What is Plan A for teens?

The Food and Drug Administration (FDA) will agree to let 17 year-olds buy Plan B (aka "the morning after pills" or emergency contraception) over-the-counter if the drug company files an application, or request, for this age group. The treatment is not just one pill, but two that must be taken within 72 hours for it to be at most 89% effective in preventing a pregnancy. Of note, it does not prevent sexually transmitted diseases (STD's). Teens will also have to ask for it at the pharmacy counter. The cost? Anywhere between $35 to $60. Not inexpensive.

As a pharmacist, I can see how some of my colleagues will feel uncomfortable about selling it to a minor. If I were practicing, I would try to find out as much information as the teen would reveal so that I can help her make the best decision for her: to buy the pills and take it or go to the hospital for further care.

As a mother, well, my daughter is only 3, but if she were 17, I'd openly educate her about it and encourage her to keep me in the loop about these issues. I know, easier said than done and I won't know until I'm there. "If Plan A fails, go to Plan B" is the company's motto. I think I might want to know what a teenager's Plan A is. For now, I can only teach her to communicate openly with me. If I can get her to be honest about whether she cut her own hair or not instead of lying, I'm going in the right direction.

What are your thoughts about Plan B?

But, what about mom?

My blogs have been focused on caring for kids, but I realized last week that I need to take care of myself, too. After being accepted as a new patient, I was allowed to schedule an appointment with an internist. I was only going to ask about my eczema; she was booked for physical exams through 2010. In the end, I got a mini-physical and my blood pressures were 150/90, 156/80, 140/80. My baseline used to be 110/60's and 120/80 during my last pregnancy. Of course, I won myself another visit in a month to recheck my blood pressure and a visit to the lab for blood work. It was pretty embarrassing that my last real check up was a year ago when I returned to the OB/GYN 6 weeks after my son was born. I have been feeling fine. In fact, I dutifully sought and received my flu shot from a pharmacy clinic last fall. I do, however, need to be revaccinated with the mumps vaccine. Bottom line is, even though I put the kids' health before mine, making and keeping all of their pediatrician and specialty appointments, I need to pay attention to my own, too.

What medicines is your child on?

Ever feel annoyed because everyone seems to be asking the same questions about your child's medicines, and your anxiety level is already high because your child is so sick? Can you even remember everything right now?

Do you have an index card or document listing all of the medicines (prescription, over-the-counter, and herbal) medicines that your child is on? Are all the doses and number of times the medicine is given accurate? How long has your child been taking them? Have you any idea why your child is taking the medicine? Is your child's weight (in kilograms and pounds) current? Do you know if your child is up-to-date with all of the routine childhood vaccinations? Can you remember which doctor prescribed a particular medicine (for example, allergist prescribed montelukast [Singulair(R)]).

It's a good idea to keep track of this information and have it handy in one place so that your child's doctor, pharmacist, hospital, or other health care workers can avoid medication errors. These can include prescribing a medicine your child is already taking or prescribing the wrong dose because your child has not been weighed in a year.

Watch this recent news segment for tips on how to give medicines safely in children. The Pediatric Pharmacy Advocacy Group (PPAG) and the American Society of Health-System Pharmacists (ASHP) have great lists that parents can complete and print out. ASHP's list can be completed online prior to printing. Google Health is another way to keep track of this information. No matter which list you choose, make sure you review and update the information several times a year, or when changes are made. This will save you time and agony, especially when there is an unexpected visit for urgent care. Then you won't feel like a broken record.

Don't be shy

I was disappointed to learn that my own mother thinks that pharmacists do not have to make any decisions as part of their job. That pharmacists would not take the time to ask a patient why they are taking a particular medication. That doctors would never call a pharmacist to ask about a particular drug. In essence, they just read the prescription, fill it, and dispense it.

After a long and heated discussion, I realized that it's not her fault for having these misconceptions. I thought back to the times when I helped her bring and pick up prescriptions at the local pharmacy that she uses. When you walk in you see a row of chairs facing the counter. There are at least 3 people behind the wall of shelves (you can barely see the tops of their heads) and 3 people in the front behind the register. When you drop off the prescription, they give you a number. You can sit and wait 20+ minutes, or go back. Picking up the prescription involves handing them the number, the cashier reaching for the tray with your number, then handing you the goods. Sometimes you are advised about the medications, but by the clerk, not the pharmacist. When does the pharmacist step down from his workspace? If you have a question about why the drug isn't covered by your insurance or if you have a specific question that the clerk cannot answer.

True, this is not that different from other pharmacies, but patients have the right to ask questions. The pharmacy experience shouldn't feel like being in a factory. Do not feel that you are bothering the pharmacist. The role of a pharmacist has been much expanded to include more direct interaction with patients (face-to-face counseling) and more involvement in the design and execution of drug therapy plans for chronic disease states, like asthma, diabetes, high cholesterol, and high blood pressure. There are pharmacists who specialize in certain areas, like pediatrics. In fact, most states allow trained pharmacists to immunize adult patients. And yes, pharmacists can be interactive with patients in the hospital setting, too.

Your pharmacist is really a great source of information and is willing to talk to you. If you sense differently, seek better care elsewhere from another pharmacist. Don't be shy about your child's, or your own, health care.

Of lice and kids

"Lice" - the 4 letter word that makes me itch just looking at it. The FDA just approved a new prescription product, benzyl alcohol lotion, 5% (Sciele Pharma, Inc.) for the treatment of head lice (pediculosis capitis) in children 6 months and older. Benzyl alcohol is not a pesticide. The lotion, in the consistency of hair conditioner, will likely require two 10-minute treatments, one week apart. The product basically suffocates the lice by preventing them from closing their spiracles. Side effects reported include skin, scalp, and eye irritations, and numbness at the scalp, which is the site of application. No word, yet, on when it will actually be on the pharmacy shelves behind the counter.

Can you handle more information about head lice and current available treatment options? Here is a quick review.

The name game

What's another name for Tylenol? Acetaminophen.

Motrin? Ibuprofen. Advil is another brand/trade name.

My husband made fun of me the other day, saying I will always call a drug by it's generic name no matter what. The truth is, that's how I was trained, and after working in the hospital setting for 10 years, I can't help it. What's the difference? The generic (official) name just refers to the drug itself, while the trade (proprietary or brand) name refers to the patented product by the manufacturer. Sometimes they are also referred to by a short hand name consisting of just a few letters or a combination of letters and numbers (eg AZT, RU 486). Here is a more in depth explanation. The bottom line is that there may be more than one generic version (CVS brand, Rite Aid brand, Walgreen's brand, etc.) of a drug, but what matters is the active ingredient in the product (e.g. loratadine for allergies). So, whether you choose to buy store brand ibuprofen or Motrin or Advil, it is the same drug and works the same way. Just make sure that the dosage form (liquid, strip that melts, chewable tablet, capsule, etc.) is the one most appropriate for your child. Yes, generic medicines work the same way as brand name drugs. There is a subset of generic medicines that need careful monitoring of their effects, but these do not include the over-the-counter medicines we buy. Don't forget, generic products generally cost less than the brand name. Some pharmacies offer 90-day supplies of generic medicines (including albuterol nebulized solutions) for under $10. So if you're looking to save some money, go ahead and pick up the generic products. I do!