UAF – 2015 – Medication Therapy Management: How it can save your life!


Okay, well we’ll get We’ll go ahead and get started this evening. Thank you for joining us. It’s a beautiful evening out, but I think Lee’s presentation is very pertinent to most of America today. As a… My name is Tiffany Ricky and I’m a
dietitian and I’ve been granted the honor to be able to
present the Healthy Living lecture series this
summer. So I’m joining with you in learning every
single week, so this is exciting me. And as a dietician, I totally get the whole drug-nutrient interaction it and how
potent drugs can be in the body system. Leah, of course, gets out a little bit more. She is a – Leah Scadden is our lecturer this evening and she’ll be
talking about medication therapy management and how it can actually save your life. She graduated from the University of Colorado Health Sciences Center with the
Doctor of Pharmacy degree in 1999. She attained the American Pharmacists
Association National Certificate for medical – for medication therapy management services – this is a lot of letters – pharmacist and patient center diabetes care, and pharmacy-based immunization delivery in 2013. Currently, Leah is the clinical staff pharmacist at Fred Meyers East and for those of you that shop there,
she did survive the remodel move and back. She’s been a clinical staff pharmacist since 2013 and has staffed there since 2008. She previously worked as a pediatric clinical pharmacist at
Providence Alaska Medical Center in Anchorage from 2003 to
2008. She’s a member of the American Pharmacists
Association and the Alaska Pharmacists Association aside
from being a smarty pants pharmacist – she didn’t write that in – Leah is a wife and mother and she stays active running her two kids to school, soccer, swimming, and ballet practice. She also enjoys scrap booking, reading, cooking, and and working on mosaics. So, I am pleased to introduce Leah Scadden. (applause) So, thank you. Can you all hear me? Is it, is it on? … now? Alright, help. I apparently wore the wrong shirt. (laughter) Okay. Well, welcome and thank you for spending your evening with
me. So medication therapy management and how can it save your life. So that sounds pretty extreme, doesn’t it?
But in fact, it’s not. Medications are there to help you. They can cure infectious diseases, they
can prevent problems from chronic diseases like diabetes, hypertension, and high cholesterol, it can ease pain. But in order to be
helpful, medications must be taken correctly and appropriately. If not, harmful
reactions can possibly occur. Errors can even happen, whether it’s in
the hospital, the doctors office, at home or even in the pharmacy. There
must be an appreciation of the power of medicine, the value of medications when used
properly, as well as the consequences when used improperly. So today I’m gonna be talking about two main topics. The first one is the idea of polypharmacy and how to manage it, as well as – I really wanted to express how
important it is to create your own medication list. And the second part in my lecture is to understand more about vaccines
and know which ones are right for you So, polypharmacy always pretty much defined a number of different ways in the
literature, but mainly it’s defined as anybody taking more than four medications.
It’s also the prescription, administration, or use of more medications than are
clinically indicated. And polypharmacy is a growing problem seen in medicine today, especially with the increase in the
number of people with chronic disease states. Also with the increase in the number of
medications available to treat these disease states and also the growing elderly population. And this not only plagues patients, but
also clinicians and pharmacists as well and it’s also been well documented that
as the number of medications a person takes… sorry. As the number medication… medications a person takes goes up, the
potential for drug-related problems goes up as well, such as adverse affects
and also hospitalizations. And adverse medication outcomes have
been estimated to be the fourth or fifth cause of mortality in hospitals. I just wanted to give you a couple
examples of polypharmacy just so that you can get a better understanding. The first one has
to do with hospital medication formularies. Probably
all of us have been admitted into the hospital one time or another in our lives, and hospitals have medication formularies and these are put in place to do a number of things, but mainly to
help reduce costs. and what not. But… So an example I have is that when a patient gets admitted, all of their medications are looked at on their intake and so say for instance, a patient is taking a
medication called prevacid. at home. But when they go into the
hospital prevacid isn’t on the hospital formulary prilosec is. So those medications, they’re in
the same drug class and they pretty much do the same exact thing. But, when you’re in the hospital, that patient’s gonna be switched to
taking prilosec. And then upon discharge, when the patient goes
home, that doctor may just write their discharge medications for prilosec, not maybe understanding that the patient
was switched when they came into the hospital. So
now when the patient goes home, they’re saying, “Oh I have to take this new medication called prilosec, but I still have this prevacid at
home,” and so then they end up taking two of the same medications when they’re at home, not fully
understanding that they’re on essentially two medications but they only
need to be on one. Another example: sometimes patients, the more sicker patients, when
they’re admitted into the hospital – they’ll be started on a medication called
famotidine and that is to help reduce the risk of stress ulcers developing in their stomach and sometimes
this medication may not be stopped when they leave the hospital. So
again, a person may be on a medication that they don’t necessarily need to be
on when they leave the hospital. And then my other main example of polypharmacy is when additional medications are started
to treat side effects. And, so sometimes you’re going to be on a
medication and unfortunately medication sometimes
they just come with side effects. But sometimes patients will end up being
given a whole new medication to treat that side effect and sometimes
patients – It might be better for a patient to be on a different medication that doesn’t
have such a, a high side effect profile medication. As we get older we metabolize things
differently so sometimes the older population, there’s different criteria that doctors and pharmacists, nurses, the
health care community, should look at what groups of
medications will be better for the older population. But – so say for instance,
sometimes sleeping medications would be used to treat insomnia that
are some time caused by anti-depressants. Sometimes
laxatives are used to treat constipation from opiate pain medications. There’s other kind of a group of medications called tricyclic anti-depressants. The main one that is
prescribed a lot amitriptyline and they use that a lot for nerve pain, they use it for sleep, they use it for a whole wide range of things, but unfortunately, in the older
population it really comes with a high-risk of side effects including
constipation, urinary retention, blurry vision – so then you end up being prescribed eye drops for blurry vision
and you know it just kinda spirals out of control. So sometimes we
try to curtail that trying to hopefully get the doctor to
prescribe a different medication. Polypharmacy has the potential to
cause various outcomes – and some good – some are good and some are bad. So the good, or appropriate, uses of polypharmacy may include individuals who are very sensitive to
the side effects associated with the medication. When the dose is increased and these
particular people may benefit from having more than one medication, but at
lower doses. So even though you may be on multiple
medications, you’ll be at lower doses so that you don’t experience some of the side effects that
are seen with the higher doses. And that’s a totally appropriate use of
polypharmacy. And that way when they’re at the
lower dose, they don’t experience the
intolerable side-effects and this is often seen it with patients being
treated with hypertension, as well as diabetes, and they’ll use multiple medications
that provide different mechanisms of action just to provide a better
disease state management and improve the patient outcomes. And
it’s not unreasonable or even uncommon to see patients who, say for instance, have diabetes, to be
on six to nine medications just to help manage their diabetes as
well as the complications that may arise from
diabetes, such as secondary coronary events. They’re gonna be on medication for –
to help protect the kidneys, to help protect their pancreas, you know, that’s just – it may
seem like a lot, but again it’s something that is backed up by national treatment guidelines. Some
of the bad or negative outcomes of polypharmacy may include an increase in
adverse events – falls, hospitalizations, casts – and all of these can decrease a patient’s
physical function and overall working against the patient’s health. So who is at
risk with this mainly happening and it’s like I said – mainly people with multiple
the disease states of those seen with people who see
multiple clinicians. And… Us here in Alaska, we see – we’re kind of
a smaller community here – and so we see our doctors here but if you’re needing a
specialist for some reason, we may need to travel to Anchorage. Some
people even need to travel to Seattle and sometimes these patients who are seeing
multiple clinicians sometimes those doctors aren’t all on the same board. you know, they don’t know everything a patient is prescribed. And sometimes there’s drug interactions, there’s allergy interactions, there’s all
different kinds of things that can happen. Who else is at risk are the older
adults due to the fact that they’re – they’re more likely to require multiple
medications to treat multiple health related conditions. They can also experience cognitive
difficulties and this can lead to confusion with
medications. And also, if you’ve had a recent hospital – hospitalization like I was talking about, just because when you’re in the hospital
a number of medications may be started or changed or stopped while in the hospital and so your whole
routine may have changed when you get out of the hospital. And why is this a problem? So this can lead to a breakdown in
communication between healthcare professionals. It can also lead to a disjointed care
and fragmented medication lists and also filling
medications that multiple pharmacies – this can bypass electronic safeguards
that are put in place. So if you’re going to multiple different
pharmacies sometimes you bypass those safeguards and sometimes things can be missed, whether it’s
allergies, multiple retails for a medication – that
kind of thing. And also more medication… more
medication increases the likelihood of more side effects which may result in new medications prescribed to treat the
side effects, like I was currently – like I was previously talking about. So
how do you manage polypharmacy? The first step to
decreasing any problem including poly- pharmacy is to consider what can be done
to prevent it. So what can you do to decrease the risk
factors associated with your particular disease state? So for example, if you’re
patient with diabetes, hypertension, high cholesterol, living a healthier lifestyle with a proper
diet and activity levels can help reduce the burden on these chronic conditions and chronic conditions often lead to
increases and medications. And this is one of the most important
points that I wanted to stress to people because I just really don’t
see often enough, is patients should keep an up-to-date and accurate medication list and I really encourage you to use one
pharmacy – you shouldn’t cheat on your pharmacist. But I like I was talking about
before if you’re using all these different
pharmacies, it can bypass the electronic
safeguards and yes I totally realize sometimes you just need to go to another
pharmacy whether someone is out of stock in a particular medication, I totally
understand that. But ideally, you should try to use one pharmacy. And polypharmacy is a concern that may
require an intervention called de-prescribing and this is the
process of tapering off – stopping, discontinuing, or trying medications with the whole goal love improving your outcome
and I’m by no means saying just to stop these medications. This
is something that should really be discussed with your doctor. If you’re having intolerable
side-effects or something like that, definitely
bring this up to your doctor. I find a lot of patients just kind of go with
the flow and if something is really not making you feel correct or you know something is just
happening in your life is just not allowing you to lead the life that you want, please discuss that
with your doctor. Sometimes medications can be changed
to a different whole profile of medications and they can really
make a drastic effect in patients. And the end and each prescribed medication
should be linked to current disease state. And I’ve had a number of instances where patients have brought in duffel bags
– like a duffel bag – filled with their pill
reminders, stuffed with medications, bottles that were prescribed to them years and
years ago and they come in and say, “Oh, well I knocked it off of my counter and now I don’t know where my medication
should be and I don’t know,” and when they put them in these pill reminders, they
don’t know which pill is which, and it is so scary and
sometimes it’s really hard to just say, “How are you still living!?” But it’s really important that… You know, making sure you’re on a
prescribed medication that is linked to a current disease state
that you’re having. And if you are not on these medications, get rid of them. Just get them out of the house that children aren’t into them or anything like that. If you’re not on it, you don’t need it
around. So you can also help prevent errors mainly by knowing your medicine. You should keep a list of your medicines
and this should include the name, dose, how many times you take it, and what the
medication is used for. And like I was saying before, I just don’t see this enough. And I get patients calling me
and saying, “Oh I just need my, my little white pill filled.” Well, I don’t know if you’ve ever really looked behind the pharmacist to see the whole array of
thousands and thousands the medications that we have on the shelf, but probably fifty percent of them are a little white
pill and we don’t know where that is, so, but your list should definitely include over-the-counter medications, any
vitamins, herbals, supplements, all of these should be on your list because just
because it’s over the counter doesn’t mean that it’s perfectly safe to
take. There are gonna be drug interactions. Nasal decongestants can increase your blood
pressure. If your blood pressure is not controlled, it may not be the safest thing for you
to take. There’s many medications that can increase the risk for bleeding. If you’re on blood thinners, this can be
a problem. So please always check with us – a
nurse, doctor – we cannot help with you. We can just do screens of your
medications just to make sure you’re being as healthy as you possibly can. (…list, take it with you or carry it at all times?) Carry it at all times. Keep it in your purse, keep it in your wallet. And I didn’t add this to this even I should, you
should also have a list if your allergies on there. And take this list to each and every doctor’s appointment that
you go to. It… it’s absolutely mind-boggling how all
these providers don’t know what a patient is
on and unfortunately our computers are not linked together.
You know, patients say, “Oh I need all my current medications filled.” But you know, I can see at the pharmacy, I can see what
you’ve most currently – what you’ve most recently gotten filled, I can see if you have refills on something, but
I don’t know if something’s been changed, I don’t know if something has been
discontinued, and a lot of things sometimes – pharmacies these days have automatic refills where you can you to plug into the
computer system where it will fill routinely every month and sometimes that
can be really great if you’re mainstream and there’s no
problems, but boy if you’re having issues, you’re ending up getting medications filled each month that
you may not need or duplicated therapy and we may
not know that and so it it helps if everybody just
opens up the lines of communication. So… also make sure that you’re
reading your medication labels and following the directions. I can’t
even express to you how many horror stories I’ve heard up different
patients taking their medications not how they’re supposed to and I’ve
had – just recently I had a guy call me and he said, “I was just prescribed this heart – this
medication for high blood pressure but my blood pressure still really high
and I’ve taken three doses already and this was in a span of like 10 minutes.” And, I’m like, “Oh my goodness.” and you know, his blood pressure – it could
bottom out. He can seriously get in a lot of trouble but… So anyways and they also want to look
at the medication before you leave the pharmacy. If you’re on multiple – you know, if you’re
on refills and everything, picking up your refills, make sure that the pills still look the same that you had before Is it the same color, size, or shape? Sometimes it’s different because it’s a
different manufacturer. It’s the same medication, it’s the same active
ingredient, but sometimes at pharmacies were at the mercy of
what the wholesaler has in stock and what they sent us. So even though it’s the same medication it may look different, but boy, patients who only know that they take
that little white pill they can be in a lot of trouble because
they’re just like, “This is the wrong medication!” And and you know sometimes it can really stress a lot of people out. So and you also don’t want to
take medications that are prescribed for somebody else. It’s also illegal, but it happens. You also want to take
extra caution when giving medications to children. They’re not just a little
adults – their medications are prescribed
much differently than in the adult population. And this is just an example, which it’s probably a little bit hard to read. I just pull this off the internet, but
you’ll see that it has like a start or stop date, it has the name of the medication, the
tablet strength, how to use it or when to use it, and what the medication is for. And you by no means have to find some
nice pretty piece of paper on the Internet to fill this in. If you do, great! But you can definitely make your own. We can print them off at the pharmacy
for you and I’ve also had – seen some patients
come in where their doctors office had printed out things for them just to help everything run smoothly. But again, I just don’t see it
often enough in my line of work so… Yes ma’am. Yes, because there’s – there’s plenty of
interactions. Just for example: vitamin C – it’s
supposed to be a water-soluble vitamin so you think, “Oh I can’t get
too much of that.” You can definitely get it. I… vitamin C causes kidney stones. I know that; I have tons of kidney stones in both my kidneys that I’m pretty positive came from vitamin C –
taking vitamin C on a daily basis. Now some people, you need to be on
vitamin C, especially if you’re on an iron supplement. If you take them together, it helps with the
absorption. But again, you know, everybody is different,
everybody is patient-specific. So… and you definitely want to ask questions.
Why am I taking this medication? If you’re picking up something new, definitely know why you’re taking it. When do you take it? How do I take it? Do you take it with food, do I just take it with water? Do I take it on an empty stomach? Is it gonna… cause any common side effects? And these
are all things that you should know. All medications come with a patient
leaflet that you should definitely familiar with.
But what do you do if they do occur and when should you stop this
medication? Also… a lot of questions that we get
are “can I take this medicine with my other medications?” There’s food and drug interactions that are that are quite
common so please ask us. And again, we can always help you with
that and if you don’t know these answers, like I said, please ask us. So… Behind the scenes at the pharmacy. So I don’t know if you’re ever curious
about really what happens at a pharmacy. I guarantee you that I didn’t go to
school for many, many years and pay thousands and thousands of dollars in
tuition just to… pour some pills in a bottle and slap a
label on it and hand it to you. We do definitely do more than that. On the surface it may look like a
patient just brings in a prescription and then we put it into the computer and pour it in a bottle and slap a label on it and sell it to you at the register, but we’re actually doing much much more. We’re also checking for like I said
drug interactions, drug allergies, sometimes food allergies, the correct dosing, checking to see if the drug or dose is appropriate for
patient’s age, we’re checking kidney and liver function. We’re also checking refill dates to assess your
compliance. Have you gotten something filled, you know, you should have gotten it
filled last month, but it but it’s been three months. Are you still taking that medicine or did you just, maybe, forget about it? And you know, we run into all different kinds
of scenarios. We’re also complying with different state and
DEA laws, cost issues, packaging issues, we’re calling
insurance companies all day long, calling doctors back, whether we can’t read their handwriting or in many instances, We’re also processing prior authorizations, A lot insurance companies, they just – they
don’t wanna pay for the more expensive medication. So we call it, we’re calling your
doctor, as well as your insurance company, to get these process
through so that you can be on the medication that you need to be on. And something that the health care field is relying on
pharmacies to do is to do vaccinations. So that kinda brings me to my next part of the talk, and that is vaccinations. So why am I talking to you about
vaccinations? I think that vaccinations are just
another way of keeping us healthy. I’m a firm believer in them and every
year, thousands of Americans suffer from serious health problems and even die from diseases that we can
be vaccinated against. And this can include diseases like
whooping cough, hepatitis A and B, flu, pneumonia, and even shingles. If you can get – if you
end up getting the… the more severe symptoms. So, many adults and children are behind
on their vaccinations and vaccinations just don’t protect
yourself. It also helps to prevent the spread of disease to others in the
community. It also helps to protect those who are
still too young to get the vaccine. There’s also patients have allergies
to some components of the vaccines and there’s also those who cannot get
the vaccines because their bodies are too immunocompromised from diseases like
cancer and also those who can’t or won’t get vaccinated. They can still get a benefit from
herd immunity. These diseases have not disappeared. Fortunately, the US has low rates of
vaccine-preventable diseases but that’s not true elsewhere –
elsewhere in the world. And as we saw with just a few cases at the ebola
virus, it’s just a plane ride away. Only smallpox has been totally erased
from the planet, except for in some laboratories, but polio is no longer occurring in the United States, but it’s
still paralyzing many children in countries like Africa. And what would
happen if we stop vaccinating? We could find herself battling epidemics
diseases that we thought had – that we thought we had conquered
years ago. An example if this is in 1974, eighty percent of all Japanese children
were getting the pertussis vaccine and at that time in 1974 there was only 393 cases the whooping cough and not a
single pertussis-related death, but within five years, immunization rates
had dropped only about 10 percent and there was over 13,000 people who got whooping cough and forty-one people died from it. And then they started vaccinating again
and the disease numbers dropped again. And we also saw back in December 2014, there was a multi-state measles outbreak
in California at Disneyland and
Fairbanks also just got its first measles case and we haven’t had one in over 10
years. So the first one that I’m gonna talk
about I’m gonna mainly talk about
vaccines that are geared more towards the older population. So the first wanna talk about shingles. And, shingles is caused by the same
virus that causes chickenpox, so if you’ve had chicken pox before,
that virus stays in your system and years later, it can potentially cause shingles later in life. It’s a painful skin rash often
accompanied with blisters. It typically appears on one side
of the face or body or in a dermatome, and typically this rash can last for two
to four weeks. but one in five patients can
experience severe pain long after the rash clears up and
this can happen for months to years. I have a number patients
who have what’s called postherpetic neuralgia and they’re on pain medications from just a
horrible nerve pain that they experience from shingles. So, symptoms of shingles can also be fever, headache, chills, upset stomach, pneumonia, hearing
difficulties, blindness, encephalitis, or death. The shingles vaccine is a single dose that’s approved for adults fifty years and older. It’s
just a one-time dose that’s a subcutaneous shot that’s given in the back
of the arm and this can reduce the risk of shingles
by fifty percent. You can also – 50 percent doesn’t
really sound like a lot but it can also help reduce the pain in
people who still get the shingles virus even after they get vaccinated. So I found some pictures of these different disease states that I’m going to talk about and my husband wanted me to say that they’re pretty gruesome. so be warned. This is a shingles rash on somepody and you can see how it’s only on one side of his body – so in one dermatome. And this is the patient who has shingles on
his face and he is at a huge risk to becoming blinded from this. Yes ma’am? (If you’ve had shingles on the skin, can you get it again?) (And if so, will a vaccine protect against it?) Yes, you can potentially get shingles again and I would get a vaccine. There are kind of regulations on if you have had shingles you should
wait a certain amount of time before you get a vaccine, and the shingles vaccine is a live
virus so you – there’s different stipulations so you can’t have another vaccine like in the previous month that you get
the shingles vaccine. Since it is a live virus, if you’re immunocompromised in any way, if you’re a cancer patient, that kind of thing –
that’s something that the pharmacists and the doctor really have to discuss to
see it and if you’re well enough to get the
vaccine because, by golly, I wouldn’t want to give you a shot and
give you shingles essentially. So my sister-in-law is actually kind of an oddball case and she’s younger than I am but she
has chronic shingles. And that’s only a little bit, but she
still has chronic shingles and anything that just kinda stresses her body, she’ll get an outbreak of it and she is the only one I have ever heard
of this and I was like, “Are you sure that’s shingles?” and she was like, “Yes. They’ve cultured
it over and over just to make sure.” So she’s kinda an oddball case but yes. Alright so the next vaccine I’m going to talk about is the TDaP and that’s the tetanus, diphtheria and
pertussis. And so the tetanus – this is lockjaw – and it’s a painful tightening of the
muscles in the head and neck so that you can’t open your mouth or swallow. Sometimes you can’t even breathe. And tetanus will still kill one out of ten
people, even with the most – even with patients receiving the best medical
care – you can still die from it. Tetanus enters the body through cuts,
scratches or wounds, So, diphtheria – probably you just hardly ever see
some of this stuff anymore – but diphtheria causes a thick coating to form in the back of the
throat and it can lead to breathing problems, heart failure, paralysis
and death. And pertussis is probably one that were maybe a little bit more familiar with. But that’s your whooping cough and that causes severe coughing spells, difficulty breathing, vomiting, rash, sleep disturbances, weight loss,
incontinence and rib fractures. This can often
lead to pneumonia as well as death. It’s especially the most dangerous in children and diphtheria and pertussis are spread from
person to person through coughing and sneezing and adults are typically the carriers of
pertussis. We may not really experience it but we could sure pass
it on to little kids. So if you have grand babies around, that
kinda thing, you should always make sure that you are at least vaccinated against
pertussis. So, and since vaccination began, case
reports a tetanus and diphtheria have dropped by almost 99 percent and then by about eighty percent of… for pertussis. So, you should get a tetanus booster about every ten years and if you can’t recall if you’ve had
the T gap with the pertussis, it’s totally fine to get it. Yes? You said the tetanus… for ten years. Should I just get the tetanus or TDaP? So, with you, what recommendations are is if you’re due for a tetanus booster,
go ahead and get the TDaP if you – because the TDaP came out in 2005, so we’re still in the process of
vaccinating a lot of people with the TDaP so they can get that
booster pertussis, but if you – you know where we’re
kinda we’ve have reached at 10 your point people got it back in 2005 – so if
you’ve had the TDaP before then you can just get the… the tetanus component, the TD booster. Does that make sense? Okay. And like I said, TDaP or – I’m sorry – pertussis especially dangerous for the little
kiddos, especially if they’re twelve months and younger. Anybody who is working in the
healthcare community should have – should be vaccinated so
health care workers, anyone having close contact with babies, and it’s
also recommended – they just changed this not too long ago – any pregnant woman, with each
pregnancy she should get a TDaP. So even if she is pregnant every year, she is supposed to get a TDaP every year, because that pertussis components protect her… her child. So… let’s see… Back in April of this year there’s
still – we still get pertussis outbreaks and like down in Nenana this past April, their elementary school was closed because
there was, I think, twelve pertussis cases that happened and so you
end up seeing a flux of people getting vaccinated for it. So If I could just plead with you: if you know
that you have this, please don’t go walking through Fred
Meyer exposing everybody. We had… We’ve had a couple instances where doctors send over prescriptions and they’re right on it, you know, positive for pertussis, un-
vaccinated children or you know, something to that extent, and further
letting us know and, boy, 10 minutes later here they come, waltzing through the whole store, exposing everybody, and it’s like Oh, go through the drivethrough, please. but its… it happens. So… so anyways, a picture of a gentleman with pertussis and you
can really see how his neck and jaw is just really rigid. And this is what pertussis looks like
you can really see it – that chick white coating in the back of
the throat it’s really swollen and I’m hoping that this works. (coughing) so that is what pertussis sounds like – healthy right? But that is – that’s the definite pertussis whooping
cough sound that is highly distinguishable. so now I’m going to talk to you about influenza. Most of us are fairly… we… fairly know quite probably a bit more about influenza. It’s a contagious disease that spreads typically through the winter time, usually between October and May and it’s
caused by coughing, sneezing, close contact. And symptoms include fever, chills, sore throat, muscle aches, fatigue, cough, headache, runny or
stuffy nose. Those that are at risk at becoming much sicker are the
younger children, as well as the older population over 65, those that are pregnant, and those with health conditions like heart
and lung disease, kidney disease, any kind of
weakened immune system – you’re more risk of developing more
severe complications from influenza. Every year thousands of
people in the United States die from influenza and many more hospitalized. So the flu vaccine – it’s the… It’s not perfect, I know that, but it’s
the best protection that we have against the flu and it also helps prevent the flu from spreading from person to person.
After you get the vaccine it takes about two weeks for your protection to develop and the vaccination, it’ll last for several months to a year – about six months or so of
the year. The flu vaccine is made to protect
against three or four strands of the virus that are likely
to cause disease that year and like I said, flu vaccine cannot prevent all cases of the
flu, but again, it’s the best defense that we have against it. So I highly recommend
getting your flu shot every year. There’s many different kinds a flu shots
and there’s like a trivalent and a quadrivalent, there’s nose spray that I get my son because boy, will he fight me tooth and nail to get him a poke, but there’s also ones that
are formulated without the egg protein if you have egg allergies, there’s cost – there’s ones that are cost differences as well as age differences, and also for the… for the older
population – if you’re 65 and older there’s a special flu vaccine made just
for you. It’s called the Fluzone high-dose and it has
four times the amount of antigen as the regular flu shot and as we get older our immune systems
wane and this just kinda builds up up
higher immunity for you to get. So… it’s also covered by Medicare
Part B. When you have these… special sessions where people can get flu shots, if you’re over 65, do they have the fluzone that you need? Yes. We… (and you have to ask for that) Yes. (or do they give it to you automatically?) I would… I don’t think we do it automatically but
we, we really try to – if you’re 65 and older – we really recommend that you get the high-dose flu vaccine. Yes. Alright. So now I’m going to talk to you about pneumonia and individuals between 19 and 64 years old who have some kind of lung disease –
if they smoke or have asthma, they should be getting a dose of… pneumonia vaccine. Also anyone when you, you know, if you go in to the doctor
and say oh you’re 65. You should get the pneumonia vaccine and thats when it’s recommended again is when you’re 65. Now, the recommendations have recently
changed. You may or may not have heard of these, but
there’s now two pneumonia vaccines. One is the pneumovax, which if you’ve gotten the pneumonia vaccine, this is the one that
you’ve probably gotten. Now the recommendations are to add there prevnar 13 vaccine. Pretty much the rule of thumb that
we go through at the pharmacy is to wait basically
a year. The reason behind that is for you to get a
better immune response and also Medicare will pay for one pneumovax and one prevnar if you’re 65 and
older, but they were only pay for them a
certain amount of time away from each other. Yeah, it gets crazy. So, but we can always look into
that. Yes ma’am? (How often do you get these?) It’s recommended that you just get so what the – if you’ve gotten it your pneumovax, but you are
younger than 65 years old and then you turned 65, you should be
getting another pneumovax, but five years after your first one. If you have not
gotten a pneumovax, when you turn 65, you should get the
prevnar, a year later get the pnemovax. If
you’ve gotten a pneumovax, some years ago but it’s been over a year, get your prevnar. If you’ve turned 65 get the pneumovax again. We can totally
discuss all this if you come to the pharmacy. It’s… It’s a little mind-boggling, but
and (…annual booster, or…) It’s pretty much after you’re 65 it’s
a one shot deal for each. (You don’t get any more?) Not with the recommendations. I have had some people come in and say
my doctor is really recommending me get, you know, a pneumonia shot every
five years I don’t really think it’s gonna hurt ya, but… I, you know, I can just tell you what
the recommendations are. So, this is just an illustration of what happens in
pneumonia. So, up at the top circle this is what your
normal air sacs look like – your normal alveoli – and then in ammonia they’ll start filling up with fluid, so it can be very painful and definitely
hard to breathe and coughing up all that stuff can be very difficult. So I’m just gonna talk briefly about
hepatitis B and hepatitis A. Hepatitis B – it’s a serious infection that affects the liver. Each
year about two to four thousand people die in the United States from cirrhosis
or liver cancer. Hepatitis B can cause either a short term or a long term infection and people who are chronically infected
they can still pass the virus along even if they’re feeling totally healthy
and not showing any signs or symptoms. So, the hepatitis B virus is easily
spread through contact with blood or other bodily fluids from an infected
person. And I’m kind of a germaphobe in when
I was reading this I got really creeped out, but and people
who are infected with… People can be infected from
contact from the hepatitis B virus that’s on a surface and it can live on a surface for
up to seven days, and that just… that just gives me the hibbie jibbies. So those that should be vaccinated probably more for this
population, if you are six – little bit younger than 60 – and you have diabetes, I would
definitely recommend it. You know, you’re checking your blood all
the time, the doctor’s they’re probably drawing more blood samples. It’s just a good idea. I
personally think that everybody should be vaccinated against hepatitis B because why not? The effects that can
happen from getting this virus are just, just so outweigh the risk of getting the vaccine. Also if you’re doing any kind
international traveling it can be recommended with
different places that you’re going. So again, that’s just something that I recommend.
Typically it’s a 3 dose series given at zero one in six months. So get up here doing them international
travel it’s a good idea good idea and plan a little bit
beforehand if you are wanting to get back to me didn’t
have the full course of therapy. So, this is jaundice that’s caused by
hepatitis and jaundice is the yellowing it affects the bilirubin in your
system and it can just yellowing of the skin and eyes cuz you’re just – you’re having just – your liver is not functional well at all
when this happens. (Sorry. With hepatitis B, if you had the series-) You’re good. (you’re good? You don’t need a booster?) Correct. Now, you can always have a titer done, like when I started working at Fred
Meyer, they were like, “Oh you’re gonna give shots. You have to – you’re a healthcare professional,
you need to make sure you’re vaccinated against hepatitis B.” Well I didn’t want to
go through a whole new series of vaccine, so I just had my doctor draw a
titer and I was fine. (You do have to complete a series though?) To get the maximum benefit, yes. So hepatitis A, again, is another serious liver disease. This is found in the stool of infected people. So this is the one that you hear about
maybe in some restaurants, that kinda thing, that it can be spread by eating
contaminated food or water. So you just wanna make sure you wash
your hands before and after you’re eating. So… it causes a flu-like illness. Again it can cause that jaundice
that you saw previously, severe stomach pains and diarrhea. Those it should be vaccinated – it’s very
similar to the hepatitis B population… Kind of a different little bit of a population
are people who are planning to adopt a
child or care for a newly arrived adopted child from a country where
hepatitis A is common, such Central or South America, Mexico, Asia, Africa, Eastern Europe, they should
also get vaccinated. So it’s a two dose series that’s given six months apart and also the hepatitis A and B vaccine These can also be combined into one shot given in a three dose series as well. (audience question) I have heard that. So… (What was the question? I couldn’t hear it.) If you’re traveling like in the bush in Alaska,
sometimes it can be recommended – depending on where
you’re going – to get vaccinated against hepatitis A. It’s – again it’s one of those
things that why not you know and if you’re ever interested in the
vaccines but you’re not sure if your insurance pays for it or not, let us run a test claim and we’ll tell you
right then and there if your insurance pays for these. (And the three dose series, is that over a year’s time span then?) No, it’s… it’s, again, given at zero, one, and six months. So and I wasn’t really gonna
talk about the MMR which is the measles, mumps, and rubella, but then… (I have a question about hepatitis. I have a question on that because just recently, I’ve been seeing ads that are addressing hep C and it’s a capsule that they have developed that says that they can take, I think it’s 12. One each week for 12 weeks.) So, there is not a vaccine against hepatitis C. There’s a hepatitis A, B, C… and I’m not sure if there’s more, but there’s not a
vaccine against hepatitis C, but they have come out with these new
wonderful, extremely expensive medications to help treat hepatitis C and from the reports that I’ve been reading
is these medications are so wonderful that their vaccine load in some of these patients
that they’re seeing is is almost none, so it’s – they’re considered
almost in a sense, a cure. (Are the symptoms pretty much the same? And the cause?) Yeah, you know, it’s, I’d… Yeah. With the hepatitis C, getting it is, you know, the sharing of bodily fluids, illicit drug use, you know, all that
kind of thing that can – the multiple sex partners, all that
can make that the virus can be spread and if
anybody in your household has this disease, you just – it’s a good
idea to be any of the household members should
be vaccinated against hepatitis A or B, You know, if… You know, you’re living with your sister, she has it type of thing, you should be vaccinated against it and you wanna do things, you know, don’t
be sharing toothbrushes or even razors in the shower cuz it’s, it’s a potential
to spread the virus. So. Yes ma’am? (You said hepatitis C is a…?) The two vaccines that I talked about
are hepatitis A as in “apple” and B as in “boy” and then
she was asking about hepatitis C as in “cat.” So… So like I said, an adult with recent travel to Central Asia developed measles. Fairbanks
had their first measles cases to that we’ve seen in
the past 10 years. So, measles is a highly infectious viral
respiratory disease and it spreads via the airborne route and direct
contact with respiratory secretions and just simply being in the same room as
somebody with measles is enough to get the disease. It’s one of the most virulent diseases that you can get. So symptoms are a fever up to 104 degrees, runny nose, cough, red
eyes and sore throat, and it’s followed by a rash that typically starts, like, on the face and then the hairline
and then it kinda travels down and maybe you’ve seen a lot of measles, but a lot of… a lot of doctors these, this day and
age, they don’t see it. It could be totally misdiagnosed almost just because
we don’t see it a lot So the incubation period typically starts
to appear about eight to ten – in eight to twelve days after exposure
and the rash typically onsets about 14 days and the infectious period is four days
before the rash even starts. So you may be – think you’re sick, but not know you have
measles and you could be infectious because the
rash haven’t even started and up one of the reasons why measles
can just run rampant so and then you’re also infectious for four days at least
until after the rash onset. And like I said before, if you think you
have it just definitely don’t go into hugely populated areas. Call you know, you’re supposed to call the
doctor’s office first and they’ll more than likely send somebody
out to see you versus you going to an area and potentially exposing people. So, if you were born prior to 1957,
you’re pretty much presumed immune because you’re probably more than,
at one time or another, exposed to the live virus and then adults born during or after 1957, if you don’t have any evidence that
immunity against measles, then you should at least get one MMR
booster dose. I have been giving MMR at the pharmacy, not as much as
I was expecting, which I think is hopefully good didn’t but so, and then… (I was born in ’49 and to volunteer at the hospital, they wanted me to have a shot or a test.) (They tested me and I was not immune. So I had to have an MMR. So that’s true, but not completely?) Correct, and even when I… So I was living down in pharmacy school in Colorado and then I moved to Wyoming and from Wyoming moved to Anchorage and before I started working at Providence
Hospital, I… I was one of the pediatric clinical
pharmacists, so they are making darn sure that I had my MMR up-to-date everything and so
they drew a titer even though I had documentation that I’ve had my MMR and I even, I can’t recall which
component was, but I’d – I wasn’t immune to one of the components and
then they gave me an MMR and now when they draw titers, I’m immune to all three but, so yes. You know, people can get all up in arms
about all these anti-vaccers and blah blah blah, but you know, in reality, it just may
not make a difference some people don’t seroconvert. So… Yes ma’am? (I was born in ’47 and when I was a junior in high school, we got all those vaccines.) (…whole class, and we were all born about the same year, so we were not immune to it.) (if you have… are you immune to measles or are they two different viruses?) It’s all different so (And I don’t have any record of having an MMR. Should I get one, do you think?) So I… (I imagine I got one at some point, but I…) Right, and you can always ask your doctor to
draw a titer and then, you know, or you can… you can come in and get a booster. You know, it’s either or. When I talk to the health department,
they were saying, you know, if you, if you really don’t have documentation
but you think you were exposed, then they’re airing on the side of caution
and come in and get a… a shot. So… (Would they do it in three separate vaccines in the old days?) I don’t think so. I think it’s always been an MMR. (So a tighter shows all of your immunities?) So I know when they drew a titer on me, they looked specifically for the rubeola, mumps, and rubella. I don’t know – I would imagine you would
have to ask for them to draw for… (Ok, we don’t know what a titer is.) (laughter) So, you basically go in for a blood
draw and they’ll draw a tube of blood from you and… however they do it, they – they’re looking at, like, the the antigens and you immunity in the blood, but it’s essentially just going in for a blood draw. (Where does word come from? How did it start?) Titer? T-I-T-E-R? (Okay) But again, I… Okay, so, in just briefly mumps is – particularly when you would see that
it’s the inflammation of the salivary glands and is extremely painful and then rubella is the German measles,
or sometimes they call it the three-day measles. It may not be as as severe as the typical measles that you
would see, but the rubella is the one that is most detrimental to pregnant women. It could cause her to have a miscarriage or her
baby could be born with serious birth defects. So, this is typically what measles looks like and then this is mumps, just with the really
swollen salivary gland. And then, so on the left, this is rubella – the German measles – but to me, that rubella and the rubeola, or the measles, and this is roseola. There is no
vaccine for roseola, but kind of a childhood one, sometime you’ll see it
go through day care centers, but they all look pretty darn same to me (When they look very severe, is there a gradation to the … ) There is. When I was, you know, looking at
pictures and stuff, there’s all all kinds of severity and some of the rashes will be really itchy, some of them won’t, and that kind of thing. So, this is just – I know this is
hard to read – this is just the 2015 recommended immunizations for adults and it’s based on age. Typically, if
you’re like 65 and older, pretty much this is just sayin get your yearly flu shot, get at least one dose of the TDaP. If you’re over 60, get your shingles. Actually, in the state of
of Alaska, shingles is approved for 50 and above.
It’s just that some people’s insurances may not pay for it when
you’re 50. They will sometimes make you wait till you’re 60, like
Fred Meyer insurance but again, if you’re ever interested
we can always run a test claim and let you know if your
insurance will pay for it or not. (I’d like to make a point about that. You usually have to pay for it, but take my word for it. After having the shingles, it’s worth the 200 or whatever it costs.) Thank you. (laughs) (It’s really worth it.) So yeah, I had – I got bronchitis not too long ago, but I… I could’ve sworn it was pneumonia and I really wish I could just get a pneumonia shot, but with my age, they were like, “Well, we don’t recommend it,” and I’m like, “I don’t care, I just want it!” (laughter) Briefly I just wanted to… talk about what we offer at Fred
Meyers and of course we will fill your prescriptions for you. We also offer these MTM
services and MTM stands for medication therapy management.
Some people might know them as like a a brown bag event where – we did these a lot in pharmacy
school – where we would get people bringing an all their medications that
they have, everything that they’re taking or not taking, put it in a brown bag, bring it to us, and
we sit down with you and we go through everything. We look at drug interactions,
making sure you know what medication is used for, are you experiencing really bad side
effects, are there any holes in your therapy, you know, if you’re… if you’re a patient who is diabetic, you should probably be on a
medication for cholesterol as well just to help prevent these potential outcomes that can happen – the coronary syndromes that can happen – you know, we just kinda sit down and see if there’s any issues that we can look at, making sure that you’re on a
medication that is – that you have a clinical indication
for basically. So we also do screen services. I
can check blood pressures, I can check your blood glucose, if you’re diabetic I can also check your A1C and you know
most people think that you can only get this done at your doctor’s office. It’s a
very quick finger poke. I can do A1C. Your BMI is your body mass index – I can also check cholesterol panels.
We have the machine that it’s just a
finger stick and we can check your cholesterol panel. I also do coaching services for
diabetes management and care. FNW stands for Fitness Nutrition Weight and Heart Healthy
is more for hypertension and cholesterol issues and
I also do smoking cessation. Again, we do all immunizations as well as
travel consult. So we’ll do, if you’re traveling the world,
we can do Japanese encephalitis, rabies, typhoid, polio, we can do everything
but yellow fever. But that’s going to be
changing. So… (audience question) It’s a mosquito-borne illness, but it’s… but it’s only seen like in certain
countries but… (… hadn’t heard about it.) it’s a mosquito-borne illness.. (Is it like…. fever… ?) I’ve only given once – I have to re-read it. But it’s…. Yes. Yes. I’m pretty sure it’s different but it’s, you know, we can always take a look, see where you’re
traveling and if it’s recommended because it’s recommended in some areas but not
others so we can – so, I can do travel consults. I know in town, at certain doctor’s
offices, they’ll charge you about two hundred and
forty dollars just to do a travel consult. Our fee is fifty dollars but, you know, if you even wanna hop on the
CDC website you can… you can check, you know, you can put in
your itinerary and see which vaccinations that you should get and it’ll save you fifty bucks, so… But again, you know, call me up – we
can always discuss it. Let’s see… we also do diabetic food tours and this is a new thing that
we’re doing. We just had our first one a few months ago, but they’re led by a dietician and it basically if you have diabetes or
even somebody with diabetes and your family,
we do an overview of diabetes but then we walk the food aisles and it’s patient-led and they ask questions of the dietician, finding
out what is a better bread, how to count carbohydrates, that kind of thing.
And we got really good reviews from it, so we’re waiting to do our next one. So and I just wanted to tell you a
little bit about the Fairbanks Health Department. They do all
childhood vaccinations up until 18, but for adults I know a vaccination can potentially of a lot of money. I know that. My goal is for you to get what you need to make
you as healthy as possible. So, the Fairbanks Health Department, they will do adult vaccinations, but only some.
They will do the TDaP, they will do the tetanus and they’ll do the pneumovax, but they don’t do
the new prevnar. And then they will only do shingles
for ages 60 to 64 – something with their grant, that’s only
what they’re able to vaccinate for – and they also do the HPV vaccination,
with it which is that human papillomavirus one, but it’s only… it’s only for that age group which is like to 26
years old or something. So, the cost at the Fairbanks Health Department, it’s $27.44 for your first vaccine and fifteen
dollars for each additional vaccine. So if you’re really strapped for cash
and you fit within these parameters, by all means, go see them at the Fairbanks Health Department. They are very, very wonderful there so. The TDaP is the tetanus, diphtheria, and pertussis. So, these are just my take-aways.. And the biggest piece of information that I want you to take away from this is just know the potential hazards of poly-
pharmacy and how to help manage it, also keeping a current list if your
medications with you that you take with you to each and every doctor’s appointment and… and again that should include your
allergies, name dose, how you take it, and what it’s used for
and then also knowing which vaccines are right for you. And you can also go to the CDC website.
That website is pretty phenomenal. You can take like a
little test where you plug in your age and gender and answer
a few questions about your lifestyle and health conditions and it will pop out what recommended vaccinations you should get. So, and again if you’re ever curious, you
know, talk to your doctor, talk to your pharmacist, and we can always go through that, even
if you don’t have a record of your vaccinations, probably getting an extra one is not gonna
hurt you. So and again, just one of the most
important things is just help us help you and be active in your own health care.
Ask questions and be an informed consumer because the most important person in
your health care is you. So, any additional questions? (laughter and applause) Sorry, I know I ran a little bit over and I tried to pare it down
apparently I can really talk. Yes sir? (This concerns medications. If you’re traveling, specifically out of the country, and your medications are expired or lost or stolen or damaged or something like that, are things on medications pretty much standardized and how would you go to a foreign pharmacy and say, “I need this?” So, medications are not the same. Like, I don’t know if it’s Canada or Europe acetaminophen, which is Tylenol, it goes
by paracetamol. It’s one of the fairly more common ones that I know of, but I would definitely now there’s – but there’s references that we can pull up online – I’m assuming they
can also do that there – that you can look for medications that are out of your country or… I’m trying to think of the word that I’m trying to say, but there’s… there’s references that you
can look up, like, okay I’m on this – what is your version of it and are there
are ways to look at that and you know, try to at least go to a
hospital or a pharmacy and see. You know, there’s a ton medications that
are you can buy at a pharmacy elsewhere that you can’t buy here. They may be able to definitely get you what you need or something hopefully similar. (Should you get a doctor’s or pharmacist’s from this country or…. ?) Like here in the United States we, we cannot take prescriptions from
elsewhere, from out of the country so it’s… (audience question) Right. Like, I mean, in Canada you can get muscle
relaxers over-the-counter, you can get all kinds of stuff over-the-counter. (So you can talk to the pharmacists and they are very knowledgeable and they will come to, you know, they look at the ingredients and at what you’re taking.) Right. And I would, you know, I would say it try to go to
like a hospital type of place… They have national health in a lot of the countries They’re pharmacies are not our pharmacies, they’re not drug stores…) Right, correct. Like I know down in
Mexico – I was born and raised in El Paso, Texas. You just walk right across the border and you’re in Mexico and, boy, you
can go to the pharmacies, you can get antibiotics, if you can get – they may go by a different name but it’s,
you know, you can get a lot more that’s essentially over-the-counter that the
pharmacist will get you that that you couldn’t get here in the States. But I would definitely, when you’re traveling
make sure you keep those on your, your carry-ons – don’t put it in your luggage. Yeah. So… yes ma’am? (Recently…. had an influx of people…. thousands of people who have come into this country and nobody knows what they had or haven’t had. What is being done – do you know – about this?) I don’t know exactly what is being done do you know, Tiffany, anything at all? (… I’m not, but that’s a very good question.) hope that you know some kinda it
government regulated but again, I don’t know for
sure. Any other questions? Yes? (Sometimes if you get behind or skip something, they say when you’re trying to get a prescription refill and you skipped two or three days, my impression is you’re supposed to take all of those two or three days to catch up.) No, I would not. If you missed three days of medications, especially like diabetes medication, I
wouldn’t take, you know, three pills of metformin you’re gonna
bottom not your blood sugar, so I would start – you know, you shouldn’t double up on a medication. Take it as soon as you remember, but don’t double up on a medication. Well thank you everybody. (applause) I talked to Leah oh my goodness, was this back in September or October to do this presentation because as a dietician and working in a hospital, the list of medications, and I mean, I have to take a few medications and just knowing that my synthroid has to be on an empty stomach, before I eat, you know, I have to take it every day, my
refills, and that’s just – those are two medications. And I can’t imagine having more than that and the scary reality of what happen if you
forget to take your medication and so I’m so thankful for your advice and just
that medication she – I mean, we get prescribed medications and we
trust that the doctor knows what they are for us, but when you have multiple medications it’s important that you… that you know what they are, what they do,
when they look like, and if you’re – my husband is notorious, “Well I know that it’s almost expired, but we
should keep it just in case.” Yeah, no no no. If it’s expired, throw it away. and in just a little blurb on getting rid of your medications if you don’t use them or they’re expired, some people here… a number of people, they’re just like, “No I don’t wanna flush it down the toilet because the fish,” or you know, and that is hunky-dory fine and dandy. What you should do is if you have coffee grounds or kitty litter, get your medications that
you aren’t using grind it up, mix it with something like
kitty litter or coffee grounds that makes it unappealing to somebody digging through
your garbage and then put it in a sealed baggie and
then you just throw it away. That is typically what you’re supposed
to be doing. (They also have the….) Yeah, drug take-backs. Now… Yeah, I… Yes but I… I am not positive on this, but I don’t know if they’re doing that anymore. And which is a complete shame. (Prescriptions… has a bin…) here are you third (It’s a new service and some of the pharmacies are subscribing to it. It’s a take back and it’s in a sealed container and it’s sent to a company that’s…) Yeah, and I know we sell these bags. Yeah, we sell these bags that you can put them in and then seal them up and I think it’s even free shipping and ship it off to somebody, but… (I think the coffee grounds and the kitty litter idea is better because you can just put it in a ziploc and put it in with the rest of your…) (The other thing, you know, I’m a pharmacist too and so I really appreciate what you’ve said and the most important thing to me is get your prescriptions at one pharmacy please because we don’t – we talk to each other – I’ll talk to Leah if my computer’s not functioning so I don’t have a record. When I was working, I didn’t have a record of what you had filled yet, at Fred Meyers, Safeway, and a the Emergency Health Center…. So it’s really important that this is great, that’s the best thing of all but just get everything filled at one place and figure out which is the most convenient or best for your particular… If you shop at Fred Meyer all the time, that’s the best place, or Safeway good yeah really And it’s really best to keep everything in one spot.) im (So, do any doctors not approve of you changing to generic when they become available?) They will specify – like they will put a DAW in, which means dispense as written. There’s a few eye doctors that they really want certain particular brand-name eye drops, or it’s pretty rare. We have some patients on like their duragesic pain patches and by golly they have to have brand-name on all their pain meds. They can’t have generic and they’ll raise a huge stink if they don’t get brand-name but it’s, you know, we see it
with classes of drugs but doctors for the most part, they don’t really mind…. (But your insurance minds.) Right. Insurance – if there’s a generic available your
insurance wants to pay for the generic. They don’t pay for the brand (Yeah, I’m also on synthroid and I have to take the brand.) Now, there are certain class…. Right, there are certain… Right, there are certain drugs that, by golly, if you are on the brand, stay with the brand. And those would be things like coumadin, the blood thinner, but if you take warfarin, then stick with warfarin. If you’re on synthroid, stay with synthroid and
because if you’re flip-flopping back and forth that can have a tendency
to mess with your INR or your levels… what’s another one… (…and the doctor needs to write it on the prescription and oftentimes I have to remind the pharmacist…) Yes. (… do generic, and I realize that…) Yes, yes. And sorry! (laughs) If you take more than one medication, it would be very helpful if medications were sold like, in either 90 pill sized containers, instead of some come with 90, some come with 100, so you can’t keep them together because if you want them refilled, all of a sudden you’re getting them too soon for the one prescription. So here’s the deal with that. Some certain doctor’s offices will either write for 30 pills, they’ll write for a month’s supply with 11 refills for your year or they’ll write for 90 tablets plus 3 refills for a year. Now, at a pharmacy we can only… we can only bill an insurance company what that prescription says. If you’re – if we’re gonna bill it to insurance and if
your doctor wrote it for 90 tablets, we will put it in, we will charge the insurance company
essentially for 90 tablets and then they’ll send us back a reject saying, “Well, our plan only pays for 30 pills.” So then we change it to 30 pills if you want it on insurance. Now if the doctor
writes for only 30 tablets even though your insurance company will pay for a three-month supply, it… it’s insurance fraud if we change that to
90 if the prescription is not originally written for 90 tablets. It’s something that is so minute and so ridiculous, but it’s insurance fraud. And so if we get audited, and we’ve bill them for 90 tablets but the perception is only written for 30,
we’ll get humongous fines. So it yeah so we will… we encourage doctors and patients to, gosh, you know, just write for those 90 tablets you know, and we’ll take it from
there. We will bill it for 90 but even if your
insurance company only allows a 30-day then okay, we’ll fill it for 30, but for those patients who allow a third
a 90-day supply a you know, please just let us do that. It’s just, you know, it’s something that’s so little, but it really affects a lot of patients if
you can just… yes, I agree. (laughter) (Is the use of next med md pretty common? I’ve ordered my pills and I’m reminded of my 90 days, when I ask for a refill.) Is that something through your doctor’s office? (audience speaking) Oh, it’s like where you can send them emails and stuff Yeah, and I’m military, and so… and I know that that is coming about where it… and it makes it much easier for patients, you know,
if you have a question for the doctors, nurses, you know, something like that, you could just shoot them off an email versus making a phone call and waiting three days for them to finally call you back and by golly, you think you have trouble getting a hold of your doctor? We do it all day long. (laughter) So… yes? (I had a funny situation where…) Yeah, it all is based on your insurance company and the drug. They you know, they… sometimes they’ll pay for a 30-day supply, but boy, sometimes they’ll really stick it to you, you know, for certain medications. No, and to tell you the truth, doctors have no idea what medications cost. I don’t even think they care – I mean, they
do, but I mean, essentially they have no idea
how much something costs. We, you know, we get patients all the time
like, “You’re kidding me, that antibiotic is eighty dollars! I don’t have insurance.
I can’t pay for that!” You know, when when whatever they’re being treated for
could be treated with amoxicillin almost just as effectively, you know, that is pennies compared to what they’re on. So it’s… you know, if that’s an issue, you know, we will call. We will… say you know, either the patient isn’t gonna
pick up this medicine because they can’t are please call in something that they
can afford so we can cure their infection. you know sometimes arm you know we do that with your drops
and eye drops a lot to you I’m can the other currently and homeless arms so and you know it you feel he well no him wrong and your here hit you know I kitty have to fire missus and they pretty much they just let the
diet let the doctor diagnosed patients and
let us treat the peace you hit no it doesn’t but ok but yeah it would be a wonderful
world if that happened you but yep me he had called it’s not called Leah the police %uh taking it next week acupuncture and
Oriental Medicine so it should be another interesting up
interesting lectures I appreciate your time tonight and if
you like update as well and Michelle are let well and %um email what’s coming up out for summer session
thank you very much well little yet excellent lindon okay K the keeper setting only employees you know little I go to just one good girl I cary mullis not know Paul Hunt it’s just really important like poultry
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healed cashier I know it you on okay here’s down right well down no law here and my bad hit me happy keep in touch