Pharmacies, a cautionary post

Look at the Featured Image, at the Top. These are “most” of the Pills that I take, a weeks worth of Daily Pills. Look how much the Shape and Color has changed since August 2019 (top) to December 2021 (bottom). The Dosage was changed by the Doctor since then, the Histamine Blocker that I take for Stomach Acid is decreased in dose and changed from Zantac (Ranitidine) Over the Counter in 2019 to Pepcid (Famotidine) by Prescription. It appears that in 2019, I was taking Zantac (Ranitidine) twice a day. I was taking it for Urticaria under a Doctor’s Instructions. I now take Pepcid (Famotidine) for Stomach Acid once a day.

I was taking 200 mg Phenytoin in the morning and 300 mg at night, now I take 200 mg in the morning and 200 mg at night (Doctor’s Change in Dose based on Blood Levels).

But look how much the pills have changed (the arrows point to what the Pills looked like in 2019 and now in 2021), and this was a gradual thing. But since the last time I had prescriptions filled, 3 changed that I take and 1 that my wife takes to different forms of the same Generic Medications.

If the intent of the globalists was to close down stores and open mail order stores, they are succeeding. Pharmacies, once a time honored small town thing, are becoming more rare. The chain pharmacies are taking over, but they are having trouble keeping up.

We use Rite Aid Pharmacy. Two local pharmacies have closed, one before covid, one during it. Their customers got shifted to other pharmacies, and with the closing of the 2nd one, Rite Aid got their customers (apparently the records of the prescriptions, refills left, expiration date of the prescription, etc. were transferred to Rite Aid). Of course, people transferred don’t need to stay with Rite Aid, but the options seem to be having issues too.

We used to get phone calls, voice messages, that our prescriptions are ready to “pick-up”, but no more. My wife has called the prescription refill in to the store, and when she shows up 2 weeks later, they still haven’t filled the prescription and only does it when she is at the register, or waiting with the herd of others that came from other pharmacies or that called their prescriptions in a week or longer ago but it was never filled.

There’s a pandemic, we’re told, but Rite Aid has created a situation where people, often sick, are coming into the pharmacy to have a prescription refilled that they phoned in, or with a new prescription, and they need to wait with several others while the prescription is only then filled, she said she has seen 7 to 10 people waiting. Does this sound reasonable?

She tried to transfer our prescriptions to Giant Eagle, and they would have accepted them, but the Pharmacist from Giant Eagle phoned her and told her they are on the verge of having similar disruptions in operation from being inundated with customers from closed pharmacies.

So, in this post, and in one or more in addition, I’d like to explain why this is an issue.

1. Crowding people together that have a higher probability of being sick with a communicable illness should be discouraged, from a covid stance and from a stance of suprainfections that can dramatically undermine a covid patient’s medical state.

2. Prescription Errors. There is a term for it, alas, the last time I heard the term was in the late 1980s, when I was in Pharmacy Technician School.

Know Your Medications, Your Pharmacist, and Trust, but Verify when Your Doctor Prescribes New Meds – A Case in Point

A Suprainfection is, literally the term Supra (meaning above) and infection. When a person gets sick, they are not limited to 1 infection at a time, they can have multiple infections. So if covid is a concern, and they are pushing how contagious the Omicron Variant is, it may be communicable from one person in the pharmacy line to another, or other illnesses may be communicated to a person that makes the person more vulnerable to covid. In either case, reducing the number of people waiting indoors is needed, not increasing the number. To complicate the problem, they are operating at reduced Hours, and in fact, they did not open at all one day as they should have, according to a conversation my wife overheard.

Prescription Errors. UGH.

I take a ton of medication.

One medication I take, Phenytoin, is for seizures. When the pharmacy shops for lower prices on Generic Medications, they buy different suppliers of Generic Medication, and this is what they supply. There’s a problem with that, they have different levels of Bioavailability, so despite being the same Dose, it does not mean that I’ll have the same Blood Levels. So, when the pharmacy switches, I can have break through seizure symptoms (I have temporal lobe seizures and haven’t had Grand Mal), and if they persist, I contact my doctor, he orders a blood test, that shows the level, and the Dose is adjusted to achieve the correct level. One Neurologist suggested I take the Brand Name only Drug, and I did for some time. It’s Phenytoin and it’s made by Mylan. But Mylan decides periodically that they are suspending the manufacture of Phenytoin for some reason, and so, you guessed it, I’m back on Generic, the Blood Levels change, etc.

Enter the new problem. I take Coumadin, and Phenytoin Interferes with Coumadin and Coumadin Interferes with Phenytoin. But the interference is in a predictable way. So I get Blood Tests for Coumadin, and I get Blood Tests for Phenytoin, and Doses are adjusted and are stable, and all is right with the world. Until Mylan shipments aren’t being received by Rite Aid, and I get put back on Generic, and my blood levels change, and I went from an PTINR Anticoagulant Level of 2.9 (2 to 3 is the range) to 3.5 and my likelihood of bleeding is greater, so I need to contact the doctor, and he needs to adjust down the Coumadin Dose, and I need to have blood tests for Coumadin and Phenytoin. Grrr!

So, with the pharmacy under stress, I am now being given Metoprolol, Montelukast (Singulair), and Phenytoin from a Different Supplier or Generic Sources than I did before, therefore I cannot be guaranteed what the Blood Levels will be on my complex pharmacological use. My wife is being given Atenolol from a different source than before, and with all this different source stuff, Pharmacy Errors become a real possibility because what you were taking now looks different, and if you don’t check, you can be harmed.

Remember the terms Tablets, Capsules, Caplets.

I search DuckDuckGo for: JSP 523 Tablet Green

Drugs[dot]Com comes up as the first hit. Bingo. It’s the Pill.

I search DuckDuckGo for: X51 Capsule White

Drugs[dot]Com comes up as the first hit. Bingo. It’s the Pill.

I search DuckDuckGo for: PHN 100 Taro Orange Capsule

Drugs[dot]Com comes up as the first hit. Bingo. It’s the Pill.

I search DuckDuckGo for: A 100 Round White Tablet

Drugs[dot]Com comes up as the first hit. Bingo. It’s the Pill, BUT, no Picture.

The Pills Must be as Pictured, the Sites have Disclaimers that they can make mistakes. So it’s not absolute. Your Bottle of Medication should have a Description of the Pill, “A 100 Round White”, something like that. If you are not satisfied, call the Pharmacist and ask him or her. Tell them that the appearance of your medication changed since the last time you had it filled and you want to be sure you have the correct Medication.

Searching online is only to help decide if you have the correct pill. “A 100 Round White Tablet” may also yield “A100 is White, Elliptical / Oval” but this is different, in one case, it’s a Losartan Potassium 100 mg and not the Metoprolol Succinate Extended-Release 100 mg that I take. The Pill Must be Identical, Marked Identically, and be identified as you expect it to be. If any doubt exists, phone the pharmacy.

The other issue is that with changes in the Generic Version can come changes in Blood Levels of the medication. Between Brand Name and Generic, or Generic and Generic, most are highly compatible, but when you take several medications, changes in the interactions between them can occur, as I saw the Anticoagulant PTINR Value of my Blood Test increase significantly with a different Phenytoin. And now they have supplied all new forms of Generic Medications, and it’s a concern.

But watch for Stressed Out Pharmacies trying to get prescriptions filled and mistakes are made. In my life, with all the Pills that I take, I only once had an incorrect prescription and I didn’t take it, by the time I got home, the pharmacy phoned and said I needed to return, they dispensed the incorrect dose. One time my wife, taking Atenolol, was having problems, and I was talking it too at the time, so, since they were filled at different times, but Identical in Dosage, she started using my pills and her problems went away. I actually think the manufacturer failed to put the medicine in the pill, or failed to provide the proper dose in the pill. By the markings, we knew it was the correct pill. The pharmacy exchanged the pills and everything was fine.

Be Very Careful with Medication.

Author: Dr-Artaud

A Doctor that is not a Doctor, but named after a character in the movie "No Such Thing", as is the Avatar.

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