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Practice Pearls
- 28/05/2007
Pearl: Eichorn's remedy - noughts and crosses
Peter the pearlcaster writes:
The recent Eichorn's remedy thread noted that it is mixed in ethyl alcohol 68% v/w.........
 Sixty-eight per-cent. Why? Nobody knows. But it gives us a chance to show some really flashy pharma-stuff.
A) First year students -- cinchy:
Have Alc 90% Need Alc 68%
By simple proportion, take 68mls of SVI and add water to make up to 90mls (or scaled up proportionally) in a measure.. Wait until it cools and further adjust to volume.
NB Don't just add 90-68=22mls. It will be MORE than 22mls because of 'shrinkage.' Somewhat like adding water to sand.
Now! A practical pharmaceutics calculation for the BYTs (Bright Young Things) who haven't been shown this magic. Be amazed and impressed ... More... 
- 18/05/2007
Pearl: Prednisolone reducing schedule
Peter the pearlcaster writes:
We get prescriptions for a stat dose of steroids, such as prednisolone tablets, or child's mixture, with the dose reducing over following days.
One I dispensed today was Rx 30 tabs 25mg, sig: "2 daily reduce by half a tablet every two days until zero." Another was for a young boy; 5mg "6 stat reduce one a day." Here's a tip that was well received by both clients. One of them already had a scrap of paper with the dose schedule scribbled upon it but liked my idea better.
Plus two more useful counselling tips that value add your professional image and take very little time; a bonus for your intelligent patients showing exactly what is happening and WHY they should be complicit in their reducing dosing. For the best motivator towards compliance is understanding, much more effective than a didactic "You must..." More...
- 16/03/2007
Pearl: 'Medicines are expensive.'
Peter the pearlcaster writes:
When you've heard the comment "Medicines are expensive" and you think it's worth refuting, here's something I find works.More...
- 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...
- 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...
- 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...
- 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.
AAAAARGH!!!
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...
- 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...
- 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...
- 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...
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