Originally Posted by nitemagi

This is hilarious. Wrath?

"Relative equivalent" in a patient with major liver impairment, and you want to manage without even seeing if the patient is in withdrawal? The pt. needs an ED eval or at minimum a clinic eval first. Prescribing a long-acting benzo to an alcoholic benzo with possible liver failure is quite risky.

The point of the mnemonic is that lorazepam (which is glucoronidated by the liver) is considered safer in liver impaired pt's than klonopin. Oxaz and Temaz are used, but not usually in a detox setting. If you review the literature, there are no studies that, even amongst experts, that give actual benzo "equivalencies." The most you can hope for is to ballpark it, which is why the pt needs close monitoring and not prescribing 3rd-hand via recommendations to a covering physician for their pcp.

BTW, every "resident," which is hilarious that you use the term in an inferior fashion, has at more than twice the medical education you do, and residents within my year have at least twice the psychopharm training with good supervision. But clearly You must be superior.

I don't really care if you "justify every little decision," or any decisions at all. But you're the one posting anecdotes showing your great medical knowledge and ability to handle psychopharm better than physicians. So you're opening yourself up to scrutiny. It's just that at the moment I'm the only one pointing it out. Probably because it's wiser to let you just diddle on, rather than expect you to admit there's any problems with RxP. Diminishing returns at this point.