Counterculture 45: Repeated requests for the same medicines
"No, why?" Amanda replies.
"I'm sure that last week I sold her a pack of ibuprofen tablets and antihistamine sleeping tablets. She just came in again and when she saw me at the counter she turned away and started browsing on one of the stands. I went round the back for a minute and when I came back I saw Bea serving her the same medicines I sold her last week."
"Do you think she might be buying them too often, then?" Amanda asks.
"Possibly."
"All right," Amanda says "I'll tell the sales staff to look out for her and that if she comes in again for the same medicines they should refer her to Dee."
A few days later the woman returns and requests the same medicines and is referred to pharmacist Dee. She tells Dee that she has been buying them because she had been getting aches and pains all over her body and she was having trouble sleeping as a result. Dee tells her she really needs to see her GP. The woman returns to the pharmacy a week later with a prescription and tells Dee that her doctor had diagnosed a condition called fibromyalgia. She thanks Dee and the staff for the action they had taken.
Questions
1 Cate asked the woman the WWHAM questions before she made the sale, to which the woman gave appropriate answers. What are the WWHAM questions?
2 You should always check with the pharmacist before making an over the counter sale for which patient groups?
3 Patients requesting an OTC medicine should always be referred to the pharmacist if they report which ‘red flag' symptoms?
4 Under which other circumstances should somebody requesting an OTC medicine be referred to the pharmacist?
5 Which categories of medicine can be sold if the pharmacist is not present but has signed in as the responsible pharmacist?
6 In which legal categories are the following? Nurofen for Children suspension 100ml; Calpol Infant suspension 100ml; Calpol Six Plus suspension 100ml; Calpol Six Plus sugar-free suspension sachets (pack of 12).
Answers
1 Who is the medicine for? What are the symptoms? How long have the symptoms been present? Actions already taken? Medicines taken for other reasons, prescribed or otherwise?
2 Babies and young children, the frail and elderly, and pregnant or breastfeeding women.
3 Bleeding, severe pain, vomiting or loss of appetite. There are other symptoms your pharmacist may want referred too, so ask them.
4 If the duration of symptoms is beyond what is normally expected for the condition in question; if there are potential interactions with prescribed or OTC medicines or herbal products; requests for medicines of potential abuse (such as those containing an opioid, laxative, or pseudoephedrine); repeated requests for the same medicines; if at any point you feel you do not have the expertise or feel unsure about any aspect of the sale.
5 GSL only.
6 GSL; GSL; P; GSL.
When should you involve the pharmacist?
A middle-aged woman asked at the medicines counter for antihistamine tablets for ‘itchy legs' and was referred to Dee. The woman told Dee she thought she must have become allergic to something because in the past few weeks she had been getting a strange feeling in her legs. She said it was "more like insects crawling around inside them" than an itch, and that she had to keep moving her legs to relieve it. It was worse at night and giving her trouble sleeping, so she thought that an antihistamine that also causes drowsiness might be helpful. Dee asked if she was suffering from any illnesses or taking any medicines, and she said that she was taking tablets for depression.
Dee told the woman that the symptoms she described sounded like a condition called restless legs syndrome, which is fairly common and occurs more often in women than men. It's not known what causes it exactly but it is thought to be linked to a deficiency of a substance in the brain called dopamine that is involved in the transmission of nerve impulses. There also seems to be a link with iron deficiency. Some antidepressant medicines can cause or make the condition worse, as can some types of antihistamine. Caffeine and alcohol can also intensify symptoms.
Dee advised the woman to see her GP. She returned to the pharmacy a few days later with a prescription for a different type of antidepressant and some iron tablets. The woman's symptoms faded away over the course of the next few weeks.
