Albuterol question....

SHGR, MSN, RN, CNS · Apr 7, 2012

Oh, yes, crazy stuff. Yesterday a doc ordered Novolog 70/30 insulin, and the pt was supposed to pick it up and bring it to the clinic, to learn how to use the pens.

No brainer right?

... the patient didn't come, and didn't come, and so I called the pharmacy and asked, so...did the patient pick it up ok? Any issues? And this rocket scientist pharmacist said, they didn't have Novolog 70/30 in stock so they sent the guy across town to a different pharmacy to get it. And he got lost because they gave him wrong directions, apparently. Instead of picking up the phone to call us, and saying, we don't have Novolog 70/30; is Humalog mix or Humulin mix ok on a late Friday afternoon for a person who has never injected insulin before in his life?

/rant

nurseprnRN, BSN, RN · Apr 7, 2012

"i always thought it was the exact same thing too but this also begs the question of why is a pharmacist calling the nurse to verify substitutions? shouldn't said pharmacist be calling the prescriber for that? "

"begging the question" is a form of logical fallacy in which a statement or claim is assumed to be true without evidence other than the statement or claim itself. when one begs the question, the initial assumption of a statement is treated as already proven without any logic to show why the statement is true in the first place.

a simple example would be "i think he is unattractive because he is ugly." the adjective "ugly" does not explain why the subject is "unattractive" -- they virtually amount to the same subjective meaning, and the proof is merely a restatement of the premise. the sentence has begged the question.

[h=3]what is it not?[/h] to beg the question does not mean "to raise the question." (e.g. "it begs the question, why is he so dumb?") this is a common error of usage made by those who mistake the word "question" in the phrase to refer to a literal question. sadly, the error has grown more and more common with time, such that even journalists, advertisers, and major mass media entities have fallen prey to "btq abuse."

more at beg the question // get it right.

(working on literacy one day at a time, so sue me.)

MunoRN, RN · Apr 7, 2012

All albuterol orders get subbed with levalbuterol where I work, but when we carried albuterol it was always written as "albuterol" on the ordersets, a brand name wouldn't have worked well since we switched between brands every few months.

Each hospital/hospital chain negotiates their own prices for each medication with each company, sometimes this allows for brand name substitutions when a medically necessary reason is documented, other times it sets a single reimbursement regardless of generic or brand. My hospital only carries brand name coumadin, although for the most part they only get reimbursed for the generic, buying a single type/brand in a larger quantity saves some money and makes brand name price similar to buying a bunch of individual generics at lower volumes.

I don't see any reason why your pharmacy can't fill a prescription for "albuterol", considering there is no generic available they should have some sort of auto-sub already set up.

MattNurse, MSN, RN · Apr 8, 2012

there are different ratings for drugs, AB ratings can be substituted in most states, see the FDA's orange book. More then likely the pharmacist (if retail) was just calling the hospital and ended up with you on the phone. Especially if the rx was albuterol CFC rather then written for albuterol HFA.

SHGR, MSN, RN, CNS · Apr 8, 2012

there are different ratings for drugs, AB ratings can be substituted in most states, see the FDA's orange book. More then likely the pharmacist (if retail) was just calling the hospital and ended up with you on the phone. Especially if the rx was albuterol CFC rather then written for albuterol HFA.

This is the really baffling part re: albuterol. Isn't this just a sub for the propellant? Not the med itself?

The irony being (speaking as both an asthmatic and a nurse) that this whole propellant hullabaloo implies that inhalers caused the hole in the ozone in the first place. No, we're the ones wheezing because of ozone. And give the patient the inhaler already. :no:

Mehalkolypse · Apr 8, 2012

So I got a call last night from a pharmacist to get a confirmation on a prescription. She couldn't fill a prescription for albuterol, she wanted me to tell her that Ventolin would be fine. Now I get that there are "no generic albuterol inhalers" anymore. But ventolin IS albuterol. Why can't the pharmacist just fill a prescription for albuterol with ventolin?

$$$ !

MattNurse, MSN, RN · Apr 11, 2012

This is the really baffling part re: albuterol. Isn't this just a sub for the propellant? Not the med itself?
The irony being (speaking as both an asthmatic and a nurse) that this whole propellant hullabaloo implies that inhalers caused the hole in the ozone in the first place. No, we're the ones wheezing because of ozone. And give the patient the inhaler already.

Yes it is the propellant issue, CFC versus HFA. CFC's did contribute to the hole in the ozone by creating free radicals that destroy the ozone molecule. A pharmacists cannot change the delivery method, even though it is the same drug. It all depends on the orange book ratings set forth by the FDA. If a pharmacists were to change a drug and bill medicare/insurance improperly they could lose reimbursements.