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Practice Pearls

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  1. 23/02/2007

    : Pearl: Intothicated?

    Peter the pearlcaster writes:

    People on a daily methadone dose sometimes arrive intoxicated. It may be booze, they may be 'nodding' due to gulping benzodiazepines. It doesn't matter which -- it's our responsibility to not dose them with more opiate, sending them out into the world to perhaps kill themselves or an innocent person, and wouldn't that be disastrous in the coroner's court and newspapers.

    Here are two ways to show them that they are unfit to collect their opioid today. The thing is, doing it this way, they don't get nasty.

    More... premium

  2. 02/02/2007

    You call that a splinter? THIS is a splinter

    Peter the pearlcaster writes:

    There's nothing more freaked-out than a child with a splinter which needs to be removed. Here is a technique that makes the process almost painless. For both of you.More... premium

  3. 15/12/2006

    Methadosing the easy way; with a Methadongle

    Peter the pearlcaster writes:

    Methadone pharmacies have many different ways of measuring out doses. I have seen the simple conical measure (whose precision is pretty ropey), an antique pharmacy college chem lab burette clamped in a stand at Harry's pharmacy, to the computerised systems like Jack Zufi's . And ours, which is easily set up for someone thinking of providing the service, but unsure of the logistics. It is a rewarding specialty, though demanding of time and personal aggravation at times, so not for everyone; don't take it on simply as an income extender.

    For years I have used a 'methadongle' a calibrated bottle-top dispenser, and that was fully satisfactory, except that for multiple take-away bottles of high doses, one was prone to repetitive pumping injury. Then I saw an ad in a trade paper and had a brainwave. Plus a visit to the bottle shop, and .... More... premium

  4. 24/11/2006

    D'oh! Draggin' the magic Puff: Ventolin multi-puffs

    Peter the pearlcaster writes:

    So many people have their asthma puffer technique so wrong, yet it really matters that they get it right.
    One way NOT to handle it: "Have you had this before?" The dead-end question that should be banned.
    One fellow in here last week was desperate, he goes PUFF-PUFF-PUFF , three in one go.
    Gee, how has he been doing it so wrong for so long without being picked up? It's what he always does, and it's why he goes through his MDIs faster than he should (and which you noticed on his history).
    You think, "You goose!" but you'd better not say that. His technique is crap. How to put him right, without making him feel bad?
    Losing face is very important for Australians.
    You also wonder, 'why haven't my colleagues been doing their job?' Here is an opportunity to turn a 30-second consultation into a big plus for your pharmacy, to win him, to have him thinking, 'well, not all pharmacies are the same.'

    I recommend the approach of asthma educator Luisa Hogan, one magic phrase... More... premium

  5. 13/10/2006

    Dish-washing chemicals, yum

    Peter the pearlcaster writes:

    The Age October 6, 2006:
    "[...] A CAMPAIGN urging parents to poison-proof their home aims to prevent an alarming rate of child poisoning ­ the second highest cause of hospital admissions for children under four in Victoria. At least eight children a day receive medical treatment after swallowing toxic substances. Paracetamol and dishwasher powder are among the most common causes of accidental poisoning..."

    * * *

    When you are dispensing for a mother with young children and you feel like saying something helpful (because that's why we got into this profession) tell her about the deadly poison in her kitchen, where her baby can get to it and eat it. It's just like the stuff she tips down her blocked drain that fizzes and pops and dissolves grease and gunk. And skin.More... premium

  6. 15/09/2006

    EIGHT Paracetamol? Not me!

    Peter the pearlcaster writes:

    We're constantly being warned of the Triple Whammy. At the recent, famous New Drugs Course for PSA (Vic), Louis Roller and Jenny Gowan, once all of the new drug presentations were complete, worked over some therapeutic examples.

    An issue that recurred was the inappropriate use of Non Steroidal Anti-Inflammatory Drugs (even the new Prexige / lumiracoxib) for aching patients with a history of serious coronary disease, commonly on something like Karvezide, (ACE + diuretic) hence the (often inadvertent) 'Triple Whammy.'

    Plus every day we get recommendations from on high: Use less NSAIDS, more paracetamol.

    What to do?

    Well, first of all, a Consultant friend advises:

    "I think pharmacists and prescribers over-react to the potential 'triple whammy' interaction. It is never as simple as saying people with Osteo Arthritis and chronic non-cancer pain should take regular paracetamol. It is simply not enough to get them out of bed and have a quality of life each day. The triple whammy interaction needs to be monitored and be aware of situations where it may become clinically significant eg dehydration, worsening renal failure for other reasons. It is always about the patient and not the drugs."

    Like my 80-year old aunt, on phenylbutazone (the one that caused ulcers in 40%) 'because it works and from the knees up, I'm perfect.'

    But where appropriate, replace the NSAID with paracetamol, IN SATISFACTORY DOSE, and that can be the problem.

    "But I don't like taking paracetamol."

    The sale begins when the customer says 'No.'More... premium

  7. 25/08/2006

    A string of two small but practical pearls

    Peter the pearlcaster writes:

    Not every pearl needs to be a biggie. This time, a couple worth a try, a pair to lubricate our daily interpersonal transactions.

    We have a super practice pearl prepared, a story all about dispensing Methadone and Bupe. It is applicable not only for pharmacists handling it now, it is of interest also for people considering providing the service -- and gives the best ways we've found to make the process efficient, featuring a new technique with a Methadongle. We're holding it back until September, for premium subscribers only. Join up, it'll be worth it.More... premium

  8. 04/08/2006

    The strange case of the vanishing mouse (or 'Wot -- No CMIs?')

    Peter the pearlcaster writes:

    For a long time I thought I was the only dill. Heck, I even tried uninstalling my mouse, and in Windows that is indeed a brave thing. I survived; unfortunately, it made no difference.

    When going to print patient medicine information sheets in WiniFred (which I must say we all love dearly) if one hits key [I] for Information, then the mouse pointer disappears. It's a trouble. And it afflicts all of us. Have you given up trying to print those CMIs?

    But we do have an elegant solution.

    Read on...(or should I say 'Hit any key to continue')More... premium

  9. 14/07/2006

    : Zen and the art of nose blowing

    Peter the pearlcaster writes:

    "Mrs Client, here is your Nasonex / Rhinocort nasal spray. Before you use it, you could blow your nose to clear the mucus, so the medication can get to work on the surface of your nostrils.

    But there is a right way and a wrong way to blow your nose. Not everyone knows this. AFL footballers all know it. It's something your mother would have told you, but in case she didn't, I'll show you the *wrong* way to blow your nose."

    What is it? What at first sight seems like a very trivial topic, is actually nothing to be sniffed at...More... premium

  10. 16/06/2006

    Desperately seeking a pharmacy in Scrubville

    Peter the pearlcaster says:

    A customer phones in, desperate, from a tiny town without a pharmacy, far far away. "Help me, Peter! We visited our daughter out of town for her university graduation ceremony, and I left all my blood pressure tablets back at home. What can I do?"

    "No worries. Where are you, and I'll find you a Guild pharmacy nearby, who might be able to assist you with your medications. Hang on just a minute ... yes, I've found one, Harry's Helpful Pharmacy, in Nowhereville, the next town from where you are in Scrubville. Here is his address and he will look after you almost as well as we do. Not only that, I can give you directions on how to get there too."

    I hang up, then call Harry, arrange to fax the scripts which we hold for him here, and to post them up later. How did I find a pharmacy near Scrubville so quickly? And generate a fancy trip-map...and without a Yellow Pages phone directory for the area?More... premium

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