6 Helpful Things to Know When Choosing a Pharmacy
Here are another few things that we came across that seemed a little obvious once we learned them, but in the middle of everything happening with the boy, we had no idea were a thing. We just never had to think about it. Now that I know these things, my day to day is a little bit easier!
I never considered that pharmacies could still make their own liquid medication suspensions rather than just having the manufacturer send it already done. It was never something I had to think about before we got the boy’s epilepsy diagnosis. Compounding pharmacies are able to make the medication into a syrup for the little one. The hospital will give a list of compounding pharmacies in your area, but this is not necessarily a complete list. The list told us that the closest one was a 25 minute drive from our house. I was looking for a pharmacy that carried the premade suspension from the manufacturer in a different flavour when I happened upon the compounding pharmacy just a 10 minute walk from our house. That was a nice treat.
2. Flavour Preferences and What to Do
Pharmacies have different flavour syrups they use for their suspensions, and if the little one hates the flavours from one pharmacy, try another. You can ask to have the perscription faxed to a different pharmacy if they have a different suspension flavour or are closer to your home, generally speaking, and within reason of course, they want to make it easier for you to administer meds.
3. Emergency Doses
If you forget to have the doctor write a new prescription for refills, or get jumbled with hours like I have accidentally done, the pharmacist has the ability to fill 2 days worth of a prescription at their discretion. This goes on record so that it isn’t abused, and the compounding/filling fee is the same even though it’s a tiny bottle, so it really is just a safety net in case something happens...like ordering a refill on a Friday morning and forgetting to pick it up in the afternoon, then to realize they aren't open on weekends and you don't have enough to make it until Monday... But, like I did, when you’re freaking out because you don’t have meds enough for the weekend and you can’t get a hold of your doctor, because of course it’s the weekend, this is handy. This is another good reason to have more than one pharmacy aware of the prescription. Chain pharmacies can usually see prescriptions filled at other locations on their system, which doesn’t do any good for filling the prescription like normal somewhere else, but does allow another pharmacist to know you’re telling the truth and not just looking for hard drugs. It’s worth asking at your pharmacy if this is a setup they have.
4. Know Their Drugs
Often, drugs for epilepsy or other such things have an immunosuppressant side effect, ask your kid's doctor how careful you need to be. Sometimes contributing factors are things like the size of the dose, or the number of different medications the kid is on, sometimes it’s their health previous to starting the medication, and all of that will vary on a scale. Therefore, the level of care required changes from kid to kid, so ask. We didn’t know to ask until my sister, a nurse, mentioned it. Then covid went crazy and we found out we needed to really hunker down for a bit. It’s better to check early, rather than being surprised.
5. Keep the little bits from the bottles - Making sure to get at that last mil.
We found out that the little one-way flow cap in the spout of the medication bottle can be forgotten by the pharmacist pretty easily, especially when they’re on their own for the day or they’re a small pharmacy in a high demand area. We found it’s best to save a couple to have on hand when they’re forgotten. To get it out without causing damage, use the back of a thin butter knife, press under the lip of it until it slips down to the cylinder underneath, then angle the knife and twist like you’re trying to unscrew it. It takes a couple turns, but it’ll give up and pop out. Once that’s out, you can let the open bottle sit upside down in a medicine cup to get that last sneaky milliliter out of the bottom of the bottle. Sometimes the lid you get on a new bottle is partially defective and the pharmacist didn’t notice, it’s hard to open for example. On those, I check before I wash and toss the old bottle.
6. Not all syringes are made equal!
This one’s important, and has a few different parts that all deserve to be mentioned:
a. Types we found work the best are these, Medisca PreciseDose 5ml and 10ml. When the pharmacy has these in stock, I usually ask for a few extra and we hoard them for as long as they’ll work.
What to look for: the tube is a tube, is a tube, not much to do about that. But the nose needs to fit snugly in the one-way stopper of the meds bottle, not all of them do. The plunger part should be all one piece, rather than being able to come apart at the seal. If they come apart, it’ll be hard to get more than a few uses out of them.
(Like this one. These are great for G/J tube flushes or for just water, but don't hold up to sticky stuff)
b. To wash and keep for a while (assuming they don’t need to be sterilized, at which point your contact nurse should be instructing you), rinse well after use, and then when you're ready to wash, an extra large reusable-straw scrub brush is really effective with warm soapy water. If the syrup stays in and gets sticky, the plunger won't move as nicely which can cause accidents or spills, and that can get expensive. Once washed, we put down a line of plungers on the drying mat and lay the tubes with the spout side up so the water drains. If you have a little fan to point at them, they dry pretty fast with that set up.
c. How to tell when the syringes are dead: the ink on the side will start to wear with reasonable use and gentle washing, when that happens, assuming you have enough to only wash every few days and still throw some out, you can start being picky.
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