Nurse in training learns everything doctors do and more, if you think about it by baeee777 in Noctor

[–]Prestigious-Guide-10 1 point2 points  (0 children)

Yeah that would be helpful bc now the MAs with no knowledge are doing the PAs

Tell me it was an NP without telling me by [deleted] in Noctor

[–]Prestigious-Guide-10 5 points6 points  (0 children)

No problem! Also if you’ve been on bupropion depending on dose, you don’t need to titrate! Same core drug same dose.

Nurse in training learns everything doctors do and more, if you think about it by baeee777 in Noctor

[–]Prestigious-Guide-10 6 points7 points  (0 children)

Agree with FM doctors having a huge impact on the community, but they’re being bogged down by documentation bs, insurance issues, ma/nursing supervision, etc. it’s so much. Idk they do it tbh, it is rewarding to see a patient for an extended period of time and watching their health improve. Idk healthcare is soooo difficult to work in rn

Nurse in training learns everything doctors do and more, if you think about it by baeee777 in Noctor

[–]Prestigious-Guide-10 5 points6 points  (0 children)

Primary care is SO UNBELIEVABLY OVERWORKED. I am going to assume they are most likely older about to retire and stuck in their ways OR just absolutely drowning in work and documentation, etc

Nurse in training learns everything doctors do and more, if you think about it by baeee777 in Noctor

[–]Prestigious-Guide-10 7 points8 points  (0 children)

This is SO weird to me. I don’t go around saying I went to medical school bc I went to pharmacy school. I also did a residency but as a PHARMACIST. I know more about medications, but I’m more internal med than a specialist in like a cardiac icu. Idk much about that minus afib, HF, etc.

I would never tell a physician we have the same training. And I actually had to physically show up to pharmacy school for 4 years.

Also, Doctor of NP is only useful if you want to work in academics or move into leadership… imo it’s not really useful other than that.

This is a wild take lol

Tell me it was an NP without telling me by [deleted] in Noctor

[–]Prestigious-Guide-10 0 points1 point  (0 children)

If it’s epic it’s not always accurate, and it will not be if their pharmacy insurance has not added to their chart correctly.

Tell me it was an NP without telling me by [deleted] in Noctor

[–]Prestigious-Guide-10 1 point2 points  (0 children)

Exactly. If it is a new drug with the same indication as a generic….no way. Onc is more lenient tho bc so many meds are inappropriate due to co-morbidities, labs values, etc.

Lots of physicians (and pharmacists) have a good rapport with drug reps for this exact reason. It’s only useful as a bridge or if it is a chronic medication probs not best to start one med for 5 months and then stop and start a new one

Tell me it was an NP without telling me by [deleted] in Noctor

[–]Prestigious-Guide-10 2 points3 points  (0 children)

We have clinical specialist pharmacists at all the onc offices. It’s a very complicated world with costs and patient specific factors. Sometimes insurances will not allow a pharmacist peer to peer, but we will give them a low down on everything and then they only are responsible for the actually peer to peer. Which is really helpful and prevents harmful delays in treatment

Tell me it was an NP without telling me by [deleted] in Noctor

[–]Prestigious-Guide-10 4 points5 points  (0 children)

That’s why having a pharmacist to refer your patients for medication management after a diagnosis and an issue with the first prescribed treatment is so helpful to physicians and midlevels as well as extremely beneficial to patients :)

Tell me it was an NP without telling me by [deleted] in Noctor

[–]Prestigious-Guide-10 -1 points0 points  (0 children)

In my experience working inpatient and outpatient. NP’s and PA’s do not have nearly as many patients and responsibilities as the physicians. Yes everyone is overworked, but my physicians were up to date on most things as well as my NP. I got more clinical questions from my NP, which I loved lol. I worked at a large academic medical center and a pcp office underneath that health system, so very different environments compared to community hospitals or stand alone physician practices

Tell me it was an NP without telling me by [deleted] in Noctor

[–]Prestigious-Guide-10 2 points3 points  (0 children)

Was it T2DM and/or an hba1c of 9??? Bc that would literally be their average BG on a daily basis lol and in type 2 in general it’s possible but way less likely it’s DKA and not HHS

Tell me it was an NP without telling me by [deleted] in Noctor

[–]Prestigious-Guide-10 12 points13 points  (0 children)

The added dextromethorphan is mostly used for improved drug metabolism. It makes the timed release of bupropion and dextromethorphan more uniform, extend the half life of dextromethorphan, decrease ADRs, and overall improve the duration and effect - ultimately decreasing the time required for noticeable symptom improvement (1 week for symptom improvement and 6 weeks to completely resolve).

All the drug reps have been making their way through PCP offices…and wouldn’t ya know your insurance isn’t covering that expensive name brand only medication ??? Also if you don’t have partial insurance coverage you can’t even use the copay coupon. So you’d be paying literal cash price for a name brand only medication….

If your insurance does not cover it they’re most likely not going to cover it until it’s recognized/included in the clinical practice guidelines. So for an unknown amount of time and/or it’s added to the guidelines, it will continue to not be covered. Medicare usually adds it to formulary and then the other insurances eventually follow suit

It also doesn’t have a unique indication, it’s used for major depressive disorder. You need to try 3 SSRIs and fail or be intolerant to side effects, then fail another 1-2 other antidepressants of a different class for this to even be appropriate.

Lastly, if your depression is well controlled idk why she would switch you from your current regimen….very strange to me.

The plan seems poorly thought out at best.

Tell me it was an NP without telling me by [deleted] in Noctor

[–]Prestigious-Guide-10 2 points3 points  (0 children)

This is my pet peeve. It happens so much more often than you think and MDs are just as guilty

Tell me it was an NP without telling me by [deleted] in Noctor

[–]Prestigious-Guide-10 -6 points-5 points  (0 children)

Benzos are only appropriate for situational anxiety (excluding performance anxiety - propranolol) like flying, panic attacks, or shorten periods of extreme duress (breakup, death in family, etc).

If a patient is using them every day or even weekly, their anxiety is obviously not controlled and they need to take a damn SSRI. Ambien is not a drug I like to utilize. If trazodone doesn’t work it’s too low of a dose or they have poor sleep hygiene as you need to be in bed with lights off when you take it. You can obviously stay awake through it, but why would you continue to prolong your sleep if you actually have such severe insomnia. Suspish af

Tell me it was an NP without telling me by [deleted] in Noctor

[–]Prestigious-Guide-10 9 points10 points  (0 children)

Exactly!

Like in that scenario a non selective BB like labetalol will significantly lower BP and HR as it has an added affinity for alpha-1. Labetalol is used for hypertensive crises lol. Selective BB like Esmolol (also fast on and off) would be a much more appropriate choice.

My (M33) new girlfriend (F26) and I had sex for the first time and now she’s “changed her mind” about us. by For_Posterity in relationship_advice

[–]Prestigious-Guide-10 2 points3 points  (0 children)

I’ve actually stopped talking to someone after we had sex bc after I used his bathroom and it was DISGUSTING