Well after a winter that still doesn’t seem to want to move on willingly, the balmy climes of the Caribbean were a much-needed detour. Waking up to warm sunshine for a week worked wonders to melt the icicles of some seasonal depression. I got to thinking: wouldn’t it be GREAT to practice pharmacy on a tropical island paradise? So then I stroll into the convenience store on the resort. Among the sarongs, the cigars, and the wood-chip-filled bottles of Mamajuana, I stumble upon this:

Okay. I give up.

Your eyes do not deceive you. From left to right, we have acetaminophen 750mg, Aleve extra strength, Ibuprofen 800mg, ‘Azitromicina’, and ampicillin 500mg. This selection was found in a gift shop and it didn’t appear the ladies behind the counter were…’ahem’…well-versed in the medications they were selling. I understand that regulations are lax in some countries, but compared to the controls we have in Canada, I would hate to be doing any kind of medication reconciliation when this kind of stuff is considered over-the-counter.

From looking around the pool, and hearing from people in the party I was with, I would posit that some may have some blood pressure problems. I reckon that others may be on blood thinners for atrial fibrillation or stroke prevention. There may be hidden macrolide or penicillin allergies floating up to the wet-bar where a friend would casually say: ‘Oh, that sounds like a UTI. Here, I just picked up a few of these for myself just in case. Try some, they’ll fix you up.’ I’m sure this has never happened before on the resort.

Still, perhaps I’m taking this a bit too seriously. I should take some friendly, sun-baked advice:

The Friccilicont is a menthol / methyl salicylate rub with a funky name but not too notable other than the pesky allergy risk.  However, a little buspirone would do wonders to chill me out. Yup. Buspirone. We don’t see it too often anymore, but it’s a lovely CYP 3A4 substrate that’s used for anti-anxiety and to enhance the effect of anti-depressants. Anybody picking this up in the airport ‘Pharmacia’ may not be told to lay off the grapefruit juice at the buffet. Once again, more than a few blood pressure meds or antibiotics could be in the carry-on that don’t play well with this one, especially if it was in regular use.

One more thing: All-inclusives are known for a few perks. Adults (and perhaps some late-teens) seem to enjoy the beach umbrellas, the barter-shopping, and BARS IN EVERY LOBBY/BEACH-HOUSE/POOL/ROOM/PARKING LOT/CORNER STORE/RESTAURANT. They even come find you if you’re looking lonely out in the common areas. Reading through the monograph for buspirone, alcohol may not be the best thing to consume. Additive CNS depression notwithstanding, liver and kidney impairment are significant cautions. Any diabetics snacking in the preferred lounge?

In closing, I’m poking some fun at the relative lack of controls and standards in a foreign country, but it’s really meant to contrast the type of clinical decision-making pharmacists in Canada are making every day. We take pride in heading off many of the potential issues outlined above and in the process, reduce the risk for significant adverse effects for drugs individually and in combination for patients in our care.

Aren’t you glad that we don’t have these on our counters:

Make sure to fill up on the M&Ms while you’re at it. I can’t look at this picture without picturing the American ad where the fatherly gentleman is bouncing out his front door and down the sidewalk. This is followed by a fast-talking fellow listing all of the disclaimers and precautions over top of ‘good morning’ imagery.

Sigh – Here’s to Dominican dreams and relaxing vacations.

Disclaimer: The views and opinions expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of any agency, employer or affiliation.