Pregnant Women Receives Wrong Drug

[rnatalli]

http://www.nydailynews.com/news/national/2011/02/09/2011-02-09_expectant_mother_mistakenly_given_abortion_pill_by_supermarket_pharmacist.html?r=news/national

Talk about a screw-up. I always check my label just to be sure, but even doing that doesn't protect you completely as the pharmacy can always screw up what they put in your bottle.

 

[its phillip]

Yeah, that's gotta suck. Hopefully the baby is fine :/

 

[gmichael]

Talk about tragic! Can you imagine? She could have been trying for months or years to have a baby and now this. If she does still have the baby it/he/she could have serious defects. I just can’t even think about what this poor woman must be going through and could end up going through for the rest of her life.

 

[Patrukas777]

Now that would be an instance where a lawsuit is justified. Yes, I know that doesn't fix the problem; however, if they get their a$$es handed to them and have to dish out a lot of money, then it would probably make for a more stringent protocol on how they give out medications at that pharmacy.

 

[zildjian]

Terrible situation and I hope the pregnancy is fine, but I find it irritating the article refers to the drug methotrexate as an "abortion pill" three times, when that's is not what the drug is for at all; it's most commonly for rheumatoid arthritis or psoriasis. They want to make it sound like she got the pill that's actually used to terminate pregnancies; that drug would be Mifepristone or Ru-486. She got methotrexate, which yes could as a side effect cause pregnancy damage, but it's not an abortion pill. This is just inflammatory writing by the author to try to make it a bigger story than it is. If the title said, "Expectant mother mistakenly given rheumatoid arthritis pill by supermarket pharmacist" it wouldn't get as much publicity, even thought that's how the title should read.

 

[skers_54]

Terrible situation and I hope the pregnancy is fine, but I find it irritating the article refers to the drug methotrexate as an "abortion pill" three times, when that's is not what the drug is for at all; it's most commonly for rheumatoid arthritis or psoriasis. They want to make it sound like she got the pill that's actually used to terminate pregnancies; that drug would be Mifepristone or Ru-486. She got methotrexate, which yes could as a side effect cause pregnancy damage, but it's not an abortion pill. This is just inflammatory writing by the author to try to make it a bigger story than it is. If the title said, "Expectant mother mistakenly given rheumatoid arthritis pill by supermarket pharmacist" it wouldn't get as much publicity, even thought that's how the title should read.

I agree completely. There's way too much of this going around, even from otherwise intelligent people. Still feel bad for the mom.

Would folate be useful in this situation?

 

[zildjian]

Would folate be useful in this situation?

I don't believe folate would help, so but would have to investigate it further to say confidently. Since I'm home with the flu right now, I don't want to participate in anything that has me thinking too hard! Folate is most helpful for neuro developement, and as such, is mostly beneficial in the first few weeks of pregnancy, so women who start the folate/prenatal vitamins when they find out they are pregnant, have already missed the most critical part of their childs development when the folate would have helped. I see that a lot sadly, so I try to tell patients to take it anytime you're not on BC pills. I'm sure you know a lot of that since I see you're "Elbow deep in a cadaver...". (If you have to cut the cadaver into two late in anatomy class, volunteer to saw, not hold the cadaver... holding is the messy job and avoid hitting the colon!! have someone hold it to the side!)
Methotrexate if I recall from my pharmacology class days can cause cell division to be impaired and therefore can terminate a pregnancy, but it's never been labeled for such use that I know of. It was studied for such use, but again, not approved. Has it been used for abortions? Probably, but it's way off label. It's a terrible drug to use in a pregnant woman, especially early in the pregnancy as it can terminate the pregnancy easily. I don't recall the article saying how far along she was at the time of taking the methotrexate. If it was taken late in the pregnancy it would be a much better situation, less risk.
-Brad

 

[skers_54]

I don't believe folate would help, so but would have to investigate it further to say confidently. Since I'm home with the flu right now, I don't want to participate in anything that has me thinking too hard! Folate is most helpful for neuro developement, and as such, is mostly beneficial in the first few weeks of pregnancy, so women who start the folate/prenatal vitamins when they find out they are pregnant, have already missed the most critical part of their childs development when the folate would have helped. I see that a lot sadly, so I try to tell patients to take it anytime you're not on BC pills. I'm sure you know a lot of that since I see you're "Elbow deep in a cadaver...". (If you have to cut the cadaver into two late in anatomy class, volunteer to saw, not hold the cadaver... holding is the messy job and avoid hitting the colon!! have someone hold it to the side!)
Methotrexate if I recall from my pharmacology class days can cause cell division to be impaired and therefore can terminate a pregnancy, but it's never been labeled for such use that I know of. It was studied for such use, but again, not approved. Has it been used for abortions? Probably, but it's way off label. It's a terrible drug to use in a pregnant woman, especially early in the pregnancy as it can terminate the pregnancy easily. I don't recall the article saying how far along she was at the time of taking the methotrexate. If it was taken late in the pregnancy it would be a much better situation, less risk.
-Brad

Thanks! Bummer about the flu. It's never any fun.

I'm actually in my second year, so maybe I should change my location to "Light at the end of the tunnel." I was the lucky one to do the cutting in anatomy (missed the colon thank God). Just have to make it through step 1 now.

IIRC the woman was 6 weeks along, so past neurulation but not out of the woods. Tough spot for sure.

Mike

 

[Dan]

Methotrexate is used to terminate early ectopic pregnancies and in cases of death of the embryo in the uterus ("missed" abortion). It is used as a nonsurgical option, with surgery to back it up if it fails.

This situation of this woman is horrifically sad. Human error in pharmacies is all to common, with the large chains pushing efficiency by reducing personnel to the bare minimum. Always know the name of the drug your doctor prescribes and make sure that is what you get. Like most docs, my handwriting is bad, always was. On the rare occaisions I write a prescription I take exceptional pains to print very clearly. I don't have to do it 20 or 30 times a day though.

 

[zildjian]

Another thing I'm thinking about now, I encourage my patients to bring their medication bottles in to each office visit. I'll quickly check the bottles against the list I have in my computer to make sure things are the same. Any methotrexate bottles I see always have the "do not take while pregnant" or "do not take while trying to become pregnant". I used to work in a pharmacy years ago, and we would always put those labels on any methotrexate bottles among countless others. If such a label wasn't put on that lady's bottle, it should have been.

 

[Dan]

That sounds like a good idea. I remember that first year lecture on patient compliance almost thirty years ago. Something like 1/3 of the patients take the meds correctly, 1/3 take them incorrectly and 1/3 don't take them at all.

 

[skers_54]

That sounds like a good idea. I remember that first year lecture on patient compliance almost thirty years ago. Something like 1/3 of the patients take the meds correctly, 1/3 take them incorrectly and 1/3 don't take them at all.

We still get those lectures except now it's called patient adherence. Apparently compliance wasn't PC enough

One of my lecturers said that about 20% of patients don't even get their meds filled so she has most of them take the first dose in the office. Seems kinda time consuming, but probably pretty effective for something like OCPs.

 

[zildjian]

One of my lecturers said that about 20% of patients don't even get their meds filled so she has most of them take the first dose in the office. Seems kinda time consuming, but probably pretty effective for something like OCPs.

It would be hard if your practice is primary care medicine like mine. I'd have to have tons of different medications on hand which would be costly, and it's hard enough managing the medication samples per the official regulations we're supposed to go by. By having the patient's bring in their medications, you can see when the last refill date was on each bottle and see if there are appropriate amounts in the bottle for the length of time they've had the refill. That's just the system I use. I like it, but then again, not all patients will bring in their medications.

True funny story
We have an electronic medical record, which is great when there aren't problems! So the power was out a couple months ago... and this late 40's woman was in the office, and I've never seen her before. She's a patient of one of the other docs in the office, but she was there for "medication refills". As we sit in the exam room which is only as light as the one window will allow since the power is off.... I ask her what bring her in today; she replies, "I need to get refills on my medications." I ask what medications she is on, and she says, "they should be in the computer, can't you look them up?..." we were sitting in the dark almost... The replies that went through my head were countless, but I simply replied, "no ma'am, the electricity is out, that's why we're sitting in here with no lights on." I ask if she brought her medications in with her or a list... No she says. Every exam room we have and in the waiting room there is a sign, "please bring your medications to each office visit". I called the pharmacy she uses, but that of course takes more time.

 

[Dan]

Power out? That sounds like my area where the local power company is getting much deserved grief for their third world like service. At least Ziljian, you could do most of a physical exam and take a history.

My funny power story was from residency. I was at a VA hospital on a warm sunny summer day and they were digging up the front grounds for something and cut the main power line to the hospital! (Only a VA). Now I'm in radiology, so no CT, MR, US, fluoro. One portable xray machine can charge off the backup and there is one working processor (this is the days of film). We read the ICU portable films by holding them up to the sun. No lightboxes or dictaphones working.