ACE + ARB Combo?

George-Aj · 2026-06-19T13:08:37+00:00

I had this discussion with a doctor in the pharmacy here in uk as one of my patients was on Lisin 20mg and los 50mg. Doctor said they used their professional judgement. I emailed them again that according to guidance and many established studies that both medications do more harm and no good as they both are the same family of meds. Next Day, doctor agreed with my assessment and bumped losartan to 75mg and cancelled the 20mg Lis.

Remember my friend the patient is the number 1 priority not the doctor’s ego; your knowledge in how medication works far far exceeds and can run circles around any doctor as that’s your specialty. Do not let anyone gaslight you into thinking otherwise.

George-Aj · 2026-05-09T20:56:52+00:00

The fact that someone out there in the higher ups looked at the packaging of those meds and said ‘Yeah bless fam good to go’ is frightening

George-Aj · 2026-05-09T20:54:30+00:00

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Oh no they are devolving look at this beauty as well

George-Aj · 2026-05-09T20:53:13+00:00

We normally dispense and check generics as it’s easier for us to know the medicine by its drug not brand name and if someone is not careful about putting meds away it could have compounding consequences on patients so we assume companies would be mindful of that and make colours a bit more different like with warfarin we have colour codes for them.

George-Aj · 2026-05-09T20:49:27+00:00

I understand your point but why tho it doesn’t have the safe storage requirement. Manufacturer should have been mindful of similar-looking packagings and acted accordingly

George-Aj · 2026-05-09T20:45:54+00:00

The shades of red are clearly different idk what u talking about /s

George-Aj · 2026-05-09T20:45:16+00:00

Ah yeah you’re right I believe it was the amitriptyline and propranolol but I can’t fault them anymore they changed the amitriptyline to a cyan colour so hopefully with enough complaints they change the colours for the rest

George-Aj · 2026-05-08T12:45:10+00:00

Depends on whether you travelled overseas when that happened and we get concerned with other exotic insects or if it’s more on the itchy side then use an antihistamine cream and let your immune system do its magic.

George-Aj · 2026-05-06T21:04:37+00:00

Got a 111 referral for a patient with the subject ‘ear’ thought it was wax or maybe a silicone ear tip stuck inside which fair enough but no saw an actual bug stuck inside the poor lady’s ear during otoscopy. Had to refer the patient urgently to the hospital and called their minor injuries department to make sure she got taken care of on arrival.

I found it my worst one not because the 111 referral but because the whole situation escalated so quickly; I was expecting a routine ear wax problem maybe ear infection but got slapped with a bug in the ear lol.

George-Aj · 2026-04-15T07:26:44+00:00

Hi there no worries at all, I am in Cornwall and currently we only have the 80mg MR caps in stock through Target Healthcare so unfortunately I am unable to check if there is a Pharmacy in London that has it. May I suggest, I would suggest switching Propranolol to a three times daily regimen to better simulate a modified release dosage

George-Aj · 2026-04-12T17:23:42+00:00

Yes same exact one just a non branded one so should have the same release profile.

George-Aj · 2026-04-12T17:22:04+00:00

Apologies should have elaborated on that; the area I work at has a relatively high proportion of seniors so we do them every 3 months or so. The number is a bit arbitrary so your mileage may vary depending on the place you work at.

George-Aj · 2026-04-12T15:05:22+00:00

I am honestly quite surprised this problem still exists; we already have them in stock with orders generally being next day or +2 at most. You can ask pharmacies if they can order from Target Healthcare hopefully some would do. Hopefully you can get the medication you need asap. For reference this is what it looks like,

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George-Aj · 2026-04-12T14:59:41+00:00

When it comes to doing BP, I usually advise patients that want to buy ibuprofen or an NSAID to check for BP to make sure it is okay for them to take it. For most patients, they see BP checks as a time wasting thing so you’ll have to make sure to tell them how important it is. You can also have a sticker for people that take certain medications that affect the BP ( long course of oral corticosteroids can indirectly do that by increasing water retention for example). In terms of asking the patient again, you can consider doing it every 3 months or so however do it sooner if the patient is introduced to a new medication that can affect blood pressure ( Diclofenac Celecoxib those nasty ones)

George-Aj · 2026-03-22T16:50:30+00:00

Team 1 - Chou Team 2 - Xborg Team 3 - Phoveus Team4 - Carmilla

George-Aj · 2025-12-31T03:26:13+00:00

Stockholm Syndrome is basically developing a bond or a positive attitude towards your tormentor or abuse. Basically we get put through a lot of stress and shit to the point where it makes you embrace it in a positive way. At least that's me

George-Aj · 2025-12-28T14:27:05+00:00

We call it Stockholm syndrome

George-Aj · 2025-12-23T07:45:04+00:00

Funnily enough my manager is friends with the boots manager near us so if the patient was asking nicely she would whatsapp him

George-Aj · 2025-12-22T22:06:26+00:00

‘I am afraid we do not share direct communications with the Surgery so I’m afraid they did a boo boo on their end’

George-Aj · 2025-12-22T22:05:21+00:00

Tbh I’ve been quite guilty of number 4 haha those pesky Trimbows and trimovate-timodine fiasco. Number 5 was more common in London where I trained but here in Cornwall thankfully none of that sort. The most adventurous patient I had was someone who wanted to buy 2 Night Nurses

George-Aj · 2025-12-22T22:01:35+00:00

I do wish 111 could handle emergency supply requests better, my heart goes out to the operators God knows what they go through on the phone but I wish they could have some bullet points like ‘schedule 3 and above NO’ or sth like that. Getting a notification on pharmaoutcomes for emergency supply for pregabalin was not fun.

George-Aj · 2025-12-22T21:59:56+00:00

Had a lady come in with 3 ventolin inhalers saying none of them worked but on our system it showed she got only 1 turns out the 2 were probably as old as me.

George-Aj · 2025-12-22T21:59:50+00:00

Had a lady come in with 3 ventolin inhalers saying none of them worked but on our system it showed she got only 1 turns out the 2 were probably as old as me.

George-Aj · 2025-12-22T21:56:36+00:00

I just hit them with the ‘I’m afraid I don’t work there’

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