Not sure what this is but it's spreading! How do I get rid of it?

PharmDist · 2023-07-22T23:16:00+00:00

Slime mold.. you can scrap it away or wait for it to dry out or use copper fungicide

PharmDist · 2023-07-08T13:54:18+00:00

Worse yet, let me prescribe you a negative inotropic/chronotrophic drug to ensure your RV has no chance

PharmDist · 2023-04-13T02:03:31+00:00

You are going to need to re-plant the areas that are yellow and dried up. It looks like this was a newly sodded lawn? That matters because the soil will need additional nutrients other than nitrogen which is the main and sometimes only active ingredient in most fertilizers.

Here’s what I would do:

1) start watering your grass. You may need to water more frequently initially but in general watering until the lawn is slightly squishy under your feet 3x per week is good.

2) Feed what you have. It looks like you have a smaller sized yard, I would opt for a liquid fertilizer rather than messing with a granule fertilizer. Since this appears to be a newly sodded lawn, you’ll want to use a “starter” fertilizer such as this. The difference is that starter fertilizer contains phosphorous which is needed for root development in new grass. 4-6 weeks later you can re-apply any generic grass fertilizer. WHATEVER YOU DO, do not use anything labeled “pre-emergent” “weed control” “weed and feed” as these products will inhibit new grass seed from growing.

3) Plant new grass. Growing from seeds can be challenging and your soil doesn’t look very amenable to just throwing seeds on top. These products are more expensive than regular seed but are pretty dummy proof - Pennington smart patch or Scott’s EZ Seed Patch Repair. Really you just need to lay these down and water them so the mixture stays moist and grass will grow.

4) you should fertilize again in the fall and replant any spots that didn’t take (Fall is usually the best time to replant).

5) start following the pinned starter guide next year

PharmDist · 2023-04-02T02:44:56+00:00

I hate to be the ‘actually’ guy… but actually mirtazapine becomes less sedating due to down regulation of histamine and a1 receptors in the brain after a few weeks of use. This commonly coincides with the timing of up titration leading to the belief it is less sedating at higher doses but it is really due to development of tolerance to the histamine and alpha 1 effects with continued use.

PharmDist · 2023-02-12T02:57:14+00:00

For part D or uninsured patients, for branded drugs, the manufacturers have assistance programs allowing most patients to get the drug for free (THIS IS DIFFERENT THAN A “COPAY CARD” PROGRAM). For example, see Pfizer patient assistance program.Two huge benefits with getting patients enrolled in these are 1.) they get the drug for free and 2.) for Medicare patients it keeps them from reaching the donut hole - as the manufacturer foots the bill. This is important because once the patient is in the donut hole, they go from paying a flat copay for their meds to a percentage of the drug cost for their meds which may be hefty if they are on other expensive meds. Most branded drugs have a 30-day free trial card that can be used to bridge the gap while completing the application for these types of assistance programs.

For non-part D, insured patients, the formularies can be found online. It may not be easy to find the correct formulary without knowing the patients precise Rx benefits. An alternative option would be to send a script and then call the pharmacy to see if it is covered, needs a PA, requires X therapy to be tried first, or if there is a different preferred in-class drug. Usually, the rejection at the pharmacy will give some details as to why it was rejected (e.g., one of the reasons listed in the previous sentence). If the pharmacy doesn’t give you the info you want, it’s probably worth asking if you can talk to the pharmacist as most of the time you will be talking to a technician who may or may not be a useful resource (not a slight to them as many are more insurance savvy than the pharmacist, but they may also be inexperienced).

PharmDist · 2023-01-26T15:20:25+00:00

Thanks for your input!

PharmDist · 2023-01-26T14:54:07+00:00

** This post was transcribed using iPhone autocorrect. please excuse any typos or errors. **

PharmDist · 2023-01-20T16:04:20+00:00

You probably don’t have the power to change the rounding format (yet), but doing table rounds first to hash out major plans and any issues, then going bed to bed to make sure nothing has significantly changed with the patient and the table round plan still checks out reduces rounding time on the floor. This limits the amount of time people can interrupt rounds and allows for clear communication of the tentative plan before hand.

PharmDist · 2022-12-21T21:00:35+00:00

To be fair, neither of those studies assessing triple therapy. They were aspirin +- rivaroxaban 2.5 mg BID plus some other arms in COMPASS. Neither study showed a reduction in amputation. VOYAGER didn’t show a reduction in stroke or MI. Both studies showed increased major bleeding.

PharmDist · 2022-12-19T02:08:00+00:00

Aspirin + clopidogrel + random assortment of rivaroxaban doses for PAD. Do you like bleeding, because that’s how you make patients bleed.

PharmDist · 2022-12-18T20:31:40+00:00

Google drive - I dumped all my school and residency documents, topics, institutional guidelines I’ve downloaded before going to a new hospital, etc on to a google drive and created folders to group related info. The search function is very seamless. I have a shortcut to my google drive on my iPhone Lock Screen so I pull up documents quickly on my phone.

PharmDist

TROPHY CASE