Why is my pharmacist asking so many questions?

I remember not too long ago, a friend of mine was complaining that the pharmacist asked her too many questions when she was getting her prescription filled. "What were you asked?" I wondered aloud. It turns out she was prompted to provide information about her weight, whether she was pregnant or breastfeeding, what other medications had she taken in the past, and what other medications is she on now. I explained to her that these questions are meant to help complete her profile so that the pharmacist can identify potential drug therapy problems with her medications before any adverse effects occur. She accepted that and later felt appreciation rather than the initial resentment.

In Connecticut, "a pharmacist shall make a reasonable effort to obtain, record, and maintain...:

(1) name, address, telephone number, date of birth or age, and gender;

(2) individual history where significant, including disease states, known allergies, and drug reactions;

(3) a comprehensive list of drugs and relevant devices dispensed by the pharmacy within the last 180 days; and

(4) the pharmacist's comments relevant to the individual's drug therapy."

This information will be helpful to the pharmacist when a patient presents a new prescription to identify any potential problems with the overall drug therapy. Basically, the pharmacist is looking for any:

• duplication of therapy (e.g. is the patient taking multiple medicines that work the same way or multiple products that contain the same active ingredient?);
• contraindication between the medicine and a disease (e.g. does the patient have a condition that precludes him/her from taking the medicine?);
• drug interactions (e.g. will this medicine increase or decrease the effects of the other medicines the patient is currently taking or vice verse?);
• issues with the dose and length of therapy prescribed (e.g. if the patient stated that he has kidney problems, is the dose going to be too high? or does the patient need to be on 3 weeks of high-dose steroids by mouth for an acute asthma attack? or if the patient is pregnant, she should not be taking certain medicines for blood pressure or cholesterol control);
• interaction of a medicine and allergy (e.g. if the patient stated that she is allergic to soy, she should not be given Atrovent as an inhaler); and
• clinical abuse or misuse and any other significant clinical issues relating to the appropriate use of drugs (e.g. is the patient really still in pain 4 weeks after a root canal treatment?). One's weight can be used to determine the appropriateness of the dose.

It is our duty as pharmacists to ask these questions. Unfortunately, as a patient, I've only been asked about my allergies and nothing else when I have had my prescriptions filled. In fact, I had to ask about the effect of the medications on the breastfeeding baby. I also wish I was asked my children's weight when I present their prescriptions. Well, it's not relevant when it is for a topical cream, but it could be for an oral antibiotic. It really doesn't matter what state you live in, because all pharmacists have been well-trained in all aspects of medications and common disease states. So, if you're visiting a pharmacy for the first time, and your child has a chronic illness or is currently on multiple medicines from a different pharmacy, ask if there is any other information the pharmacist might need for your child's profile. To make it easier, fill out a medication list (The Pediatric Pharmacy Advocacy Group has a sample you can download) and have a copy available for the pharmacist to review. It could save you some hassle later on.

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.