Geek Thread

[veyep]

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Sometimes during the interview process or even on rotations preceptors ask so what's new in the pharmacy world? Here we can discuss those!

 

[jack rabbit]

Just another thread for all the saturation talk. But I know you didn't mean for this thread to head in that direction.

 

[veyep]

Just another thread for all the saturation talk. But I know you didn't mean for this thread to head in that direction.

how long have you been a psychic for?

 

[kmapes]

Just another thread for all the saturation talk. But I know you didn't mean for this thread to head in that direction.

This thread was meant for the new aspects of pharmacy. Saturation talk is nothing new.

 

[crazybob]

I got the email update from APhA about limits on APAP. What do you guys think about this?

 

[phathead]

I got the email update from APhA about limits on APAP. What do you guys think about this?

I think the APhA is great for patting themselves on the back repeatedly.

 

[veyep]

I got the email update from APhA about limits on APAP. What do you guys think about this?

Everyone has been talking about hepatotoxicity associated with apap and reducing the daily limit from 4 grams to 2.5 grams! Is it official recommendation now or do we still recommend 4 grams or less?

 

[owlegrad]

Everyone has been talking about hepatotoxicity associated with apap and reducing the daily limit from 4 grams to 2.5 grams! Is it official recommendation now or do we still recommend 4 grams or less?

4 gm/day is still the offical line. No reason to go that high though, safer to switch to a different med before you start getting that high.

 

[Passion4Sci]

4 gm/day is still the offical line. No reason to go that high though, safer to switch to a different med before you start getting that high.

Huh, odd, in the world I live in, the only acceptable notation for gram is "g".

 

[chakapow]

Huh, odd, in the world I live in, the only acceptable notation for gram is "g".

 

[owlegrad]

Huh, odd, in the world I live in, the only acceptable notation for gram is "g".

You would think so, huh? That's that excepted metric unit, I agree. But I constantly see gm used in the pharmacy world, so I have adapted to that notation. What are you going to do, you know? I don't mean once in a while either, it's practically the only way I ever see gram written out. Interestingly it seems to me to be more dangerous that just using g, but who am I to say?

Eidt: Google "gr as gram". Some sites support it's accepted use to mean gram and others forbid it, claiming that it is both inaccurate and dangerous. All I can say is I see it quite often and comes pretty natural to me know.

 

[Passion4Sci]

You would think so, huh? That's that excepted metric unit, I agree. But I constantly see gm used in the pharmacy world, so I have adapted to that notation. What are you going to do, you know? I don't mean once in a while either, it's practically the only way I ever see gram written out. Interestingly it seems to me to be more dangerous that just using g, but who am I to say?

Eidt: Google "gr as gram". Some sites support it's accepted use to mean gram and others forbid it, claiming that it is both inaccurate and dangerous. All I can say is I see it quite often and comes pretty natural to me know.

It's on the list of unaccepted abbreviations at my hospital. It's so easily confused with "mg" that writing it borders on negligence.

gr?? Are you serious? That's the abbreviation for grain, not gram. If you were a shooter, you'd know that. The only thing I can think of is 335 gr bullet and 1 gram is about 15 grains lol. That is a seriously old apothecary unit and most RPhs I work with would fkin' murdalize an intern or resident that used "gr" or "gm" to denote "gram." Ayyyy. I've either never seen "gm" used so far in pharm. school or my mind just automatically replaced it with "g" lol.

Either way... Now it's Passion 5004 : Owle 1.

 

[owlegrad]

It's on the list of unaccepted abbreviations at my hospital. It's so easily confused with "mg" that writing it borders on negligence.

gr?? Are you serious? That's the abbreviation for grain, not gram. If you were a shooter, you'd know that. The only thing I can think of is 335 gr bullet and 1 gram is about 15 grains lol. That is a seriously old apothecary unit and most RPhs I work with would fkin' murdalize an intern or resident that used "gr" or "gm" to denote "gram." Ayyyy. I've either never seen "gm" used so far in pharm. school or my mind just automatically replaced it with "g" lol.

Either way... Now it's Passion 5004 : Owle 1.

haha, no not gr, I meant gm. But seriously, I see gm all the time. (not gr, not sure where that even came from - that really was an error, I am familiar with gr as a unit, but have never seen it in practise)

We use gm in pk class, I have seen it in the hospital, on dosing charts/nomograms, dosing guidelines, etc. Can't remember if I used to see it at CVS, so few things are dosed in the gram range there. I thought it was strange at first, but now I roll with it. Maybe it is a bad habit I should review though.

Anyway google "GM as gram" and there are medical websites on both sides of the issue.

 

[Passion4Sci]

haha, no not gr, I meant gm. But seriously, I see gm all the time. (not gr, not sure where that even came from - that really was an error, I am familiar with gr as a unit, but have never seen it in practise)

We use gm in pk class, I have seen it in the hospital, on dosing charts/nomograms, dosing guidelines, etc. Can't remember if I used to see it at CVS, so few things are dosed in the gram range there. I thought it was strange at first, but now I roll with it. Maybe it is a bad habit I should review though.

Anyway google "GM as gram" and there are medical websites on both sides of the issue.

Eh, if that's the way things work in your neck of the woods, and it's an accepted practice, (P 5005, O 1), then you should be good to go.

Still so weird to me though! I mean, all through undergraduate it was "g", I don't think I could switch to "gm" if I tried, but when in Rome...

 

[owlegrad]

Eh, if that's the way things work in your neck of the woods, and it's an accepted practice, (P 5005, O 1), then you should be good to go.

Still so weird to me though! I mean, all through undergraduate it was "g", I don't think I could switch to "gm" if I tried, but when in Rome...

Youre fun. 😉

 

[Passion4Sci]

Your funner.

 

[crazybob]

I thought of a chance to be like Bob: 2, P4Sci: 5005, Owle: 1
But I decided not to do it

Anyway, I haven't seen anyone at school use "gm" for gram yet. Isn't it kinda old? I mean that as in, didn't they use "gm" a long time ago?

 

[chr19873]

Your funner.

You're

 

[Passion4Sci]

You're

You're doing it wrong bro.

Also, funner is not a word, so you lost all the points you thought you were getting for missing that.

Get on my level.

 

[crazybob]

You're doing it wrong bro.

Also, funner is not a word, so you lost all the points you thought you were getting for missing that.

Get on my level.

That reminds me of a rap song by Trillville

 

[Adaggiote]

you're doing it wrong bro.

Also, funner is not a word, so you lost all the points you thought you were getting for missing that.

Get on my level.

+1

 

[owlegrad]

You're doing it wrong bro.

Also, funner is not a word, so you lost all the points you thought you were getting for missing that.

Get on my level.

I was hoping someone would fall for it, I knew you never would. That made my day.

 

[Passion4Sci]

I was hoping someone would fall for it, I knew you never would. That made my day.

I think the levity of my reply to your reply has been destroyed by analyzing it.

You (intentionally) made a mistake with you are, (youre) so I did the same thing in my reply (your) and added one of my own (funner) in the hopes to start a bad grammar chain.

Alas... it petered out and I have been reaffirmed that I should indeed not quit pharmacy in favor of exploring stand up comedy.

 

[owlegrad]

I think the levity of my reply to your reply has been destroyed by analyzing it.

You (intentionally) made a mistake with you are, (youre) so I did the same thing in my reply (your) and added one of my own (funner) in the hopes to start a bad grammar chain.

Alas... it petered out and I have been reaffirmed that I should indeed not quit pharmacy in favor of exploring stand up comedy.

And I think that analyzing my reply to your comment about the other poster's comment ruined the levity of your comment about...wait I lost it. Damn.

I know an upperclassman who was going to start doing improv at a local comedy club. She only got interested this year. I bet she is pretty good too, I need to find out if she has really started yet, or if she is stalling.

 

[veyep]

You do use gm for gram... Especially doctors do when they prescribe for cream or something! Our chemistry teacher in undergrad might've taken points off, but out there they do use it! I just came across a prescription and first thing i thought was about this thread haha... I took a picture, i'll post it when I get home : - )

 

[crazybob]

You do use gm for gram... Especially doctors do when they prescribe for cream or something! Our chemistry teacher in undergrad might've taken points off, but out there they do use it! I just came across a prescription and first thing i thought was about this thread haha... I took a picture, i'll post it when I get home : - )

Make sure you edit the hell out of that thing

You want to keep as much hidden and a secret as possible.

 

[veyep]

Make sure you edit the hell out of that thing

You want to keep as much hidden and a secret as possible.

YUP, I zoomed in so much you just see the gm and refills nothing else lol It's HIPPA-Proof : - )

 

[owlegrad]

YUP, I zoomed in so much you just see the gm and refills nothing else lol It's HIPPA-Proof : - )

Really? Immune to HIPPAs? How does that work exactly?

 

[veyep]

Really? Immune to HIPPAs? How does that work exactly?

Here how it works... When you can't see the patient name, dob, address, doctor, Pharmacy, date, dx, etc... That's how it's immune to hippa! Need I say more?

 

[owlegrad]

Here how it works... When you can't see the patient name, dob, address, doctor, Pharmacy, date, dx, etc... That's how it's immune to hippa! Need I say more?

HIPAA dude. The way I remember is it ends in Affordability Act. Thus the two a's.

Edit: Accountablity Act is what I meant to say. Really.

 

[crazybob]

Here how it works... When you can't see the patient name, dob, address, doctor, Pharmacy, date, dx, etc... That's how it's immune to hippa! Need I say more?

What about the doctor's address and phone number? Those would need to be hidden as well. Because of Google, people can look up a doctor's name at a clinic if they can see a phone number.

You should also hide NPI and DEA numbers.

Did I forget anything?

 

[crazybob]

HIPAA dude. The way I remember is it ends in Affordability Act. Thus the two a's.

Accountability actually.

http://www.hhs.gov/ocr/privacy/

Health Insurance Portability and Accountability Act of 1996 (HIPAA)

Were you thinking of "Healthcare Affordability Act" or "Patient Protection and Affordability Act"?

 

[owlegrad]

What about the doctor's address and phone number? Those would need to be hidden as well. Because of Google, people can look up a doctor's name at a clinic if they can see a phone number.

You should also hide NPI and DEA numbers.

Did I forget anything?

OK those are great, but to be HIPAA-proof you only need to remove the patient's Personally Identifiable Information (PII). Doctor, date, dx, etc. are all fine as long as there is nothing that can be used to idetify the patient.

Removing all the other stuff is prudent, but not HIPAA required.

 

[owlegrad]

Accountability actually.

http://www.hhs.gov/ocr/privacy/

Were you thinking of "Healthcare Affordability Act" or "Patient Protection and Affordability Act"?

er, yeah that's what I meant. 😉

Probably, yes.

 

[veyep]

What about the doctor's address and phone number? Those would need to be hidden as well. Because of Google, people can look up a doctor's name at a clinic if they can see a phone number.

You should also hide NPI and DEA numbers.

Did I forget anything?

All you see is 100gm on the rx, nothing else!

 

[veyep]

French researchers have found that Prozac may help stroke victims regain muscle function. The study suggests that antidepressants aid in the improvement of motor skills by increasing levels of serotonin in the central nervous system. An added benefit is stroke patients taking generic Prozac were less likely to be depressed. Dr. Francois Chollet, from the University Hospital of Toulouse said the study "opens a new pathway" in the treatment of strokes where the cause of the attack is a blockage in a blood vessel. Whereas most other stroke medications just re-open arteries, Prozac also targets the neurons themselves. Dr. Robert Robinson, professor of psychiatry at the University of Iowa reviewed the findings and suggested that antidepressants may help in preventing inflammation on the brain, as well as producing new nerve cells in the brain that could help in creating new connections between these cells. Findings were published in The Lancet Neurology. Yahoohealth.com

 

[Passion4Sci]

All you see is 100gm on the rx, nothing else!

The SI unit of mass is gram, abbreviated "g", not "gm."

I've never seen "gm" on a 'scrip label so I'm not sure what rx you're looking at. Maybe the same bass-ackwards part of the pharmacy world that Owle comes from...

 

[owlegrad]

All you see is 100gm on the rx, nothing else!

Think twice about posting that pic? Prolly a good idea not to, don't want to get into any trouble, HIPAA or otherwise.

What is dosed 100 grams anyway? I am thinking that almost has to be a mistake, I can't think of anything that is dosed like that. Please educate me. Also follow up with that patient to make sure they are not dead. 😉

 

[R2pharmD2]

Think twice about posting that pic? Prolly a good idea not to, don't want to get into any trouble, HIPAA or otherwise.

What is dosed 100 grams anyway? I am thinking that almost has to be a mistake, I can't think of anything that is dosed like that. Please educate me. Also follow up with that patient to make sure they are not dead. 😉

Maybe it was a poorly written levothyroxine? I can see where mcg might be confused for a bad gm.

 

[rxlea]

That reminds me of a rap song by Trillville

Trillville? Wonder where they got that name...

 

[veyep]

Voltaren 1% Gel 100GM Per Doctor Apply three times as directed.

Doctors and our system both use GM for GRAM!

 

[veyep]

Tobramycin/Dexamethasone 4GM Per Doctor

 

[veyep]

My Naplex review book: do not exceed 2.6gm in 24 hours for children <12 (tylenol)

The SI unit of mass is gram, abbreviated "g", not "gm."

I've never seen "gm" on a 'scrip label so I'm not sure what rx you're looking at. Maybe the same bass-ackwards part of the pharmacy world that Owle comes from...

 

[owlegrad]

Fail

 

[delano2000]

Trillville? Wonder where they got that name...

Oh I remember one of their songs back when I was in high school.😳

 

[veyep]

RUMOR: Taking cranberry supplements or drinking cranberry juice helps prevent urinary tract infections (UTIs).
TRUTH: Don't recommend cranberries to TREAT UTIs...there's no data supporting their efficacy.

Don't recommend cranberries to TREAT UTIs...there's no data supporting their efficacy.
And data supporting that cranberries PREVENT UTIs is conflicting...partly due to the wide variety of products and regimens studied.
Cranberries seem to act by preventing bacteria, such as E. coli, from sticking to the bladder wall...but there's no guarantee they will prevent recurrent UTIs.
Don't routinely recommend cranberries for PREVENTION...but if patients want to give them a try, they are unlikely to cause more harm than an upset stomach or heartburn.
For patients wanting to try them, suggest specific products and doses with data supporting them... 300 mL/day of Ocean Spray Cranberry Juice Cocktail... 500 mg/day of Buckton Scott's Cran-Max capsules...or 400 mg/day of Cranactin cranberry caps.
Suggest Ocean Spray Light Cranberry Juice Cocktail to minimize sugar and calories...or Cran-Max capsules for patients who don't like cranberry juice.
Discourage using AZO Cranberry for those seeking to prevent recurrent UTIs...it's popular, but it doesn't have data showing it works.
Explain that diaphragms and spermicidal contraceptives can make women more likely to have recurrent UTIs. Suggest alternative contraceptives when appropriate.
If recurrent UTIs are still a problem, recommend oral antibiotic prophylaxis...continuous daily TMP/SMX or nitrofurantoin...or single post-coital doses.

 

[veyep]

RUMOR: Echinacea cures the common cold.
TRUTH: There’s no PROOF that echinacea prevents, cures, or decreases the severity of colds.


But debate continues because the data is inconsistent.
A recent large study failed to prove any benefit with echinacea pills compared to placebo pills or no pills...but the study has enough limitations to fuel doubts about its findings.
Tell patients that echinacea MIGHT modestly shorten the duration of cold symptoms and decrease their severity...but it doesn’t work for everybody.
Don’t routinely recommend echinacea supplements for colds...but for patients who really want to try them they are unlikely to cause more harm than some mild nausea, vomiting, or diarrhea.
Suggest starting echinacea as soon as cold symptoms start and continue it as long as symptoms continue. Recommend products with the best evidence...Echinaforce or EchinaGuard.
Advise patients with ragweed allergies not to take echinacea...cross sensitivity may result in allergic reactions.
There’s a lack of data supporting echinacea’s safety during pregnancy...advise pregnant women to avoid it.
Explain to patients trying to get pregnant that echinacea MIGHT decrease fertility and they may be better off avoiding it...especially since echinacea’s cold fighting abilities are modest at best.
Tell patients not to expect too much from other “immune system boosters” for colds, either. Explain that evidence is also conflicting for zinc lozenges and vitamin C.
Tell patients not to depend on andrographis, elderberry, garlic, Asian or American ginseng, Lactobacillus probiotics, or Umcka ColdCare...data is promising, but too preliminary to support routine use.
Other supplements are promoted for colds, but have no evidence supporting their efficacy...astragalus, Airborne, and Oscillococcinum. Don’t recommend them.

 

[veyep]

RUMOR: There is more than one dose worth of epinephrine in each EpiPen device.
TRUTH: This is true...only one-fourth of the epinephrine in an EpiPen auto-injector is released with the injection.

But don’t run out and tell everyone they can reuse their EpiPen. The extra epinephrine in the cartridge is overfill to ensure that the release mechanism works properly.
Patients can’t get to the overfill epinephrine without dismantling the device and taking out the cartridge. DON’T recommend that they do this.
The extra epinephrine isn’t separated into individual doses, so if patients get it out they could inject the wrong amount.
Plus, most patients only need 1 dose per allergic reaction.
Recommend an extra EpiPen, or using the Twinject for patients who could need 2 doses of epinephrine...people who have had a severe reaction or live in a remote area.

 

[veyep]

RUMOR: Opioids increase the risk of cardiovascular events in elderly patients with noncancer pain.
TRUTH: Data is too preliminary to conclude that opioids CAUSE cardiovascular events.

The concern is driven by recent studies showing an ASSOCIATION between cardiovascular events and certain opioids...hydrocodone, oxycodone, propoxyphene, tramadol...with codeine being the highest risk.
But caution patients and prescribers not to make too much of this. The cardiovascular findings from these studies are highly questionable. For example, they didn't track the use of important OTC meds that are proven to impact cardiovascular outcomes...NSAIDs and aspirin.
Don't avoid opioids when they're needed. Recommend following current pain management guidelines.
Encourage nondrug approaches for noncancer pain...gentle exercise, stretching, weight loss, etc.
Recommend acetaminophen if an analgesic is needed. Consider NSAIDs, if appropriate. They work better than acetaminophen...but they're riskier in the elderly.
Recommend judicious use of opioids...especially when NSAID risks are high...history of GI bleeding, kidney disease, heart failure, etc.
Suggest a low-dose opioid plus acetaminophen or tramadol at a dose of 400 mg/d or less.
Keep an eye on total daily acetaminophen and NSAID doses...especially in patients taking multiple combination and OTC products.
With isolated joint pain, consider suggesting topical NSAIDs (Pennsaid, etc)...they might be a safer choice than oral NSAIDs.
And suggest SNRIs (Cymbalta, etc) for neuropathic pain or chronic pain where analgesics aren't enough...especially if the patient is also depressed.

 

[veyep]

RUMOR: You can accurately predict whether you're pregnant with a boy or a girl with a simple OTC test.
TRUTH: False. You may find OTC test kits on your pharmacy's shelves...but their accuracy is questionable.

Sometimes the suspense is too much for parents-to-be...waiting for an ultrasound at 18 to 20 weeks...and even that isn't 100% accurate.
IntelliGender Gender Prediction Test can be used as early as 10 weeks of pregnancy. It costs $35 and claims around 82% accuracy.
The test consists of mixing a morning urine sample with a cup of chemicals...waiting for 10 minutes...and looking for a color change.
But tell patients not to rely on the results. There are no published studies of the test's accuracy. And the company won't reveal how it works...due to pending patents.
Pink or Blue Early Gender Test is a DNA test that can be performed as early as 7 weeks of pregnancy...and costs about $150.
The woman collects three drops of blood and sends it to the lab for testing. The test looks for Y-chromosomes using a polymerase chain reaction technique that claims 95% accuracy.
Using polymerase chain reaction techniques to find Y-chromosomes in blood samples collected through venopuncture is proven to work. But there's no proof that this specific test is accurate when using only a few drops of blood sent through the mail.
And the lab can't test samples from women in NY, MD, or other states that restrict DNA testing.
Don't recommend these tests. Caution people not to pick a name, paint the nursery, or make any other decisions based on these results.