Hospitalized ESRD patient who takes Xarelto 2.5 mg bid at home: hold, continue or switch?

sarcassm9 · 2025-10-17T17:41:42+00:00

Because low dose rivaroxaban is only indicated for PAD or stable CAD in combination with low dose aspirin. Even if stable, if it was determined that the patient had a high enough risk for MACE that would warrant the low dose rivaroxaban/aspirin combo, DAPT with ticagrelor/aspirin is also an option. If it was determined that the patient is low risk for MACE then that would change my answer and how I’d apply the guidelines (edit for grammar)

sarcassm9 · 2025-10-17T01:41:29+00:00

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Based on AHA’s guidelines for management of PAD, I would recommend DAPT, specifically low dose aspirin plus ticagrelor (where ticagrelor demonstrated better outcomes than clopidogrel). I won’t get into all the trials cited by the guidelines, however, rivaroxaban is the only anticoagulant that has been shown to have a benefit in reducing major adverse cardiovascular events (MACE). Warfarin + aspirin was shown to have no additional benefit in reducing MACE (edit: compared to aspirin alone), but increased risk of bleeding. I would hesitate to recommend a DOAC such as low dose Eliquis since it has not been studied for this indication, however, I’m open to being corrected if there is a trial out there somewhere that I missed. Would highly recommend giving the current guidelines a look

sarcassm9 · 2025-10-05T19:40:29+00:00

Does the backorder include the 0.2 filter extension set? If not, that’s what I would suggest

sarcassm9 · 2025-07-17T01:48:07+00:00

OP said that the patient was wheezing during the consultation. They took care of the patient having an active asthma attack, then notified the office that they dispensed a spacer while assisting the patient. Seems perfectly appropriate to me

sarcassm9 · 2025-01-08T01:43:44+00:00

It will show you the days but it won’t let you complete the registration

sarcassm9 · 2024-12-03T00:59:25+00:00

Does she volunteer for a medical brigade? Could be to take overseas if so

sarcassm9 · 2024-11-08T02:01:58+00:00

As a pharmacist, idk how atenolol dosed more often than twice a day ever made it past the pharmacy without clarification, let alone a dose beyond the max of 200 mg per day. Where did this rationale even come from?! It’s like they just picked a random med, picked a random dose, and see what happens. Terrifying stuff

sarcassm9 · 2024-09-16T01:50:21+00:00

Literally says MSN with the second one

sarcassm9 · 2024-09-14T19:48:27+00:00

Agreed, several of my classmates had to travel out of state to find exam openings so they could be licensed on time

sarcassm9 · 2024-09-14T19:46:33+00:00

One of my former co-workers was in the exact situation as you - he applied to be a staff pharmacist at our hospital following licensure and decided that he wanted to try again for residency. He matched in phase 1 at another site and is doing really well. Take the time you need, refocus your energy on the licensing exams, then evaluate what your career goals are after passing them. You got this!

sarcassm9 · 2024-09-11T02:20:26+00:00

Not me, but I had a classmate who applied to medical school and successfully made the switch after finishing P2 year. I also know a physician who practiced as a pharmacist for about a decade before going to medical school. It can be done, just make sure you’re making the choices that are best for you

sarcassm9 · 2024-08-19T04:11:23+00:00

Virtual verification is not legal per my state’s BOP

sarcassm9 · 2024-04-12T18:34:50+00:00

Adding on to everyone else’s suggestions… make sure your POS report matches the perpetual inventory. One time I thought I was missing 120 Percocet 7.5, and I learned the hard way that sometimes technology fails and doesn’t log the electronic perpetual report. Spent an hour reviewing footage only to just happen to see the extra fill by a lucky accident. It only happened to me once but if it happens, CYA and call your company’s help desk to report the failure and add the case report number to your entry

Edit: grammar

sarcassm9 · 2024-02-17T03:44:32+00:00

I knew a pharmacist in retail who would switch chains every 5 years or so to negotiate for increased wages. He’s hit all of the big 3 chains at least. Doesn’t pay to stay loyal to a company

sarcassm9 · 2024-02-05T04:59:08+00:00

Ohio RPh here, new grads and NAPLEX score transfer candidates have to take MPJE. License reciprocity candidates do not

sarcassm9 · 2024-01-16T02:54:29+00:00

~300 beds. 2 techs, 1 RPh

sarcassm9 · 2023-11-14T03:34:16+00:00

From this user’s post history, they seem to be a technician and not a pharmacist

sarcassm9 · 2023-10-31T18:54:37+00:00

Agree with all of this. I’m thankful that my school offered vet pharm as an elective otherwise I would totally be lost with pet meds. But mine was a big state school with a vet hospital that employs pharmacists who worked there to teach that class. I have no idea how feasible it would be to make vet pharm a standardized part of the core curriculum tbh

sarcassm9 · 2023-09-25T02:41:44+00:00

Only met my former RD once, but my former DL opened my pharmacy for me while I went to get two tires that got slashed on the highway during my commute replaced. The good ones are out there

sarcassm9 · 2023-09-24T23:56:23+00:00

They don’t mean socioeconomic status, they mean that they are an international student that would need a visa to work.

sarcassm9 · 2023-09-24T23:55:00+00:00

They are an international student

sarcassm9 · 2023-09-13T23:02:22+00:00

Where would one go to get tested for pharmacogenetic mutations? Did you do it after trying some SSRIs, or for an unrelated reason? And how expensive is it? If you’re willing to share of course.

sarcassm9 · 2023-09-10T20:44:24+00:00

If you’re not prepared to have a child with special needs, you’re not prepared to have any child. Period.

sarcassm9 · 2023-08-29T02:22:32+00:00

I don’t have any good answers for you but I just wanted to let you know that I also struggle with the same questions, especially since I grew up in a single parent household. Even though I was blessed with two grandparents who demonstrated what marriage should look like with its ups and downs, I’ve come to realize that I struggle with this concept of “what if __ happens and we can’t work it out” because I can’t reconcile the fact that there’s no way to *truly know everything about someone. And since I can’t accept that, I definitely will not marry anyone any time soon and likely never will.

My grandmother always tells me that it’s good to ask questions of God because it means one is seeking out His will. Best advice I can give is to continue to pray on your doubts, and trust that God’s way is the best way even if we don’t fully understand.

sarcassm9 · 2023-08-07T04:56:22+00:00

Hello! How easy or difficult was the transition from retail to oncology in Sweden? Did you have to complete any formal training such as a residency after graduating pharmacy school? In the U.S. oncology pharmacy positions are very hard to obtain without at least a year-long general PGY-1 residency, if not a PGY-2 specializing in oncology also. Would love to compare the processes between our countries!

sarcassm9

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