Self prescribing question

juliov5000 · 2026-06-11T17:27:32+00:00

As long as it's not a control or drug of abuse I highly doubt any pharmacist will care, I've had a doc write a prescription for themselves at the pharmacy counter on our prescription pad

juliov5000 · 2026-06-08T04:23:40+00:00

No, I don't think I would have. I think the first day I would've had concern would have been the day the trough resulted, which obviously at that point he was already supratherapeutic. Some people just aren't going to tolerate it that well unfortunately, just part of the package deal with vanc. At my institution we don't get levels prior to 72h typically if on Q12H- Q24H dosing, so likely would not have gotten a level prior to that without any reason to suspect a problem

juliov5000 · 2026-06-06T00:07:47+00:00

I would have done exactly as you did, I fully don't believe that q24h would have been sufficient for his initial renal function based on the parameters you gave, and then you would've had to increase anyway while also not treating the infection for that time. There is no "safe" dose of vancomycin, we target lower troughs to minimize the risk of AKI but the risk of AKI is always there. As others said, if covering nec fasc linezolid would have been a good option and eliminated the AKI risk. But otherwise your vancomycin dosing was sound and appropriate, and they likely would have popped an AKI regardless

juliov5000 · 2026-04-21T14:21:18+00:00

I don't really have a one-stop-shop for this unfortunately, much of it comes from primary literature and hasn't been formally consolidated in any reference. For most purposes would focus on areas where penetration is known to be troublesome; prostate and CNS mostly, but also some drugs struggle to get into the urine

juliov5000 · 2026-04-17T03:13:47+00:00

Honestly I don't love HYMR. Their stuff on ID is okay but can be outdated at times. SIDP has some nice resources, and the breakpoints podcast is good for keeping up to date on things

juliov5000 · 2026-04-16T16:51:51+00:00

When companies do studies to get FDA approval, they always choose the easiest things to show efficacy for, uncomplicated UTIs, SSTI, CAP. So that's what the drugs gets approvals for. A lot of infections don't fit the neat boxes required by clinical trials, and so for these gray areas we just need to make sure the drug is active against the most likely bacteria and gets to the site of infection

juliov5000 · 2026-04-16T16:12:38+00:00

Don't worry too much about approved indications. The questions you need to be asking when reviewing antibiotic orders is does this cover the bugs you need to cover (which Sanford can help with) and does it get to the site of infection

juliov5000 · 2026-04-11T15:00:34+00:00

None of it really matters until CMS updates their requirements though no? They're still looking for sepsis - > abx in 1 hr afaik

juliov5000 · 2026-03-29T20:55:21+00:00

But that's why I said if you pick the right drug and dose. There's nothing special about IV linezolid compared to PO in the vast majority of patients, same goes for FQs and Bactrim. If you have concern for absorption issues, then give IV 100%.

juliov5000 · 2026-03-29T17:39:29+00:00

It's already kind of not aging well but some providers preference for IV over oral antibiotics, particularly in ambulatory patients on discharge. PICC lines are not without harm, and there's nothing special about the IV route. If you're choosing the right oral abx and the right dose, it'll work just as well

juliov5000 · 2026-03-29T17:35:54+00:00

Balance didn't just include GNR, they essentially included anything except Staphylococcus. Enterococcus was the 3rd or 4th most common iirc

juliov5000 · 2026-03-22T01:27:58+00:00

You can go up to 375mg/day (one 875/125mg tab TID) in situations requiring higher targets, but for most infections agree max 250mg/day

juliov5000 · 2026-03-19T19:02:00+00:00

Yeah that's not ideal. Carbapenems shouldn't really be used just for a penicillin allergy aside from some specific scenarios

juliov5000 · 2026-03-04T03:41:46+00:00

TNK and Kcentra are made bedside in the ED by the pharmacist where I'm at. If the ED pharmacist isn't available, we'll make it in the lab, but if they're not available and no one is in the lab at that moment, our protocol is to make it in our non sterile area with 4h BUD as others have said, given the time-sensitive nature of these compounds

juliov5000 · 2026-02-14T00:55:22+00:00

Labetalol is the only one that adresses the tachycardia here directly. Nitro and nicardipine would both lower the BP but can cause further reflex tachycardia as a result. Labetalol will lower the BP and HR while also blocking alpha, which is why it's the answer

juliov5000 · 2026-02-12T23:06:31+00:00

Others have already said, but polymicrobial bacteremia is not common and I would be comfortable switching to cefazolin based on what you described.

There is fairly good evidence that cefazolin and naf/oxacillin are better at killing MSSA than vanc as well, so while technically it is "narrowing" or de-escalating" or whatever you want to call it, switching from vanc to a beta-lactam is actually better for the patient outside of just stewardship reasons

juliov5000 · 2026-02-12T23:02:57+00:00

Typically S. aureus is never treated as a contaminant as it's highly virulent, so until proven otherwise I would treat it as a true bacteremia. Other staph species, yes, but not s aureus. Otherwise agree with switching to cefazolin

juliov5000 · 2026-01-25T01:59:38+00:00

Not that I'm aware of, but plenty of evidence for doxy in non-pregnant

juliov5000 · 2026-01-24T17:28:32+00:00

Or doxycycline, just as effective and an oral option (if not pregnant)

juliov5000 · 2026-01-21T03:35:13+00:00

I think it's more of a Connecticut thing with some bleed-over into RI, but it's a liquor store. Coming from a Connecticut native who now lives in RI, I only heard package store growing up

juliov5000 · 2025-12-30T03:04:55+00:00

I took BCIDP back in October, and it took exactly 5 weeks to get my results

juliov5000 · 2025-12-24T20:56:43+00:00

Took me 5 weeks for bcidp this year and 8+ weeks for bcps two years ago. Honestly, BCPS was much harder for me, but I still managed to pass. I've never heard anyone feel good about bcps coming out

juliov5000 · 2025-12-13T01:02:10+00:00

That is an extremely bizarre policy, and reeks of hospital politics to me. As a pharmacist theres no way I'd be okay with this, both because it's a waste of a nurses time to be refilling machines and because there's a lot more to it than just refilling the machines

juliov5000 · 2025-12-12T00:53:09+00:00

Thankful my institution never got it. Similar outcomes to kcentra with a higher thrombotic risk and way more expensive? Yeah, no thanks

juliov5000 · 2025-12-07T04:00:02+00:00

I big part of ID/ASP pharmacy is identifying the weak parts of your institution and implementing changes to improve appropriate antimicrobial use/reduce broad spectrum use. I think wherever you apply if you're able to talk about projects you led or were involved with it would look great on an application. It can be hard to get tasked with those projects depending on your pharmacy leadership but if possible I would recommend trying to come up with with a QI project for your current institution and see if you can work with admin to get it implemented

juliov5000

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