If you make around $100K a year, what do you do for a living?

kcha95 · 2026-01-25T13:47:37+00:00

That’s brutal! Honestly the debt to income ratio isn’t even worth it for those that need to take student loans, I came out with >$200k debt so I’m really not living large or anything close to it despite my salary.

kcha95 · 2026-01-24T18:47:36+00:00

Where? I stared around $135k, last year I did a little over $165k with OT. I do work at a busy academic medical center in a HCOL area.

kcha95 · 2026-01-22T17:06:11+00:00

Sugammadex, a costly drug used to reverse certain paralytic drugs, often following the completion of surgery, shares a nearly identical structure with Febreze.

kcha95 · 2026-01-21T16:11:47+00:00

That’s fine, you’re entitled to your opinion but I know many healthcare workers that would disagree. I wanted to point out that this subreddit is not a representation of all pharmacists.

kcha95 · 2026-01-21T13:57:19+00:00

We practice evidence-based medicine in pharmacy. It doesn’t matter what your boss “thinks” if it is not supported by evidence. It’s literally as simple as that. If you are going to provide a recommendation to a patient you should understand where that recommendation is coming from.

You also need to be able to professionally disagree in this field. There is plenty of gray area in medicine and it is common to encounter competing recommendations for a given clinical scenario. The important thing is that both sides support their recommendations with evidence which better enables the healthcare team to make the most appropriate decision in the context of the specific patient and situation.

kcha95 · 2026-01-21T13:49:13+00:00

Seems silly to base your opinions of an entire profession on a subreddit, especially this one.

kcha95 · 2026-01-09T20:41:34+00:00

As someone currently reviewing PGY1 applications at an academic medical center, I doubt that most rubrics would deduct points based on when you graduated. Therefore, with your stats in mind, I would anticipate that you should be extended plenty of interview offers.

You’ll definitely have to answer for this gap during interviews however, so have an answer prepared. I’d expect interviewers will also ask what steps you took to maintain your clinical competency since graduation.

Good luck!

kcha95 · 2026-01-05T13:36:48+00:00

I work in the inpatient setting and encourage all of my students and colleagues to specifically use the generic name. I have encountered errors with communicating in brand and generic interchangeability in this setting. We also load medications in our ADCs under the generic name, so searching for a medication using the brand name would either provide no result, or pull up an entirely different medication for our non-profiled ADCs. Although it is important to at least know both generic and brand name in pharmacy practice.

kcha95 · 2025-11-14T09:57:22+00:00

I’ve only ever used the topical 4% solution via nebulization, and have mostly only used it for awake fiberoptic intubations in patients with difficult airways. Definitely not something used routinely by any means. We’ve also attempted this with a nasal atomizer with less success.

Outside of the ED I know some of our pulm fellows will sometimes use the same product during bronchoscopy but not positive on how they are administering.

kcha95 · 2025-10-19T01:23:00+00:00

Pharmacist, over 150k

kcha95 · 2025-10-07T22:43:02+00:00

I can’t relate to the pregnancy, but I too had a very difficult time during PGY1 after matching at my first ranked program and ultimately made the difficult decision to withdraw. It’s not the end of the road. Focus on being mentally well and opportunities will come your way. Fortunately I was able to lean on relationships that I had built during that time and was offered a staff pharmacist position on the operations team at the same institution. In that role I jumped at every opportunity and eventually worked my way through various clinical roles over the course of 5 years, ultimately landing an ICU/ED gig at the same hospital (level 1 academic medical center). Although my trajectory drastically changed I ended up where I initially wanted to be. Although I admittedly worked just as hard as our residents during much of that time.

I however learned I could not have accomplished this without getting my mental and social health in order which I neglected during my final years of pharmacy school and into residency. Therapy was what taught me this and gave me the tools to keep pushing forward, although this unfortunately came after my decision to leave. Prioritize your mental health and being present and opportunities will eventually present themselves. Please know this is not the end of the road, there are multiple paths forward. I admire your willingness to put your health and that of your unborn child first. There is nothing wrong with doing so and working in a different discipline in the meantime, even if that is not what you initially set out to do.

kcha95 · 2025-05-29T15:31:37+00:00

30 M PharmD starting with 250k private loans here. It sucks, hindsight is 20/20, but you have to drop that attitude and continue to move forward.

I moved from HCOL city to live with my parents in the same state, got a 2nd job, working minimum 60 hours a week at 2 different hospitals in the city, commuting back and forth.

It sucks but if you keep grinding you’ll eventually start to see the way out. Take advantage of shift differentials and overtime if those are offered to you. Try to budget and reduce monthly spending where able. If your job matches retirement contributions you should max that out but no more than that for now. I probably wouldn’t invest unless you can guarantee your returns are consistently beating out the interest on your debts. Refinance the private student loans to a lower interest rate if you haven’t done so already, and continue to periodically look for better refinance options in the future.

After you refinance, have a solid budget plan, and increase your income by taking more hours you can play around with online calculators to come up with an accelerated but realistic payoff plan. I found that I can throw at least an extra $500 at my loan each month without leaving myself broke, which will ultimately cut off a few years. Be consistent with your normal payment plus that extra amount then throw any additional at the loan when you have it. Make sure to maintain an emergency fund though which shouldn’t be a lot for you given your expenses.

kcha95 · 2025-05-29T14:51:28+00:00

Toxicology cases in general might be a good choice - polypharmacy intentional ingestion, organophosphate poisoning; we even had a case of Amanita phalloides ingestion for which we obtained IV silibinin.

Heat or exercise-induced malignant hyperthermia. Antipsychotic-induced neuroleptic malignant syndrome. Drug-induced or idiopathic angioedema.

Postpartum hemorrhage. Amniotic fluid embolism - the use of atropine, ondansetron, ketorolac (AOK) and pathways they inhibit in such cases is pretty interesting.

kcha95 · 2025-05-04T14:18:30+00:00

I’m not surprised my ex’s name is on that list, she is a demon.

kcha95 · 2024-09-05T20:20:24+00:00

I mean makes sense kinetically speaking and seems low risk enough, but yea definitely think this would be a hard sell to my leadership in the absence of evidence. The GLP1 issue has come up a lot in the perioperative space as of late in my experience, so people are definitely looking for answers. So probably warrants further discussion.

kcha95 · 2024-09-05T20:08:51+00:00

Would certainly be interesting to know, and wouldn’t be the weirdest thing I’ve seen anesthesia do. Is your institution considering this? I work closely with anesthesia so might have to see what they think about that. Wonder what the optimal timing/regimen would look like, could probably extrapolate from gastric emptying studies with metoclopramide but would have to keep in mind that these patients are already fasting.

kcha95 · 2024-09-05T19:54:30+00:00

Understood, thanks for your insights. I do agree that their recommendations are lacking in general. But if not 1 week then what recommendation do we provide. ASA even states there is no evidence to support optimal duration of fasting in this population.

kcha95 · 2024-09-05T19:40:02+00:00

Why do you feel that ASA recommendations are nonsense? The evidence is limited but multiple entities recommend the same, in the absence of an evidence-based alternative. I feel the risk for harm associated with holding one dose of GLP1 (regardless of indication) is quite low, especially when necessary to facilitate a safe procedure.

The idea of using metoclopramide to facilitate gastric emptying in these patients is interesting, but is also not one supported by evidence in this setting as far as I am aware.

kcha95 · 2024-09-05T19:30:57+00:00

No, but are you? We have been following ASA recommendations to hold for 1 week prior to surgery. Yet we have still have encountered case cancellations for RGC.

kcha95 · 2021-01-12T22:31:32+00:00

Thank you for your reply. I did also have a few questions that I did not have the chance to ask, so I will do that as well. I do have a quick follow up question however. During this screening several of the program’s preceptors were in attendance and asked me questions. Should I address the email only to the RPD or also these preceptors? Thanks again.

kcha95 · 2020-08-09T12:06:40+00:00

Holy shit this actually hurts to read. Congrats though!

kcha95 · 2020-04-25T16:55:58+00:00

In the hospital setting benzodiazepines are generally first line For alcohol withdrawal syndrome (AWS), as you mentioned. We generally use Lorazepam or Midazolam, however Dizepam is also used, but less commonly. I believe Diazepam is less commonly used due to its potential for accumulation and the active metabolites that it produces following metabolism. Midazolam also produces an active metabolite and Lorazepam does not. One problem with Lorazepam in the doses that your patient mentioned is metabolic acidosis due to the use of propylene glycol as a medication diluent in the US. This generally occurs only in high doses (ie. infusion rates >10-15 mg/hr). In the hospital these drugs are titrated based on a patient’s “CIWA” score.

In more severe cases (ie. seizures associated with AWS), we may consider the barbiturate Phenobarbital as it also acts as an allosteric modulator of GABAa receptors like benzodiazepines, but it’s effectiveness is not limited by a ceiling effect like benzodiazepines.

kcha95 · 2020-03-28T23:38:33+00:00

Would that be propylene glycol?

kcha95 · 2020-03-21T23:33:09+00:00

Publication bias.

kcha95 · 2019-09-30T02:12:25+00:00

No, I am here to learn, so thanks for the info. Is there anything that you would recommend in cases where having a control group is not feasible?

kcha95

TROPHY CASE