I am not posting here to dis the knowledge of a pharmacist, but I have to disagree with the blanket statement that pharmacists know more about drugs and drug interactions than MDs will ever know. The person who was prescribed a sleeping pill and who was told by a pharmacist that it was an antidepressant is a classic case of the pharmacist "going by the book" in the absence of knowledge the clinical situation.
The person was most likely prescribed a tricyclic antidepressant, which are mostly used these days as mild tranquilizers, muscle relaxants, or as adjuncts to the pharmaceutical management of depression with modern antdepressants.
So the pharmacist was just giving the patient the "label" description of the drug, not in the context of it being used for helping sleep, or whatever.
On the other hand, I usually try to remember to warn my patient that the label will say antidepressant, and explain the situation so that this kind of misunderstanding will not occur.
See, the books that are used as references for prescribing are very out of date, and there are many, many meds that are used for well researched and accepted usages that the huge reference tomes are just not caught up to yet.
As far as side effects go, the big books are written in a non clinical, CYA (cover your ass) format which must by law, list *every* side effect anyone has ever **thought** might have been due to the drug wheter is actually was or not. And the book does not usually list the side effects in a probability or "liklehood of happening" format. Again, the clinical situation MUST be taken into account, and this is something that having spent hours and hours with my patient over many years, I have a pretty good handle on, and this is not usually the case with the dispensing pharmacist.
This is not to say that I do not appreciate the call from the pharmacist on a drug interaction tha they pharmacist thinks I might have missed, but it is just that I am usually following current research or current patient oriented evidence based clinical guidelines that have not yet filtered down to the dispensing counter level yet, let alone the out of date reference manuals, which are usually several years behind the times.
I also use a hand held computer program that automatically check drug interactions that are possible given the set of meds my patient is on, so that can be checked before the patient leaves the office.
The package insert which is basically just a legal description of the drug is rarely useful in the clinical situation, and more often than not simply complicates or confounds the situation. I prefer to give the patient a description (written or verbal) of two types of side effects: the ones that are rare but dangerous, and the ones that are common but usualy not worrisome or are manaageable or transient, or whatever.
If, as a patient, the only info I received about the drug was that legal small print stuff, I guess it would confuse and frighten me too!
The patient - physician relationship is very, very important, and there must be a strong element of trust. I think if the patient has doubts or questions about the meds after the visit to the pharmacist, the patient should revisit the doc and talk over these concerns rather than jsut dismissing the medical advice and prescription outright.
Communication, communication, communication. Nothing beats it.
Regards,
Sandy
