Phun Scripts

[Mags]

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Once again, maybe some laughs for good measure


Yesterday:
Reglan 10mg suppository.


hmm.
Keep in mind this was called into a local chain pharmacy, not a compounding pharmacy.

Share yours🙂😀

 

[Bonny2007]

Over the last days I receive scripts from one doctor for cromoglican eye drops - mitte 1ml.

 

[JerryPharmD]

Estinyl estradiol 0.05 mg

Also, some kind of probiotic that I couldn't find the name in any reference.

 

[Priapism321]

Some interesting ones from a couple weekends ago:

Orthopedic surgery: Lortab 2-4 mg IV q1h prn severe pain

Maalox 1 tab PO (30 cc) (That's the entire order)

Epogen 100 U weekly (more entertaining when you make the call giving them the benefit of the doubt seeing as there is a very similar agent dosed somewhat the same and they have no earthly clue what you are getting at).

 

[Mags]

I had a vet tech (for a dvm) call in
Thyrosyn 0.1 mg

I was pretty sure it was levothyroxine, but the vet tech had no clue what it was , and I couldnt find it anywhere in my lexicomp on my pda.

Finally the doc called back and it WAS in fact levothyroxine. Maybe they have different names when they market for animals?

Also
I had a naturopathic call me for advice on what to give for pylo. She wanted to use a ceph, and thought cipro was "big guns". I had to giggle (silently) b/c I worked in a student clinic for 4 years and cipro was the least of big guns. Especially for pylo. I said for pylo she should probably use levaquin but she refused, probably in part to her naturopath philosophy.

And she didnt have any clue on what dose to use, and for how long. At least I felt like I helped though😀

 

[All4MyDaughter]

Finally the doc called back and it WAS in fact levothyroxine. Maybe they have different names when they market for animals?

Vet drugs do have different names.

Also
I had a naturopathic call me for advice on what to give for pylo. She wanted to use a ceph, and thought cipro was "big guns". I had to giggle (silently) b/c I worked in a student clinic for 4 years and cipro was the least of big guns. Especially for pylo. I said for pylo she should probably use levaquin but she refused, probably in part to her naturopath philosophy.

And she didnt have any clue on what dose to use, and for how long. At least I felt like I helped though😀

Do you mean H. pylori?

 

[SpirivaSunrise]

Do you mean H. pylori?

Probably pyelonephritis? 🙂

 

[SpirivaSunrise]

Maybe they have different names when they market for animals?

Yep! My vet prescribed doggy Meloxicam...only it wasn't Mobic...it was liquid "Metacam" 😉

 

[Mags]

Probably pyelonephritis? 🙂

thank you
No I think I mentioned above it was for pyelo, not h pylori

 

[Ndcyciv]

My favorite once was from a recently graduated med student that said...

Solu-medrol dosepak
Take 1 tablet by mouth everyday

 

[All4MyDaughter]

thank you
No I think I mentioned above it was for pyelo, not h pylori

This is a bit old but since it was bumped, I read it.

You actually said "pylo" a couple of times. That's why I wasn't sure whether or not you meant "H. pylori" or "pyelonephritis" since levaquin can be indicated for either.

I had a naturopathic call me for advice on what to give for pylo. She wanted to use a ceph, and thought cipro was "big guns". I had to giggle (silently) b/c I worked in a student clinic for 4 years and cipro was the least of big guns. Especially for pylo. I said for pylo she should probably use levaquin but she refused, probably in part to her naturopath philosophy.

Cipro probably would have worked: http://www.medscape.com/viewarticle/505095_6
It's often the drug of choice in urinary tract infections/pyelonephritis - particularly if SMX/TMP isn't tolerated or the organism is known to be resistant. The main advantage of Levaquin over ciprofloxacin is increased Gram positive coverage, but the implicated organism in pyelonephritis is likely G (-) such as E. coli or a Proteus species.

 

[njac]

last pyelo I got called about was a 6month pregnant chick allergic to beta-lactams.

pregnant women shouldn't be allowed to get sick.

 

[All4MyDaughter]

last pyelo I got called about was a 6month pregnant chick allergic to beta-lactams.

pregnant women shouldn't be allowed to get sick.

Now that complicates matters a bit - what did you do?

 

[andaheart]

I had a naturopathic call me for advice on what to give for pylo. She wanted to use a ceph, and thought cipro was "big guns". I had to giggle (silently) b/c I worked in a student clinic for 4 years and cipro was the least of big guns. Especially for pylo. I said for pylo she should probably use levaquin but she refused, probably in part to her naturopath philosophy.

And she didnt have any clue on what dose to use, and for how long. At least I felt like I helped though😀

Are you referring to an ND? I had no idea they could even prescribe...

 

[njac]

actually, I didn't work again for like a week afterwards so I didn't get to follow up.

The nurse hung Ancef and called the pharmacy just to make sure it was ok, she wasn't sure, the patient said she gets a rash from pcn. I told her I wasn't comfortable with it, but I'm just an intern (and my pharmacist agreed), so she decided to turn it off and call the MD. MD says give her some benadryl and turn it back on butwhen the nurse went to do so the patient was like "please, please don't" and showed her this nasty welt at the IV site (apparently it had only been running a minute or 2).

So RN calls MD, MD calls the pharmacy while I was out delivering and the MD tells the RPh "she got a couple hives" so they decide on Rocephin. I run into nurse on delivery and ask her what they decided to do and she tells me. So in the end we told the night nurse to sit in there during the whole infusion and 30mins afterwards and premed with benadryl and apap.

I'm not sure how that one ended as I didn't work again for awhile, but I have to say I was more impressed with the ID consult recommending Zosyn to a pcn allergic patient yesterday.

 

[All4MyDaughter]

The Rocephin might be OK - 3rd generations have the least cross reactivity in a pcn-allergic patient. Macrobid is also pregnancy category B. That's a tough one.

SMX-TMP is category B as well - but we were taught not to use it in pregnancy.

Hard case.

Edit: SMX/TMP is category C throughout and category D at term.

 

[bananaface]

Are you referring to an ND? I had no idea they could even prescribe...

They can prescribe non-synthetics in some states.

 

[bananaface]

The Rocephin might be OK - 3rd generations have the least cross reactivity in a pcn-allergic patient. Macrobid is also pregnancy category B. That's a tough one.

SMX-TMP is category B as well - but we were taught not to use it in pregnancy.

Hard case.

SMX-TMP is only contraindicated at term. Did they have some new info to indicate that it should not be used earlier in pregnancy?

Nitrofurantoin is okay for cystitis, but not pyelonephritis. The drug concentration is lousy in the kidneys.

 

[All4MyDaughter]

You're probably right about SMZ/TMP being OK - and Macrobid definitely isn't the first choice here.

According to this source, either are OK as a follow up medication upon discharge after IV antibiotics. But I'm not at school so I can't check my antibiotics guide that I was looking at this morning.

 

[bananaface]

That is a consumer geared .com article with no citations. It doesn't look like something that should be used to direct patient care. Some of the info in it is not consistent with the literature.

Maybe fosfomycin would be a better choice. It's Preg cat B, IV, and has good coverage for E. coli.

 

[All4MyDaughter]

It might be a less than academic source but it supports the point you were trying to make about Bactrim, which is why I posted it. I was agreeing with you! 😛 🙄

I can't link to my academic sources b/c they are password protected. I like Lexi-Comp though.

Fosfomycin is not indicated for pyelonephritis. According to the literature it is indicated only for "acute uncomplicated cystitis" and "should not be used to treat infections outside of the bladder such as pyelonephritis". IDSA guidelines concur. Lexi-Comp also indicates that it is only available as a powder for PO administration in water (gross!) as the tromethamine salt.

 

[njac]

The Rocephin might be OK - 3rd generations have the least cross reactivity in a pcn-allergic patient. Macrobid is also pregnancy category B. That's a tough one.

SMX-TMP is category B as well - but we were taught not to use it in pregnancy.

Hard case.

Edit: SMX/TMP is category C throughout and category D at term.

Yeah - I know the 3rd generation had the least possibility for cross-reactivity, but the lady had a huge welt and I guess felt like "her throat was closing" (of course the MD didn't relay that to the RPh... I heard it from the RN) after a minute or two of infusion.

Fluoroquinolones are also contraindicated in pregnancy, but I don't remember why. Do you know? (it's Saturday, I don't feel like looking it up. See, I'm being honest!)