Racist in AL, MS, AR, NC, or colistin?

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Are you kidding?
 
This isn't the 60s, I don't know if you know but they passed laws banning that
 
Quiksilver said:
This isn't the 60s, I don't know if you know but they passed laws banning that
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Unfortunately, there are no laws banning racism, lest the government is able to control our thoughts (not yet).
 
I am in NC~ and I think it is the way it is everywhere....I am a minority myself....and I love NC and doubt I will ever live anywhere else......regarding your random ?....if you are thinking about applying to Pharm schools in one of the states I would suggest visiting and getting a "feel" for the schools....to answer your question.
 
heatherkmd said:
I am in NC~ and I think it is the way it is everywhere....I am a minority myself....and I love NC and doubt I will ever live anywhere else......regarding your random ?....if you are thinking about applying to Pharm schools in one of the states I would suggest visiting and getting a "feel" for the schools....to answer your question.
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Some of us don't have the financial ability to scope out every university they're interested in.
 
Ben1988 said:
Some of us don't have the financial ability to scope out every university they're interested in.
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Well then that is too damn bad (says the middle class american white male). I am racist against idiots, so don't come to Florida if you are one of those.
 
i have lived in the west coast, midwest, and east coast


bottom line


there are dumba$$es everywhere



from my vacationing/traveling..........there are waaaaaaaay more uneducated people in the south and midwest............uneducated people = ignorant people............ignorant people = come off racists...............come off racists = deep down they are

if you are scared you will get hosed down with a firehouse or be told to sit in the back of the bus, then you don't have to worry...........

but if you are scared you will be looked at funny or called a name or two..........then welcome to "LIFE"
 
feelit83 said:
Does anyone know if there is extreme racism towards blacks/hispanics in either of the above states?
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Racism is everywhere, but it's overwhelmingly present in the south. Just look up "Jena 6". If that's not racism I don't know what is.
 
Ben1988 said:
Some of us don't have the financial ability to scope out every university they're interested in.
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I would just apply where I know I would fit in then. If you can afford to apply and IF you get an interview then I would get a feel for the campus then. I agree with the person that says you will encounter ignorance at every corner of the country.....sad but true.
 
Priapism321 said:
Well then that is too damn bad (says the middle class american white male). I am racist against idiots, so don't come to Florida if you are one of those.
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Then you must be prejudice against yourself because almost all pharmacy residents are idiots...

Then when you're done with the residency, hopefully someone with a clue will deprogram you and learn you the right stuff. 😎
 
Epic said:
Then you must be prejudice against yourself because almost all pharmacy residents are idiots...

Then when you're done with the residency, hopefully someone with a clue will deprogram you and learn you the right stuff. 😎
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Probably a statement I will agree with in a few years......how many of your hospitals have added doripenem to the formulary for empiric therapy because the guidelines say you can use carbapenems for community acquired pneumonia?

A real question, what do you think about the resurgence of intravenous colistin? I actually think this could be a good move.
 
Priapism321 said:
Probably a statement I will agree with in a few years......how many of your hospitals have added doripenem to the formulary for empiric therapy because the guidelines say you can use carbapenems for community acquired pneumonia?

A real question, what do you think about the resurgence of intravenous colistin? I actually think this could be a good move.
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Don't ask me a question you don't fully comprehend. :meanie: Tell me resident.. why should we or shouldn't we add dori?? Why did Ortho release Dori when penem market is saturated with imipenem ready to go generic? Well, at least your question is semi stimulating...

colistin is ok... but we haven't encountered panresistant pseudo and acinetobacter that requires colistin...knock on wood, yet.
 
Epic said:
Don't ask me a question you don't fully comprehend. :meanie: Tell me resident.. why should we or shouldn't we add dori?? Why did Ortho release Dori when penem market is saturated with imipenem ready to go generic? Well, at least your question is semi stimulating...

colistin is ok... but we haven't encountered panresistant pseudo and acinetobacter that requires colistin...knock on wood, yet.
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Your first question will take me some time to ponder, as I don't think the release time was strategic; on the surface I feel like you are asking me why Merck tried to gain approval of etoricoxib after rofecoxib was removed from the market: the same reason pharmaceutical companies do everything that they do: money. If they can manipulate people to believe doripenem is superior against Pseudomonas with slanted marketing practices, they win. Though there may be something more, my hospital has not considered even evaluating the agent at this point. As for imipenem, I feel it is inferior; 14% of Pseudomonas strains in the institution I work at are resistant, and it clearly has an inferior toxicity profile. The fact it is going generic makes it worth reanalyzing the cost:benefit ratio. However, I would be hard pressed to think doripenem can do anything meropenem cannot.

As for colistin, in a patient with end stage cystic fibrosis, Pseudomonas only sensitive to tobramycin, what do you think?

Likewise, another patient was placed on tigecycline with a strain of Acinetobacter only suscebtible to gentamicin. Would you think colistin may be of use here?
 
Priapism321 said:
Your first question will take me some time to ponder, as I don't think the release time was strategic; on the surface I feel like you are asking me why Merck tried to gain approval of etoricoxib after rofecoxib was removed from the market: the same reason pharmaceutical companies do everything that they do: money. If they can manipulate people to believe doripenem is superior against Pseudomonas with slanted marketing practices, they win. Though there may be something more, my hospital has not considered even evaluating the agent at this point. As for imipenem, I feel it is inferior; 14% of Pseudomonas strains in the institution I work at are resistant, and it clearly has an inferior toxicity profile. The fact it is going generic makes it worth reanalyzing the cost:benefit ratio. However, I would be hard pressed to think doripenem can do anything meropenem cannot.

As for colistin, in a patient with end stage cystic fibrosis, Pseudomonas only sensitive to tobramycin, what do you think?

Likewise, another patient was placed on tigecycline with a strain of Acinetobacter only suscebtible to gentamicin. Would you think colistin may be of use here?
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I thought you were an oncology guy! What's with all this boring ID talk?
 
SpirivaSunrise said:
I thought you were an oncology guy! What's with all this boring ID talk?
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As Epic will be quick to tell you, I am currently a lowly PGY-1 resident (and he would be absolutely right). I am pursuing a second year in heme/onc, which consequently includes a lot of ID.
 
SpirivaSunrise said:
Grrrrrrrrrrr....speakin' of that,

I have some kick-ass drugs you have to read up about. Betcha never even heard of them.
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Haha, do they all start with levo-, dextro-, des-, etc. Real novel therapies? I'm just kidding, I don't actually know who is a drug rep. or not, just am entertained by the banter.
 
Priapism321 said:
Haha, do they all start with levo-, dextro-, des-, etc. Real novel therapies? I'm just kidding, I don't actually know who is a drug rep. or not, just am entertained by the banter.
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No...fortunately I'm not a drug rep (although Epic will beg to differ). He's the real drug rep.

Nuclear by trade...or should we say "nukyuler"? 😉
 
Priapism321 said:
Your first question will take me some time to ponder, as I don't think the release time was strategic; on the surface I feel like you are asking me why Merck tried to gain approval of etoricoxib after rofecoxib was removed from the market: the same reason pharmaceutical companies do everything that they do: money. If they can manipulate people to believe doripenem is superior against Pseudomonas with slanted marketing practices, they win. Though there may be something more, my hospital has not considered even evaluating the agent at this point. As for imipenem, I feel it is inferior; 14% of Pseudomonas strains in the institution I work at are resistant, and it clearly has an inferior toxicity profile. The fact it is going generic makes it worth reanalyzing the cost:benefit ratio. However, I would be hard pressed to think doripenem can do anything meropenem cannot.
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Imi may be inferior at your place because bugs are used to seeing it more often. But at a place where more mero is used, imi could be more potent...part of antibiotic rotation/holiday theory. 14% resistance aint bad. More neuro and seizures with imi? maybe... so reserve mero for neuro patients. But there much more than therapeutics...contracts!! Dori contract is very favorable... and the reason J&J released dori...is to stay in the loop in antimicrobial realm.. until the big guy hits the market. Ceftobiprole.. See..you can show off to your preceptors.. I would inquire about your marketshare contract with mero and imi... and indigent patient stock replacement program Imi vs no indigent program by Astra Zeneca.



As for colistin, in a patient with end stage cystic fibrosis, Pseudomonas only sensitive to tobramycin, what do you think?

Likewise, another patient was placed on tigecycline with a strain of Acinetobacter only suscebtible to gentamicin. Would you think colistin may be of use here?
Click to expand...

1.Use tobra. 2.use gent. I thought you said you guys had an antibiotic stewardship... doesn't sound like it.
 
Priapism321 said:
As Epic will be quick to tell you, I am currently a lowly PGY-1 resident (and he would be absolutely right). I am pursuing a second year in heme/onc, which consequently includes a lot of ID.
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I like pharmacists fresh out of residency... they know so little yet so full of themselves.. Like me right now.

Also, I can make them do goofy project and make it sound oh so important and they eat em up...

I like the preceptors even more... especially with their blinders on.
 
Epic said:
1.Use tobra. 2.use gent. I thought you said you guys had an antibiotic stewardship... doesn't sound like it.
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1. We are, I was just asking; the patient also had synergy studies with another agent that was on board.

2. Patient started complaining of auditory disturbances, was discharged on home tigecycline. Once again, I am just wondering about this from afar. I have not talked with our ID Pharmacists about it. I am hanging on the Bone Marrow Unit, and just happen to be reading some interesting opinions/literature on colistin, and thought I'd run it by you. My whole thing is, our ID Fellows and some Attendings would be much quicker to jump at a carbapenem or tigecycline for a multi-drug resistant gram negative; I am starting to think we should start getting some older drugs back in the mix.

Also, have you seen that a fairly large trial in Israel has begun recruiting patients in a study comparing sulfamethoxazole/trimethoprim versus vancomycin for severe, hospital acquired MRSA infections? This is another area that intrigues me....
 
Epic said:
1.Use tobra. 2.use gent. I thought you said you guys had an antibiotic stewardship... doesn't sound like it.
Click to expand...

Also, based on this answer, you believe aminoglycoside monotherapy is adequate for documented pneumonia? Perhaps this is so; is there data to support this?
 
Priapism321 said:
1. We are, I was just asking; the patient also had synergy studies with another agent that was on board.

2. Patient started complaining of auditory disturbances, was discharged on home tigecycline. Once again, I am just wondering about this from afar. I have not talked with our ID Pharmacists about it. I am hanging on the Bone Marrow Unit, and just happen to be reading some interesting opinions/literature on colistin, and thought I'd run it by you. My whole thing is, our ID Fellows and some Attendings would be much quicker to jump at a carbapenem or tigecycline for a multi-drug resistant gram negative; I am starting to think we should start getting some older drugs back in the mix.

Also, have you seen that a fairly large trial in Israel has begun recruiting patients in a study comparing sulfamethoxazole/trimethoprim versus vancomycin for severe, hospital acquired MRSA infections? This is another area that intrigues me....
Click to expand...


Colistin is an interesting concept. Fairly safe, potent bactericidal, and useful for long term use. Though I believe it's a dropship only and I don't have the cost data. No issuses with therapeutic aspect on my part. But I reserve judgment until I complete a pharmacoeconomics assessment.

Yes, I am aware of smx/tmp vs Vanc. I wish they would mix in dapto and linezolid also...of course that would be difficult to blind. I hope they publish specifics on Vanc levels..which all linezolid and dapto vs vanc studies fail to do.

Too bad cefepime just got blasted by an israel analysis... just after it went generic.
 
Priapism321 said:
Also, based on this answer, you believe aminoglycoside monotherapy is adequate for documented pneumonia? Perhaps this is so; is there data to support this?
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Perhaps mono AG is adequate and no I can't support it with data. But we all know Tobra/Pip Tazo combo provides one of the best synergy.
 
SpirivaSunrise said:
But all the insurance companies just follow suit. Blind leading the blind...at least when it comes to making clinical decisions.
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I resemble that remark...I for one believe CMS did a heckuva job with ESA dosing guideline and monitoring algorithm.. but a drug rep would never understand that..
 
SpirivaSunrise said:
True...it's just frustrating to see reimbursement/financial incentives trump appropriate patient care.
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Before you blame CMS, look to those drug companies taxing the US by forced subsidization of rest of the world in drug cost.
 
SpirivaSunrise said:
I was talking about Zevalin anyways...not your precious ESAs. Zevalin's much cooler anyways.

Oh...and you don't have the power to do that 😉
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Pay attention to scene 7:28 mark.

[youtube]http://www.youtube.com/watch?v=Nn5jlrxcpkI[/youtube]
 
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