Monday, September 24, 2007

I need to learn my crap

One thing that has been made abundantly clear in the last few months is that I know next to nothing about treating constipation. This creates a problem because it seems like every freaking question I get asked is what to use to make someone shit.

The only thing I know about laxatives is that every person receiving opioid pain relievers should be on senna and docusate. Other than that, I have no idea when to use an enema as opposed to miralax. I don't know whether miralax works better than mineral oil. And where the hell does bisacodyl fit in all this.

I can tell you how the laxatives work. I just have no idea when to use one over any of the others. Moreover, I never understood this whole obsession with bowel movements. Maybe I've just never had a problem moving my bowels. I don't know. Whatever it is, it seems like people are obsessed about being "regular," whatever the hell that means.

I'm just sick of all these constipation questions. Why can't someone ask me about their beta blocker or ACE inhibitor? I know that stuff. I've had a million classes and rotations that deal with them. I think I had one 50 minute class on constipation in my entire time in pharmacy school. I'm not adequately prepared to talk to people about their shitting habits.

While we're on the subject of questions I hate.... I hate it when a parent comes to me and asks me for advice on what medicine to give their 2 year old who has a cold. I know that dimetapp or triaminic will help. I know that the doctor is going to tell them to get one of those products. However, because of the labeling on the box, I can't recommend them without a doctor's approval. See, the labeling for antihistamines says to consult a doctor in children under 6 years old. The labeling for phenylephrine (a decongestant that may or may not work) has no dosing for children under 12. Even though I can find the proper dosing for any antihistamine product, I can't give out that dosing information without a doctor's approval because that falls under the category of prescribing, which is something pharmacists can't do.

Actually, now that I think about it, I almost never get asked a question I'm comfortable answering. I often get asked by older people what to use for arthritis. Now, I know most pharmacists would quickly point them in the direction of the ibuprofen or naproxen. I, on the otherhand, think about how NSAIDs aren't particularly great drugs in the elderly population due to the risk of GI bleeds as well as studies that have shown NSAIDs actually increase the risk of falls in the eldrly. I usually recommend against NSAIDs in patients 65 or older unless recommended by a physician. If I'm forced to give an answer, I'll recommend tylenol. "But I've tried tylenol and it doesn't help!", they say. The only thing I can tell them is to talk to a doctor.

Same thing with OTC sleepaids. I don't recommend tylenol PM, Simply Sleep, or any of those antihistamine sleepaids to many people and certiainly never to older people. If a relatively young person has trouble falling asleep every once in a while, I'll tell them to try some benadryl, but only if they're going to use it occasionally. In older people, antihistamines like diphenhydramine (benadryl) and doxylamine have too many anticholinergic side effects to recommend. People are almost never satisfied with this answer.

Cough and cold meds: We all know that dextromethorphan does absolutely nothing to suppress coughs, so even though I do recommend Delsym and Robitussin DM regularly, I do so knowing that they don't really work. Furthermore, guaifenisen (Mucinex) has never been shown to do much of anything to break up congestion, but it's still out there being marketed for it. How can I not recommend the product if it says "RELIEVES CHEST CONGESTION" right on the box.

In any case, I have today off after working Friday, Saturday, and Sunday. I'm going to watch some baseball, drink a couple Sam Adams' Octoberfests, and just generally relax for the next couple of days before I have to go back to work Wednesday.


greensunflowerRN said...

Somewhere probably is a rubrick on how to use laxitives, like there is for treating HTN medically.

Everyone is obssessed with either thier own or their child's bowel habits. No matter what kind of medical profression you enter, there will always be questions about poop.
Learn to mouth breath, just in case someone brings it in for you to take a look at:)

Anonymous said...

oh but i'm taking iron supplements to combat anemia and it is constipating!
let's talk bowels..
- Karen

Pharmacy Mike said...

Senna and docusate???

Anonymous said...

This is kinda gross. Years ago I had a male customer (not a patient, this guy only bought OTC items) who would come in every 4th Friday. He always grabbed the same three items... a large bottle of cheap wine, a box of Magnum condoms, and a large bottle of mineral oil. He fit the flaming homosexual stereotype. I assume the mineral oil was used for its lubricating laxative effects.