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HealthCare & Wellness Breaking the Chains of Addiction. The Last Door Recovery Society
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Old 12-15-2011, 01:24 AM   #1
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Any pharmacists?

My mother has rheumatoid arthritis and is now on Remicade. However because of her past medical history of TB, she is required to take Isoniazid. The doctor said she has to be on it for 5 months ( she has been on for over 1 month ) but lately she has been experiencing severe headaches, high blood pressure, and nausea. She believes it is Isoniazid's side effects and the doctor does not seem to believe so. My question to you is, is there any thing we can do to alleviate the side effects? I read on wiki that it metabolize in the liver and creates a toxic by-product which is linked to hepatitis thus the side effects. Thanks!

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Old 12-15-2011, 09:50 AM   #2
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I think the best thing to do would be to go to a pharmacy like Medicine Centre or People's. They actually give you good advice and take the time to listen to you (vs. shoppers/superstore/any big box pharmacy). Its not a good idea to give specific medical advice over the internet without the entire story :P
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Old 12-15-2011, 10:46 AM   #3
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Old 12-15-2011, 06:42 PM   #4
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Like Nocardia stated, it's best to go to your mother's regular pharmacy and get a medication review done. If she doesn't have a regular pharmacy, any pharmacy can look up the list of meds that have been filled through 'Pharmanet', which every pharmacy in the province is linked up to. Seems like a thorough workup needs to be done in a situation like this and missing info can be harmful. Online interactions can be useful in some cases, but a pharmacist can tell you which ones are relevant and which ones are irrelevant.

If she has high blood pressure, it could be harmful to other organs and contribute to severe headaches. Best to get it checked out in person and not over the internet.

PS. the reason why I recommend her regular pharmacy is because they are more likely to spend quality time with her, rather than a pharmacy that does not have any past history.

Good luck!
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Old 12-15-2011, 07:36 PM   #5
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PS. the reason why I recommend her regular pharmacy is because they are more likely to spend quality time with her, rather than a pharmacy that does not have any past history.

Good luck!
if your mother takes the same medications regularly you can just bring your bottles into a "dead" looking pharmacy as well.. if they have no business then they can afford to spend more time with you for the $60 fee they receive.. or they will scam you.. YMMW
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Old 12-15-2011, 08:18 PM   #6
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1 - What other medical conditions does she have? (high blood pressure?...)
2 - What are her typical average blood pressure levels ? (prior to starting new med, and after starting the isoniazid)

3 - What other medications is she on? (prescription and non-prescription.. advil/tylenol etc.)
4 - What was she on for the initial treatment of her TB? (How did she catch TB?)
5 - How long has she been on Remicade?

6 - When did she actually see the doctor and, did the doctor put in any kind of lab-work requests?
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Old 12-16-2011, 09:00 AM   #7
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^he's a pharmacist so answer his questions XD
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Old 12-16-2011, 06:07 PM   #8
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is your mom being monitored by the DOT program or some sort of organization for her TB treatment? usually if the side-effects aren't severe, they can be treated with drugs to minimize the headaches and nausea. and as sirV is asking, what is your mom's regular BP? if it suddenly shot up after taking the drug, it may or may not be the drug. there are so many causes to high blood pressure which makes it difficult to point out what's causing it.

remicade can be an immunosuppressant, which basically means it weakens your body's immune system. while your mom is on antibiotics, remicade may be contraindicated (incompatible taking two drugs together) when taking isoniazid because the immune system is needed to kill TB.

if you're worried about the liver, you can always ask your family doctor to order liver enzyme tests to determine if there is any damage to the liver. it's just a simple blood test. don't count on my information being 100% accurate. i'm just giving you information based on what i know. see a pharmacist or wait for sirvfung =)
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Old 12-17-2011, 12:23 AM   #9
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SIRV really a pharmacist? I plan to persue a career in pharmacy, any tips? did you graduate in BC as well?
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Old 12-17-2011, 03:13 PM   #10
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^ go get your PCAT done, apply at UBC.
It'll be best if you have a science background
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Old 12-19-2011, 11:45 AM   #11
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get some volunteer/work experience at a pharmacy to see if it's really what you want to do. it's also good for a reference too.
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Old 12-19-2011, 11:48 AM   #12
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to be honest, super shitty time to get into pharmacy.. bad investment in my opinion. Jobs are few and far in between now. Government legislation has cut funding for pharmaceuticals by over 80% in Ontario, shrinking budgets of all the major pharm companies (SDM, LD, Superstore etc.). Staff cuts, hour cuts, wage cuts going on across the board, and other provinces following suit in attempts to save money on healthcare.
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Old 12-19-2011, 12:17 PM   #13
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+1.. got an interview last year.. didnt get in.. but kind of glad i didnt.. my pcat is still good for a year.. but i'm jumping ship because of the regulated technician initiative..

now trying to get into BCIT nursing
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Old 12-19-2011, 12:58 PM   #14
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to be honest, super shitty time to get into pharmacy.. bad investment in my opinion. Jobs are few and far in between now. Government legislation has cut funding for pharmaceuticals by over 80% in Ontario, shrinking budgets of all the major pharm companies (SDM, LD, Superstore etc.). Staff cuts, hour cuts, wage cuts going on across the board, and other provinces following suit in attempts to save money on healthcare.
i blame the college of pharmacists for technician regulation. it looks good on paper but is clearly being used by retail pharmacies to cut pharmacist positions and save on labour.
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Old 12-19-2011, 01:10 PM   #15
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+1.. got an interview last year.. didnt get in.. but kind of glad i didnt.. my pcat is still good for a year.. but i'm jumping ship because of the regulated technician initiative..

now trying to get into BCIT nursing
i'm in bcit nursing. if you have any questions, feel free to ask. it's no joke when people mention that it's a very intense program. i have no bias, but after working in 5 different hospitals, almost every RN prefers a bcit>ubc grad. however, ubc is 2 years and bcit is 3. great profession and i highly recommend =)
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Old 12-19-2011, 04:39 PM   #16
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i blame the college of pharmacists for technician regulation. it looks good on paper but is clearly being used by retail pharmacies to cut pharmacist positions and save on labour.
huge conflict of interest when you look at the people lobbying for it.
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Old 12-19-2011, 06:00 PM   #17
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^I kind of assumed so... but are there actually names of people who are lobbying for it that are posted somewhere? There should be some kind of uproar from the pharm community also.. protests on campus etc. about the expansion program at UBC and what the college is doing.
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Old 12-20-2011, 02:28 PM   #18
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SIRV really a pharmacist? I plan to persue a career in pharmacy, any tips? did you graduate in BC as well?
He's not a pharmacist. Still a pharmacy student
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Old 12-20-2011, 06:31 PM   #19
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^I kind of assumed so... but are there actually names of people who are lobbying for it that are posted somewhere? There should be some kind of uproar from the pharm community also.. protests on campus etc. about the expansion program at UBC and what the college is doing.
Yeah. Basically any upper level management at EVERY pharmacy chain, starting with Randy Conrad, the regional/district manager of Safeway who also happens to be the chair of our College.

Last year there was an extraordinary College meeting where registrants were also invited to attend. The majority of us voted against the whole certified tech movement. It was firmly smacked down because the vote is non-binding and the College wrote it off as "a misunderstanding/lack of information between pharmacists and the certified tech movement".
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Old 12-20-2011, 07:00 PM   #20
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Yeah. Basically any upper level management at EVERY pharmacy chain, starting with Randy Conrad, the regional/district manager of Safeway who also happens to be the chair of our College.
Actually, didn't he get voted out in the most recent election?
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Old 12-20-2011, 11:32 PM   #21
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the cost of the bridging programs and the intensity of them is also ridiculous. technicians all recognize this as a huge money grab.
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Old 12-21-2011, 12:50 AM   #22
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I had no idea there were pharmacists on Revscene! Thread has been officially hijacked. Anyone in the hospital setting?

PS. Did OP get answers?
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Old 12-21-2011, 01:04 AM   #23
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Yes SiRV answered my questions, thanks everyone for their input!
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Old 12-21-2011, 02:17 AM   #24
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Warning: Long post up ahead.

Pharmacists are the easiest to shaft because so many are employed by the big chains. You could easily start an uprising against the motives of the big chains, but jeopardize your own job as the leader... Plus it'd be hard to get overwhelming support when it's difficult for others to join you because they can't go against what the big companies want while also working for them... Tough spot to be in.

If you try to shaft physicians, they can say screw you, we're looking after our own best interests or we don't have to see patients.

If you try to shaft nurses, they can say screw you, we're looking after our own best interests or we're going on strike.

If you try to shaft pharmacists, they can say screw you... then the corporations say you're fired...

It's a funny position that we're in unfortunately. With the regulated technicians, it is what it is, and it's too late to complain and bitch about it when they already exist. Yes, there are less jobs, and yes it is stupid that they're increasing enrolment to the pharmacy program at this time, but someone has to pay for the new building (i.e. more students = more tuition). Everything is happening, there is no way for us to stop it really. However, all it means, is that Pharmacy jobs are now competitive, just like NORMAL jobs. No more wining and dining by companies during recruitment, you actually have to look for work like normal people. You no longer get hired just by having a pulse and a pharmacy degree, you actually have to be good now. So as long as you're a good pharmacist, there's no need to worry. If you aren't, then now is a good time to learn to be good.

As for selection of pharmacy, I believe that finding a good pharmacist is a total crapshoot. It is totally wrong to generalize saying that small independent pharmacies are going to provide better care than a chain one. It is purely luck of the draw, depending on the pharmacist. A good pharmacist is a good one no matter where they work. In fact, I think it may be better to find a good pharmacist at a chain, as opposed to a good pharmacist that owns his own independent shop for example. I work for a chain myself, and would consider myself reasonably good at what I do. Come Christmas time I usually get enough gifts, chocolates, bottles of wine, and thank you cards from my patients to fill up my whole locker and then some. When it comes down to it, my motivation for being good is purely for the patient. I make the same amount of money regardless of what I do, so I have no incentive to sell you more over the counter goods, cough and cold products, etc. If you don't need something I'll tell you straight up, don't waste your money. If we were in a situation where the pharmacy may lose money, it's not my money, so I could really care less if the chain takes a hit. Just a cost of doing business.

But think on the flip side, if every dollar you spend in a small independent were incentive for the Pharmacist owner because every dollar goes into their pocket? If a hit to the store is a hit to their paycheque, it might make them think twice.

Either way, if you find a pharmacist that is willing to take the time to go through your concerns, no matter what setting, you've got yourself a keeper. Keep in mind, that spending time is one thing, but also a good idea to make sure they actually know what they're talking about. Try asking some questions, see if they'll spend time answering them, and then ask "why?", or "how does that work?", and see if they can explain it. Or if they can't see if they're able/willing to look it up.

Last but not least, it's one thing to see if a pharmacist will spend time with you, but also it's nice to be respectful of their time as well. If they're totally slammed and a huge lineup is forming behind you, if it's not an urgent question, offer to leave your number so they can get back to you when it's slower.
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Old 12-21-2011, 02:43 AM   #25
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Ok haha13, here's some information for you. I generally try to refrain from giving any specific medical advice because it would be to a patient that isn't one of mines, and I don't have all the appropriate information about them to make all my decisions with. Any specific questions should be directed to the healthcare professionals taking care of your mom. However, here are some suggestions, just by looking at the general information you posted.

First off, find out how high your mom's blood pressure is. If it's consistently over 140/90 it is considered normally high, but if you're looking at like 180/90 or something like that then that'd be pretty dangerously high. High blood pressure may cause headaches also because of the extra pressure pushing outwards on the blood vessels in the brain pressing on pain receptors in the brain (sort of like a migraine headache). Nausea from things like migraine headaches can be very common as well, just because of how bad the pain is.

Isoniazid can sometimes cause an increase in blood pressure because it has a little bit of what's called Monoamine Oxidase Inhibitory activity. (MAO-I). This basically blocks the breakdown of things like Tyramine which we find in lots of foods like pickled foods, smoked foods, cheeses, alcohol, chocolate, etc. If you're not breaking down Tyramine normally, it can lead to a push/increase in norepinephrine leading to a spike in blood pressure.

The MAO-I effect of isoniazid isn't really huge, but if your mom is having symptoms, she would likely benefit from cutting out or down on Tyramine rich foods. Google a list of Tyramine rich foods, and experiment by having her cut down on eating those things as much as she can and see if she feels better. Monitor her blood pressure during this time, and see if things become controlled again.

Plus also, during this time when we're trying to get her blood pressure down, have her cut down or out caffeine (i.e. tea, coffee, cola), and reduce salt intake. All the usual high blood pressure precautions for the time being, to see if it will help.

Anyways, these are merely suggestions, and not to be taken as definitive medical advice, given the lack of information about your mom that I have.

Best of luck
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