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The Legal Drug Dealer Podcast

Getting Pharmacy as a profession Closer to The Patient

COMPOUNDING PHARMACY

With Algela Solis, RPh & Marilena Grittani, RPh

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Episode Transcripts

Marilena Grittani, RPh 0:05
Hola Marilena Grittani here. Welcome to The Legal Drug Dealer Podcast. I am a registered pharmacist. Get it? a pharmacist is Legal drug dealer, and also your host. Today you are in for a treat. One of the most experienced pharmacists that I’ve ever known and that happens to be one of the sweetest and nicest person ever, is here today. She is an independent retail pharmacy manager and a compounding expert pharmacist. And I’m very proud to call her my friend.

Marilena Grittani, RPh 0:38
Her name is Angela Solis. And, and without wasting any more time, let’s go to it. Welcome to The Legal Drug Dealer Podcast we have today the wonderful, and very funny Angela Soliz, my colleague and pharmacist she is an expert in compounding. She works on this area that is so important and So looked for, these days because of allergies and a bunch of stuff that we’re going to discuss. So, we’re going to have a nice conversation with her. And I hope all the questions that you have are answered. And if not, you know, you just have to send it a comment@thelegaldrugdealer.com. And I’d be happy to send it to her. And I know she will answer them. She’s a sweetheart. Angela lives in Austin, Texas, and she works in an independent pharmacy that also has a beautiful lab have been very awesome. And you will enjoy the conversation with her. So welcome to our podcast. Angela, how are you?

Angela Solis 1:35
I’m great. It’s nice to see you Marilena . Yes.

Marilena Grittani, RPh 1:38
I love working with you was so much fun and the type of information the expertise that you have is wow is so much so it’s an honor for me to have you here.

Dr. Angela Solis 1:49
Thank you.

Marilena Grittani, RPh 1:50
So, Angela. We want our listeners to learn a little bit about you. So tell us why did you become a pharmacist why was that thing for you?

Dr. Angela Solis 2:01
Well, funny story because I just fell into it accidentally. Oh, my father’s best friend was a pharmacy manager. And he called my dad and said, I need a clerk to work in my pharmacy. We just lost somebody’s daughter 16. Now Can she come work part time. And so it was my very first job. And I had no aspirations of becoming a pharmacist or going into a medical field or anything yet at the age of 16. I didn’t know what I wanted to do. But I went to work as a little clerk, I ran the cash register and filed the prescriptions and things like that. I even learned how to count pills. What at that time, there weren’t pharmacy technicians at all. It was just the pharmacist and the clerk. And so I spent two and a half years working in his pharmacy before I started college. And he was very well respected in the community. People loved this pharmacist. His wife was the manager of the store and he was the pharmacist of the store. And I grew to respect both of them because they were both so admired actually by their patients. And that’s not always true. In every pharmacy that you walked into today. Pharmacist might be some person behind the counter that you never get to speak to. They’re behind a wall. You don’t know who they are, what they do in some pharmacy settings. But they were they were personable, though respected by their patients. And I grew to admire this person, and he meant toward me and decided to become a pharmacist. So when I started college, I started with a plan of eventually going through pharmacy school. And that’s what I did straight into college with the goal of becoming a pharmacist and went into pharmacy school and graduated to become a pharmacist at a young age. I was only 21 when I graduated from pharmacy school.

Marilena Grittani, RPh 3:55
Me too. We were kids.

Angela Solis 3:57
We were youngsters

Marilena Grittani, RPh 4:00
That is true

Dr. Angela Solis 4:01
in my pharmacy job as a real pharmacist. None of the old country boys and sweet little country ladies in this small town that worked in wouldn’t even allow me to fill their prescriptions because they thought I was still a kid.

Marilena Grittani, RPh 4:18
And a girl, on top of that and a girl

Dr. Angela Solis 4:20
On top of that, and pharmacists were only old men with gray hair.

Marilena Grittani, RPh 4:24
Yes. That does it. That is not the truth anymore. Not anymore. Did you know that today 55. Today in 2019, the end of 2019, 55% of pharmacists in the US are female. Did you know that’s?

Dr. Angela Solis 4:39
Amazing and wonderful, and the women make great pharmacist.

Marilena Grittani, RPh 4:44
The best part is that if you account for everybody that is in pharmacy school right now that are going to graduate in the next four years, we will make 73% girls, pharmacists, female, pharmacists are going to be 73% of the profession. It happens Come a female profession and very proud we are taking over and we’re fixing this right?

Dr. Angela Solis 5:05
That’s right.

Marilena Grittani, RPh 5:06
Yes, ma’am. So, since you graduated, what type of pharmacy jobs have you had?

Dr. Angela Solis 5:12
I initially practiced in that small town traditional community pharmacy, but then later went on to work in a university pharmacy setting that serve pharmacy that serves students at a major university. And after that, I was invited to become a member of the faculty of that university. So I was on the faculty at the University of Texas at Austin College of Pharmacy for many years. And that was my original long term career goal.After I retired from there, I practiced in hospital pharmacy, which is when I met you, and finally ended up in the position that I’m in now. Where I manage an independent retail community pharmacy that specializes amongst other things,in compounding pharmacy service.

Marilena Grittani, RPh 6:00
Wow, Lot of jobs and different all of them. So let me just go back a little bit to the faculty job. So you were a professor,

Dr. Angela Solis 6:09
Professor pharmacy. That’s right.

Marilena Grittani, RPh 6:11
So you were teaching people that were going to become pharmacist?

Dr. Angela Solis 6:15
That’s correct.

Marilena Grittani, RPh 6:16
And what subjects did you teach?

Dr. Angela Solis 6:19
I taught non prescription drugs, the things you can buy without a prescription. I taught a course in drug interactions, how one drug and another drug can interact with one another. I taught a pharmacy practice lab, where you learned to mix and make compounds and sterile preparations and fill prescriptions and counsel patients on how to take those medications. And I taught an introductory pharmacy course for first year students that introduced them to what the truly pharmacy profession really is and, how broad and diverse the career opportunities are.

Marilena Grittani, RPh 6:54
But that is something that I didn’t have that class when I went to pharmacy school, of course, it’s been 27 years. But that’s is something that is very interesting because most of the people that go to pharmacy school think about retail, they don’t think about what the other opportunities and the other specialties within our pharmacy profession that they could practice. And same thing for our listeners, they just think that all what we do is count pills in a pharmacy in a counter and put them in a bottle and give it to you and charge a lot of money. And because it does, so. No, none of that is the truth we would that’s really the purpose of this podcast is to educate them and letting everybody know what what really we do. So you said that you work in a hospital. So you were an inpatient pharmacist, which means that you get in stuff and you were getting all the drugs that the patients that while they were in the hospital, they need it. Right.

Dr. Angela Solis 7:44
Right. That’s right. And their specialties even within that area, as you well know, their specialties within that area, such as specializing in pediatrics over in the neonatal intensive care unit, or in the ICU unit helping patients who are in critical care. So, many opportunities, little pocket opportunities within the various professions of pharmacy. Same way in retail pharmacy, there’s a traditional big box pharmacy that fills on like commercial medications. And they aren’t just about counting, basically counting pills out and getting the med right to you. But there’s other specialties in retail pharmacy, such as provision of immunization services, or provision of compounding services. And so compounding services is one of those niche areas that you and I decided to talk about today.

Marilena Grittani, RPh 8:32
And that’s what you do, because you’re awesome at it and that lab of yours, if you guys so it’s like a it’s like a living room is big, and it has glass walls… that are made of glass so you can just walk Yes, the patients can

Dr. Angela Solis 8:49
look through the windows and watch us as we compound. Yeah. Especially for them.

Marilena Grittani, RPh 8:55
Absolutely. I’ve seen it and then,everybody’s gowned up, like he’s there in a sterile facility. Because that’s the point they need to be absolutely clean. The dishes have been specifically trained to do this and they wear hairnets and bear nets, to protect themselves

Dr. Angela Solis 9:15
And to protect the patients that protectors and gowns and they work under hoods that are laminar flow is that protect them and everyone else from the drug powders being spread around? Everything’s contained within a hoof.

Marilena Grittani, RPh 9:30
Well, let’s just go back to that because I think the hoods which are my favorite places and the compounding labs, need a little bit more time but I want you to go to tell us please, what is the definition of a competitive drug? And what is the difference between them and the commercially or pills that you get on the regular pharmacy?

Dr. Angela Solis 9:49
Okay, so my pharmacy dispense is commercially made drugs. A manufacturer makes a drug in certain strength or maybe they’ll make the same dragon two or three strings 250 milligrams or 500 milligrams or 750 milligrams, and they’re packaged in bottles of say 100 and sent to pharmacies, pharmacies purchase those big stock bottles of drugs. And then when you are prescribed that drug, amongst the other things that pharmacist does is we can count those pills out.

Dr. Angela Solis 10:20
We were talking about commercially compounded commercial drugs, not compounded, being stock made for the broad, general public, nothing special about it, because they’re made for the general public. They’re made only in, a few numbers of strengths. And often the tablets or capsules, my head fillers, or binders or dyes or things that certain people can’t tolerate, Right.

Marilena Grittani, RPh 10:48
Let me just say something about that. When the best way to describe I think what a filler binder or or excipients that are in the medications Is like, When you make white rice, you put other stuff in it is white rice, you put salt you put a little bit of pepper, I put garlic powder on it and my auntie which I hate puts red bell pepper on it. I have onions too. So all those extra ingredients that you put in the white rice to make it flavorful the way that you like it are extra. That is not the main reason of the dish. It is the white rice. So the same thing with pills or any medications you have the drug but the drug itself cannot be dispensed like that because it’s too concentrated because it doesn’t it’s not stable because a ton of reasons and it has, extra components that are added which are called as Angela said of fillers or other products that are specific just to complete the size or to finish it up or to have a good taste sometime to Some might be allergic to those, like in my case, I’m not allergic to red bell pepper, but I hate it. So whenever somebody cooks white rice with bell pepper, I’m like, No, I’m gonna go to another restaurant I’m gonna go to another person’s house because I don’t want to eat that rice. So is that similar to what happens to your products?

Dr. Angela Solis 12:17
That’s exactly correct. A manufactured commercial drug might be put into a capsule that has yellow dye to make the capsule beautiful in yellow. And if you’re allergic to yellow dye, you can take that medication. And if you really need that medication, your alternative is to have it compounded. So in my compounding pharmacy, but a compounding pharmacy. A compounded drug is a combination of pure chemicals. We take the pure active ingredient, the drug itself, and we create a one of a kind medication that’s specific to that patient’s needs. If they need to have no yellow dye in it, we can make it in a formal No yellow die. If they need to have it in a strength, that’s a different strength from all the commercially viable strength based on their size or body weight, then we can make it specific to meet that patient’s needs. So their custom medications.

Marilena Grittani, RPh 13:17
So if I want my rice with a bell pepper, I order it and you will make it that way. Absolutely. Okay, perfect. So why Angela is so important to have this alternatives. Why cannot everybody take the same thing? what’s what’s the problem with that?

Dr. Angela Solis 13:34
Okay, so the added flavors, and dyes are one thing that can cause problems for patients patients could be allergic to them, but also there are medications that tastes terrible. Think of a child’s pediatric antibiotic liquid, and some of them tastes pretty good, but some of them are miserably bitter and afwul.

Marilena Grittani, RPh 13:59
How about Metronidazole

Dr. Angela Solis 14:01
Oh, it’s terrible. It’s one of the worst. We can in a compounding lab, add special flavors that make it more palatable where you can actually not taste the bitter awful taste of a drug like that. We can make it great marshmallow flavored, or tutti frutti flavored or chocolate mint flavored, etc. So we can improve palatability. One of the most funny things we do in the lab to improve palatability is we make medications for pets in our lab as well that veterinarians prescribe and kitty cats don’t like the taste of certain drugs, or dogs don’t like the taste of certain drugs. Try to give a dog a commercial pill that tastes better. You’re probably going to have a really hard time to disguise it. Maybe you can wrap it in a cheese or a pill pocket one time and sneak it down and but then he learns

Dr. Angela Solis 14:57
Yes, they’re smart kids treats and kittie paste that are a little dispenser. So you dispense it and measure out a certain amount of the pace like toothpaste sort of. We make it in triple fish flavor for Kitty, hero I get in liver or chicken flavor.

Dr. Angela Solis 15:20
Do we have some at the pet owners?

Marilena Grittani, RPh 15:23
So that is what you do you customize the dog personalized to each individual. It doesn’t matter if it’s a female, a male, a kid or a pet. That’s right. That is that is awesome. So how does that happen to the let’s say that I am allergic to die or I don’t like whatever flavor? How do I get it? How does that work? Do I go to your pharmacy with my prescription and then you fix it for me? How is that?

Dr. Angela Solis 15:55
Absolutely we coordinate with your physician who prescribed the drug to get his permission to compound it in a different way. And then we work with you as the patient to figure out what your needs are. If you’re gluten intolerant, we make sure to make the product with not containing any gluten sources at all. lactose intolerant, if you can’t swallow pills and we’ll make it as a liquid or a suppository. If you needed applied topically, we can apply it topically. topical pain creams are a big mover in our compounding pharmacy. And that can combine more than one ingredient that helps to relieve chronic pain into a cream that you rub on externally to relieve that pain.

Marilena Grittani, RPh 16:43
So you don’t have to take it and get all the bad consequences of taking

Dr. Angela Solis 16:47
some drugs can be used topically and often there are that’s a safer means of compounding certain drugs and taking certain drugs than taking them.

Marilena Grittani, RPh 16:57
So we have alternatives! We do know all this sounds very nice and cute and pretty. But is this covered by my insurance? How am I going to pay for this?

Dr. Angela Solis 17:09
insurance companies think they ruled the world?

Marilena Grittani, RPh 17:12
Oh, they do! (Ironically)

Dr. Angela Solis 17:13
Yeah, well, they think they do. We do have choices as a consumer. So insurance companies today rarely cover compounds. They just figured out, I’m not going to have to pay for this. I don’t want to pay for this. So I’m going to say not covered. So often they do not cover. There are a few insurance companies that cover compounds or certain compounds, and we work with patients to try to get insurance coverage when we can. But if it’s not going to be covered by the insurance and the custom preparation is necessary for that patient, we work with the patient to make it the most affordable we can if the doctor prescribed a very expensive, active pure chemical ingredient, and there’s a less expensive one for example, that would work equally as well. We Contact the doctor and ask if we can substitute it to make it more affordable for you the patients. We also contact our particular pharmacies contact every patient before we ever start making the compound for you. And when we contact you will talk with you about what your special needs are. So we make it exactly right custom for you. And we’ll give you a price so that you know before we ever start making it, what price expectation to start. We even work with patients by making a small quantity of the prescription the first time if necessary, so they can see if it works well for them and tolerate it so they don’t have to pay a higher price. The prescription compounded prices are more expensive than some commercially available drugs, but there are certainly commercially available drugs that cost hundreds if not thousands of dollars. But there are commercially available drugs that are inexpensive generics that are inexpensive like $5

Marilena Grittani, RPh 18:59
Yes.

Dr. Angela Solis 18:59
So we’re, we’re at in a happy medium. Most of our compounding prices for a one month supply range in the 40 to $125 range for a one month supply. So if we have the alternative of taking a medication that is going to cause allergies and could potentially kill me or pain $60 a month for my drug, well, I’m gonna go with the $60 a month is $2 a day you probably spend more on your Starbucks. Yeah, definitely.

Marilena Grittani, RPh 19:30
Oh. I do!

Dr. Angela Solis 19:33
So this is a part that is very important for us to discuss them that our listeners understand that. This is an alternative. We’re not talking about that every patient needs to get their medication and tailored to them. It’s just not. It’s for specific patients. requirements. I remember having a little patient when I used to work in one of the compounding pharmacies in Colorado. This baby was born with a deficiency See certain enzymes and he could not digest the liquid that they needed for his seizures. So we needed to make a specific product for him and the insurance didn’t want to cover it, it was Medicaid and they didn’t want to cover it. But the baby was having a ton of seizures a day, that the only way to stop it was what was with this drug. But at the same time, he couldn’t take it because the his body wasn’t taking it and it couldn’t get the effects to do it. He was pooping it as he took it, it didn’t work for him. So we had to design a specific product for him. So he could take it and the baby stop having seizures and the baby now he should be like five years old. But if he wouldn’t have that opportunity, the baby would probably end up with brain issues and he would probably not be a normal kid because of the issues that seizures cause on this baby so so it’s not necessarily just for taste, some palatability, or just to spoil somebody Is because it’s needed.

Dr. Angela Solis 21:02
it’s needed. You’re right. Marilena there. I’ve had an infant that was a liver transplant patient who needed drugs, which would cause the baby’s body not to reject the new liver transplant. We’ve had a lung transplant, double lung transplant teenager that had to have custom medications may. I have several young children now with cardiac problems that need to be on important drugs to support their heart health, that are made only in adult strengths. So we can make it make it in a baby or pediatrics strength in a form that they can take rather than having to swallow a pill. So it’s a life saving

Marilena Grittani, RPh 21:43
And it tastes good too, because you make sure you put the good taste on it. There you go. So I just want everybody to think about the alternative that as I mentioned before, insurance companies try to rule it out, because yes, it’s more expensive. But this is custom made this is personalized to exactly what you need exactly what is required. And it’s not as expensive because it’s made just for you. They take a technician that spent half hour an hour or longer than that specifically mixing your drug on top of the fact that each ingredient is but precisely for you. And that is costly!. So in order for them to be open and to guarantee the quality they need to get, the proper amount of money for their work, any spare you work hard. Your technicians work hard and unique is fair for you to be paid.

Marilena Grittani, RPh 22:40
Now talking about requirements. Angela, tell me about what is it that is so special about your lab? What do you have to have a hood and all the stuff… Why is that so important but isn’t that like cooking like you can do it anywhere?

Dr. Angela Solis 22:56
Well, this the Food and Drug Administration and the state boards pharmacy regulate what’s done in a compounding lab and that makes sure our patients receive a pure product. Just like in the food industry. We want you want a pure food product. In a restaurant inspectors inspect restaurants to make sure the kitchens are clean, and they’re being cooked in a in a safe and sanitary measure. Similar lab inspections can occur in compounding labs, by state boards of pharmacy or the Food and Drug Administration. So there are very specific requirements set out by the United States pharmacopoeia convention USP. It’s called that guide, how and when we make drugs for the safety of the patient and for safety of the pharmacists and technicians who are in the lab making those drugs as well because some drugs could be hazardous. If inhaled by the person making it for example, they make it every day, and they make it every day they’re under ahead. So that’s why they’re wearing all the masks and taps and gowns and so forth. So very specific guidelines. Exactly.

Marilena Grittani, RPh 24:07
And then they have a hood that is like the one that you have in the kitchen that actually takes away all the smoke and the smelly things that you have. But

Dr. Angela Solis 24:16
what what is it that this hood does specifically? Well, it’s much more high tech than your kitchen hood. And it draws away from the person making it any vapors or fumes or powders and draws them through a special filtering system. And it’s collected not just emitted to the outside air. So it’s a very special very expensive hood that we use in hospitals and in compounding pharmacy

Marilena Grittani, RPh 24:43
So just the setup of your lab would be extremely expensive to start making this. So that’s also included in the cost of the medication that you’re making. It’s not just the product. So if you say well this cost the main drug cost me $5 and it My technician half hours to make it one minute charges $7 for it, you have to take into account all the costs that is including electricity and, and the waiges everybody that gets paid for that.

Dr. Angela Solis 25:11
And all the training, the training also because extensive training is required for any pharmacist or pharmacy technician that’s involved in the compounding.

Marilena Grittani, RPh 25:20
So what are you what you’re saying is that you don’t get out of pharmacy school and you can go straight to work in a compounding pharmacy. Is that not the truth?

Dr. Angela Solis 25:28
You have the licensure to do so but you don’t have all of the knowledge that you need. So additional training is necessary before you could run or work in a compound.

Marilena Grittani, RPh 25:38
So what what length of time are we talking about how much training and specifically?

Dr. Angela Solis 25:42
There are schools that people can go to that might be like an 80 or 100 hour school that you attend to get that extra training. There’s also hands-on training by qualified staff, hands on right there in the laeb, sort of like an apprenticeship. Yes, and we have some apprenticeship positions in our pharmacy for example, but we have lengthy the documentation and written materials that they have to read first and sign off on, take quizzes on. And then they have a long checklist of training, observing a certain thing being made, and then making it under supervision several times themselves with a qualified compounder observing them, and then finally make them the only then are they allowed to make it on their own. So it’s a lengthy process.

Marilena Grittani, RPh 26:33
So it’s not just mixing, putting two things together and put in a jar and given it to people

Dr. Angela Solis 26:37
A lot more complicated than cooking. We also have lots of other special equipment in the lab. So for example, we just don’t put your cream in a bowl and stir it up with a spoon or spatula. We have special mixers that mix the cream or ointment until it becomes entirely homogenous or the same throughout. So there’s not lumps of the drug and certain parts of the cream and not the otherpart

Marilena Grittani, RPh 27:03
Because that could burn you right?

Dr. Angela Solis 27:05
Absolutely. We have hot plates and suppository moles and things designed to heat certain ingredients up and then put them in the suppository mold and then the suppositories have to harden. And children are like making ice cubes would be except the opposite. We heat them up and then once they come back to room temperature, they become the suppository,

Marilena Grittani, RPh 27:26
Suppositories? I thought you were talking about Pills and liquid

Dr. Angela Solis 27:30
we also make suppositories Believe it or not. I had a patient who was four years old, who would not take anything by now. Anything by mouth, nothing. No pills, no tablets that dissolve in your mouth. No liquids. absolute refusal, spit it in mom and dad’s face. He had to be given everything by suppository. Can you imagine that a child would prefer a suppository to a liquid? I couldn’t imagine that either. But he did. So we made working with his pediatrician we made everything he had to take when you do antibiotic or Tylenol or whatever we made it, in a specialized suppository form to make it for ease of administration

Marilena Grittani, RPh 28:13
Another type of patient that are required, did require suppositories are those patients that cannot eat whether it’s because they have a problem their mouth or throat, or they had a surgery in their intestines that they cannot get anything through, because they’re healing or they’re simply not allowed to eat because of certain stuff that happened to them. And then even cancer patients are taking everything but via suppository. And the rectal way which is done there is very effective because he gets a lot of absorption of the drug so it works as fast or almost as fast as putting it directly in the vein. So suppository even though everybody that hears suppositories, they say. What? I’m not gonna do that is an alternative. And it is important to think about it when you have no other choices. So I but they do limited suppositories that are commercially available.

Dr. Angela Solis 29:10
Very limited, very limited, but we can compound a lot of things into suppository.

Marilena Grittani, RPh 29:14
So basically Angela, what you’re telling me is that you can do anything and everything for a patient and you have a wide variety of stuff that you can provide for them.

Dr. Angela Solis 29:23
Yes, another good example is that I have two adult patients currently, who can’t swallow pills at all. Capsules, tablets nothing. So we can make certain drugs into what’s called a rapid dissolve tablet, a trocci and so it’s a tablet that you simply put is a powdery tablet that you put in the mouth and it dissolves between the cheek and the gum, or a trocci is more like a lozenge sort of that you put under your tongue and let it slowly dissolve. So the patient gets the drug that way rather than having to swallow a tablet or a capsule.

Marilena Grittani, RPh 29:59
So it’s an alternative, as well it alternative. So I am very curious to know, what is the stuff that you make the most what are the most popular compounded products that you make in your lab.

Dr. Angela Solis 30:11
Hormone replacement therapy is one of our very big movers; males and females a lot we compound products like estrogen or progesterone or testosterone into a custom made preparation. There are commercially available alternatives for those some are oral some are topical, but they’re only made in a very small range of strengths. So for example progesterone capsules for women are only made in a 100 and a 200 milligrams and that’s it. But perhaps you the patient can’t tolerate the hundred milligram strength it makes you too sleepy.

Marilena Grittani, RPh 30:53
It is!!! It makes you sleepy!

Dr. Angela Solis 30:55
It makes you sleepy. So we can compound it is a 50 milligram or a 75 milligrams We can also compound it as a sustained release preparation. If the patient needs the drug gradually released into the body over the course of more hours than would be a regular preparation, we can do that we can make testosterone or estrogen in a wide variety of strengths specific to you. So you’re not getting too much or too little of the hormone compared with what your personal body actually needs. Whereas with the commercial product, there might be only a choice of two or three strengths available.

Marilena Grittani, RPh 31:32
So we are going to have a episode very soon with Dr. Sharzad Green. She is a specialist on hormonal replacement and she is she’s going to talk in more detail about this. But basically what we need to know is that not everybody is the same and that is the problem with commercially available medications. They’re made for whatever is convenient for the manufacturer to makeit, faster and they think that will if not take half of it or a quarter of it. But not all the time, it works much less when you’re talking about combined drugs when it’s a combination of more than one drug in the same, which is normally what it is. Because when you are going through the time that we females go through, that we have lower level of progesterone, estrogen and testosterone, we need a replacement, but not everybody has the same needs. So if you start taking stuff that are commercially available, you might not have exactly what you need. So when you go back to the doctor and they check your levels, they’re like well, you have to high obsess too much of that, but you need a little bit of that. You have that that option as a commercial product. That’s why most of this replacement are made just specifically custom made for the patient. And I am one of the consumers of this drugs for years since I started having my creative metropolitans And it means the world to me, not only because I don’t have that many risks, that pills will give me with my heart and also cancer development because I never had kids. And that is a risk that I have. And also because it is exactly custom made for me, I don’t have side effects. I don’t have issues, I don’t have problems. So whenever you get into products that are in a pharmacy, like in the form of a pill, but you’re getting side effects or you’re getting not enough at the doctor is telling you that there is no alternative you should demand to the physician to say can I get something specially custom made for me? Would you order something to the pharmacy that is going to make it just for me. So not only it helps for you, but it also prevents other complications. You have to have enough power to decide what you’re going to get and what you’re not going to accept. Because it’s your life!

Dr. Angela Solis 33:52
It’s your life. It’s your life, and you don’t realize that there are over 56,000 community retail pharmacies In the United States, but only a little over 7000 of those are able to compound. Many of the compounding pharmacies are independently owned retail pharmacy. But sunshines have at least an option where you can go to that chain pharmacy and they’ll send it off to their mail order centralized facility and calm down. But the vast majority of compounders are located in independent local community pharmacies. So you have to find a compounding pharmacy when you have this special needs.

Marilena Grittani, RPh 34:32
And when you find them, you’re not going to let them go trust me on that. So I want to make sure this is clear. I already talked about it in the initial episodes, but I want to refresh your minds on if you’re a new listener, I just want you to be aware of this. There is very important laws that apply to pharmacy to drugs. There are the federal drug laws that are for the whole country and that there’s also state laws, and we must follow them because if not we are culpable. People and we can lose their licenses. So when you live in Texas like Angela does, and you need her product, even if you live in Corpus Christi, you can call Angela, you can send a prescription to Angela. And in Austin, she can get it ready for you and ship it to you to corpus or to Amarillo wherever you are. That’s not a problem because it’s the same state. Now when you live in Kentucky on you live in Mississippi or you live in Alabama, you most likely won’t be able to do it. Because each pharmacy needs to have a license in the states that they’re allowed to distribute those drugs. So if I Angela’s pharmacy, it has a license that has been approved for the Board of Pharmacy of Alabama or Mississippi or Kentucky to sell drugs there, then she can. But most of the independent pharmacy and compounding pharmacies don’t have that ability, simply because it’s expensive is complicated and he has too many rules. But there is some that do so if you. Are winter Texan For example, I know if you that you live in in Minnesota, you live in Michigan and you’re going away from the winter and you want to go to Corpus which is where I used to live. And that’s why I know for a fact people live there, you cannot get your medication shipped from Michigan to Corpus. So you need to find a compounding pharmacy in that area at listen to the state for you to get it shipped to you. So don’t please be mindful of that. If you are doing a retirement somewhere else if you’re traveling for a long time. If you are visiting your grandkids and you need to be there for three months because your daughter is having a baby. Be sure that you have enough drugs if that is a possibility, or make sure you find a compounding pharmacy in the area that you’re going to be so they will serve you, they can transfer that prescription to that new area and then you will be served. Don’t think that is the same as regular drugs because it is not you can not get it anywhere. Some pharmacies are not making the same drugs. Or the same products that others do, because they have a smaller lab. So be mindful of that and always be ready because the last thing that you need is not to have your medication.

Dr. Angela Solis 37:09
Absolutely. Good point

Marilena Grittani, RPh 37:12
Angela the tell me how compounding pharmacy helps regular pharmacies and pharmacist when they have a patient that has issues or has requirements like those.

Dr. Angela Solis 37:23
Well, there are several pharmacies in my neighborhood, for example, and not all our account with compounding pharmacy, so I collaborate frequently with the pharmacist in those non compounding pharmacies. When a patient brings a compounded prescription into their pharmacy and they can’t make it refill it. So we collaborate by telephone, transfer the prescriptions from one place to the other to allow it to be made in a place that’s qualified to make a compound. I’ve also often have questions from pharmacist and other pharmacies who don’t have compounding experience. They’ll call me and say can X drug be made into a compound for My patient, for example, we work closely together that way.

Marilena Grittani, RPh 38:06
So when you are in a retail pharmacy that is recommended to go a compound, this is what it is. Maybe you have one of the issues that we are ready to discussed. And then you need something specially made for you. So don’t think that they don’t want to help you. On the contrary, they are actually helping you. It’s not that you don’t want to help you at their pharmacies, just that they don’t have the capability to do it and they’re recommending somebody that does

Dr. Angela Solis 38:28
Yes.

Marilena Grittani, RPh 38:29
Okay, so this has been really interesting and very informative. Thank you, Angela. For all this information. Why is it something else that you want to add up before we move on to a fun part of pharmacy for you and me?

Dr. Angela Solis 38:40
Yes, one of the things that I want patients to take home from this episode is that many patients don’t realize the depth of knowledge that pharmacists have about drugs. We spend four years we go to college regular college courses, then We spend four years in pharmacy courses, four solid years, lots of college credit hours focusing on drugs. To understand the drug, you have to understand the disease state first. So you might learn about congestive heart failure. But then mainly you focus on the drugs that are used to treat congestive heart failure. Compare and contrast that with physicians who go to school the same length of time 4 years, but their focus is on disease states. doctors know much more probably about congestive heart failure than I do, especially a cardiologist in that area with it with that specialty. They know a lot more than I do, but I might know a lot more about the drugs in that area. So I think patients need to understand that it’s a collaborative effort. Pharmacist or the drug experts, doctors or the disease experts. Wouldn’t you want to have a good team working together?

Marilena Grittani, RPh 39:56
Exactly. And is a that triangle the patient says what It has what is causing if is having any allergy reactions or any problems that is not expected from a commercially available drug and then they report it to the doctor, the doctor, consults the compounding pharmacist and then they just work together for the best of the patient. Yes, we are the drug experts and actually most physicians that are confident and want the best for their patient would call a pharmacist to ask questions about specific drugs. Hey, you have a patient with the circumstances This is what it is, this is what I’m looking for. What is the drug that I need to use. So that that way they you as a patient will have the best of the best. The best of the one that knows about the disease and how your body works, and the best and the expert of how drugs work on your case. So you will have the best team for your health and taking care of you. That is ideal. So Angela that so because you’re so knowledgeable and because you’re so cool and so nice. And if you have We have a listener that is from Texas, how would they contact you how they can get you to answer questions or to make some drugs for them.

Dr. Angela Solis 41:09
And at the conclusion of this podcast, you will be able to download a short two page document a PDF file. And it’s about compounding pharmacy. And at the bottom of that document is our website for my specific small group independently owned, there’s three pharmacies owned by the same owners. And that the website, which I’ll actually tell you as well is Martinswellness.com. That’s Martinswellness.com. But that’s going to be on that PDF document. And that document will provide you a summary of some of the things we talked about about compounds, what are compounds used for what are when do they need them, what are the most common types of compounds and how do I get a specially made compound if I have to me

Marilena Grittani, RPh 41:58
Yes, it will be also in the show now. So I will get there the web page and also the way that you can download it. Now if you are part of the mailing list, when you receive the notification for this episode, you had the download, I mean the document already included there. So that’s why I encourage everybody to be part of the mailing list, because you will get all this information you didn’t have to do anything you will be every Tuesday will be in your email inbox and anything

Dr. Angela Solis 42:26
That I would encourage these listeners to do because visuals are sometimes everything. If you go to Martinswellness.com website and find the page that’s about compounding, there are wonderful color photographs of our staff in action that show all these hoods and the specialized equipment and it shows you a little bit visually how these medicines are custom made. It’s a really neat experience to look at some of those pictures if you haven’t set that in a compounding pharmacy.

Marilena Grittani, RPh 42:53
I have been there and it’s awesome. I love component because,it’s I love it. It’s one of the passions of mine, but It will be very interesting for you to see it and to understand how it gets done. So anything else because we before we move on Angela, that you have to add?

Marilena Grittani, RPh 43:09
Okay, so let’s just talk about you and me about being pharmacist in general not specifically about compounding because this is a point that I tried to make with every single guest, just to make our listeners knowledgeable about what they think of who we are. So what is something that you have heard that is the most disrespectful thing that have a patient have told you?

Dr. Angela Solis 43:32
Every time a patient gets a new prescription at my pharmacy, we make the offer to councel and that is my technician or customer service representative will say to the patient, the pharmacist would think that would be a good idea to speak with you about your medication. Would you like to step up to the counseling booth to speak with her. When I hear a patient respond? No, I don’t need you to tell me anything about my med. The doctor already told me everything And I don’t need to hear anything from you. I feel that’s a little disrespectful, because of what I said about the depth of knowledge a pharmacist has, we probably do have a few things to add, or points to make that might not have been highlighted by the doctor. Think about that doctor, he’s covered a lot with you today. He’s covered a lot of detail about your illness or your condition. And the focus isn’t only on the drug, it’s on the condition. So I think I think a patient declining to be counseled, when really, they don’t know very much about the drug, and they don’t know everything they should know about the drug might be a little disrespectful to them.Yeah. And want to talk to you.

Marilena Grittani, RPh 44:40
Yeah. And the second that we know exactly what you should expect and what you shouldn’t have, but it could happen. Like if you have a rash if you have this side effect that we know for a fact that would happen with that drug that the doctor did not talk to you about. You might be scared, you might want to talk to the doctor and meet you talk to The doctor or a nurse, they don’t know, because they don’t are not drug experts like we are. So please give the time Take yourself a little time and talk to the pharmacist and make sure the expert on the drugs, educates you and helps you the way that we want to do it. Because we offered it as a as a courtesy, but also in some states, it’s the law, we must do it. If we do not counsel a patient that is having a first time medication, that you never had before. If you don’t get counsel, we can get penalized, we can even end up in jail. So please understand that is that important. Drugs are as I said before, are not a simple thing to take lightly. They are very dangerous and they could harm you too. So please listen to the drug expert, which is as the pharmacist, the legal drug dealers, and we will be able to help you. Thank you for that. Now just go the opposite way. What is the funniest lie that a patient have told you because they need their control/narcotic medications sooner than they actually supposed to get them.

Dr. Angela Solis 46:10
I’ve heard a lot of probable mistruths or lies. The one that most sticks in my mind was actually a patient who was brutally honest with me. When I asked him why he was trying to refill his sleeping pills early every month; and I guess he trusted me, because he came over confidentially that counseling booth and said, well, quite honestly, the reason I’m running out early is I’m sharing them with my wife.

Marilena Grittani, RPh 46:38
Oh, okay. Okay. Okay. This is a big Oh, between two drug dealers because we know better. And number one, it is illegal to share your drugs with another patient that is against the law. So that’s why we were like Oh, wow.#2 It’s a controlled drug, which means that has as I explained in one of the initial episodes, it can cause be very much harm to somebody else that is not been seen by a doctor have not been reviewed on on blood tests and stuff like the should. So that’s why you shouldn’t share your medication. And thirdly, he was cheating the insurance.

Dr. Angela Solis 47:22
He was so… we had a little talk about that and he doesn’t get them filled early. You need any longer

Marilena Grittani, RPh 47:28
Yes. So please be careful with this stuff. Because you might think is something that belongs to you, but it’s not that simple. And yeah, when we both went Oh, that is what that is why we have big reasons for that. So please be absolutely careful. And one thing that I have said several times and I will not stop saying not because you’re causing the lease across the street from somebody that has a friend that got married to a doctor said once that this is good, that’s what you need to take and that’s how you need to take it. That is not the case. Everybody’s different, we are different. You need to be seen, to be determined exactly what you need. And then it’s when you take it. Don’t tell me, oh, my cousin told me that that was good for her. So I need to take it. Please don’t do that. Don’t even if it’s your husband, please don’t do that. So it’s something else that you want to remind our patients before we finish up this besides the fact that we’re going to have this documenting for them to access to recap, what we talked today about is anything else that you want.

Dr. Angela Solis 48:29
The last thing I’d like to share is is what ever kinds of medications you need, compounds or not. Find a pharmacy and a pharmacist that you trust, and that you respect and that respect you and will take the time to take extra good care of you. If you’re not satisfied with the service that you’re getting at any pharmacy. You don’t have to go to that pharmacy. You need to find someone who will go the extra mile will take the time to speak with you about your medications, and who will carefully research things like drug interactions or drug allergies or special compounding needs, with you.

Marilena Grittani, RPh 49:11
Most likely, it’s not the busy pharmacy because they just don’t have time for that. So that’s a very good advice for our listeners, please listen to Angela. She has a little bit of experience. She’s done a little bit of this. And she knows what she’s talking about. So thank you very much, Angela. It was a pleasure, as always, appreciate it.

Dr. Angela Solis 49:31
Thank you for inviting me today. Marilena

Marilena Grittani, RPh 49:32
Well, this is what we’re going to do. We’re going to you’re going to come back and you’re going to talk to our listeners about vaccinations because I know you know a little bit about that.

Dr. Angela Solis 49:40
Absolutely. I’ll look forward to that.

Marilena Grittani, RPh 49:42
Yes, me too. And you guys need to come back to listen to this because you are wanted to learn about this because Angela, again is an expert. And number two, there’s some stuff that you are not aware of, and you need to know so let’s just look forward for that. Thank you so much, Angela. I will put the information in the show notes for everybody to get your webpage, the document that you put together for us and then everybody will be informed. Now if you have any questions, just make sure you send them to comments@thelegaldrugdealer.com and we will be able to send it to Angela and she will help us out. Thank you, Angela. Have a wonderful rest of your day.

Dr. Angela Solis 50:19
Thank you. Happy 2020

Marilena Grittani, RPh 50:21
Yeah, between 2020 everybody.

Marilena Grittani, RPh 50:24
So what do you think? Isn’t she wonderful? I told you she is a sweetheart and a very knowledgeable pharmacist. I hope you got good information from Angela, and that you now understand how compounding works. And most importantly, that you have alternatives to the drugs that are available commercially. I have invited Angela to come back to our podcast and talk about vaccinations that is coming soon. So stay tuned for that. Okay. Now don’t forget to review and save the document that Angela Prepare for you with a key points of our chat. You’ve already got it in your inbox because it was included on the announcement of this episode, the one that I sent you on Tuesday. Now, if you’re not subscribed to our mailing list, go to my website, thelegaldrugdealer.com forward slash six, and the link is included there on the show notes. Go ahead and subscribe. And then you will get it with the email that you will receive as a welcome also, I have this link included in the homepage of my webpage and the profile of the show’s, Instagram and Facebook account. It is everywhere, so you will not miss our mailing list subscription button. You don’t want to miss this review is simply super concise and easy to follow. Angela is the best!

Marilena Grittani, RPh 51:51
So that is it for this episode. Thank you so much for listening to it. Please subscribe to our podcast. Give us a review. You if you have a little time, if you have a question, please send it to me at comments@thelegaldrugdealer.com, and I will respond to you directly or I will include it on my solo episodes that I will make once a month. And that will answer your questions there

Marilena Grittani, RPh 52:19
Also, please visit thelegaldrugdealer.com. Look around to see what I have there for you. Lots of stuff by the way, follow us on Instagram, join our private Facebook group community and subscribe to our mailing list so you don’t miss a detail. Next week. I will be talking to you about hormonal replacements for male and females and also bioidenticals with Dr. Sharzad Green. It will be a very interesting episode and she is so knowledgeable that you will absolutely love her,the way that I do.

Marilena Grittani, RPh 52:53
But before I go, and just in case no one has told you today I wanted to take a minute to remind you of how awesome you are and how lucky are those that have you in their lives. Thank you for being the awesome you that you are

Marilena Grittani, RPh 53:07
Have a wonderful rest of your day. This is Marilena Grittani, the Legal drug dealer. Bye for now.

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