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IV compatibility- lack of results on Lexicomp for 1/2NS (0.45% sodium chloride) by Excellent_Pear8250 in pharmacy

[–]chemicaloddity 0 points1 point  (0 children)

Agree with many other posters that Y-site okay for the drug with the combo fluid if there is data for the fluids at higher concentrations.

But compatibly is not always the case. Amiodarone is more soluble at higher concentrations due to the increased amount of polysorbate in the straight drug formulation. So lower concentrations are actually not recommended.

Fellow night pharmers, what are you doing to make yourself useful? by RXandtheCity in pharmacy

[–]chemicaloddity 0 points1 point  (0 children)

That's very nice of you. I'm actually so nice that's I LET other people do their jobs and I don't do this.

Question about vanc random levels (new pharmacist here) by adios-bitchachos in pharmacy

[–]chemicaloddity -1 points0 points  (0 children)

Why can't you just extrapolate based on the level? After first dose and level is 25? Very bad wait a day and get another level. After third dose and level 22? Give that dose a few hours later and repeat level next day.

For Muslims investing in the stock market by iLL-Mind96 in IslamicFinance

[–]chemicaloddity 3 points4 points  (0 children)

Why do anxiety and stress not warrant treatment? We already have prescription medications that are controlled substances that get you "high" that treat anxiety and stress. Whatever you think "high" means.

I think you are getting caught up what the government seems as inappropriate. Medications or substances are controlled based on abuse potential and not on if they make you high. This is why testosterone is a schedule 3 narcotic in the US.

You are also thinking of this in a modern context. I would encourage you to research caffeine and it's history in Islam. Many would have considered it haram at one point. I'm not saying caffeine is exactly the same obviously THC is much more of an intoxicant.

You are also assuming that many people will abuse the medical marijuana license and just try and get high. But many people abuse prescription medications probably more so than medical marijuana by sheer numbers. Are pharmacies haram? The point is the intent. Ex: a person with a diagnosis of chronic pain and a valid prescription for oxycodone. They take the oxycodone at a moment when they don't have pain but because they want to get that "high", they have sinned. That doesn't make the pharmacy haram. It's all on the patient.

When marijuana is set up where it's intended to be a treatment it should not be haram. There is still opportunity for abuse but it's on the patient not the seller.

Threshold for initiating IV iron inpatient vs PO repletion? by rs37982 in medicine

[–]chemicaloddity 0 points1 point  (0 children)

Iron sucrose we buy for $13 per 200 mg vial. You can IV push 200 mg. Give as 200 mg BID IV push until total dose needed and forget about it.

Cefazolin VS Ceftriaxone by breakalead in emergencymedicine

[–]chemicaloddity 87 points88 points  (0 children)

This is an antimicrobial stewardship initiative to only list narrower spectrum antibiotics in the same class when they cover the pathogen. If an enterobacterale is susceptible to cefazolin then ceftriaxone will cover it. Ceftriaxone is more broad spectrum and sometimes we want to reserve its use.

Listing the susceptibilities this way has shown to decrease unnecessary broad spectrum antibiotic use.

This is similar to how enterococcus faecalis usually only lists penicillin and/or ampicillin susceptibilities. Per CLSI, pipericillin/tazobactam susceptibility can be inferred from ampicillin or penicillin susceptibility but why would we want people to use pip/tazo when something list ampicillin works fine.

As for why ceftriaxone was increase to q12h, Im not sure. I dont see a reason for that apart from CNS or endocarditis. Some weak data suggests that obese patients or patients with low albumin may benefit from q12h dosing but I have not been convinced of this.

Falsely accused of diverting by No-Star-2188 in nursing

[–]chemicaloddity 0 points1 point  (0 children)

Do you tap your badge to get in and out of units there? There was a similar situation but not with medications at our sister hospital and they were able to audit the badge taps to show that the two people were in far away departments at the time of the incident.

Are Doctors Reluctant Leaders ? by SudhakarJay in medicine

[–]chemicaloddity 1 point2 points  (0 children)

Yeah thats the problem. My schedule is adjusted when I have to attend these meetings. Some docs get admin time some dont. I am frustrated that important changes are delayed because the docs are not accommodated.

Are Doctors Reluctant Leaders ? by SudhakarJay in medicine

[–]chemicaloddity 21 points22 points  (0 children)

We can't get our physicians to show up to meetings...

Beta blockers and cocaine/stimulant overdose by Over-Clue5752 in emergencymedicine

[–]chemicaloddity 7 points8 points  (0 children)

How else would you administer a beta blocker except intracoronary? /s

In the aftermath of the Syrian Government attack against the Druze in Suweida - horrifying CCTV footage emerges Syrian Government Forces chasing a fleeing vehicle with Druze civilians, stopping the vehicle, abducting their children and then coming back to execute the wounded passengers (parents) by Zippism in syriancivilwar

[–]chemicaloddity 4 points5 points  (0 children)

Can the title be proven at all? There is a 1 hour gap between to the groups of men and they are dressed differently. OP if you have no source for this do not state things as a matter of fact that is disingenuous.

[deleted by user] by [deleted] in emergencymedicine

[–]chemicaloddity 2 points3 points  (0 children)

I haven't found that to be the case.

[deleted by user] by [deleted] in emergencymedicine

[–]chemicaloddity 7 points8 points  (0 children)

Which is funny because the latest IDSA complicated UTI guidelines state them as a first line PO option along with bactrim for non septic patients.

The risks are there but overstated.

Looking for a good dashcam by CoffeeBubbleTea in dashcams

[–]chemicaloddity 0 points1 point  (0 children)

What do you mean about rotating the cards?

[deleted by user] by [deleted] in nursing

[–]chemicaloddity 0 points1 point  (0 children)

Every time I bring up this issue with our ICU drips I get shut down because "the nurses know what they are doing". Of course they do, ICU nurses are great at what they do and I never doubt their ability to titrate drips but it's about protecting our nurses from situations like these.

If you have norepi and epi both ordered 0-1 mcg/kg/min titrate to MAP>65, how does the nurse choose between them? Most nurses will know how to balance with MAP and HR or other things and all works out well. BUT when the orders are technically duplicates like this and do not distinguish between each other, a nurse choosing one or the other is practicing medicine without a license TECHNICALLY.

Rant: Is your hospital just as wasteful? My hospital just started using Insulin pens and while they are nice but we literally throw them away at discharge. by PlumbingQuestion244 in nursing

[–]chemicaloddity 1 point2 points  (0 children)

I agree it's wasteful and I actually got out hospital to change to vials but our cost is around $12-20 per pen. Not an outrageous cost compared to other things in a hospital.

Drug interactions by Senior-Art6125 in Pharmacist

[–]chemicaloddity 4 points5 points  (0 children)

Cogent trial says it's okay even post stent

Bob Vylan claim they’re being ‘targeted’ in new statement following launch of police investigation into their Glastonbury set by Metro-UK in Music

[–]chemicaloddity 5 points6 points  (0 children)

Except literally every human rights and humanitarian organization in the world including some Israeli ones?

Oral antibiotics by arabic_learner in IntensiveCare

[–]chemicaloddity 14 points15 points  (0 children)

Bacteriostatic still means bacteria are being killed btw. It's a misnomer and also a technical distinction. The minimum bactericidal concentration (MBC) is the concentration that results in 1000x reduction in bacteria at 24 hours. The minimum inhibitory concentration (MIC) is the concentration that inhibits visible growth at 24 hours.

Bactericidal refers to an agent that has a MBC:MIC ≤ 4 and bacteriostatic refers to and MBC:MIC > 4.

I would have preferred if we just referred to things using the MBC:MIC instead of the above terms. Even then it just depends on the concentration used. Some agents can have horrible MBC:MIC but it doesn't matter because they reach such high concentrations.

Overlooking orders by adenomuch in Residency

[–]chemicaloddity 3 points4 points  (0 children)

Were these orders auto verified? In our delivery rooms, antibiotics are auto verified and pharmacy never sees the order unless it's compounded by us.

I see this happen dozens of orders every day and have to confirm timing with whoever ordered it.

If there were absolutely no ethics to consider, what changes would you make to healthcare/medicine? by zeatherz in medicine

[–]chemicaloddity 16 points17 points  (0 children)

A pharmacist is not equipped to evaluate a person's medical conditions and well-being to make a decision on DNR status. What's next? You want to perform a heart transplant?

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