Drug Dosing

[PhillyMed777]

just started clerkship this last month.
i was asked multiple times what dose of a drug i would give, to which i did not know the answers
when did you guys learn drug dosing? and what's the best way to learn it in general

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[LUCPM]

Epocrates? I mean if you just started your rotations, this is probably the last thing to worry about for now.

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[namiie]

Epocrates, Micromedex, UptoDate, Tarascon.

It also just comes with time. In your notes and presentations, write out/say the doses unless you're specifically told not to. You'd be surprised how much writing/reading/saying it multiple times will help. E.g. in your note, don't just put "Continue Keppra" under the plan; write it out: Continue PO Keppra 1000mg BID.

 

[deleted763299]

It also just comes with time. In your notes and presentations, write out/say the doses unless you're specifically told not to. You'd be surprised how much writing/reading/saying it multiple times will help. E.g. in your note, don't just put "Continue Keppra" under the plan; write it out: Continue PO Keppra 1000mg BID.

Look up the dosing in a drug reference, my favorite is Lexicomp. You can also look at other patients on whatever service you are on and see what they're getting 😛

The above is great advice. In general, don't worry so much about dosing as a student. When I've been asked doses of things and I don't know, no one really scolds me for that. At the beginning of clerkships, focus on learning everything else. A lot of drug doses you learn by hearing/seeing/writing them over and over.

 

[DrYoda]

I learned most of my drug dosing intern year and you generally learn it just from repetitively ordering the drug. Personally I don't judge students on drug dosages, but that's just me. My general recommendation for students is if you are going to learn drug dosages prior to residency (there are much more hi-yield things for you med schools tests and board exams to worry about) learn ACLS, RSI and PALS drugs. Obviously the needs for certain ones of these depends on specialty. Realistically these are the only drugs you would have to know emergency and off the top of your head (ok maybe also meds for severe allergic reactions). For example if you don't know how to dose a "Z-pak" for a 30kg kid you can always walk back to your desk and look it up and no one other than you is going to know.

 

[jdh71]

just started clerkship this last month.
i was asked multiple times what dose of a drug i would give, to which i did not know the answers
when did you guys learn drug dosing? and what's the best way to learn it in general

What might be more instructive for you is finding out why they asked you about the dose. It is probably because there was some kind of dosing issue in the clinical context that they felt was important to emphasize. Bad kidneys? Bad liver? Something usually dosed by weight? Any classic drug-drug interactions in that patient?

 

[PhillyMed777]

What might be more instructive for you is finding out why they asked you about the dose. It is probably because there was some kind of dosing issue in the clinical context that they felt was important to emphasize. Bad kidneys? Bad liver? Something usually dosed by weight? Any classic drug-drug interactions in that patient?

Thanks but i figured it out, they literally just want me to present all doses of drugs while presenting.
I did that for the rest of the rotation, and they were happy.
No "special" reason for them to ask.

 

[jdh71]

Thanks but i figured it out, they literally just want me to present all doses of drugs while presenting.
I did that for the rest of the rotation, and they were happy.
No "special" reason for them to ask.

seems pretty stupid

 

[sloop]

I had people ask me more dosage questions on Peds than all other rotations combined. Everything is weight-based with them so I guess it's a big thing for them. I think fluid maintenance was disproportionately asked out of this (4-2-1 rule, etc.)

I did have one surgeon ask me about the renal dosing of Lovenox, but I think that was more to harp on a pet peeve issue for him which was "You can absolutely give Lovenox in renal patients, you just have to dose-adjust!"

I kind of came in knowing a fair amount of dosing for psych meds, but I think you pick this up pretty quickly as a student just caring for the patients. Most of them are just standard dosages and not based on weight (at least the most commonly used inpatient drugs), so it took like 4 days to sort of know them. I felt like it was kind of useful to know roughly what amount of haldol was a lot. I think I presented one consult on rounds as being on "a homeopathic dose of 0.5 mg Haldol" and got a good smile and chuckle from the attending and residents.

I think that in general, nobody expects you to know dosages off the top of your head as a med student. If you need to figure it out, use epocrates.

seems pretty stupid

I had one IM attending who seemed to want this too. I mean, maybe not dosage for literally everything (I think you could just say Colace or something and get by), but you had to list every medication when you were presenting and most things he wanted you to say the dosage. He was a nice enough guy but it made rounds take ****ing forever. Incidentally, he was also one of the most anal retentive physicians I've ever met—his patients practically perished of natural causes before he deemed it okay to discharge them.

 

[cabinbuilder]

Repetition is the key. You learn it as you go. As you have to adjust medications or start antibiotics or replace potassium/magnesium you get to the point where you get sick of looking things up and get the basic memorized.

 

[Pisiform]

They usually ask me too, I just stare into abyss!


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[ProfMD]

Personally, I think it is lame to ask medical student the doses of random drugs. Now, if you have a patient you are following, you should have a list in your pocket with the patient's meds and doses. Also, if you are proposing a plan to change a dose or add a medication, you should probably have looked up the dose you want to use.

 

[Cytarabine]

Personally, I think it is lame to ask medical student the doses of random drugs. Now, if you have a patient you are following, you should have a list in your pocket with the patient's meds and doses. Also, if you are proposing a plan to change a dose or add a medication, you should probably have looked up the dose you want to use.

I agree, with rate exception where there's a pertinent dosing point to drive home (e.g. ASA, seroquel, etc)