what would you have done?

[Smithy]

fact --- 18 week pregnant lady goes to gp with constipation

gp for some unknown reason prescribes lactulose and cyclophosphamide

lady goes to pharamacy and pharmacist comes out an says "we dont keep these tablets in stock we can get them for tomorrow"

lady goes back and gets tablets and takes them for constipation-- after day or two stops tablets as lactulose has worked.

i am trying to establish if the pharmacist on the clapham bus would have queried this medication.

i do not know if pil was given out or not

as this is a genuine case please keep confidential

[Jeff]

i am trying to establish if the pharmacist on the clapham bus would have queried this medication.

i do not know if pil was given out or not

as this is a genuine case please keep confidential

Was the pharmacist aware that the patient was pregnant?

If it's confidential should it be on a public forum?

Jeff

[Pharmanaut]

Was the pharmacist aware that the patient was pregnant?

If it's confidential should it be on a public forum?

Jeff

Apart from confidentiality...
Is the patient a regular at that pharmacy...
Was there a drug history of previous treatment with cyclophosphamide on the PMR?

[Smithy]

justr trying to establish what colleagues think they would have done

is this a public forum in that sense of the word??

I do not know if the pharmacist was aware that the patient was pregnant

she was in early thirtys -- all i want to know is if this should have raised concerns in the mind of the pharmacist

[Jeff]

justr trying to establish what colleagues think they would have done

Depends on how busy I was at the time and how familiar I was with the dispensary etc.
I'd like to think I'd have questioned it, but who knows.

is this a public forum in that sense of the word??

Anyone can see what has been posted here - it's is in no way private.

I do not know if the pharmacist was aware that the patient was pregnant she was in early thirtys -- all i want to know is if this should have raised concerns in the mind of the pharmacist

Should have - certainly. Not sure why it would be prescribed in a primary care setting.
Would have - depends on workload and levels of distraction.

Jeff

[Jeff]

Was there a drug history of previous treatment with cyclophosphamide on the PMR?

Dangerous trap - even if there was - should it be repeated?

"Prescriptions should not be repeated except on the instructions of a specialist."
eBNF 8.1 Cytotoxic drugs

I'd like to see what warnings (if any) flash up on PMR systems.

Jeff

[johnep]

Repeats was the cause of the prescibing of mephalan resulting in death, by the head of dispensing drs organisation. He got a slap on the wrist. If the script had been dispensed by a pharmacist????
johnep

[Pharmanaut]

Dangerous trap - even if there was - should it be repeated?

"Prescriptions should not be repeated except on the instructions of a specialist."
eBNF 8.1 Cytotoxic drugs

I'd like to see what warnings (if any) flash up on PMR systems.

Jeff

Agreed, but its a start.
Cegedims Pharmacy Manager puts up a warning about cytotoxics, I'll see if cyclophosphamide is covered.

[Smithy]

just to clarify a point

it was not the intention of the gp to prescribe the cyclophos he/she messed up the script.
so it follows that the patient had no cytotoxics on record--

issues that arise are --- should all systems have a red alert like the one for methotrexate? what would liability be? etc cregedim does not have one as far as i can see.

thanks for all the feed back much of it is what my first thoughts were ie a lot depends on the circumstances etc etc and, as always, hindsight is a great thing.

[Jeff]

Repeats was the cause of the prescibing of mephalan resulting in death, by the head of dispensing drs organisation. He got a slap on the wrist. If the script had been dispensed by a pharmacist????
johnep

Similar thing happened in Yorkshire a few years ago, a vartiety of GP's at one surgery repeated scripts for a cytotoxic a variety of locum pharmacists dispensed it.
AFAIK no action as meaningful as Dr Roberts "slap the wrists" took place.

Jeff