The effect of medicines on the olfactory system

The effect of medicines on the olfactory system

Introduction

Olfaction is the sense of smell. A pharmaceutical drug, also referred to as medicine, medication or medicament, can be loosely defined as any chemical substance intended for use in the medical diagnosis, cure, treatment, or prevention of disease.

Aim

The aim is to find smelly drugs

Method

A closed leading question was sent as a tweet was sent to 370 people that follow @MrDispenser asking to tell me about drugs that smell good or bad. No financial inducement was given. Ethics approval was not obtained. An application for funding was made and denied by the National Lottery. Consent was obtained via direct message for tweets to appear in this report.

Results

30 people replied.

Table 1: Table to show gender of people that replied

Gender	Number
Male	7
Female	21
Unable to work out as name is ambiguous and profile pic is not a face pic	2

My tweet was retweeted once. Two people did not give consent for their tweets to appear. Two did not reply so consent was given on their behalf

Selection of tweets

@zams123: depakote does smell like cannabis.

@L1ttlepetal: my dispenser ex bar manager said it smells like stale beer

 

Neo-Mercazole

This was very popular and my personal favourite too!

@josephbush cannot beat Neo-Mercazole

@indisangar neo-mercazole smells like strawberry milkshake

@susieminney carbimazole smell of milkshake

 

Celevac

Another popular choice

@laura_anne182  prefer Celevac. Serial tub-sniffer

@JustHelenYeah Celevac has to be the best for smell and colour

@Mushypea Celevac… just like strawberry milkshake

 

Bendroflumethiazide 2.5mg

This is the ronseal of tablets

@laura_anne182 Bendro 2.5mg (tubs of 500) smells like a chair in an old folks home.

@indisangar bendro smells like p**s, kind of appropriate, isn’t it?

@jommcmillan bendros smell like what they do

@cathrynjbrown Bad = bendro,

@susieminney bendroflumethiazide smells like stale wee. Ironic really.

@zams123 I like the musky smell of bendros! Weird I know!

 

Relifex

Also popular

@catrionabrodie: Nabumetone (especially Relifex) smells like butterscotch

@alkemist 1912: Relifex smell of butterscotch

@Mushypea:  Relifex was like butterscotch

@cathrynjbrown good: relifex

 

Vitamin B

Controversial tablet

@PatelSuk  Can’t believe no one’s mentioned Vitamin B compound. Weirdly addictive

@Anj17 I don’t like vitamin B. ewww smell.

@susieminney I love the smell of vitamin B in any shape or form

Vitamin caps BPC

Another controversial one

@laura_anne182 Funny how the smells can grow on you. I am now quite fond of the stinky vitamin caps

@lilygidley vitamin caps like Bovril

@JoMyattL I love vitamin caps BPC

@zams123 vitamin bpc caps smell horrible.

@josephbush vit caps = Bovril-y goodness

@NeelmSaina vitamin bpc capsules… Marmite smell?

@cathrynjbrown  Bad:  vitamin caps bpc

 

Antibiotics

Strong views on these common drugs

@Anj17 the banana amox.. yummy

@NeelmSaina bad = cephalexin caps

@Sairah_Banu flucloxacillin smells of the 1p sherberts

@Mushypea: fluclox caps are suphur like

@cathrynjbrown:  Bad:  flucloxacillin caps

@laura_anne182: Ciproxin susp smells like barrats fruit salads

@adamplum love the smell of fluclox mixture

@clareylang yes I agree. The liquid is completely the opposite of the caps

@cathrynbrown  Oh yes, the waft of amoxil or distaclor powder as you pour the water in

@clareylang Augmentin Duo smells well nice

@susieminney cephalosporins smell of cat wee

@becky_ross_23 Co-danthramer suspension smells exactly like tinned peaches

 

Aspirin

The smell is explained with science!

@zams123 Aspirin 75mg disp smells of salt and vinegar crisps

@clareylang aspirin really does smell like that

@adamplum cos acetyl-salicylic acid breaks down to acetic acid

 

Spironolactone

Smells like toothpaste

@EmmTurner spironolactone smells like menthol

@Pillmanuk spironolactone used to smell of minty wee

 

Miscellaneous

@tinaallsup: Neoral smells very strongly of beer. No complaints

@pakili1981: lamotrigine smells like lollies

@Sareenuh Vicks VapoRub Mmmmmm@mgcmitchell capol yum yum

@mgcmitchell pabrinex, TPN, and coal tar are bad

@Sairah_Banu: fentanyl patches smell really weird as well

@jommcmillan: Anybody remember Junifen? Used to smell like lemon puff biscuits

@pillmanuk NEVER smell heminevrin liquid

@misspill never break a full bottle in the dispensary either

Two people have said that Mecysteine smells horrible!

27 drugs were mentioned.

Discussion

Drugs smell. Vitamin caps BPC was the most commented drug. Relifex and Celevac were the best smelling drugs. Bendroflumethiazde was the worst smelling drug.

Future research

Use facebook too

Conclusion

MURs will never be boring again

References

Wikipedia

Why does it take so long to slap a label on a box?

1: Patients walks in and leaves the door open on a cold day

2: assistant puts down her Take-a-Break mag and looks up

3: patient hands assistant the prescription

4: assistant makes small talk and complains she has no money

5: asks if patients pays or is exempt

6: takes a charge off the patient

7: assistant tells patient all about her last holiday which was a cruise

8: assistant brings script into dispensary

9: script falls on the floor

10: dispenser can’t pick it up due to her nails

11: pharmacist picks it up

12: places it in basket or clip to indicate waiting

13: tech scans the prescription

14: ETP not working

15: labels it manually

16:checks if its NCSO

17: broken bulk

18: eligible for NMS

19: due for MUR

20: proscript flags up that it is eligible for NMS

21: try to print out consent form

22: no paper in printer

23: paper reloaded

24: labels generated

25: labels run out half way

26: labels replaced

27: endorser not working

28: product dispensed

29: hand to pharmacist

30: checks for signature

31: in date

32: clinically appropriate

33: not blacklisted

34: wrong formulation dispensed

35: sent back for amending

36: re-dispensed

37: pharmacist loses his pen

38: the whole pharmacy team looks for the pen

39: pen is found in pharmacists trouser pocket

40: near miss log filled out

41: pharmacist hand endorses script

42: patient has a hard to pronounce name

43: pharmacist ponders whether the forename or surname is easiest to pronounce

44: pharmacist turns over script and sees that patient has paid for the prescription

45: shouts out patients name

46: patient comes to counter

47: pharmacist tells patient that their 28 disp aspirin 75mg is cheaper to buy

48: patient is refunded and buys 100 x aspirin 75mg disp

49: pharmacist secretly upset at losing NMS

50: patient leaves

Non-pharmacist area managers

I don’t like the idea of having non-pharmacist managers. Don’t get me wrong, I am sure they are lovely people and great managers but they don’t fully understand pharmacists.

Its all targets with them. I understand that they are being pressured from above to ensure that we make the company the most money possible. It is frustrating and disheartening for the pharmacist to be harassed to complete services.

I am sure the pharmacist would love to offer a full range of services if they had an ACT/second pharmacist/lots of staff.

I feel fortunate to have a pharmacist as an area manager. I can ring them and ask for advice. However, my friends at other companies are being bullied by people who don’t understand.

Pharmacist managers probably do this too. I just feel that they understand what we go through on a daily basis better than non-pharmacist managers.

What do you think?

Dress to impress

Pharmacists are professionals and should dress as such. I have only come across a couple of pharmacists that still wear white lab coats at work. The majority wear smart attire.

We are told that it is important for us to look professional so that the patient will be more likely to listen and accept our advice. However, I have seen two GPs who wear jeans in their surgery and the patients don’t seem to mind.  Whilst I was a student I saw one locum pharmacist wear jeans and another wear a skirt and flip flops.

Some companies make their pharmacist wear a uniform e.g.  Tesco.  Some hospitals have a no tie and long sleeve shirt policy or a uniform. This is to minimise infections.

I rarely wear a tie at work and the only people that seem to care are my parents. The quality of my clothes is directly proportional to the amount of food that I spill on me at lunch. Be it Armani or Primani, yoghurt stains on black trousers are hard to explain.

Tell me what you think about our dress code.

Deliveries

Nowadays, if you don’t offer a delivery service then you are losing customers. People expect a delivery service.

It used to be that only housebound patients were eligible for delivery. The rules have changed now. The 100 hour pharmacy down the road started offering it to anyone and now we have to do the same.

Its quite annoying when lazy jobless (but capable of work) people ask for deliveries. They can manage to drive to the shops to pick up cigarettes and alcohol but are unable to pick up their Champix and Campral themselves.

And then you have the ‘demanders’. These people want to know exactly what time the delivery will arrive so they don’t miss any of Jeremy Kyle. Others are perfectly happy for you to push it through the letterbox. They don’t understand that we need a signature. Most things that gets delivered needs a signature these days except takeaways. Ah, I see now why they get confused!

And then you have the urgent deliveries that always seem to be life and death. ‘The surgery are faxing it over’ they say. When the fax arrives, the gaviscon or paracetamol on it makes my BP rise steeply!

Don’t get me wrong. I would do anything to help my patients. I have frequently delivered medicines after work, on foot, even in the snow. Just don’t make me come and let me see your car in the driveway!!!!

Upselling

Everybody loves upselling. This involves convincing a customer to buy a larger pack of the item that they wanted as it is generally better value.

Customer love it as they are saving money. Head office and management love it as they are making more money. Do I love it? Not always.

I feel uneasy when the assistant convinces someone to ‘go large’ on codiene containing products. Solpadeine Plus, Sopladeine Max and Nurofen Plus are a few examples. Less is more when it comes to combating codeine addiction.

Don’t get me started on the sleeping liquid, sorry I mean Benylin Chesty Original! Also do you really need 100 Senokot???

I’m not totally against it though. You can save 20% when you buy the bigger pack of Frontline Spot On. Ask instore for details!

Naughty kids

This is not about Attention Deficit Hyperactivity Disorder. It is about the many naughty children that are brought into the pharmacies across the country by their parents and run wild.

A typical scenario is a 5 year old running around screaming, pulling boxes off shelves (not bottles if we are lucky). They are also infamous for treating lipsticks as glorified crayons, as they ruin the make-up section before jumping up and down on their seats with their muddy shoes. The brats don’t like it when I wrestle the chlamydia/EHC/Erectile Dysfunction leaflets away from them whilst trying to be polite in front of their overly protective passive parents.

However some parents decide to solve this problem by keeping the child’s hands occupied with doughnuts and sausage rolls whilst running around. I wonder to myself, are the kids like this at home? Probably so.

I am by no means advising spanking marathons in the pharmacy . That would create too much paperwork for me and is ethically wrong. I am merely asking for ‘the look’.

‘The look’  was designed and patented by my mum when I was young. She deployed it whilst we were out and I misbehaved in public. ‘The look’ stopped me in my tracks. ‘The look’ meant that she was legally unable to strike me in public but if I carried on, she would have a ‘discussion’ with me at home. It always worked.

Some parents don’t seem to care at all that their kids run riot in shops. Should we teach “the look”? …my new pharmacy lifestyle advice for the mental stability of parents and pharmacists of little rascals.

Death and Taxes

The American inventor, Benjamin Franklin once said that in this world nothing can be said to be certain, except death and taxes.

I got a letter from the HMRC a few weeks ago. It was regarding the tax that I paid during my last year of university and my pre-reg. I genuinely did not understand whether I owed them money or vice versa. More about that later.

Its always sad to hear that one of your patients has passed away. Unfortunately, it is inevitable. Its a fact of life. You may have known the patient for years or just seen prescriptions for them recently.

It may be sudden and unexpected or the patient may be terminal and you are expecting it. Doctors and Nurses see a lot of death. I could not do what they do.

Unfortunately, you get a bin liner full of unused medication back too and you realise that you are not as good at MURs as you thought!

I got another letter from HMRC and a cheque. It turned out that they owed me money! Tax is inevitable but every once in a while, you get some good news. Although, I suspect that the HMRC will somehow find a way of making me pay more tax…

NPSA alerts

There are lots of NPSA alerts relating to pharmacy. We have a choice of Opioid, Warfarin, Lithium, Methotrexate, Insulin and Paraffin based emollients.

I would be interested to know if pharmacists do any, all or none and why?

A missing Rx

Two days ago, I was at work happily (not really) checking away. I shouted John Smithson’s name out. No one answered, I repeated myself. There was still no answer. I carried on checking.  Then I realised that a woman had been sat in the waiting area for a very long time. I asked what name she was waiting for. She said John Smith (not his real name) and that she had been waiting for 45 minutes!  I assumed that she was absent when I had called out and that she had now returned or that she had not heard me.

I did not remember checking a prescription for that name so I looked on the computer.  Generally, I forget patient’s names but remember medications they are taking. John Smith had last had his prescription dispensed in November. Then I remembered John Smithson’s prescription. Is there a chance that we had made the fatal mistake of labelling under the wrong name? It happens unfortunately.

The woman was collecting the prescription for her husband. I dug out the prescription and showed her the reverse asking if it was her signature. She said yes, ending the moment of panic. I told her that this was not the prescription she asked for, by possibly breaking patient confidentiality and telling her the name on the prescription and that it was similar. This was wrong. However, I was glad that it was not our mistake. It was the receptionists. She had given her the wrong prescription…

I marched over to reception and spoke to the receptionist explaining that the woman had been given the wrong prescription. The receptionist was in shock. Claiming she had confirmed the address with the woman before she gave it out.  I paused and shrugged my shoulders. I turned over the prescription verifying the credibility of this situation by double-checking if it was his signature. She said it was, as far as she knew. Aware of the growing queue at the pharmacy, I left it for the receptionist to sort out.

I went back to the pharmacy and took delight in telling my staff what had happened. It was not our fault. The woman was quietly waiting for 45 minutes. She would probably still be there if I had not spoken to her!

Then someone turned up asking for John Smithson’s prescription. After confirming the address and drug I handed it to him. My Sherlock Holmes moment was now upon me, I  was very puzzled and even more curious Where was John Smiths prescription and why had the woman signed for John Smithson’s?

At our pharmacy, waiting prescriptions are placed in white baskets. I spotted a white basket in the far corner of the dispensary. Gazing at the basket I walked over slowly, and there, was John Smiths prescription! WHAT THE HELL WAS GOING ON?!?!!? I turned it over and compared the signature to John Smithson’s. They were not identical but similar. During the second round of questioning, the woman had mentioned the signature was his AS FAR AS SHE KNEW!

The woman returned holding a reprint prescription for John Smith. My pharmacy assistant started talking about finding it, I shushed her. I processed the prescription and apologised for it taking an hour and the woman left.

 I decided to shred the original and no one would be none the wiser. That’s before my conscience got the better of me. Telling me I should have been honest with the woman. I decided to apologise to the receptionist. I took that mornings purchase of Galaxy Caramel chocolate over to the receptionist and explained that I had found the prescription. She was a lady about it and was glad that it had been found. She refused the chocolate, but accepted a mutual sense of confusion, as we both pondered on why the woman could not recognise her own signature!

Later I ate my Galaxy bar whilst reflecting on the events. I concluded that 1) Pharmacy is never dull place and 2) chocolate makes you happy….