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Pharmaceutical Calcultion
Started by Jaguis
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ah duh! peaks = efficacy...troughs = toxicity
You wish your rotation was this interesting.
hah! i hope you don't really believe that.
You'd be amazed at the stuff I believe in.
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With a little bit of thinking, hopefully I am not far off...
I haven't really learned too much about it but I assume the PAE has to do with the fact that the drug enters the organism and effects the drugs ribosomal structure. It therefore can be inside the bacteria past the actual 5 half lives that is usually expected out of the drug? It may be circulating drug has been long cleared, but the drug is inside the organism hasn't been cleared and thus PAE?
Uptake and clearance from the organism are therefore important.
To keep the drug concentration above MIC will then provide ample drug to be absorbed by the bacteria. PAE must be effective for just as long as it takes the drug to penetrate the bacteria as a population and keep its numbers at bay. It must keep it at bay at least from the time that it drops below MIC until the next dose.
Am I at all correct, or is this really just an awful answer?
I don't think people are really sure of the exact mechanism of PAE, and our professors didn't say either. I rationalized it as AG are irreversible binder of 30's subunit, aka suicide inhibitors. Every dead ribosome must be remade, and translation needed to make them incidentally require working ribosomes. There maybe be other MOA involved, but the rationalization seems to make sense.
and when can you NOT use QDay? (remember, QD is not legal anymore so it's good to practice using Daily or otherwise.)
renal patients? some won't wash out even at once a day dosing.
QD thing, yeah, but try tell that to the professors and physicians. 😳
I do tell physicians. And they rewrite. (yay for teaching hospitals and residents!)
And...
Why can't you tell it to them? It's the policy and violation means possible loss of accredidation. No accredidation, no hospital.
yeah, and ticking them off is a great way for an intern to get recommendation letters next year. 🙄 If the pharmacists and professors won't do it, I'm not sticking my neck out for their sorry asses.
infants, ototox. synergistic dosing with another drug... elderly... many more. what exactly are you looking for? 😕
wow... I didn't learn it at school.... I don't want to jeopardize my rec letters.. I got high scores in math and Pk...
hey, if you want to risk your neck, go right ahead. Don't tell me to risk my neck when you sit there with nothing to lose. 😴
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burns.
enterobacter.
sepsis.
I couldn't remember the exact list and apparently don't have my kinetics notes on this computer, but per global rph:
" *Renal failure, CHF, Burn patients, cystic fibrosis, severe
hypotension, rapidly changing renal function. (Burn victims
and patients with cystic fibrosis usually have increased
rates of elimination. Patients with CHF or severe hypotension
will have decreased rates of elimination due to decreased
renal perfusion)"
It's not the complete list, I'll have to find that. But high dose once-daily AGs isn't always an option, even if it's the easiest way to do them.
are you planning on getting LoRs from MDs?
pregnancy
and immediately post bebe.
no, but you think making an MD miserable will make my preceptor taking his orders have a pleasant day? Of course she will then writes a great rec letter about how great I am as a team player.
My philosophy might be a bit different than yours: when you are the lowest on the totem pole, don't stick your neck out and tell others what to do, let your work speak for itself. Make lots of allies, and don't be making enemies until you are up a few rungs. 🙄
Have you actually TRIED to suggest the QD thing to a physician? How about your preceptor?
it's not making them miserable. And if it's a resident, they know they're learning and they need to learn it right. That's why we have to call on the "Kayexalate 30 mmol NG x 1" and clarify they meant grams, etc.
And you can bring it up diplomatically - or even in a joking manner. Just because you're lowest on the totem poll doesn't mean you don't have anything to contribute.
I work in a Level 1 trauma center with an established ER pharmacy program. As a student I've been known to go around with a ruler and threaten to rap knuckles when orders don't get signed. You develop that relationship with the other members of the team and they know it isn't personal.
And you can bring it up diplomatically - or even in a joking manner. Just because you're lowest on the totem poll doesn't mean you don't have anything to contribute.
I work in a Level 1 trauma center with an established ER pharmacy program. As a student I've been known to go around with a ruler and threaten to rap knuckles when orders don't get signed. You develop that relationship with the other members of the team and they know it isn't personal.
no, why? Isn't being told by an intern just once bad enough? I know if I'm the MD I'll be irritated.
Look, you guys obviously don't mind being risk taking moral crusaders, especially when its telling someone else to take all the risk. Hey, that's great for you guys, but I'm going to keep my head down until I'm not the little fish in the pond any more. 😀
Well, if that works for you, more power to you. But that's not me. I work in the ER too, and I've seen MD chew my preceptor out enough about needing her approval for antibiotic access (per hospital policy) to the point that she was red in the gills and ruminated all day. So no, I know how things are, and there's no way I'm going to try your stuff, no offense.
Oh, they'll remember me, I'm only 1 of 3 interns manning the ED sat, and the only one who did a poster so far, and I haven't offended anyone in the department yet which can't be said for one of the interns.
Then i miss understood why you brought it up. My apologies.
You can't transpose your hypothetical reaction as a hypothetical physician without having been in that situation somehow. Just try it once and see what happens. Notice I mentioned you bringing it up to your preceptor, too, not just to the MD.
And earlier you mention professors, too. Many professors don't work in the field regularly and may not be aware of the changes.
no. Let's agree to disagree. The best course of action obviously differ depends on the individual and what each person deems to be more important.
In my current situation, I deem getting along with everyone at work and securing rec letters to be most important to me. To stick my neck out for this just has too little potential gain and too much potential cost, making it a needles risk to take. Sorry, when it comes to my future I play it safe, because nobody is going to look out for my ass except myself.
This is not intended to say what others choose to do is irrational. Just to each his own. 👍
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Don't worry. It's an Asian thing.
A few thousands of years of civilization and viola! --> automatic totem poles.Honestly, I think it's a cultural thing.
Being a 3rd gen American and a 1st gen professional student, I don't try to follow other people, because if I did, it would make following difficult since there aren't very many people like me in the first place. What I've found to work is the following: rationalism, adhering to a standard of ethics, and unbiased generosity.
So, if I felt that said MD or resident or preceptor needed to update their sig codes, then I would tell them sincerely and politely, because that would be rational (staying current makes sense), ethical (in terms of patient care), and addressed appropriately (without being snide or uppity).
It's the middle of the night... and I have a test tomorrow that I keep studying for back and forth. 😛
From my notes: Edema, ascities, post partum, surgery all increase Vd. Sepsis decreases Vd
Increased elimination occurs in burn patients and cystic fibrosis patients. And populations with renal issues obviously have decrease in CL.
one of the nice things about the hospital that i work at is that all physician orders are put into the computer by the physician. They don't even have the opportunity to use those abbreviations.
Don't worry. It's an Asian thing.
Honestly, I think it's a cultural thing.
I'd agree that there is a cultural component to it. I was born in China, my family like so many other asian families, came to this country with basically nothing, and we prospered by studying hard, work hard AND staying out of trouble with the natives. The down side of our ways is that we are not a politically active ethnicity, but so far that hasn't stopped us from becoming a prosperous one. 🙂
As the old chinese saying goes: mountains and rivers are easy to alter, people's nature is hard to change. I largely agree with this -- people don't change (most of the time). Of course, then I also agree with the american old saying "it's a free country", and they can do things the way they want. 😀
First Id like to say Hi to everyone as this is my 1st post. Second...boy o boy am I glad I didn't go to a proffesional program right out of undergrad. I was such a kid. Most of you here seem severely lacking in the social skills department. Having been out of my undergrad for the past 4 years and being part of the "real" world (working full time, lay offs, etc...), seems to now have been a good decision. Many of you in this thread, through no fault of your own of course, come off as naive and immature.
My advice is to *realize* everyone around you is human and to put away these ideas about how you SHOULD talk to people of various position. Treat everyone and i mean everyone the same. Respect them equally because you all share a common humanity not because of title or position, unless they give you reason not to. By not being honest with people you are disrespecting them. Don't forget that.
This is a great forum very glad I found it. Hope you all have a great rest of the the day. 😀
My advice is to *realize* everyone around you is human and to put away these ideas about how you SHOULD talk to people of various position. Treat everyone and i mean everyone the same. Respect them equally because you all share a common humanity not because of title or position, unless they give you reason not to. By not being honest with people you are disrespecting them. Don't forget that.
This is a great forum very glad I found it. Hope you all have a great rest of the the day. 😀
not be a dick, but you are being a hypocrite. You post how to treat everyone equally but at the same time you talk down at us as if we were children that do not know anything. I thought we are all equal?
All animals are equal, but some animals are more equal than others. George Orwell, Animal Farm.
2 things,
1. the original eq'n by xiphoid was not only correct, I can't think of a more logical/simple way to approach the question?
volume*conc + volume*conc + volume*conc = total volume * total conc
I didn't even read through the rest of this thread and can't believe a pharmacist would dispute this 😱.
2. Omega sub D over 2 = Omega sub Z + Epsilon
http://www.noob.us/humor/conan-and-jim-carrey-talk-quantum-physics/
1. the original eq'n by xiphoid was not only correct, I can't think of a more logical/simple way to approach the question?
volume*conc + volume*conc + volume*conc = total volume * total conc
I didn't even read through the rest of this thread and can't believe a pharmacist would dispute this 😱.
2. Omega sub D over 2 = Omega sub Z + Epsilon
http://www.noob.us/humor/conan-and-jim-carrey-talk-quantum-physics/
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No, I said treat everyone the "same". And maybe you confused "respect equally" with "being" equal? Scope of my post was social interactions, not "anything"! It was meant to be helpful.
Awesome book. I loved it. Easy read. I recommend it. Russian Revolution.
You have not answered how you can say what you said without being in the least bit hypocritical? How do you respect people equally when you talk down at them? Is that not counterintuitive? We are supposed to be equal.No, I said treat everyone the "same". And maybe you confused "respect equally" with "being" equal? Scope of my post was social interactions, not "anything"! It was meant to be helpful.
How can you respect someone equally if you don't view them as being at least your equal? the use of the word "anything" in that context means "anything about communication".
I apologize for my rudeness, I enjoy philosophy. I enjoy these convos, even though your intentions are good, if your message is contradictory, what message do you really deliver?
Anyways, no hard feelings, welcome to the board. Welcome to pharmacy. The profession for Big Egos that didn't make it to medical school.😀😛
if you honestly consider what I said "talking down to you", be prepared to be "talked down to" much much more once you start your career. Otherwise you should look at it as honest advice which you may or may not enjoy hearing.
Some physicians can be downright vindictive. I wouldn't act in deference to their professional prestige if the issue concerns patient safety, but if the advice is not well received then you should reconsider your approach. I've offered well-intentioned advice and have been utterly burned. Intentions count little in the healthcare hierarchy. Choose your battles wisely, coordinate your attacks precisely, seek timely reinforcements, and prepare for total war.
Some physicians can be downright vindictive. I wouldn't act in deference to their professional prestige if the issue concerns patient safety, but if the advice is not well received then you should reconsider your approach. I've offered well-intentioned advice and have been utterly burned. Intentions count little in the healthcare hierarchy. Choose your battles wisely, coordinate your attacks precisely, seek timely reinforcements, and prepare for total war.
As an intern, I just play chicken and avoid battles all together. Some battles are just not worth fighting, even if you win the battle, you lose the war. 😀 When you are stronger than the enemy, attack them; when you are equal in strength, you can offer battle; when you are weaker, you can avoid -- sun tzu.
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