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Today, I had a breastfeeding mom coming in to pick my brains on how to product more breast milk. I was stunned for a moment, as I have not encountered such a question in the past, and obviously I am not a mother yet, I have no clue. So, I could only be honest telling her I don’t know much about it, but I could look it up and give her a ring back. So here I am, spending some time to do some reading on this.

Basically low production of breast milk can be caused by various reasons, which include previous breast surgery, combined contraceptive pills, stress, being ill, or only allowing your baby to nurse for short time can also cause reduction in breast milk.

In order to increase breast milk production, breast feeding mom has to make sure all breast milk are used up during each feeding, if not then you will need to use a pump to get rid of the remaining milk, this will help to trigger the body to produce more milk. Mother getting enough nutrition is also vital. Mother should also allow feeding whenever baby wants to feed, this will help let the body know that it needs to make more milk. Some other measures to help with the production of milk include herbal and prescription medications, which I will spend more time on next time. Have you got any other tips to add?? Feel free to suggest.

Recently, I have had several queries on acne skin care products in the pharmacy. I reckon it is due to the over indulgence in chocolates during Christmas period. As I did get more spots recently due to the fried food, snacks and chocolates I had over Christmas and new year.

What remedy do you use for acne and spots?? Normally I would recommend any products with benzoyl peroxide like oxy 10 or panoxyl, however I realised these products causes over drying of the skin on application, and after several use, they are not as effective anymore. So I for one like to use different products after a few weeks to get the maximum effect. Tea trea oil is another great stuff for spots. What do you think?

The need for Emergency supplies due to the mucked up managed repeat prescriptions systems(F–S) are getting on my nerves. I have to put a full stop to giving emergency supplies. Yesterday I said No to someone who wanted some test strips, she came in telling me that the regular pharmacist knows her and would normally give them to her. OMG. Don’t even try it on me anymore. Its a NO NO NO from now onwards. She glared at me?! I asked her to get the doctor to fax a prescription or go pick it up from the surgery (the driver was on holiday), then I will do it, because it is a weekday, there is no reason why she can’t get a prescription. But she said she can’t. I dislike those looks they give you, like you OWE them something.

Today another customer shouted at me, that’s it. My patience has a limit too. She wanted her migraine tablets, but apparently it has been ordered but hasn’t come back to the pharmacy yet. She came in several times but it wasn’t there for her. So the dispenser gave the surgery a ring, and confirmed that the prescription was on its way to us (arriving next day), and was expecting me to supply it first. Right, I knew it when dispensers give me that look. I said No, of course, unless there is a faxed prescription(surgery not willing to fax). That lady, Shouted at me and said ‘ ARE YOU GIVING ME THE TABLETS OR NOT?’ I wont come back to B***S anymore. Wth. I still said no. I was going to consider, but needed to ask if she is running out today, and trying to find out why she can’t get to the surgery etc, but all she said was are you giving me the tablets?! Few minutes after she left, we received a faxed Prescription for her. See, it is possible if you be abit more responsible for your own meds.

Some customers are just rude. But I don’t blame them at all, because F–S system aka the ‘magic’ system ’should’ automatically do everything for them and be sat there on the shelf waiting for them to come pick them. But when it is not, they get so mad. And the pharmacist has to bear the consequences if it is not ready for them. I think everyone should have some responsibility in their own medicines, instead of having everything done for them.

If you have read the Pharmaceutical Journal for September, you probably noticed this recent update. You must be thinking how hardworking I am, reading my PJ. Lol. The reason I am aware of this now is because, my tutor came across an FMed 296, then saw this article on PJ, and put it in front of my face and made me read it. ha-ha. Yet another CPD!

The MOD (Military of Defence) currently has a contract with LLyods pharmacy only. So if military prescriptions are presented to non-contracted community pharmacy, what we do??

The prescription is written on a specific beige colour form – FMed 296. It is treated as a private prescription. If the patient presents their prescription to Llyods pharmacy that is contracted with MOd, he doesn’t have to pay, an invoice will be sent to the MOD directly. However, if FMed 296 is presented to other community pharmacy that is not contracted with MOD, it will be treated as a private prescription as well, but patient has to pay upfront. Then they will have to claim it back from their military unit if there is prior agreement.

For NHS prescriptions (FP10 forms), they are required to pay the normal fee if not exempted, this cost can be reclaimed by the patient from the MOD.

For ‘real’ private prescriptions (normally on white forms), patient has to pay for it, and the requirements are the same as for FMed 296, invoices not accepted by MOD from non-contracted pharmacies.

Things to look out for when dealing with military prescriptions (LPC website)

1. Codeine, and other CD schedule 4, Drugs for Erectile dysfunction, these drugs has a tight control within the military dispensing unit.

2. Prescriptions with a BFPO stamp may be generated from outside the country, should be dispensed from where it came from. Check registration of doctor with GMC before dispensing. 

3.Check handwritten prescriptions at all times, because it is unusual to get handwritten prescriptions.

So today my brain was being picked by one of the customers in the shop. So the customer’s husband had a recent stroke 3 weeks ago. Ok, so patient has been on aspirin for awhile, but he was asked to carry on aspirin till Sunday. At the same time, he was given Warfarin to start with on Saturday. The question is, why does he still need to carry on the aspirin until Sunday, especially if it increases the risk of bleeding when used together. Carer asked me why.

Well I wasn’t exactly sure, but the 1st thing that came to my mind was that.. Aspirin/warfarin was important to prevent further clots formation, thus preventing another stroke. The key thing is warfarin can take up to 72hours to exert an effect, so maybe the doctor wanted the warfarin’s effect to kick start 1st before removing aspirin.. I hope I was right. What is your say??

I dispensed Midodrine tabs for the 1st time today. Information cannot be found in the BNF, and is only available for order through specials. Brand name is ProAmatine or Gutron. So Midodrine forms the active metabolite called desglymidodrine which falls into the group of alpha1-agonist.

Its main indication is symptomatic orthostatic hypotension. Midodrine can cause drastic increase in supine blood pressure, >200mmHg systolic, so it is only used in patients whose lives are still impaired despite standard clinical care including non-pharmacological interventions or lifestyle changes.

Everyday I learn new things. Such a joy!

3 things I learnt today and will remember for awhile : -

1. The difference between Dalacin T lotion and Dalacin T solution.  The lotion is aqueous based, where as the solution is alcohol based.

2. Folic Acid 5mg not allowed to be prescribed by community nurse

3. Regaine (minoxidil)

 - treatment for baldness in woman cannot be prescribed under NHS, but for men, it is allowed

- minoxidil is also used to treat severe hypertention, anyone who is on antihypertensive are not suitable to use this

I was looking through my emails earlier today, and saw a newsletter on Sativex. Have you ever dispensed this in your pharmacy?? I have only seen a prescription for it once, and I can barely remember now. But I think it is good to learn if you do not know much about it by now.

Some facts : -

- Oromucosal mouth spray for MS patients for neuropathic pain, spasticity, overactive bladder, pain due to cancer
- 1^st cannabis based med licensed in the UK (June)
- Only specialist should prescribe (neurologist) as add on for MS spasticity when other regular med provides  inadequate relief
- Dose – gradual increase, maximum 12 sprays per day, 15 min gap between sprays
- Interactions with drugs that causes drowsiness
- Not for use in under 18
- Those travelling with sativex require doctor’s letter
- Currently a Schedule 1 drug, might be reschedule to schedule 4 later – homeoffice allow doctors to prescribe and pharmacist to dispense
- Can be on nhs or private rx
- No legal requirement to record in CD reg currently (I have seen it being recorded in CD reg)
- Store in fridge prior opening, once open it is ok.

4×5.5ml is the old and unlicensed pack size, current pack size is 3×10ml, need to confirm with prescriber accordingly

Ooh.. I was asked this question by someone over the phone the other day.

I couldn’t help the person coz i didnt know what active ingredient was in lidoderm, it wasn’t in my ‘bibles’ … ishh so I had to refer her to the doctor, which i hate doin because it is such a simple question. Anyway Versatis is the one we commonly see in the dispensary – lidocaine 5% plasters, I have seen Lidoderm, and kinda knew it was the same stuff, but i wasnt sure. So my friend sent me the link online for Lidoderm http://www.lidoderm.com/ .. so we found out its exactly the same as versatis plasters.

Learnt another thing today. Great.

Just a reminder – lidocaine is a local anesthetic, that temporarily blocks pathway of pain signals along the nerves.

So if you followed my blog, ud know about the lady who bleed all over. She came back yesterday, to say thank you. To remind you, it is the lady that I tried to bandage, and sent her to the nearest surgery as the bleeding went on for hours. So she said the doctors applied steri strips for her to stop the bleeding. It is that simple. I thought about it only after she left, they are also called the butterfly strips. So now I know what to do with deep cuts!

2 queries that I had to look up today

1. Lump/swelling inside the mouth, on the gums. Red, and a lump bulging out. No pain. Didnt know what it was, referred.

2. Query on treatment for worms. At 1st customer said round worms, then later she said its threadworm, she got confused with ringworms. Anyway I looked it up in the bnf, so mebendazole, over the counter, can be used for all sorts of worms. However, it is only licensed as single dose of 100mg, and maximum packet size of 800mg. If it is threadworm, single dosing will be sufficient. However if it is round worm, whipp worm or others, they require several dosing a day for 3 days. So I guess we can only treat thread worm in the pharmacy? I sold 2 packets, ech with 4 tablets, so that makes it 800mg. For a family of 5. SO hopefully I didnt do anything illegal today