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 Post subject: Over the counter meds and pharmacists
PostPosted: Fri Jan 21, 2011 12:43 pm 
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I have some questions for doctors or pharmacists or anybody in the know.

Some drugs you can pull off a shelf and purchase at the front counter. Some drugs, although considered over the counter, you have to ask a pharmacist for. Plan B, for example, and some drugs for colds.

I'm going to ask a couple questions here:

1. Is the reasoning behind asking the pharmacist so that people don't "harm" themselves with these drugs? Because if someone really wanted to abuse the drug, they could go from pharmacy to pharmacy asking a different pharmacist each time for the drug. It wouldn't be too hard to amass quite a collection. Does it really make a difference to have the pharmacist eyeball you or ask you questions before handing it over?

2. Why won't they allow people to have a pharmacist sell them antibiotics? If you have a sinus infection, for example, or a vaginal bacterial infection? What about strong acne medications? Do you REALLY need a prescription for a medicine that has 2% more salicylic acid that what you can buy already? Sometimes people need relief for a problem, and can't get to their doctor in time for a prescription. Some people can't afford a doctors visit. Sometimes it feels like a visit to a doctor is just to get a prescription you already knew you needed (a stronger version of something already sold over the counter).

Discuss.


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 Post subject: Re: Over the counter meds and pharmacists
PostPosted: Fri Jan 21, 2011 1:06 pm 
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Also, I realize that there are different kinds of antibiotics for different things, but I'll give an example of how it could work:

If you think you have bacterial vaginosis, there are over the counter tests that will tell you if you have BV or if it's a yeast infection. Then, there are only about 3 different antibiotics that are used for the BV. You could just walk up to the pharmacist and tell them you need an antibiotic for BV.

Just like any ole over the counter drug, it's possible people might not take it correctly. But even if a doctors gives you a prescription, there's a chance you won't take it correctly. So what's the harm?


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 Post subject: Re: Over the counter meds and pharmacists
PostPosted: Fri Jan 21, 2011 1:06 pm 
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I don't know about Plan B but for certain OTC drugs, I've had to fill out my name/address to get them. I'm guessing it goes into a database.

As for antibiotics, there is a large overprescription of antibiotics by doctors and I think it'd be a bad thing if people started getting antibiotics on their own.

Not that wikipedia is the best source but they have a decent article on antibiotic resistance
http://en.wikipedia.org/wiki/Antibiotic_resistance

Which is the number one reason doctors are backing off on prescribing antibiotics unless absolutely necessary. And then there is also the fact that people can develop severe allergy to antibiotics.

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Last edited by linanil on Fri Jan 21, 2011 1:16 pm, edited 1 time in total.

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 Post subject: Re: Over the counter meds and pharmacists
PostPosted: Fri Jan 21, 2011 1:15 pm 
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Cold medicines are restricted because the government is trying to stop people from making meth.


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 Post subject: Re: Over the counter meds and pharmacists
PostPosted: Fri Jan 21, 2011 1:33 pm 
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mollyjade wrote:
Cold medicines are restricted because the government is trying to stop people from making meth.


Yes, this.

Here in México (some years ago), cold meds containing pseudoephedrine were reformulated because of that.

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 Post subject: Re: Over the counter meds and pharmacists
PostPosted: Fri Jan 21, 2011 1:36 pm 
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Plan B is on the shelves in Canada as far as I know, but maybe the age restriction has to do with why you have to ask for a pharmacist's help in some places.

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 Post subject: Re: Over the counter meds and pharmacists
PostPosted: Fri Jan 21, 2011 1:38 pm 
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The book Methland: The Death and Life of an American Small Town by Nick Reding is a great introduction to the meth problem. Reding spends enough time explaining what big pharma did in response to the meth issue that you will bang your head against the wall...

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 Post subject: Re: Over the counter meds and pharmacists
PostPosted: Fri Jan 21, 2011 1:55 pm 
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So for the people who use the cold medicine to make meth, having to go to 10 different CVS's makes it more difficult for them to cook it up? Does that work?

What do you guys think about just stronger versions of what is already available? The acne medicine, maybe stronger dandruff shampoo? Stronger pain medicines?


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 Post subject: Re: Over the counter meds and pharmacists
PostPosted: Fri Jan 21, 2011 2:05 pm 
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linanil wrote:
I don't know about Plan B but for certain OTC drugs, I've had to fill out my name/address to get them. I'm guessing it goes into a database.

As for antibiotics, there is a large overprescription of antibiotics by doctors and I think it'd be a bad thing if people started getting antibiotics on their own.

Not that wikipedia is the best source but they have a decent article on antibiotic resistance
http://en.wikipedia.org/wiki/Antibiotic_resistance

Which is the number one reason doctors are backing off on prescribing antibiotics unless absolutely necessary. And then there is also the fact that people can develop severe allergy to antibiotics.


Okay, I get this. But I'll just continue to focus on BV for simplicity. Most of the time BV can go away on it's own, but most recommend that it is treated right away because there are some serious negative consequences if it's not treated. Complications with pregnancy, higher risk of contracting STDs, increased risk of Pelvic Inflammatory disease.

So with things like this, wouldn't it be nice to be able to get the drugs without a doctors visit? Is it better to not treat it with antibiotics and risk these consequences?

ETA: I didn't read the whole Wiki article because it's a bit too confusing for me. So maybe you can explain how my example might be bad in the context of resistance. Because I don't know enough and now am curious.


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 Post subject: Re: Over the counter meds and pharmacists
PostPosted: Fri Jan 21, 2011 2:20 pm 
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graffitipassion wrote:
So for the people who use the cold medicine to make meth, having to go to 10 different CVS's makes it more difficult for them to cook it up? Does that work?

What do you guys think about just stronger versions of what is already available? The acne medicine, maybe stronger dandruff shampoo? Stronger pain medicines?

I was a manager for CVS for 5 years and "Meth labs" stole the cold meds-now they don't have as much access and there is a limit on purchases-but it doesn't take a lot of sudafed to make meth. Meth labs are everywhere still so it didn't do much other than make it a pain in the butt to get Sudafed after hours.
As far as making things like antibiotics OTC-1 every sniffle and all yeast infections will be treated with them by the Pill loving public.
I think especially in the US it all boils down to money! The drug stores and drug companies can charge way more for a rx and not risk being sued. Then the doctors would miss out on the appoitment fee as well.

The stronger versions of say salicylic acid being available may not have horrible consequences but still not a great idea.

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Last edited by Puma on Fri Jan 21, 2011 2:32 pm, edited 1 time in total.

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 Post subject: Re: Over the counter meds and pharmacists
PostPosted: Fri Jan 21, 2011 2:29 pm 
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I think about the only thing signing for cold medicine does is make a paper trail that can be used in a court case later.


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 Post subject: Re: Over the counter meds and pharmacists
PostPosted: Fri Jan 21, 2011 2:34 pm 
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I'm having a hard time concentration and can't seem to express my self so sorry I'm all over the place here-

Another issue is there are 100's of antibiotics and not all work the same way. The one that works for BV best is really bad for the liver. I was Positive I had BV once and just call my doctor. DR called in a prescription since it was a holiday. I had trich.

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Last edited by Puma on Fri Jan 21, 2011 2:41 pm, edited 1 time in total.

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 Post subject: Re: Over the counter meds and pharmacists
PostPosted: Fri Jan 21, 2011 2:35 pm 
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graffitipassion wrote:
linanil wrote:
I don't know about Plan B but for certain OTC drugs, I've had to fill out my name/address to get them. I'm guessing it goes into a database.

As for antibiotics, there is a large overprescription of antibiotics by doctors and I think it'd be a bad thing if people started getting antibiotics on their own.

Not that wikipedia is the best source but they have a decent article on antibiotic resistance
http://en.wikipedia.org/wiki/Antibiotic_resistance

Which is the number one reason doctors are backing off on prescribing antibiotics unless absolutely necessary. And then there is also the fact that people can develop severe allergy to antibiotics.


Okay, I get this. But I'll just continue to focus on BV for simplicity. Most of the time BV can go away on it's own, but most recommend that it is treated right away because there are some serious negative consequences if it's not treated. Complications with pregnancy, higher risk of contracting STDs, increased risk of Pelvic Inflammatory disease.

So with things like this, wouldn't it be nice to be able to get the drugs without a doctors visit? Is it better to not treat it with antibiotics and risk these consequences?

ETA: I didn't read the whole Wiki article because it's a bit too confusing for me. So maybe you can explain how my example might be bad in the context of resistance. Because I don't know enough and now am curious.


So say you have BV, you go to the store and buy antibiotics. Lets say you get BV semi-regularly, eventually, that antibiotic will stop working for you because it has mutated into a new, stronger bacteria resistant to the antibiotic. There may be an alternate antibiotic, their may not. This could happen to many people and become widespread. If BV is spread, then that resistant bacteria is also spread. Then eventually you have a strong bacteria which requires stronger antibiotics to be developed which may cause more harm than good.

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 Post subject: Re: Over the counter meds and pharmacists
PostPosted: Fri Jan 21, 2011 2:42 pm 
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 Post subject: Re: Over the counter meds and pharmacists
PostPosted: Fri Jan 21, 2011 2:54 pm 
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If I was so worried about BV causing a risky pregnancy right away, or increasing my risk for an STD or PID and could not get to my regular Dr. then I would go to an immediate care center or ER.

People are way too pill happy to ever be trusted with antibiotics, especially when there are so many that work so differently. Dr's are trained on these things, most people aren't.

Plan B is an age restriction.

And yes, you can't go to multiple pharmacies and buy more than 1 box of cold medicine. I tried buying some too close together once (at different pharmacies) and was not allowed.


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 Post subject: Re: Over the counter meds and pharmacists
PostPosted: Fri Jan 21, 2011 3:50 pm 
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linanil wrote:
graffitipassion wrote:
linanil wrote:
I don't know about Plan B but for certain OTC drugs, I've had to fill out my name/address to get them. I'm guessing it goes into a database.

As for antibiotics, there is a large overprescription of antibiotics by doctors and I think it'd be a bad thing if people started getting antibiotics on their own.

Not that wikipedia is the best source but they have a decent article on antibiotic resistance
http://en.wikipedia.org/wiki/Antibiotic_resistance

Which is the number one reason doctors are backing off on prescribing antibiotics unless absolutely necessary. And then there is also the fact that people can develop severe allergy to antibiotics.


Okay, I get this. But I'll just continue to focus on BV for simplicity. Most of the time BV can go away on it's own, but most recommend that it is treated right away because there are some serious negative consequences if it's not treated. Complications with pregnancy, higher risk of contracting STDs, increased risk of Pelvic Inflammatory disease.

So with things like this, wouldn't it be nice to be able to get the drugs without a doctors visit? Is it better to not treat it with antibiotics and risk these consequences?

ETA: I didn't read the whole Wiki article because it's a bit too confusing for me. So maybe you can explain how my example might be bad in the context of resistance. Because I don't know enough and now am curious.


So say you have BV, you go to the store and buy antibiotics. Lets say you get BV semi-regularly, eventually, that antibiotic will stop working for you because it has mutated into a new, stronger bacteria resistant to the antibiotic. There may be an alternate antibiotic, their may not. This could happen to many people and become widespread. If BV is spread, then that resistant bacteria is also spread. Then eventually you have a strong bacteria which requires stronger antibiotics to be developed which may cause more harm than good.


That part I get...

But then how do we treat it? Do we not treat it?


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 Post subject: Re: Over the counter meds and pharmacists
PostPosted: Fri Jan 21, 2011 3:53 pm 
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graffitipassion wrote:
That part I get...

But then how do we treat it? Do we not treat it?


Well for one, we treat it when it is necessary. If someone 'suspects' they require antibiotics, they do need to see a doctor. Doctor can determine that. Yes, it'd be nice to skip the doctor sometimes but in some instances, it is necessary.

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 Post subject: Re: Over the counter meds and pharmacists
PostPosted: Fri Jan 21, 2011 3:54 pm 
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It's easy to assume that pharmaceutical companies and doctors are just trying to make extra money. While I see some unfair strategies by pharmaceutical companies and doctors, there is a lot of safety issues involved. My mom works in a pharmacy, so I've heard all of her stories about the stupid things people do, especially when they're sick or in pain. They don't want to trust the general public. The key is to regulate, educate, and monitor.
graffitipassion wrote:
So for the people who use the cold medicine to make meth, having to go to 10 different CVS's makes it more difficult for them to cook it up? Does that work?

What do you guys think about just stronger versions of what is already available? The acne medicine, maybe stronger dandruff shampoo? Stronger pain medicines?

On the meth: People who are into meth sometimes aren't the smartest. One guy went to a bunch of Giant's and bought sudafed's on credit card. Genius. If it's within a chain they do try to track it, so these people do get caught. Similarly my mom was called to testify in a case of a woman who came to different pharmacies with multiple pain med scripts from different doc's. At first glance it looks legal, but these pharmacists know when something's fishy. That case was between only a few of her company, but also with several other pharmacies. Her pharmacy managed to stall the woman long enough for the police to arrive.

On acne med's: There is stuff that rx strength available OTC. You just have to know what you're looking for. However, there are some heavy acne med's that have some serious side effects. There should be some monitoring of those people, which is exactly what a pharmacy would do. Accutane is highly restricted in a way that forces regular blood tests. Still, even some of stuff I'm on now can cause birth deformities. Other stuff in the past, made me extremely sensitive to the sun. I ended up with sun poisoning. The pharmacist or doc is there to make you aware of these issues.

On pain med's: I wouldn't let stronger pain meds OTC ever. If you're in serious pain and would need a stronger pain med, a consultation with a health professional is necessary. It's better to address the cause, rather than simply mask the symptoms.
People with chronic pain turn to OTC med's first. It's so easy to OD on this stuff and older people with back pain tend to often. The FDA has actually required reformulation of products with acetaminophen because of its liver toxicity.
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm239894.htm That's just the stuff in Tylenol! Once you get into the opioids things get nasty fast. OD on that stuff and you get hallucinations, respiratory issues, and tachycardia (entering stage II). No one wants that because it leads up to a heart attack or respiratory failure.

Many people have multiple doctors and multiple prescriptions. A pharmacist works with all of this to make sure that the patient understands the risks involved, how to properly use the drug (use the antibiotic for the full duration), what the drug interactions might be (antibiotics and birth control!) and checks back with doctors if there are contraindications. It serves as a safety net for doctors and their patients.

I'm a bit feisty, so I'm scare of this getting ranty! It's just passion speaking. I'm one of those losers who watched DiscoveryHealth until they turned it into Oprah nonsense.


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 Post subject: Re: Over the counter meds and pharmacists
PostPosted: Fri Jan 21, 2011 4:09 pm 
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AshleyUndone wrote:

I'm a bit feisty, so I'm scare of this getting ranty! It's just passion speaking. I'm one of those losers who watched DiscoveryHealth until they turned it into Oprah nonsense.


No, no! All this is great information!

I think my problem was thinking about how I, personally, would benefit from being able to get some things over the counter rather than from my doctor. I've been to an allergist who prescribed me something that she compared to OTC. I went to a dermatologist who gave me a prescription for something only a little stronger than OTC meds (but my co-pay alone was $70!!). I don't respond well to Ibuprofen or acetaminophen and I've had a sinus infection that is making my head feel like it's going to explode and the OTC pain meds don't help much.

All of these things combined have made me frustrated with the whole process of getting the meds that I need when I need them for cheap.

But having people explain why is bringing me back to my senses. Having the course of treatment monitored is important. And making sure people don't get addicted to opiates or abuse drugs somehow is important as well...


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 Post subject: Re: Over the counter meds and pharmacists
PostPosted: Fri Jan 21, 2011 7:16 pm 
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To stick with your example you can just walk into any chemist in the UK & buy something to treat BV, you can also buy a lot of stronger painkillers without prescription here.

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 Post subject: Re: Over the counter meds and pharmacists
PostPosted: Fri Jan 21, 2011 7:33 pm 
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Re: cold meds containing pseudoephedrine- the reason you have to show identification, like mollyjade referred to, is so that there is a "paper trail." You are only allowed to purchase a certain amount of medication per day (3.6g), and a certain amount per month (9g), containing pseudoephedrine. This is due to meth manufacture, and it is regulated under the Methamphetamine Precursor Control Act/Combat Methamphetamine Epidemic Act of 2005. When you show ID and write your information in the book at the counter, it is entered into a database that prevents you from going shop to shop and obtaining more of the drugs.

I get that it's a "pain in the butt" to get Sudafed, but that is why there are options to purchase the same drugs without pseudoephedrine.


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 Post subject: Re: Over the counter meds and pharmacists
PostPosted: Fri Jan 21, 2011 7:45 pm 
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jojo wrote:
To stick with your example you can just walk into any chemist in the UK & buy something to treat BV, you can also buy a lot of stronger painkillers without prescription here.


Really! That's interesting.

There's a couple cases where I really do think it could work. I used to get BV all the time, and if I can buy a OTC test that confirms it's BV, and I know which antibiotic is best for me, then why shouldn't I be able to just buy it directly (putting aside the resistance problem for now)? Having to get a prescription every single time is annoying. I think doctors can write a prescription for the future...but I'm not sure how that works.

And the problem with the pain meds is that I don't feel comfortable just going to the docter and saying "Well, I was in a lot of pain 4 days ago, but since it took so long for the appointment, now it's gone. I don't respond well to OTC pain meds, so can you write me a prescription for the next time i'm in pain?" They'll think I'm an addict. Why don't the regulate the stronger pain meds the way they do the Sudafed?


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 Post subject: Re: Over the counter meds and pharmacists
PostPosted: Fri Jan 21, 2011 7:54 pm 
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With the antibiotics, if people are self medicating they might be missing a more serious condition that their doctor did not get to evaluate.

Also, many things are only treated temporarily with antibiotics. For example, a lot of people believe that if they take antibiotics for a tooth infection and then the swelling goes down that their infection is cured. Then they don't go to get treatment until their face is so swollen they end up in the emergency room either not being able to breathe or with their eyesight compromised. Or a brain infection. Not a good thing.


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 Post subject: Re: Over the counter meds and pharmacists
PostPosted: Fri Jan 21, 2011 7:56 pm 
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graffitipassion wrote:
I think doctors can write a prescription for the future...but I'm not sure how that works.
Doctors can totally do this. I have one prescription for something that I don't use all the time, but I have enough refills on it for use when I need it. Then, if I need more, I just call my doctor and he refills it via telephone. No need to go in and pay for the office visit.

If your doctor knows your history with BV, I don't see why he/she wouldn't just set you up with a prescription for antibiotics that you can refill when needed.

Oh, kimba posted while I was typing this. I'm not all that familiar with antibiotics. Last time I took them, they wreaked havoc on my insides and I vowed to try to never take them again. So, maybe I have no clue what I'm talking about.


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 Post subject: Re: Over the counter meds and pharmacists
PostPosted: Fri Jan 21, 2011 11:03 pm 
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Meggs wrote:
graffitipassion wrote:
I think doctors can write a prescription for the future...but I'm not sure how that works.
Doctors can totally do this. I have one prescription for something that I don't use all the time, but I have enough refills on it for use when I need it. Then, if I need more, I just call my doctor and he refills it via telephone. No need to go in and pay for the office visit.

If your doctor knows your history with BV, I don't see why he/she wouldn't just set you up with a prescription for antibiotics that you can refill when needed.

Oh, kimba posted while I was typing this. I'm not all that familiar with antibiotics. Last time I took them, they wreaked havoc on my insides and I vowed to try to never take them again. So, maybe I have no clue what I'm talking about.


I have a recurring prescription for a Z-pak for sinus problems. Basically I have three refills, and then I can call the pharmacy if I need them, and within 24 hours I can get more. I only use it when it's bad...so I guess my doctor trusts me? I've had loads of doctors do this, because no one, even specialists can figure out why I get a sinus infection almost once a month...

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