Dihydrocodeine

[SolomonQ]

you got competition, R2D2, a woman walked in today and asked to speak to the Pharmacist, I came out after giving out enough Rxs to clear my path.

This is what happened,

Me; Hi, How can I help?
Patient: hello, have you got anything good for a cold
me: a cold....??
patient: Yeah, I got a cold in my stomach.
me: (compose myself, try not to laugh as i am a HCP now) talked to her a bit more and counter prescribed the appropriate med, i'll let everyone try to guess what was actually wrong with her.

good job I came out with a smile, she was a nice person so I prefer not to laugh at her, just glad I could help her, if she went to some other pharmacy she probably would have come out with lemsip or something.

also point less question of the week by a counter assisstant (CA)

Customer: Can I get a pack of 32 paracetamol tablets please.
CA: Is it for yourself?
customer: Yes
Ca: Checks it out, puts it in a bag and hands it to the customer.

[H4U2C]

Let's tidy up that and invite you to: http://psy.psychiatryonline.org/cgi/...t/44/6/515.pdf

Nice one SWHAMPA

[Nik]

also point less question of the week by a counter assisstant (CA)

Customer: Can I get a pack of 32 paracetamol tablets please.
CA: Is it for yourself?
customer: Yes
Ca: Checks it out, puts it in a bag and hands it to the customer.

is it a pointless question ? you'd want to check if it's for an adult. Obviously paracetamol can be given to kids but tablets may not be suitable.
If you're talking about the 2WHAM questions, frankly who can be arsed to ask every day for paracetamol

[SolomonQ]

is it a pointless question ? you'd want to check if it's for an adult. Obviously paracetamol can be given to kids but tablets may not be suitable.
If you're talking about the 2WHAM questions, frankly who can be arsed to ask every day for paracetamol

am I suppose to reply to this stupidity? mums come to get calpol for their 16 year olds never mind children and this isnt uncommon, time and time again I hear "oh, they wont take tablets", why on earth would the CA think that somehow for once the adult wants to purchase paracetamol tablets for a child? how stupid do you have to assume the adult is?

[Jen the 3rd]

Its gramatically wrong. They should say "Is it for you?" You use "self" when the object and the subject are the same. Like "You kicked yourself".

[Nik]

am I suppose to reply to this stupidity? mums come to get calpol for their 16 year olds never mind children and this isnt uncommon, time and time again I hear "oh, they wont take tablets", why on earth would the CA think that somehow for once the adult wants to purchase paracetamol tablets for a child? how stupid do you have to assume the adult is?

Yes but maybe with a bit of politeness If mums get calpol for thier 16yr old kids it's not unreasonable to think that some mums may buy paracetamol tabs for their little children. One woman wanted to buy aspirin tabs for her kid for example Of course it doesn't happen all the time but it might do.
Before you went back into the dispensary did you talk to the CA and tell him/her the appropriate q's and advice to give when selling paracetamol ?

[Mr Pharm S]

While we're on about codeine and dihydrocodeine can any tell me why it would have an effect on the heart rate?

Side effects include slow and fast heart rate!! never understood that!

My understanding is these drugs bind to opiod receptors. Is it one of the other metabolites that cause the effects on the heart rate.

To my knowledge there are no opiod receptors in heart tissue.

Please correct me if Im wrong.

[SolomonQ]

Its gramatically wrong. They should say "Is it for you?" You use "self" when the object and the subject are the same. Like "You kicked yourself".

for us non-privately educated commoners, english is not a language which is set in stone, if shakespeare was to hear you speak today, he wouldnt be too happy either, the above I attribute to regional variation of the language or grammatical equivalent of slang. Where I come from we also ask people "How AM you?" instead of "how ARE you", guess thats grammaticaly wrong too.....i use "yourself" in the same context all the time, it sounds more polite than saying "you".

it's not unreasonable to think that some mums may buy paracetamol tabs for their little children....course it doesn't happen all the time but it might do.
Before you went back into the dispensary did you talk to the CA and tell him/her the appropriate q's and advice to give when selling paracetamol ?

ok, it is not reasonable, you're making a mountain out of a mole hill here, I cant imagine mums coming to buy paracetamol TABLETS for their 3 year olds, but even if that was the case, mums know their children more than you would so they know if the child would be willing to take tabs or liq,and if the mother has come to buy tablets for her child, you have to assume the child is ok at taking tablets, so the question "is it for yourself?" becomes useless unless followed by e.g. "are you taking any other medicine?", and as decribed above it wasnt, therefore my opinion as stated above.

About aspirin, I prefer not to sell it, unless it's the low dose one, in my opinion aspirin in it's analgesic strenght has become obsolete and my NSAID of choice is ibuprofen.

By asking that question you're not only wasting your own time but also the customer's, the only two things worth counselling the patient about when they're purchasing paracetamol tablets is firstly the dose i.e. 2 tabs qds/4 hourly and no more than 8 daily and secondly ask them if they are taking any other meds e.g. cold remedies and advise them alot of them contain paracetamol so not to take at the same time. and did I tell him, erm.....the truth is he knew them already.

While we're on about codeine and dihydrocodeine can any tell me why it would have an effect on the heart rate?

Side effects include slow and fast heart rate!! never understood that!

My understanding is these drugs bind to opiod receptors. Is it one of the other metabolites that cause the effects on the heart rate.

To my knowledge there are no opiod receptors in heart tissue.

Please correct me if Im wrong.

The effect is caused by the effect these meds have on various typed of opioid receptors in the CNS. CNS is partially responsible for the heart rate so arryhthmias are centrally induced, same with repiratory depresion etc... if you're asking the exact mechanism, well even the highest of highest have no idea.....by the way how does paracetamol work?

[Trisha]

Is it safe to take out of date tablets? I was prescribed these (30mg) when I had a hip replacement revision two years ago and use by/sell by date is earlier this year (March I think). I am getting a fair bit of back and hip pain and cannot take asprin or ibuprofen due to some anti-depressants I am taking - only other tablets I have in are the DHC.

I did take one last night to help the pain and help me sleep but am I ok doing this until I can get a new prescription?

Thanks

(PS I'm 58 years old)

[johnep]

'Best Before Dates' are those where the manufacturer will guarantee potency. There is a gradual fall off in potency over time. Some compounds are very stable. I have a pack of Sulphamethoxazole (Gantrisin) from 1968 and I would still expect this to analyse at 97% or more potency. Most notorious tablet for losing potency was the old chocolate flavoured glyceryl trinitrate.
johnep