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maybe he's a tech too! 😀
Basic Pharm math.
Started by bambur
Not available 🙂 To the last post.. I am a PY2 CO 2015
At least in retail we could call, maybe in hospital one would use 200+50 w/o call.
Levothyroxine Sodium (T4) Micronized Hydrate USP
Levothyroxine Sodium (T4) Pentahydrate USP
Levothyroxine Sodium 100mcg Powder for Injection
Levothyroxine Sodium 100mcg Tablet
Levothyroxine Sodium 112mcg Tablet
Levothyroxine Sodium 125mcg Tablet
Levothyroxine Sodium 137mcg Tablet
Levothyroxine Sodium 150mcg Tablet
Levothyroxine Sodium 175mcg Tablet
Levothyroxine Sodium 200mcg Powder for Injection
Levothyroxine Sodium 200mcg Tablet
Levothyroxine Sodium 25mcg Tablet
Levothyroxine Sodium 300mcg Tablet
Levothyroxine Sodium 500mcg Powder for Injection
Levothyroxine Sodium 50mcg Tablet
Levothyroxine Sodium 75mcg Tablet
Levothyroxine Sodium 88mcg Tablet
Levothyroxine Sodium USP
What would your recommendation be when you called?
250 is a bit high but if I verified its correct, I would have no qualm of putting such an order in.
Now here is a real story. Patient on synthroid 200 MCG daily, MD orders tapazole. Staff pharmacist put it in, no interaction noted. I asked nurse if MD said anything, nope. Guess what was my next step?
Now here is a real story. Patient on synthroid 200 MCG daily, MD orders tapazole. Staff pharmacist put it in, no interaction noted. I asked nurse if MD said anything, nope. Guess what was my next step?
Usually doses above 150-200mcg are s/p thyroidectomy, or super heavyweights. If you don't have their history, worth calling to make sure the doc didn't mean 0.025mg with those pesky decimal places.
For your story, your rph didn't notice, or the computer system didn't pick it up? Either way, doesn't really make sense to be using both. Maybe I could see using them both if you've overdosed their regular treatment and made them hypo/hyperthyroid, and want to add/block some t4 to get them back in normal range. Not sure if this is done, but you don't draw labs until 6 weeks after a levoxyl dose change, so maybe this is done to speed up the process. Definitely not something I would assume is commonplace, so that one deserves a call too.
the usual starting dose is 1.7 mcg/kg then titrated to effect, so 200mcg is pretty common. The software didn't detect any interaction between those 2, so staff pharmacist didn't give a warming before putting it through. Realistically, how many pharmacists review the whole profile before putting in an order? This is even a bigger problem with antibiotics. Cefepime for enterococcus? Really?
It's the clinical pharmacists who should review the profiles before daily rounds. Unfortunately, it's harder to justify these positions.
I think the former is more of an issue, pharmacist should see those 2 and immediately think, no, that's wrong. Should a pharmacist catch cefepime for enterococcus? Maybe, but how often does a staff pharmacist check the micro? I haven't seen them check it that often, maybe it's different elsewhere.
also, if i saw a pt w/250mcg, and i see an inc trend in their past, i'd give 2 125's rather than dispense a 200+50 and move on.
In an inpatient setting, number of orders on a profile easily exceed 2 dozen or more. Heck just the sliding scale insulin protocol is 5 orders and K/Mag protocol is another 5, so reviewing the whole profile during each order entry isn't getting done and pharmacists are relying on the software. This is a demonstration of the limitations.
Yes. I actually see these scripts occasionally. However, I would ALWAYS call to verify, because sometimes the doctor did indeed want 250mcg, in which case I would sub for 2 x 125mcg, but the MAJORITY of times, the doctor meant 0.025mg or 25mcg.
So the point of the post was that even doctors screw this up sometimes, and I think you guys are being a bit harsh on the OP.
