! And I am scared of blood! Omg. And I remembered not to touch the blood!

My proud moment today – one of the corn ladies came back and told the counter staff, ‘I am ever so grateful, never experienced such great customer service from a pharmacy in the past’ Please say thank you to the pharmacist.. Wooohooo. That really made my day!

I am so proud of myself today. I am happy. Im glad I did something good for my patient! Woohoo.

Ok, I know you want to know what it was. It wasn’t sucha biggie really. Just a prescription for locorten-vioform ear drops. Doctor prescribed four times a day, I knew it wasn’t meant to be used that frequently, as it was a steroid drops, normally its about twice a day, so I looked it up and according to the BNF, 2-3drops twice a day for 7-10days! I rang up the surgery, clarified it, and explained to the patient, and he was really thankful! I sent the prescription back to the surgery for ammendment. But I gave out the ear drop with the correct directions on there. So thats the highlight of my day! yay!

Other things I’v learnt today :-

1. Naproxen not prescribable under NHS by a dentist. Alternative would be Ibuprofen, but patient allergic to it, next best option was diclofenac, which can be used for dental pain.

2. A lady with mouth ulcers wanted to buy something OTC. I found out she was breast feeding, so I wouldnt sell bonjela, it contains salicylic acid – aspirin related stuff – worried about reye’s syndrome- so I sold Iglu instead, that contains lidocaine, which is ok for breast feeding, as minimal quantity gets into breast milk.

Thats it for the day, I had a very pleasant, and smooth day today! Off tomorrow.

Basically you can find all these information online.. whilst I was doing my little research on them, I thought I’d summarize it, save you all the looking up.

What are horse flies?

They are also known as forest flies or deer flies, range from 30mm – 60mm in length. They are very noisy during flight. If you are bitten, it would be by a female horse fly, because they require a blood meal for reproduction. They have tiny, serrated mandibles which they use to rip and slice flesh apart, thus the bite can be very painful, and last over a few days. After the bite, the affected site will develop into a red lump within minutes, it can be itchy, hot, and painful.

How do they look?

                      
                                  No! this is not a horse fly                                 This looks more like it lol

How to treat the bite?

You can just leave it and let it run its course - the symptoms mentioned above can last for a few days.. then slowly settles over weeks.. or treat the symptoms with Antihistamine cream or tablets to relief the itch and reduce the swelling by suppressing histamine release. or low potency topical steroid i.e. hydrocortisone 1% to reduce the inflammation. Im not very keen on selling the steroid cream, especially if the wound looks nasty, and a definate no no if the wound is slightly opened or raw, it will make it worse.

I recommended the previous customer to get some non-drowsy antihistamine, cetirizine is my favourite one to sell. Piriton (chlorphenamine),the traditional, drowsy antihistamine are most effective, but of course it can be  a pest if they have to drive or work or even if they are on holiday.

When to refer?

When there are signs of infection – very painful, hot, red and produces pus. I would also refer if they have used the counter treatments and still no improvements after a couple of days.

So as the title says it all.. today was my final day of having someone else there, if i needed any help! Next week I will be on my own.. well good news is, I will be back to my own store on Monday! Yay.. missed the staff there.. After working in several other stores now, I realised how lucky I was to be a pre-reg student in my previous store.. I miss the cakes and biscuits, tea, occasional sitting down and chatting.. and of course the wonderful people there..

I really didnt like today at all. I wont tell you which store I was in.. but it was a health and beauty store.. I went in to the dispensary in the morning, no greetings or acknowledgement from the dispensary staff .. im not saying all.. at least the counter staff was nice enough to bring me to the locker room, but i still had to wait for 10 mins.. it was such an awkward moment.. you just didnt feel welcomed at all.. I really feel like saying this, their faces looked so black as if they just ‘sei jor lo mou’.. now I understand why my tutor didnt want me to do my MDS (monitered dosage system) training in this store.. she knew they wouldnt be very nice..

Well.. forget about that.. my day went by pretty quickly.. especially in the morning.. as I was downstairs checking MDS (blister packs) for nursing homes all morning.. It was my 1st time checking MDS.. against MAR sheets etc.. Good thing I identified several errors, else I would think Im not doing it right.. There are bound to be errors, so if you dont spot anything, you must be overlooking, or you probably dont know what you are doingl! Lol..

Then my remaining morning, I was just checking and checking in the dispensary.. and today is the day I had most queries on bites and stings .. all skin related problems..

If one thing I want to learn today.. it would be HORSE FLY.. someone got bitten by a horse fly, but I have no idea what a horse fly is! But that customer, almost freaked me out when he said he got bitten by a COBRA! Lol.. silly man.. Heh..

How was ur day??

My day started off well.. I arrived early and no one was in the store yet! Surprise suprise! Me being earliest? If my tutor sees this, she would say do you see pigs flying in the sky, mei? lol.. Anyway I was standing and waiting in front of the store, and here comes a lady, asking for advice at 8.45am outside the pharmacy! Lol.. well I managed to answer her query..pheww..

The day went well overall, it was a  busy but a very satisfying day today. The store is near to the surgery, that is why it was busy.. It wasn’t manic, but there were phone queries, counter queries, many waiters to be checked.. and many CD’s to be entered into CD register all at the same time. so its all about juggling and prioritizing! But I kept an eye on the CD, that is my top top priority! Oh sorry for the language, CD=control drugs.. hehe.. 

I also managed to answer to most of the queries from customers, so my day went smoothly.. but I was just checking and checking the entire day, non-stop.. the other pharmacist was in the consultation room, taking advantage of an extra person to complete his odd jobs ie. MUR (medicines use review)

Few simple queries today -

1. Lansoprazole (orodispersible)  + Gaviscon, can take them together? if attack occurs, take which one..
2. Can take metronidazole + erythromycin or not.. and how to take them etc..
3. Used zyneryt solution on scalp.. and its itching and sore, and swollen..
4. Lidoderm patch and lignocaine patch, whats the differences…

Well thats all I can remember now..

Since a friend of mine, asked for answers.. Im just gonna briefly mention what I did for the above queries, however, every pharmacist may respond differently. There are no definate answers too, it is the pharmacist’s discretion to treat, or refer

1. Antacids can affect the absorption of lansoprazole, I make sure they dont take them at the same time, i think 2 hour gap is sufficient. And if there is an attack, of course take the lansoprazole, because it would work faster, and it is a more effective drug too for heart burn and reflux disease. The reason antacids like gaviscon can be sold over the counter is because it has a safer side effect profile, remember PPI can cause tummy upset, i.e. diarrhoa are common.

When to take lansoprazole? It depends on the customer’s condition. If they always get the symptoms after a meal, then 30min-1hour before food. If their symptoms are worst at night, they can take one before bedtime, to prevent acid from coming up, especially when they are lying flat.

2. They can take the 2 antibiotics together. In some severe infection, doctors would combine another antibiotic to help treat the infection, and penicillin/macrolides(erythromycin) + metronidazole are commonly used together. What I was concern about is because of her age, and the side effects. So ask how she was coping with one antibiotic, any diarrhoa so far, if yes then warn her about adding another antibiotic, that could make it worse, if diarrhoa is bad, and last long.. gotta see doctor, due to risk of dehydration.. and not to forget about councelling on metronidazole to be taken after food and avoid alcohol. For erythromycin, it is ok to take before or with food.  

becareful if they are on other medication as well, this customer was taking PPI- omeprazole.. certain macrolides can interact with PPI..

3. I refered this case, because 1stly they are not supposed to use zyneryt on the scalp! that silly man used it inappropriately, thus head itchy, sore, and swelling. Not sure if it was due to the zyneryt, but better to refer as the scalp and head is always a very sensitive part of the body.

4. I couldnt find information on lidoderm patch, so I refered patient back to doctor.

So tomorrow is my off day for the week. Great. I have got soo much to do in my head. I definately won’t get all things done, but let’s prioritize. So these are the few things I need to get done.

• 10.00am – Go to the bank to set up new accounts for savings! It’s about time to think about the future. My short term (1 year goal is to save up 60% of my pay!! The rest will go to renting, bills, food and misc.
• Pass a friend a CD (been saying it for ages)
• 11.00 am – Get Stockley’s drug interaction handbook from WH Smith in town
• 12.oopm – Washing up- laundry, ironing, hoovering
• 2.00 pm -CPPE learning – Finish my EHC training (1.5 hrs), Repeat Dispensing Training (1.5hrs) and do the assessment, Substance Misusers training ( 2hrs) – yeah more learning!
• 8.00 pm – Update my blogs!
• 11.00 pm – Time for bed

Where do I fit time for eating and entertainment? Perhaps blogging will be my entertainment for now till I settle in. Ha-ha!

I rang the Royal Pharmaceutical Society of Great Britain yesterday, I will get my registration on Thursday, so I will officially start on Thursday!! Apparently the store I will be going to on Thursday is a very busy store!! So my AIM is to sleep early, by 11pm. So that I will be vigilant at all times, with checking, and addicts! No more after midnights. That’s it for tomorrow, I need to finish my grocery shopping – online heh.