Soon to need a prescription for Nurofen/Solphadine/etc?

bleg · 20-07-2010 06:21PM

sesna wrote: »

I understand the situation relating to starting a patient on something new, just seems a bit overkill having to return to the GP every few months for something that is long-term and repeatable.

Surely that pharmacist could take blood pressure before a repeat supply of a contraveptive, and also keep an ongoing record of what has been given.

Also supply of emergency hormonal contraception would be another possibility.

I am aware that most conditions need continuous monitoring by a GP, and may result in change of treatment/dosages involved.

Yes, there is huge scope for expanding the role of the pharmacist in the community. I would agree with you that when certain drugs are commenced by a doctor there is no reason why pharmacists can't supply provided the appropriate actions are taken. I would have no problem supplying the pill to women on such a basis. Some pharmacists would though. Their argument is that any time that they spend taking somebody's blood pressure is time away from the dispensary, supervising the safe supply of medication to other patients. Therefore taking on a second pharmacist would be a necessity but impossible due to the cost.

Ditto cholesterol testing and the requirement for extra staff. The cost is prohibitive.

Boots offer a test for 30 quid but if they find anything out of the ordinary you still have to go to the GP to be tested and diagnosed. Where is the patient benefit?

I agree with your point about the morning after pill. I'd definitely be in favour of these becoming Pharmacist supervised, along with all PPIs and most antihistamines.

There are bound to be some people that disagree with me though.

Kurtosis · 20-07-2010 06:22PM

sesna wrote: »

Maybe you should look into long-term outcomes for methadone patients. It's not quite the wonder drug some pharmacists think it is. Thats what I meant by controversial.

Grand so, but that's why it's called harm reduction, it's not a solution to the harm of abusing heroin, but it does reduce the harm to the person. But you're right, this is straying from the original topic.

Milky Moo · 20-07-2010 06:23PM

Many times in side streets of Dublin,frequented by junkies, I have seen empty packet of Nurofen+

Can someone explain why this is? Is to take the edge off of come downs and is it really that powerful?

bleg · 20-07-2010 06:28PM

Odysseus wrote: »

I would be interested to know what the rates of addiction to codeine or drugs like tramadol are like in the south of Spain when you can get them OTC.

As far as I remember, tramadol has a lower risk of dependence than other opioids. Going back to what I remember from lectures 3 years ago so I could be wrong.

bleg · 20-07-2010 06:29PM

Milky Moo wrote: »

Many times in side streets of Dublin,frequented by junkies, I have seen empty packet of Nurofen+

Can someone explain why this is? Is to take the edge off of come downs and is it really that powerful?

Codeine is metabolised to morphine in the body.

Kurtosis · 20-07-2010 06:38PM

bleg wrote: »

Codeine is metabolised to morphine in the body.

...most of the time!

bleg · 20-07-2010 06:39PM

penguin88 wrote: »

...most of the time!

Bah! It's after hours, not health sciences. Leave me alone!

Odysseus · 20-07-2010 06:45PM

bleg wrote: »

As far as I remember, tramadol has a lower risk of dependence than other opioids. Going back to what I remember from lectures 3 years ago so I could be wrong.

I think your right, but I'm also around long enough to remember treatment facilities stating that the Z drugs had no possibility of abuse. It's also about what type of psychological investment a person makes in the drug, I think I said this on one of the first pages I recently had a person referred for abusing antihistamines;)

wildswan · 20-07-2010 07:28PM

Hmmm it seems some around here are enjoying their painkillers more then they'd like to discuss with their pharmacists.

Really stupid way to f**k up your liver btw. I can think of a much more fun way to do the same damage ;-)

ORLY? · 20-07-2010 08:33PM

bleg wrote: »

I agree with your point about the morning after pill. I'd definitely be in favour of these becoming Pharmacist supervised, along with all PPIs and most antihistamines.

There are bound to be some people that disagree with me though.

You rang?

Thing about the MAP is that if someone seeks it you would hope that the doc giving it would gauge whether the person asking for it is exhibiting behaviour that is putting their health at risk. Do they normally use a trusted form of contraception, are they in danger of an STI etc. etc? A pharmacist isn't trained (correct me if I'm wrong) in dealing with patients on delicate topics, patient interviewing, information gathering etc. Also, the pharmacist isn't trained to do any investigations - they can't do an STI screen.

On the PPIs - reflux/PUD/dyspepsia are linked to obesity, alcohol abuse, stress, various structural abnormalities of the oesophagus, gastric tumours, h.pylori etc. etc. The GP would want to look into these problems and keep an eye on how things are going.

The same is true of the anti-histamines, keeping an eye on how things are progressing and information gathering are again important.

Coriolanus · 20-07-2010 08:45PM

yogy wrote: »

If you ask me they should treat these products like cigarettes...
1) Don't sell to minors
2) Ban advertising of these products (inc. pharmacy windows)
3) Have big warnings like on fags saying: "WARNING, EXCESSIVE USE MAY LEAD TO ADDICTION"
(maybe even have a picture of a junkie madouvit on the box!! )

That's actually the most reasonable suggestion so far.

delllat · 20-07-2010 09:05PM

i was in hosp recently and out for a smoke chatting to some girl who was addicted to 50 solpadol per day

her liver and stomach had given up and he was wheeling a mobile feeding and hyderation station around with her

i told her how to extract the paracetamol and take just the codeine with cold water and some coffee filters but she had never heard of the idea :rolleyes:

i cant beleieve shed been taking 25+ grams of paracetamol a day for years just to get a small hit from the codeine

she would have been healtheir smoking heroin intstead

still wouldnt like to see it banned though,sometimmes u need a decent painkiller

sesna · 20-07-2010 10:19PM

delllat wrote: »

i told her how to extract the paracetamol and take just the codeine with cold water and some coffee filters but she had never heard of the idea :rolleyes:

she would have been healtheir smoking heroin intstead

A little bit of harm reduction you had going on there :cool:

yogy · 20-07-2010 10:37PM

Milky Moo wrote: »

Many times in side streets of Dublin,frequented by junkies, I have seen empty packet of Nurofen+

Can someone explain why this is? Is to take the edge off of come downs and is it really that powerful?

Nothing to do with that. A 24 pack of Nurofen Plus is almost 8 euro.

You can buy Anxicalm 5mg (Valium) for 1e and Zimovane sleeping tablets for 3e each on Talbot St. which would be much more effective to take the edge off things. Go down to the Spar on the corner and Talbot St. and see the open dealing that goes on. Heroin users and the like don't bother with the likes of Nurofen +.

bleg · 20-07-2010 10:45PM

ORLY? wrote: »

You rang?

Thing about the MAP is that if someone seeks it you would hope that the doc giving it would gauge whether the person asking for it is exhibiting behaviour that is putting their health at risk. Do they normally use a trusted form of contraception, are they in danger of an STI etc. etc? A pharmacist isn't trained (correct me if I'm wrong) in dealing with patients on delicate topics, patient interviewing, information gathering etc.

We do get training on these actually and in fairness after a few years working in a pharmacy will soon hone those skills. They're also being built into CPD.

I take your point about STD screening.

On the PPIs - reflux/PUD/dyspepsia are linked to obesity, alcohol abuse, stress, various structural abnormalities of the oesophagus, gastric tumours, h.pylori etc. etc. The GP would want to look into these problems and keep an eye on how things are going.

Meh, pantoprazole is already available OTC, IIRC it's the most potent PPI on the market. No reason why the others shouldn't be available OTC for short term acute cases.

The same is true of the anti-histamines, keeping an eye on how things are progressing and information gathering are again important.

Ditto. Plenty of anti histamines OTC at the moment, again I see nothing wrong with supplying stronger ones according to strict guidelines.

yogy · 20-07-2010 10:45PM

sesna wrote: »

Is this guy actually a pharmacist, .

No, who said I was?

yogy · 20-07-2010 10:54PM

ORLY? wrote: »

Do they normally use a trusted form of contraception, are they in danger of an STI etc. etc? A pharmacist isn't trained (correct me if I'm wrong) in dealing with patients on delicate topics, patient interviewing, information gathering etc. Also, the pharmacist isn't trained to do any investigations - they can't do an STI screen.

I'm sure pharmacists have the intellectual capacity to be trained up in prescribing the MAP somehow. It is given by pharmacists in the UK so I can't see why not here.

ORLY? wrote: »

On the PPIs - reflux/PUD/dyspepsia are linked to obesity, alcohol abuse, stress, various structural abnormalities of the oesophagus, gastric tumours, h.pylori etc. etc. The GP would want to look into these problems and keep an eye on how things are going.

Pantoprazole is gone OTC, only a matter of time before omeprazole will be.

ORLY? wrote: »

The same is true of the anti-histamines, keeping an eye on how things are progressing and information gathering are again important.

Probably the most common nasal steroid prescribed by GPs for hayfever is Flixonase. This is identical to what you can buy OTC only a bigger pack size.

The most common anti-histamines prescribed are probably Zirtek (the same as OTC) and Neo-Clarityn (an isomer of Clarityn OTC).

sesna · 21-07-2010 12:19AM

There was a journalist on Matt Coopers show last week saying pharmacists are going to start vaccinating people. Maybe they should see how giving out MAP works first (whats with all the abbreviations)

ORLY? · 21-07-2010 12:27AM

bleg wrote: »

We do get training on these actually and in fairness after a few years working in a pharmacy will soon hone those skills. They're also being built into CPD.

I take your point about STD screening.

Meh, pantoprazole is already available OTC, IIRC it's the most potent PPI on the market. No reason why the others shouldn't be available OTC for short term acute cases.

Ditto. Plenty of anti histamines OTC at the moment, again I see nothing wrong with supplying stronger ones according to strict guidelines.

How rigorous is the training? I mean no offence but it's just that it takes up a HUGE amount of training in medicine and is practiced practiced practiced with each other and mock patients in college and then practiced practiced practiced with real patients (with the safety net of a qualified doc) in the clinical years. There's 4/5 years of this being militarily drilled into students before they see their first patient independent of supervision. Maybe it is like this in pharmacy, I'm not running down pharmacists abilities or anything, they could easily be trained in it but I just wonder if the same kind of emphasis is put on this in pharmacy training given that they have enough stuff to be specialising in.

Also, where would a pharmacist conduct this interview? Does a pharmacist have 6/7 mins to conduct a private interview with someone wanting the MAP? A GP does as this is a GPs job. Alot of people wanting the MAP would probably be in need of an STI screen. I just don't see the point in doubling up.

On the point of short term use of PPIs, yeah all well and good but if they're OTC what system is there in place to ensure that they are used short term? If one pharmacist refuses to give them, the patient can wander on to the next. Isn't there a case for saying that anything that cannot be quelled by an antacid and requiring PPIs warrants and least a chat and a check-up?

ORLY? · 21-07-2010 12:30AM

yogy wrote: »

I'm sure pharmacists have the intellectual capacity to be trained up in prescribing the MAP somehow.

Obviously, I don't doubt it. Is there time or sufficient reason to fit it into pharmacy degrees when a doc will cover the bases and then some?

yogy · 21-07-2010 07:00AM

ORLY? wrote: »

On the point of short term use of PPIs, yeah all well and good but if they're OTC what system is there in place to ensure that they are used short term? If one pharmacist refuses to give them, the patient can wander on to the next. Isn't there a case for saying that anything that cannot be quelled by an antacid and requiring PPIs warrants and least a chat and a check-up?

This can be said for every single medicine available without Rx.

ORLY? wrote: »

Obviously, I don't doubt it. Is there time or sufficient reason to fit it into pharmacy degrees when a doc will cover the bases and then some?

It works fine in the UK where pharmacists are entitled to prescribe emergency contraception. It would also prevent the situation where a women is desperately seeking the MAP on a sunday or BH when no GPs are available (particularly in smaller towns and villages) and may not have 50-60 euro to pay for the Rx.

I don't see the need to test for an STI as you state. The priority is to prevent conception. Once that is achieved then attention can be focused on possible STIs by attending a specific clinic.

ORLY? · 21-07-2010 11:17AM

yogy wrote: »

This can be said for every single medicine available without Rx.

Well I think it would be obvious that I don't really think their should be a lot of medicines availabe without prescription. If the pharmacist says, "I can give you this (e.g. antacid) but it's likely that this (PPI) would be better in your case, but you'll have to pop down to the GP to get checked out and get a prescription", I think the health of the Irish people would improve a lot.

yogy wrote: »

It works fine in the UK where pharmacists are entitled to prescribe emergency contraception. It would also prevent the situation where a women is desperately seeking the MAP on a sunday or BH when no GPs are available (particularly in smaller towns and villages) and may not have 50-60 euro to pay for the Rx.

I don't see the need to test for an STI as you state. The priority is to prevent conception. Once that is achieved then attention can be focused on possible STIs by attending a specific clinic.

Does it work fine in the UK? How is that measured? Are patients getting the right kind of care?

I also don't buy the argument about it being difficult about getting it in small towns and villages at the weekend (which I am sure is true) but this would be another case of one deficiency in the system being plugged by creating another. There should be GP access available all the time - hopefully with the switch towards primary care centers 24 hr GP availability will become more common.

If you can't see the need for STI screening I'm not sure I know what to say to you.

Do you realise that many people won't even consider the fact that by having unprotected sex they may have picked up something? I know it sounds amazing in this day and age but it really is true. Who is going to encourage them to get checked? Going to the GP for the MAP could potentially involve all of the following - a sexual health history, alcohol/drug use history, advice on contraception, STI screening/referral.

Kurtosis · 21-07-2010 11:34AM

ORLY? wrote: »

Also, where would a pharmacist conduct this interview? Does a pharmacist have 6/7 mins to conduct a private interview with someone wanting the MAP?

Well from November, all pharmacies are required to have a dedicated consultation room, which the PSI has recently issued guidelines on. Of course a pharmacist has 6/7 minutes to carry out such a consultation for the MAP, counselling patients on prescription medicines and OTC products can often take as long or even longer if you have a chatty patient.

ORLY? wrote: »

Going to the GP for the MAP could potentially involve all of the following - a sexual health history, alcohol/drug use history, advice on contraception, STI screening/referral.

Apart from STI screening (though I know chlamydia screening is operated in some UK pharmacies), a pharmacist is as capable of carrying out all of the above tasks as a GP. History taking is already regularly applied for OTC product requests or responding to patients' symptoms. Obviously the nature of the topics covered would be more sensitive, but at odd hours at the weekend or on a bank holiday, a patient is more likely to get to see a familiar face in a pharmacy than at a GP surgery.

yogy · 21-07-2010 01:40PM

ORLY? wrote: »

I also don't buy the argument about it being difficult about getting it in small towns and villages at the weekend (which I am sure is true).

How can you not "buy" the argument and then be sure said argument is true?

ORLY? wrote: »

If you can't see the need for STI screening I'm not sure I know what to say to you.

Who is going to encourage them to get checked? Going to the GP for the MAP could potentially involve all of the following - a sexual health history, alcohol/drug use history, advice on contraception, STI screening/referral.

You must not have understand what I said. I said the priority is to prevent conception. STI screening/referral would follow. BTW everything you listed above there could easily be carried out by a pharmacist.

In fact I'm sure most people with even the most basic of educations would be capable of asking and recording someone's sexual health history and alcohol/drug history as well as passing on the details of the closest STI clinic.

ORLY? · 21-07-2010 02:08PM

yogy wrote: »

How can you not "buy" the argument and then be sure said argument is true?

I do admit that it is true that it can be hard to get a GP in some places at the weekend or on holidays. I don't buy that it should be used as an excuse to start giving out the MAP without prescription. The flaw in GP access should be fixed.

yogy wrote: »

You must not have understand what I said. I said the priority is to prevent conception. STI screening/referral would follow. BTW everything you listed above there could easily be carried out by a pharmacist.

How would STI screening follow? Who would the advise to get it come from? Who would explain exactly why it's needed, what's involved in the screening, how to go about ensuring that the need for it doesn't happen again, the symptoms of infection, the risks of catching one, the possible consequences?

Who would ask about how the accident happened, does it happen often, did you feel in control of the event, if not why not etc. etc?

yogy wrote: »

In fact I'm sure most people with even the most basic of educations would be capable of asking and recording someone's sexual health history and alcohol/drug history as well as passing on the details of the closest STI clinic.

Are you doing health realted studies?

I couldn't disagree more. It's this kind of assumption that getting some info off the patient is the easy part that anybody could do that has landed people in so much crap and resulted in so much being missed or misdiagnosed. I practice it all the time with class mates and actors and real patients and think I'm pretty good at it and I still quite often miss complaints and problems that were intentionally hidden in the scenarios and I have a good idea of all the physiological, pathological and behavioural changes I should be looking for. How would someone with the most basic of education be able to do any of this, with none of this knowledge and no teaching in how conduct an interview and no opportunity to practice it.

yogy · 21-07-2010 02:21PM

ORLY? wrote: »

I do admit that it is true that it can be hard to get a GP in some places at the weekend or on holidays. I don't buy that it should be used as an excuse to start giving out the MAP without prescription. The flaw in GP access should be fixed.

How would STI screening follow? Who would the advise to get it come from? Who would explain exactly why it's needed, what's involved in the screening, how to go about ensuring that the need for it doesn't happen again, the symptoms of infection, the risks of catching one, the possible consequences?

Who would ask about how the accident happened, does it happen often, did you feel in control of the event, if not why not etc. etc?

Are you doing health realted studies?

I couldn't disagree more. It's this kind of assumption that getting some info off the patient is the easy part that anybody could do that has landed people in so much crap and resulted in so much being missed or misdiagnosed. I practice it all the time with class mates and actors and real patients and think I'm pretty good at it and I still quite often miss complaints and problems that were intentionally hidden in the scenarios and I have a good idea of all the physiological, pathological and behavioural changes I should be looking for. How would someone with the most basic of education be able to do any of this, with none of this knowledge and no teaching in how conduct an interview and no opportunity to practice it.

Fair enough. Just the pharmacist so.

BogMonkey · 25-07-2010 12:50PM

**** sake nurofen + was the only headache remedy I've come across that works. Now I'll have to resort to buying heroin on the street, becoming a smackhead and mugging old ladies to fund my habit.

moonboy52 · 25-07-2010 01:00PM

Once again the majority suffer for the actions of the few.

I think it is shocking that solpadeine will be made prescription only.

This country becomes more conservative by the day, while Europe becomes more liberal in their actions.

bleg · 25-07-2010 01:02PM

It's not being made prescription only.

Realtine · 25-07-2010 01:12PM

BogMonkey wrote: »

**** sake nurofen + was the only headache remedy I've come across that works. Now I'll have to resort to buying heroin on the street, becoming a smackhead and mugging old ladies to fund my habit.

I love nurofen + as well - it's the only thing that works on my migrane even the prescription drug from the doctors won't clear it properly.

Soon to need a prescription for Nurofen/Solphadine/etc?

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