Drugs! Drugs! ...and more Drugs!

[PMR TX MS]

Hey,

I am about to start intern year and am worried because I feel a little shaky on Pharm. Anyone know a good book that lists common drugs and basic info that would be useful for a medicine intern? I know First Aid for Step 1 is good, but I've already passed that book on.

Thanks in advance for the help!

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[Amy]

Just get yourself a pharmacopia and you'll be fine. And remember, the hospital pharmacists are your best friends!

 

[sdn1977]

I'm a hospital pharmacist & yes...I can be your best friend! We are usually very gentle with interns until Oct or so...by then you should know DSS is never stat & no...you cannot write an rx for your wife's bcp.

As for a pharmacopeia......good luck with that! Most of them are about 1000 pages & list more info than you want to know (solubility, pKa, etc....)

Ask your PD if your hospital has a formulary. This should list the drugs which are used within your facility (ie - which proton pump antoginist, which NSAID, etc...is on formulary). It will save you calls from us. Also, the lab will have an antibiogram, published monthly - which gives the current resistance patteerns. That too should give you an idea of what is formulary in your facility.

Otherwise - call us. We'll get to know you over the next year no matter what - it might as well be sooner than later!

 

[deleted87716]

As for a pharmacopeia......good luck with that! Most of them are about 1000 pages & list more info than you want to know (solubility, pKa, etc....)

My guess is they meant the Tarascon Pocket Pharmacopoeia (http://www.tarascon.com). Very concise, clinically-relevant info only. Definitely a must-have for interns.

 

[GammaRay]

& no...you cannot write an rx for your wife's bcp.

What!! Are you serious? What's so special about birth control pills?

 

[sdn1977]

What!! Are you serious? What's so special about birth control pills?

pffft! Don't want to go down this road again! There is a long thread somewhere on prescribing outside your scope of practice & on a pt who is not your own, etc.....long, long issues & not relevant here.

Sorry - pharmacopeia brings to mind my pharmacopeias - really big texts with all sorts of stuff not related to a medical clinician - just pharmacists.

I'll still say - your own hospital formulary will be your bible - you may like benazepril (as an example), but if lisinopril is on the formulary you have to have a really, really good reason to try to justify a non-formulary addition & I'm thinking an intern won't carry much weight here. Your attending has to make that request.

Good luck in July - we're happy to meet you!

 

[Amy]

My guess is they meant the Tarascon Pocket Pharmacopoeia (http://www.tarascon.com). Very concise, clinically-relevant info only. Definitely a must-have for interns.

Yeah, I meant something like ePocrates or tarascon. I use it all the time to look up doses, side effects, etc.

 

[Blade28]

ePocrates and Tarascon's will be your friend.

 

[beyond all hope]

Tylenol 650 mg PO q4h PRN pain/fever
Morphine 4 mg SC q4 PRN breakthrough pain
Maalox 30 mg PO q4 PRN indigestion
Ambien 10 mg PO qHS PRN insomnia
Benadryl 25 mg PO q6 PRN itching
Milk of Magnesia PRN constipation

Lovenox 30 mg SC BID for DVT prophylaxis

IV KCL will raise K 0.1/10 mEqs. Don't run faster than 10/hr.
For low Mag just give 2g IVPB

And don't forget...
Epi 1 mg IVP PRN no pulse

 

[trkd]

Tylenol 650 mg PO q4h PRN pain/fever
Morphine 4 mg SC q4 PRN breakthrough pain
Maalox 30 mg PO q4 PRN indigestion
Ambien 10 mg PO qHS PRN insomnia
Benadryl 25 mg PO q6 PRN itching
Milk of Magnesia PRN constipation

Lovenox 30 mg SC BID for DVT prophylaxis

IV KCL will raise K 0.1/10 mEqs. Don't run faster than 10/hr.
For low Mag just give 2g IVPB

And don't forget...
Epi 1 mg IVP PRN no pulse

Simple and succinct AND suprisingly helpful to glance at. Thanks! Quick question though, what is qHS? Haven't seen this, and can't seem to figure it out in this sleepy state of mind. I figure it means nighttime but what exactly are the initials.

 

[GoofyDoc]

Tylenol 650 mg PO q4h PRN pain/fever
Morphine 4 mg SC q4 PRN breakthrough pain
Maalox 30 mg PO q4 PRN indigestion
Ambien 10 mg PO qHS PRN insomnia
Benadryl 25 mg PO q6 PRN itching
Milk of Magnesia PRN constipation

Lovenox 30 mg SC BID for DVT prophylaxis

IV KCL will raise K 0.1/10 mEqs. Don't run faster than 10/hr.
For low Mag just give 2g IVPB

And don't forget...
Epi 1 mg IVP PRN no pulse

Great summary of the most common meds ordered on a daily basis. I'd like to know the most common dosing for these meds:

Reglan (for nausea/vomiting)
Fentanyl patch

What is the preferred med for PUD prophylaxis - an H2 blocker or PPI?

 

[GoofyDoc]

Simple and succinct AND suprisingly helpful to glance at. Thanks! Quick question though, what is qHS? Haven't seen this, and can't seem to figure it out in this sleepy state of mind. I figure it means nighttime but what exactly are the initials.

Yes, qhs means at bedtime. It's latin - quaque hora somni

 

[Blade28]

Quick question though, what is qHS? Haven't seen this, and can't seem to figure it out in this sleepy state of mind.

Ironic.

 

[GammaRay]

What is the preferred med for PUD prophylaxis - an H2 blocker or PPI?

PPI's are generally better b/c they have less interactions with other drugs metabolized by CYP450. I like pantoprazole 40 qd.

 

[Jocomama]

I add more:

Additional Surgical standing orders

Vicodin 500mg Q 4hr prn pain
Pepcid 20mg Q12 prn hearburn
Compazine 10mg po Q6 nausea
Ibuprofin 400mg po Q6 prn pain (unless Hx PUD)
Dulcolax supp Q12hr prn constipation (after MOM)
Sliding scale KCL prn
Sliding scale Insulin prn
Procardia 10mg Subl Q6hr prn SBP > 160

Tylenol 650 mg PO q4h PRN pain/fever
Morphine 4 mg SC q4 PRN breakthrough pain
Maalox 30 mg PO q4 PRN indigestion
Ambien 10 mg PO qHS PRN insomnia
Benadryl 25 mg PO q6 PRN itching
Milk of Magnesia PRN constipation

Lovenox 30 mg SC BID for DVT prophylaxis

IV KCL will raise K 0.1/10 mEqs. Don't run faster than 10/hr.
For low Mag just give 2g IVPB

And don't forget...
Epi 1 mg IVP PRN no pulse

 

[Apollyon]

Great summary of the most common meds ordered on a daily basis. I'd like to know the most common dosing for these meds:

Reglan (for nausea/vomiting)
Fentanyl patch

Reglan is 10mgIV q4-6h, although you can give more and sooner, but then you're more likely to precipitate a dystonic reaction.

As for the fentanyl patch, talk to your resident. You should NOT be prescribing one regularly. They're on for 3 days at a time, and there should be NO reason for a change in the middle of the night. If that happens, your co-intern/co-team is screwing you, and, once again, tell your resident.

 

[GoofyDoc]

Reglan is 10mgIV q4-6h, although you can give more and sooner, but then you're more likely to precipitate a dystonic reaction.

As for the fentanyl patch, talk to your resident. You should NOT be prescribing one regularly. They're on for 3 days at a time, and there should be NO reason for a change in the middle of the night. If that happens, your co-intern/co-team is screwing you, and, once again, tell your resident.

On my rotations, I had many patients who were given a Fentanyl patch, but this was always something they were receiving prior to admission and we just continued it as part of their regimen of home meds. I just forgot the dosing. Thanks.

 

[DOtobe]

Fentanyl patches come in 25 mcg, 50 mcg, 75 mcg, etc. As Apollyon said they are on for 3 days.

You will be able to spit out doses of all common drugs after about a month of internship (and tons of calls for Ambien, Ativan, morphine, zofran, etc. etc. etc...)