How do you deal w/this?

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Priapism321 said:
I knew you'd say that, same thing the ID guy at my previous institution said. For linezolid to be blown out of the water, we have to pray that ZEPHYR is done right, and the data is analyzed and reported objectively (with Pfizer as the sponsor, HEH). However, at least they are monitoring serum concentrations and maintaining troughs between 15-20. Could actually be a fair fight.

http://clinicaltrials.gov/ct2/show/NCT00084266?term=zephyr&rank=1
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c'mon dood... how will 15mg/kg q12h adjsted to renal fxn give you a trough between 15-20ug/ml? Eh?

15mg/kg give you an extrapolated peak of maybe 20ug/ml..in 2 half lives...trough is 5ug/ml..... at steady state, you're looking at trough of 7ug/ml and peak of 30ug/ml.

:smuggrin:

I know you can do this in your head...

That study is already f'cked up..... Vanco dosing isn't sufficient. We're shooting at 25mg/kg to get the peak near 40.
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Priapism321 said:
HAHAHAHAHA, but it will be "novel," the industry's favorite word that they almost never have the right to utter.
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uhhhh....Yeah! Tigecycline....new novel antibiotic...Give them Tiger!
 
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Priapism321 said:
HAHAHAHAHA, but it will be "novel," the industry's favorite word that they almost never have the right to utter.
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Are they describing THIS thing as "novel?" Because...wait...what does novel mean again?

On the other hand, it might attack said enzyme in a different fashion than trimethoprim, then it actually WOULD be novel. I need more info, dammit.
 
WVUPharm2007 said:
Well, there's a nice pharmacological backbone to it. I'm all excited and **** now.
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Wait til you start applying pharmacoeconomics model to your clinical chit... you'll have a long lasting priaprism... You'll love this stuff.
 
Smiling Moon said:
WOW!!! That's quite the attack for someone who doesn't have all the details of why I called my vet just before closing and brought my dog in. And no, it wasn't a condition that I had let fester for 5 days. It wasn't even a condition that I let fester for 5 minutes. It was a case of walking in the door and finding the problem.

I suspect that is why my vet has been my vet for the last 19 years and will be until I leave the area or she quits practicing, even though I feel like she is more expensive than other vets in the area. And just because I can get her phone number doesn't mean I call her at every little whim. It means I consider what I am doing before I call her with a problem after hours and if at all possible I handle it on my own.

Good luck on your pharmacy career. I hope you find it more satisfying than other careers where you felt like people walked all over you.
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I think she was just defending her position, because the comments were about the way that she practices.

WVUPharm2007 said:
No, but I do.
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:laugh:
 
ItsOverZyvox said:
That study is already f'cked up..... Vanco dosing isn't sufficient. We're shooting at 25mg/kg to get the peak near 40.
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Well, independent of the Pharmacy Department's Kinetics service, my old hospital still lives in the 1,000 mg q12h fits all world, whether you don't have kidneys, or you are 26 years old and 103 kg.
 
Priapism321 said:
Well, independent of the Pharmacy Department's Kinetics service, my old hospital still lives in the 1,000 mg q12h fits all world, whether you don't have kidneys, or you are 26 years old and 103 kg.
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You chitting me?
 
ItsOverZyvox said:
You chitting me?
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No sir, some services much worse than others, but I won't name them because they are my special friends. And previously, our best customers....
 
So here is my dilemma. I need to present an analysis based on my assessment. But I'm salaried and that means I'm expected to work 40 hours per week. But by thursday 2pm, I've already gone over 40 hours of work... Gosh darn it..professional or not, I demand respect and I refuse to work more than 40 hours per week. I don't care I have to present it next day to importnat client...I don't want to work past 2 pm. What should I do?
 
Priapism321 said:
Well, independent of the Pharmacy Department's Kinetics service, my old hospital still lives in the 1,000 mg q12h fits all world, whether you don't have kidneys, or you are 26 years old and 103 kg.
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LOVELY! That means there are at least 2 hospitals out there still operating under that model...
 
ItsOverZyvox said:
So here is my dilemma. I need to present an analysis based on my assessment. But I'm salaried and that means I'm expected to work 40 hours per week. But by thursday 2pm, I've already gone over 40 hours of work... Gosh darn it..professional or not, I demand respect and I refuse to work more than 40 hours per week. I don't care I have to present it next day to importnat client...I don't want to work past 2 pm. What should I do?
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call the residents and/or interns.
 
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njac said:
well, we're all trying to beef up our CVs - employ us earlier on!
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You don't need your CV beefed up....you already know bunch of stuff for a P4..
 
ItsOverZyvox said:
So here is my dilemma. I need to present an analysis based on my assessment. But I'm salaried and that means I'm expected to work 40 hours per week. But by thursday 2pm, I've already gone over 40 hours of work... Gosh darn it..professional or not, I demand respect and I refuse to work more than 40 hours per week. I don't care I have to present it next day to importnat client...I don't want to work past 2 pm. What should I do?
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I'm abstaining from the vote.....
 
ItsOverZyvox said:
So here is my dilemma. I need to present an analysis based on my assessment. But I'm salaried and that means I'm expected to work 40 hours per week. But by thursday 2pm, I've already gone over 40 hours of work... Gosh darn it..professional or not, I demand respect and I refuse to work more than 40 hours per week. I don't care I have to present it next day to importnat client...I don't want to work past 2 pm. What should I do?
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No one asked you, nor do they care.
 
ItsOverZyvox said:
Oh...so you've practiced pharmacy for all 5 mintues...and now you're going to tell me how to practice??

[rockymountaindrug-guy/]


:smuggrin:
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Hey, 40 hours is 40 hours.
 
Did you notice that no one is really taking anyone's advice? Everyone is too busy talking about what they would do in said situation....because what they do and how they handle it is the perceived professional way to do it....

The best thing about this thread has been sharing abx information between Priapism, Mikey, and I.... I learned some...Priapism learned some..and Mikey learned some... but I can tell you no one else aint learned nothing about staying addtional 5 minutes to fill some water pills..

:smuggrin:
 
ItsOverZyvox said:
Interesting...I'm going to go out on a limb and say it won't work.

And they don't monitor levels eh? Stupid... so patient goes deaf with peak of 60ug/ml...."but we don't monitor".... what arrogance?

I guess MIC creep means nothing to them

They should go aginst Linezolid not vanco. What are they going to prove?
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Well...obviously they're going "old" vs. "old".

Interesthing thing I caught when I just skimmed it...the major advantage of going Bactrim would be going PO, and the Israeli study isn't even giving it like that.
 
SpirivaSunrise said:
Well...obviously they're going "old" vs. "old".

Interesthing thing I caught when I just skimmed it...the major advantage of going Bactrim would be going PO, and the Israeli study isn't even giving it like that.
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Sulfa/Tmp might be better, but I do not think they are dosing aggressively enough. You guys are talking about vancomycin like it is out of style, perhaps it is when the Pfizer rep is around. However, the damned drug still is and still should be considered standard of care therapy for almost all MRSA infections if the strain has an MIC < 2 mcg/ml. I mean, the IDSA/SIDP/ASHP are getting ready to publish a flippin' guideline exclusively on how to appropriately use vancomycin. Now, they may very well say do not use first line in proven MRSA pneumonia, but I hope they recommend more aggressive/appropriate dosing up front and better serum concentration monitoring. Bottom line, I don't think the drug is going anywhere, and I am hoping sulfa/tmp makes a come back.

There are no studies showing that linezolid is any better than vancomycin, even when vancomycin isn't given a fair chance (ie, underdosed), and even in the sickest patients with infections vancomycin shouldn't be able to get to very readily (meningitis, pneumonia).
 
Priapism321 said:
Sulfa/Tmp might be better, but I do not think they are dosing aggressively enough. You guys are talking about vancomycin like it is out of style, perhaps it is when the Pfizer rep is around. However, the damned drug still is and still should be considered standard of care therapy for almost all MRSA infections if the strain has an MIC < 2 mcg/ml. I mean, the IDSA/SIDP/ASHP are getting ready to publish a flippin' guideline exclusively on how to appropriately use vancomycin. Now, they may very well say do not use first line in proven MRSA pneumonia, but I hope they recommend more aggressive/appropriate dosing up front and better serum concentration monitoring. Bottom line, I don't think the drug is going anywhere, and I am hoping sulfa/tmp makes a come back.

There are no studies showing that linezolid is any better than vancomycin, even when vancomycin isn't given a fair chance (ie, underdosed), and even in the sickest patients with infections vancomycin shouldn't be able to get to very readily (meningitis, pneumonia).
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I can cry... And this reminded me of..

Roberts had grown so rich, he wanted to retire. He took me to his cabin and he told me his secret. 'I am not the Dread Pirate Roberts' he said. 'My name is Ryan; I inherited the ship from the previous Dread Pirate Roberts, just as you will inherit it from me. The man I inherited it from is not the real Dread Pirate Roberts either. His name was Cummerbund. The real Roberts has been retired 15 years and living like a king in Patagonia.'
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ItsOverZyvox said:
Roberts had grown so rich, he wanted to retire. He took me to his cabin and he told me his secret. 'I am not the Dread Pirate Roberts' he said. 'My name is Ryan; I inherited the ship from the previous Dread Pirate Roberts, just as you will inherit it from me. The man I inherited it from is not the real Dread Pirate Roberts either. His name was Cummerbund. The real Roberts has been retired 15 years and living like a king in Patagonia.'
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Anyone quoting the Princess Bride before 7am is a friend of mine.
 
njac said:
Anyone quoting the Princess Bride before 7am is a friend of mine.
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:smuggrin:

Prince Humperdinck and Princess Buttercup....

The author had to be laughin his arse off...
 
Priapism321 said:
Sulfa/Tmp might be better, but I do not think they are dosing aggressively enough. You guys are talking about vancomycin like it is out of style, perhaps it is when the Pfizer rep is around. However, the damned drug still is and still should be considered standard of care therapy for almost all MRSA infections if the strain has an MIC < 2 mcg/ml. I mean, the IDSA/SIDP/ASHP are getting ready to publish a flippin' guideline exclusively on how to appropriately use vancomycin. Now, they may very well say do not use first line in proven MRSA pneumonia, but I hope they recommend more aggressive/appropriate dosing up front and better serum concentration monitoring. Bottom line, I don't think the drug is going anywhere, and I am hoping sulfa/tmp makes a come back.

There are no studies showing that linezolid is any better than vancomycin, even when vancomycin isn't given a fair chance (ie, underdosed), and even in the sickest patients with infections vancomycin shouldn't be able to get to very readily (meningitis, pneumonia).
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Who the heck are you referring to..."you guys"?

I'm just trying to figure out why they wouldn't take on something like Zyvox. Bring in the pharmacoecon argument as well.
 
Priapism321 said:
Why don't you thoughtfully answer his question, what would be the professional thing to do?
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He isn't a retail pharmacist. This thread is about retail pharmacy. No one cares about a consultant's work habits, in this thread.
 
PharmDstudent said:
He isn't a retail pharmacist. This thread is about retail pharmacy. No one cares about a consultant's work habits, in this thread.
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It's all true!

Except that post was meant to be sarcastic and satirical...

:smuggrin:
 
ItsOverZyvox said:
I think she just called us "you people."
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Unfortunately. I used to think that clinical, hospital, etc. people were cool, but now I just think that they're out of touch with the foundation of pharmacy- retail.

When my 4th year rotations start in 11 months or so, I won't be looking forward to the clinical rotations. I have no desire to give lame, boring PowerPoint presentations or argue about fluff.
 
PharmDstudent said:
Unfortunately. I used to think that clinical, hospital, etc. people were cool, but now I just think that they're out of touch with the foundation of pharmacy, retail.

When my 4th year rotations start in 11 months or so, I won't be looking forward to the clinical rotations. I have no desire to give lame, boring PowerPoint presentations or argue about fluff.
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Thats what they do in the hospital. Different strokes for different folks I guess.....

I do think your making a mistake by already deciding you will not like your clinical rotations. When weighing the value of a retail rotation verses a hospital rotation, I got more out of the hospital....by far.
 
MountainPharmD said:
Thats what they do in the hospital. Different strokes for different folks I guess.....

I do think your making a mistake by already deciding you will not like your clinical rotations. When weighing the value of a retail rotation verses a hospital rotation, I got more out of the hospital....by far.
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I know. It's sad. :( I have nothing to hope for, except graduation.
 
ItsOverZyvox said:
Did you notice that no one is really taking anyone's advice? Everyone is too busy talking about what they would do in said situation....because what they do and how they handle it is the perceived professional way to do it....

The best thing about this thread has been sharing abx information between Priapism, Mikey, and I.... I learned some...Priapism learned some..and Mikey learned some... but I can tell you no one else aint learned nothing about staying addtional 5 minutes to fill some water pills..

:smuggrin:
Click to expand...

Please post more pictures of your attic. They're more interesting than your contributions to this thread.
 
MountainPharmD said:
I do think your making a mistake by already deciding you will not like your clinical rotations. When weighing the value of a retail rotation verses a hospital rotation, I got more out of the hospital....by far.
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Agreed. I really enjoyed my hospital rotations and learned quite a bit. Don't bother fighting with the non-retail folks. They clearly don't have a clue.

PharmDstudent, come join us in MountainPharmD's cage fighting thread! I'm sure the usual suspects will try to hijack it...

Good luck with rotations:luck:
 
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loo said:
Agreed. I really enjoyed my hospital rotations and learned quite a bit. Don't bother fighting with the non-retail folks. They clearly don't have a clue.

PharmDstudent, come join us in MountainPharmD's cage fighting thread! I'm sure the usual suspects will try to hijack it...

Good luck with rotations:luck:
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You know loo, learning is fine during school. However, the application of knowledge is more important to me than a constant gain of it.

I like to figure things out on my own, worry about what's important, and then move on. When I can't figure something out, I want to know why, without dwelling too long on endless possibilities.


My sense of worry and duty is sincere at work. I want to be needed, dependable, and a person who will follow through until the task is completed properly without going overboard. I don't cut corners or leave work behind for others if I can do it myself. Also, I want my coworkers or employees to have the same respect towards me, even though I know that it probably won't happen too often.

I'm leaning towards floating, evenings, or overnight.
 
SpirivaSunrise said:
Who the heck are you referring to..."you guys"?

I'm just trying to figure out why they wouldn't take on something like Zyvox. Bring in the pharmacoecon argument as well.
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I was just referring to you and Zyvox, and I completely agree with you the best comparison would have been smp/tmp versus linezolid with some sort of economic analysis (of course, Zyvox thinks the sulfa/tmp isn't going to be up to the task of proving clinical effectiveness, and as always, he may be correct). Just wanted to point out that after 5 decades on the market, vancomycin remains as first line therapy, and no other anti-ORSA agent has proven to be any better. So, to me, although they are comparing "old" versus "old," I consider it a comparison of "old but the gold standard" versus "old but intriguing."
 
Priapism321 said:
I was just referring to you and Zyvox, and I completely agree with you the best comparison would have been smp/tmp versus linezolid with some sort of economic analysis (of course, Zyvox thinks the sulfa/tmp isn't going to be up to the task of proving clinical effectiveness, and as always, he may be correct). Just wanted to point out that after 5 decades on the market, vancomycin remains as first line therapy, and no other anti-ORSA agent has proven to be any better. So, to me, although they are comparing "old" versus "old," I consider it a comparison of "old but the gold standard" versus "old but intriguing."
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So then we'll just settle on it's "old" vs. "gold"...:D
 
SpirivaSunrise said:
Israel even using a lot of Linezolid? I know parts of Europe are...
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Not quite sure about linezolid use in Israel. But I did read something interesting about that place: they do not have community acquired MRSA.
 
So is this how it is within the pharmacy community? You all fight against each other...but are suppose to be all for one cause. Providing pharmaceuticals for people. I read how everyone fusses about hours/pay/burger flipping...blah blah blah. I went to school for 4 years. Learned about every freakin animal under the sun, all the diseases associated with them, how to do surgery on them and YES I AM ALSO A PHARMACIST!!! Guess what I don't make a 3rd of what ANY OF YOU make. I am a general practitioner, internist, surgeon, ob/gyn, pediatrician, anesthesiologist, pharmacist...on and on. I don't make any of your money and people don't want to pay us AT ALL. And they want us to feel so sorry for their pets. I love the medicine, but hate how we are abused and not paid half of what we are worth.

So someone please explain to me why you are fussing and fighting with each other. You could be a veterinarian!
 
momoftwosons said:
So is this how it is within the pharmacy community? You all fight against each other...but are suppose to be all for one cause. Providing pharmaceuticals for people. I read how everyone fusses about hours/pay/burger flipping...blah blah blah. I went to school for 4 years. Learned about every freakin animal under the sun, all the diseases associated with them, how to do surgery on them and YES I AM ALSO A PHARMACIST!!! Guess what I don't make a 3rd of what ANY OF YOU make. I am a general practitioner, internist, surgeon, ob/gyn, pediatrician, anesthesiologist, pharmacist...on and on. I don't make any of your money and people don't want to pay us AT ALL. And they want us to feel so sorry for their pets. I love the medicine, but hate how we are abused and not paid half of what we are worth.

So someone please explain to me why you are fussing and fighting with each other. You could be a veterinarian!
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I guess you answered your own question....thats why we are not veterinarians.

I realize this is the internet but you have to understand alot of this is tongue in cheek. It is hard to pick up sarcasm online. Hang around and you will learn when people are serious and when they are not.
 
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Oh and is this how the threads work here. Why do you all start talking about medications, your vacations, your attic...etc? I am not starting anything, just wondering because I wanted to read more of how people handle these situations and I spent more time scrolling through the thread to find the answers. I know pharmdstudent mentioned threadjacking. Wow, never heard of that, but I get it now. I am looking forward to learning more about the pharmacy community because I am determined to make the change, but insight is better than what I am getting...
 
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momoftwosons said:
Oh and is this how the threads work here. Why do you all start talking about medications, your vacations, your attic...etc? I am not starting anything, just wondering because I wanted to read more of how people handle these situations and I spent more time scrolling through the thread to find the answers. I know pharmdstudent mentioned threadjacking. Wow, never heard of that, but I get it now. I am looking forward to learning more about the pharmacy community because I am determined to make the change, but insight it better than what I am getting...
Click to expand...

Thats life in the pharmacy world of SDN. This thread did actually start out with very good intentions....
 
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