How do you guys sort through which EMR drug interactions are legit?

[witzelsucht]

I always click through zofran for SSRI patients (the most common one), but I get worried how cavalier I've become. The other day I gave diflucan to a woman on aripiprazole and some other AP....she didn't die, but I feel like we get alarm fatigue with the bull**** interaction checks. Is there a list of "real deal" med interactions?

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[cbrons]

Its the worst at the VA where they trigger warnings for interactions with drugs the patient isn't even taking anymore.

The biggest alert really comes from long QTc. There is a website with the most "dangerous" drugs called crediblemeds.

 

[Winged Scapula]

I always click through zofran for SSRI patients (the most common one), but I get worried how cavalier I've become. The other day I gave diflucan to a woman on aripiprazole and some other AP....she didn't die, but I feel like we get alarm fatigue with the bull**** interaction checks. Is there a list of "real deal" med interactions?

This speaks to me especially in regards to the alerts for a "allergies" like nausea with morphine that the nurses seem to like to enter. Particularly frustrating because it doesn't just pop up once but with every order multiple times ( I am sitting here entering postop orders for my first case right now ).

In a more serious vein however, I do worry that I don't have information on the seriousness and incidence of some of these interactions. It would be nice to have a list of the most serious, "don't do this" Handy such as an app on my phone.

 

[PTPoeny]

When I am putting orders in for an inpatient I like to call the pharmacist to ask about interactions I'm not sure about. You can put in other orders while on the phone and it helps the pharmacists get feedback about what we see (at least with my institution's build of epic the pharmacists see different warnings than the providers). The pharmacists have helped get rid of some of the stupid warnings.

Sent from my XT1254 using Tapatalk

 

[Crayola227]

isn't lexicomp the site where you can do some serious polypharm interaction looking up?

 

[Niosh]

isn't lexicomp the site where you can do some serious polypharm interaction looking up?

Yes and you can get to Lexicomp through UpToDate too if you have access to that. It's in the upper right corner of the main UpToDate screen, called Drug Interactions. This tool is nice because it will summarize and give you links to the study data if available.
Also, in Epic there is a link to details in the interaction pop-up window. You can sometimes get more information there and hopefully make a better decision. My personal favorites are the warnings to tell me that they couldn't find a warning.

 

[witzelsucht]

I like the lexicomp one! It is suprisingly easy interface, and has three levels of warning which is nice

 

[Ismet]

I always call the pharmacy if I encounter an interaction I hadn't encountered before or am unfamiliar with, or if there's really no alternative for what I'm trying to order. The Lexicomp feature through UTD is great too if I need to refresh my mind on interactions.

I agree, alarm fatigue is a thing, but writing things for kids makes me pretty much always double check any interaction pop-up I get. Except for the kids who get a rash with amoxicillin and Epic says I shouldn't give a 3rd or 4th gen cephalosporin. Bull.

 

[WheezyBaby]

Yep, the alerts for renal clearance get tiresome too. If I'm unsure I just ask pharmacy.

 

[IM2GI]

Semi Seriously though, we should start a "that's not an allergy" public awareness and education campaign.

So much wasted time over non-allergy allergies.

Plus we have a whole generation that thinks they are PCN allergic and whole classes of antibiotics are off limits for them (even though the cross reactivity is low and we know the odds of true PCN allergy are very low).

My anecdotal rule is that >5 "allergies" is a risk factor for fibromyalgia.

 

[12glaucoma34]

Semi Seriously though, we should start a "that's not an allergy" public awareness and education campaign.

So much wasted time over non-allergy allergies.

Plus we have a whole generation that thinks they are PCN allergic and whole classes of antibiotics are off limits for them (even though the cross reactivity is low and we know the odds of true PCN allergy are very low).

Yes, I am routinely told by patients they are allergic to antibiotic X because they felt nauseous or had diarrhea after taking this antibiotic. It is possible to have antibiotic associated side effects without an allergy, but most non-physicians don't seem to understand that. Then it is placed on their allergy list and they are never given that drug again.

It seems like a risky venture to tell a patient they aren't really allergic antibiotic X and then give it to them. Eventually, someone will have an allergic reaction and sue the doctor. Has anyone ever seen a physician give a medication despite it being on the allergy list? I get that this practice is CYA medicine, but it definitely isn't the best for patients.

 

[WheezyBaby]

I have on numerous occasions given a med that was listed as an allergy. It was then no longer listed as an allergy

 

[VA Hopeful Dr]

I have on numerous occasions given a med that was listed as an allergy. It was then no longer listed as an allergy

Same

 

[VA Hopeful Dr]

Oh certainly, especially the non-allergies like "itching with morphine".

But when someone tells you they are allergic, they had it as a kid but they don't remember what the actual reaction was...well then you're kind of hosed.

We would consult allergy in those circumstances, which often led to a desensitization protocol that wastes thousands of dollars of resources.

Meh. When that happens it's almost universally penicillin. It's not that hard to avoid your basic penicillins, since cephalosporins are still very safe as well as everything without a beta-lactam ring. And if it's serious enough where they absolutely have to have some kind of daylight to him, then odds are there in the hospital and I wouldn't feel that uncomfortable giving it a shot in that setting. It's only in the outpatient world I would be leery.

 

[calvnandhobbs68]

My fav "allergy"....red man's syndrome with vancomycin.

 

[Donald Juan]

Oh certainly, especially the non-allergies like "itching with morphine".

Am I the only one who tells my post op pts I can't give them any dilaudid or percocet because they have an opioid allergy?

 

[DocVapor]

I fairly routinely am completing a pre-op eval and see "anesthesia" listed as an allergy, and have had it confirmed to me on >1 occasion.

Um. Wat. There are legitimate concerns in anesthesia about certain medications, but I've been tempted to tell them "Well, I guess you're going to have to get your gallbladder cut out awake and without local."

What we let people, nurses, and even doctors, get away with as far as allergies is atrocious.

 

[killerleaf]

It can be frustrating from a patient's point of view, also. I have repeatedly explained what happens with a certain drug, ie, hives, hallucinations and throwing up blood, but they never would list it out. Last year, one person did list it out, and now, I am no longer offered the "good" cough syrup first...which I have to decline, and point out the allergy section....they finally give me the correct one first!