Contacting the Prescriber

[Pharmanaut]

I think my tutor is trying to make me not lazy about interactions, but I absolutely hatehatehate not engaging my brain when a computer warning pops up!

Some of the "major interactions" I have been told I should contact a gp about -

propranolol (two week course from three months ago) + salbutamol

insulin + fibrates (the patient isn't on insulin, but presumably this flashed because of other antidiabetic drugs)

another which I forget the specifics of but even the computer specifically stated there was interaction with some of the drugs in that group, but no interaction with the particular one they were on.

another example where the patient was taking an antidepressant and antiepileptic (convulsive threshold lowered), but they were taking it for migraine. They did not have epilepsy.

The last one I think you can argue for, obviously if the patient wasn't there or they didn't seem sure why they were taking it, or even just erring on the side of caution with drug types that obviously can be dodgy (even though the doctor then explained to my pharmacist like a child that the anticonvulsive threshold doesn't matter if it's not for epilepsy).

They also want me to advise patients on POPs to be cautious when on antibiotics, which often goes completely contrary to what the doc has said.

Doesn't it make us look stupid if we can't interpret what the computer gives us?

Exactly.
Gather more information from the rest of the PMR, talk to the patient!
The alerts are for decision _support_ not to make a decision.

Fancy some CPD on POP and other reproductive health issues...
Look no further than Faculty of Sexual & Reproductive Healthcare

[crit care]

common sense really!

[hibernia]

common sense really!

True, but the trouble with common sense is that it isn't that common

If the pharmacist isn't going to take the information offered by the computer programme, which is useful because it is impossible to know and remeber every single interaction, and then use their professional knowledge and judgement to apply it to the particular patient or situation then there is no need for a pharmacist.

[crit care]

but its also knowing which interactions to pick up on and follow through....i'm sure it will flash up and say there is an interactin with diuretics and ACE inhibitors...thats not something i would rush out to the patient with or ring the GP about!

[bobbin]

How do GP's normally react to there prescribing being questioned

As a general rule, prescribers prefer not to be contacted.