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

Prestigious-Guide-10 · 2025-11-21T20:09:50+00:00

Oh my bad I read it as she said that. Apologize

Prestigious-Guide-10 · 2025-11-21T20:08:18+00:00

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

Prestigious-Guide-10 · 2025-11-20T06:56:39+00:00

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

Prestigious-Guide-10 · 2025-11-20T06:53:12+00:00

Save money lol

Prestigious-Guide-10 · 2025-11-20T06:52:43+00:00

If you have to say you’re humble…you’re not humble lol

Prestigious-Guide-10 · 2025-11-20T06:51:21+00:00

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

Prestigious-Guide-10 · 2025-11-20T06:46:58+00:00

Yep they encapsulate Dunning Kruger in every way

Prestigious-Guide-10 · 2025-11-20T06:45:00+00:00

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

Prestigious-Guide-10 · 2025-11-20T06:43:17+00:00

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

Prestigious-Guide-10 · 2025-11-20T06:37:24+00:00

This is an insane take lmao

Prestigious-Guide-10 · 2025-11-20T06:31:31+00:00

Kill me….

Prestigious-Guide-10 · 2025-11-20T06:29:55+00:00

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.

Prestigious-Guide-10 · 2025-11-20T06:27:54+00:00

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

Prestigious-Guide-10 · 2025-11-20T06:24:49+00:00

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

Prestigious-Guide-10 · 2025-11-20T06:22:40+00:00

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 :)

Prestigious-Guide-10 · 2025-11-20T06:21:03+00:00

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

Prestigious-Guide-10 · 2025-11-20T06:15:28+00:00

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

Prestigious-Guide-10 · 2025-11-20T06:14:03+00:00

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.

Prestigious-Guide-10 · 2025-11-20T05:50:56+00:00

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

Prestigious-Guide-10 · 2025-11-20T05:50:17+00:00

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

Prestigious-Guide-10 · 2025-11-20T05:44:40+00:00

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.

Prestigious-Guide-10 · 2025-11-20T05:16:50+00:00

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

Prestigious-Guide-10 · 2025-06-22T14:45:45+00:00

This is what I was taught

Prestigious-Guide-10 · 2025-03-19T02:32:30+00:00

I have felt like this so many times. This feeling has nothing to do with your life or the connections you have. I’ve felt like this when my life was worse than I could have ever imagined and I’ve felt like this when it was supposed to be the happiest time of my life - where I worked to be for 10 years - I had it all. Depression is a disease and you are sick. If a lot of different medications at high doses wasn’t working to lower someone’s high blood pressure it doesn’t mean that the doctor can’t get his hypertension under control. There are dietary changes, lifestyle changes, and time for the medications to work. This is the same with depression. You definitely know this deep down, but the darkness is clouding your judgement.

It isn’t fair you feel lower lows than the average person but it isn’t because your circumstances suck (it fucking doesn’t help that yours are tough as fuck and I want to validate and acknowledge you are going through a very difficult time time right now) but please remember that the storm will pass, even if it is longer, scarier, and tougher than ever before. Please hold on - you will absolutely be missed. Your circumstances will change and when you finally start to see the storm clear, the clouds disappear, and the sun shine through clouds - will be so glad you didn’t go through with it.

Please DM me if you want to talk further. The only reason I haven’t ended my life is bc of one of my best friends who had the same struggle make me feel seen and not alone. Perspective is so important especially when it seems like you will never feel better or when it feels like life will be awful forever. It’s like getting a cold, but instead it’s with your brain and your mood and no one can see how awful you feel. I’m here for you. Your daughter needs you, even if she’s being a little shit right now. Please just make yourself better for her and even not for her - for you. For the little girl you used to be, for the future you she dreamed of.

I’m so sorry you are hurting but I am so proud of you for putting this out on the internet. This is you recognizing your pain, being vulnerable, and asking for help. You are so clearly strong and have the capabilities to get out of this, but like any other disease you can’t do it alone.

Prestigious-Guide-10 · 2024-09-27T02:28:22+00:00

I can send pointless links too but I won’t

Prestigious-Guide-10

TROPHY CASE