Friday, June 15, 2007

Tiny Pill Tales – Maybe Part 1

The other day I asked Fidel what he thought about my Saba Water blog.

F: What made you decide to blog about water on Saba?

Me: I dont know. It just came to me. Guess you havent figured out my thinking yet.

F: I stopped trying long ago.

True even I havent figured it out. For instance, yesterday morning, the idea for this blog came to me when I was in the shower. Hmmm maybe water does have something to do with it; after all, I use to solve the extremely difficult high school math problems by washing my hair.

Oh well Now back to the story

I worked in pharmacy for many years, both in retail and in hospital. I started in the days when we wore crisp white cotton lab coats (actually only me. I didnt like the synthetic fiber coats, so I had a cotton lab coat, which I just loved. I would starch it every now and then because istartching made it look so nice), you always had zillion pens (and they bled pocket protectors were for accountants) and a calculator permanently at home in your lab coat pockets (and pocket lint), and you had the time to make sure that everything you dispensed was pharmaceutically elegant.

What is that ? you ask. A good example is shown in the required final steps of preparing to dispense a pharmaceutically elegant jar or pot of topical cream . Any klutz can just fill a jar with cream . But to make it "pharmaceutically elegant", after filling, the jars are gently tapped on a cloth or folded paper towel (so the sound is muffled and prevented from reverberating through out the pharmacy and annoying customer) to remove all trapped air bubbles and pockets. This assures that the client gets a full jar of product. Then the top of the jars content is smoothed into a slightly concave or convex surface. If you are really good at this smoothing process, you finish by making a tiny little kiss in the middle (what do you call that little curl on top of a Hershey Kiss?) with your spatula. I could kiss with the best of them. Then the outside of the jar is wiped down with alcohol to clean it from any product that might have escaped (like when you really bang the jar on the counter , without "the cloth" ,and a large air pocket in the cream pops, and cream goes flying in your face and on your clothes- hence lab coats).

In my early years in pharmacy, we compounded a lot more things than we did when I left the field. We did it because it wasnt available commercially or because it saved us operating costs.

Compounding had its lighter moments. I still think of K, with whom I worked with for many years. Our pharmacy department had a standard cream preparation that we dispensed so often that one of us would have to spend a couple of hours, every couple of weeks, making a 2 kg batch, which would then be put into forty, 50 mL jars. Others in the department would use the Kitchen Maid electric mixing bowl to make the cream, but K and I preferred using spatula and slab because it was easier to cleanup at the end.

When K was the one to make the batch, it would always end up as a 2 dimensional K slab work of art before being broken up to fill the jars. If it was Thanksgiving, shed shape it into a turkey; if it was Easter you get my drift.

I have three compounding anecdotes that came into my mind, yesterday. I am going to tell one now and maybe save the others for other blogs. They may not seem funny as I guess they are the you had to be there kind of funny, so bear with me because I think they are funny and this is my blog.

Vanity, Thy Name is Sludge

About twenty five years ago, a blood pressure medication came onto the market, which, as it was discovered, had a side effect of causing hair growth. Today, a topical solution with said ingredient is available, over the counter, for those men and women who are follicularly challenged. In the days of this tale, it wasnt. However, some doctors werent adverse in prescribing the solution anyways.

One evening, a young man came into the pharmacy with a prescription. The prescription was for a topical solution containing X% of said drug. He was to apply the solution topically, to the bald area , daily. We looked at the man, who was evidently self-conscious about the situation, and blinked. We had never seen such a prescription before and were quickly trying to think of what to tell him. We knew that he was expecting us to just pull a bottle off the shelf and hand it to him - fast in and fast out.

Pharm: Sir, this product isn't available on the market, yet. Well have to make it from scratch and currently we don't have the ingredients to prepare it. Would you like to come back in a couple of days? It will take that long to get the ingredients and compound this prescription.

Man: Ohummmm... I guess... ok.

A few minutes later

Pharm & Me: Cripes!!! How are we going to do this?

Long story short

We figured out how many tablets of the medication (we had to use the tablets as nothing else was available) we were going to need to yield the solution strength the doctor had asked for. Luckily, looking up the solubility factor of the drug in our Big Book of Knowledge, we found that the drug was totally soluble in alcohol (pharmaceutical proof stuff).

To easy~ grind the tablets into a powder, add the required amount of alcohol, mix and let it all sit for a period of time in order to leach the medication from all the fillers used to make the tablets, and then filter into an applicator bottle. Voila, done!


Problem 1. We needed 200 tablets. This was going to cost the fellow $200 (new drug = expensive).

Problem 2. Expediently grinding 200 HARD tablets into a really fine powder was taking forever and the sound of doing it with a mortar and pestle was like fingernails on a chalkboard.

Problem 3. After adding the alcohol:

Me: Hey Pharm, this is looking really sludgy; really, really, really sludgy. I think we are going to have a BIG problem filtering this.

Pharm: Lets give it a go.

Me: How long do we let this sit before we filter it?

Pharm: the Big Book of Knowledge didnt say. Lets try an hour.

Problem 4.

Me: This isnt filtering at all. It might though, if we left it all for a hundred years. But by then the alcohol would totally evaporate and well be back to where we started, but this time with ONE HUGE HARD tablet.

Pharm: Lets just put the whole mess in the applicator bottle and see if he wants to take it as is.

The young fellow came in and we gave him his prescription. We explained that it was expensive because of the cost of the ingredients. However, because it was so expensive, we were not charging for compounding time or our dispensing fee.

Then we explained the sludge factor.

We gave him that moment to say he didnt want to take it. But he took his prescription, paid for it, and left.

We never saw him again, which was a shame because the doctor wrote to allow him 11 re-fills.


DeathSweep said...

I wonder if he never returned to your pharm because he couldn't manage to comb all the hair he grew or because he was embarassed because the alcohol had evaporated and he was left with what looked like a golf ball embedded in his bald scalp!

MedStudentWife said...