What do pharmacy students learn these days?

[lisinopril]

My hospital is not a teaching hospital. However, we do have students from various schools rotating for internship. I've noticed that the quality of students has been going down tremendously. I usually ask questions to see how much a student know. I was in shocking mode last week when asking a group of students (3 of them) from 2 different schools and found out they had no clue what Tygacil is for...what generation of cephalosporin will cover Pseudomona, if Acinobacter is covered by Levaquin or not, if Vanco trough of 10 is okay for Pneumonia patient, normal dosage for Lovenox in ACS prophylaxis etc....all came up with wrong answers.

Of couse, I can't just judge everyone by just 3 of these students...but I'm seeing a trend here. I proceeded to ask a couple more other students other easy questions, such as common dosage of tylenol/frequency, motrin, mucomyst, etc...and I got so irritated with their answers. Worse, some don't even know if motrin has anti pyretic characteristic....How sad.

What are students learning in schools these days? Or has our profession been too easy to accept low qualified students? What do you guys think?

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[R xxx]

Then teach them. Make sure they know the answers when they leave there. Did you know all these answers before you became a pharmacist and see it every day?

 

[lisinopril]

Then teach them. Make sure they know the answers when they leave there. Did you know all these answers before you became a pharmacist and see it every day?

Yes, I didn't know all, but I knew the basis. I knew the maximum dosage of Tylenol/ Motrin/Naproxen/ ASA by 3rd month of pharm school already. Not only me, but all of my classmates also mastered these basic knowledge too way before finishing 1/2 of first year.

By end of 1st year, we already learned and mastered all PKs, peak/trough, etc...By the end of the second year, we all learned Antibiotics and pharmacy therapeutics...Name us a bug, we will tell you which Abx will cover/not cover and how much percentage resistance pertinent to that point.

 

[radio frequency]

Yes, I didn't know all, but I knew the basis. I knew the maximum dosage of Tylenol/ Motrin/Naproxen/ ASA by 3rd month of pharm school already. Not only me, but all of my classmates also mastered these basic knowledge too way before finishing 1/2 of first year.

By end of 1st year, we already learned and mastered all PKs, peak/trough, etc...By the end of the second year, we all learned Antibiotics and pharmacy therapeutics...Name us a bug, we will tell you which Abx will cover/not cover and how much percentage resistance pertinent to that point.

Some schools have different orders for their curriculum. Not everyone does PK first year; some do it third year or second. Not every school covers abx and all of therapeutics in second year, either. All students should be receiving at least a baseline of similar learning, but the order is often different depending on the school, so comparing today's students' experiences with your experience isn't really that helpful. Some schools also eschew teaching brand names as they change so often, so it's up to the student to learn these themselves before graduation -- so if a student doesn't know Mucomyst or Motrin, they might know acetylcysteine or ibuprofen.

A complete aside, but why do you list all your weaponry in your signature?

 

[BMBiology]

He said these students are on rotation which means they are in their last year of pharmacy school.

 

[n0n0nsense]

He said these students are on rotation which means they are in their last year of pharmacy school.

they could also be P2/P3 students on their IPPE rotations during summer.

 

[Sparda29]

Schools don't teach drugs all in the same order.

We learned Antimicrobial Drugs in the first semester of school but we didn't learn Psych Drugs or Chemo Drugs or Neurology drugs until the end of 2nd year. Meanwhile some of my buddies from St. Johns told me ID was the last subject they learned.

 

[xiphoid2010]

Schools don't teach drugs all in the same order.

We learned Antimicrobial Drugs in the first semester of school but we didn't learn Psych Drugs or Chemo Drugs or Neurology drugs until the end of 2nd year. Meanwhile some of my buddies from St. Johns told me ID was the last subject they learned.

It should not matter though when they are on their last year of rotations in OP's case. I noticed that ID has traditionally been one of, if not the, weakest area for students. Probably because most are going to retail and they just don't care.

 

[Sugoi Travis]

If I was in a situation where I didn't know the answer to a question someone gave me, I'd much rather say "I don't know the answer, but I'd be willing to look it up and get back to you shortly." I'd assume that's at least a better response than giving out a blatant wrong answer, but what do I know?

 

[awval999]

My hospital is not a teaching hospital. However, we do have students from various schools rotating for internship. I've noticed that the quality of students has been going down tremendously. I usually ask questions to see how much a student know. I was in shocking mode last week when asking a group of students (3 of them) from 2 different schools and found out they had no clue what Tygacil is for...what generation of cephalosporin will cover Pseudomona, if Acinobacter is covered by Levaquin or not, if Vanco trough of 10 is okay for Pneumonia patient, normal dosage for Lovenox in ACS prophylaxis etc....all came up with wrong answers.

Tygacil --- It's an antibiotic, treats gram +, I believe. It's non-formulary here.
Cephalosporin to treat Pseudomonas --- Cefepime and cefotaxime
Levaquin and Acinobacter--- I have no idea
Vanco trough --- We aim for 15-20
Lovenox in prophylaxis --- 40mg q24hours (30mg q24hours if CrCL<30mL/min)

How'd I do?

Those questions are hard by the way.

 

[xiphoid2010]

Tygacil --- It's an antibiotic, treats gram +, I believe. It's non-formulary here.
Cephalosporin to treat Pseudomonas --- Cefepime and cefotaxime
Levaquin and Acinobacter--- I have no idea
Vanco trough --- We aim for 15-20
Lovenox in prophylaxis --- 40mg q24hours (30mg q24hours if CrCL<30mL/min)

How'd I do?

Those questions are hard by the way.

You choose poorly...on ID. ** image: you shrivil up into a skeleton and die, aka Indiana Jones style **

 

[awval999]

You did poorly on ID.

I HATE ID

I will review it again before BCPS.

 

[xiphoid2010]

Tygacil --- It's an antibiotic, treats gram +, I believe. It's non-formulary here.
Cephalosporin to treat Pseudomonas --- Cefepime and cefotaxime
Levaquin and Acinobacter--- I have no idea
Vanco trough --- We aim for 15-20
Lovenox in prophylaxis --- 40mg q24hours (30mg q24hours if CrCL<30mL/min)

How'd I do?

Those questions are hard by the way.

To expand on my tongue in cheek comment:

Tygacil covers just about everything except very few exception, most notabily pseudomonas.

Levaquin and acinetobacter, very iffy (then again what isn't short of colistin). It's more important to know cabapenems are 1st line.

Vanc tough: 6 indications + 1 MIC cut-off calls for 15-20.

 

[Sparda29]

It should not matter though when they are on their last year of rotations in OP's case. I noticed that ID has traditionally been one of, if not the, weakest area for students. Probably because most are going to retail and they just don't care.

I noticed that also about ID. I was one of the few that actually liked ID and found it interesting. Generally speaking, when docs around my hospital have an ID question, I've been noticing that they've been calling and asking for me instead of the clinical pharmacist.

I am the suck though when it comes to oncology. Hate it, and never cared about it. I probably never went to any of the lectures on oncology, failed that entire portion of Therapeutics, and probably got every question about Oncology on the NAPLEX wrong. Figured the only time I'd ever see it is if I decide to work at an Oncology Center or Hospital. Only thing I could tell someone is to take Dexamethasone, Diphenhydramine, and Famotidine 30 mins prior to the chemo.

 

[joetrisman]

To expand on my tongue in cheek comment:

Tygacil covers just about everything except very few exception, most notabily pseudomonas.

Levaquin and acinetobacter, very iffy (then again what isn't short of colistin). It's more important to know cabapenems are 1st line.

Vanc tough: 6 indications + 1 MIC cut-off calls for 15-20.

Bah, I'd take ceftaroline over tygacil any day. Add vanco too.

In my limited experience with KPCs, I've not had much luck with colistin. Doesn't help no one knows how to dose it.

 

[joetrisman]

OP, different stroke, different folks. Dollars to donuts your students can whip up some butt paste in a jiffy

 

[xiphoid2010]

Bah, I'd take ceftaroline over tygacil any day. Add vanco too.

In my limited experience with KPCs, I've not had much luck with colistin. Doesn't help no one knows how to dose it.

I like Teflaro as second/third line for MRSA but it simply doesn't have the broad spectrum like tygacil. Eg, don't cover VRE, anaeobes, atypical, acinetobacters...

Colistin is the gram negative drug of last resort. You use it when it's pan resistant, and and you are willing to sacrifice the kidneys to salvage a life or death situation.

 

[joetrisman]

I like Teflaro as second/third line for MRSA but it simply doesn't have the broad spectrum like tygacil. Eg, don't cover VRE, anaeobes, atypical, acinetobacters...

Colistin is the gram negative drug of last resort. You use it when it's pan resistant, and and you are willing to sacrifice the kidneys to salvage a life or death situation.

Eh, if someone needs an agent that broad, they *usually* don't know what they're doing (insert vanco+zosyn for everyone that walks in my ED).

Plus teflaro doesn't have an FDA bulletin and meta-analysis saying it kills pts

B-lactams

 

[xiphoid2010]

Eh, if someone needs an agent that broad, they *usually* don't know what they're doing (insert vanco+zosyn for everyone that walks in my ED).

Plus teflaro doesn't have an FDA bulletin and meta-analysis saying it kills pts

B-lactams

Its should not be used cart blanche, but I can think of few places where it make sense. You'll see those in time.

PS. The data on higher mortality is only in one subpopulation if my memories serve. But I haven't been able to keep up with the journals since I got planted behind a desk.

 

[farmadiazepine]

My hospital is not a teaching hospital. However, we do have students from various schools rotating for internship. I've noticed that the quality of students has been going down tremendously. I usually ask questions to see how much a student know. I was in shocking mode last week when asking a group of students (3 of them) from 2 different schools and found out they had no clue what Tygacil is for...what generation of cephalosporin will cover Pseudomona, if Acinobacter is covered by Levaquin or not, if Vanco trough of 10 is okay for Pneumonia patient, normal dosage for Lovenox in ACS prophylaxis etc....all came up with wrong answers.

Of couse, I can't just judge everyone by just 3 of these students...but I'm seeing a trend here. I proceeded to ask a couple more other students other easy questions, such as common dosage of tylenol/frequency, motrin, mucomyst, etc...and I got so irritated with their answers. Worse, some don't even know if motrin has anti pyretic characteristic....How sad.

What are students learning in schools these days? Or has our profession been too easy to accept low qualified students? What do you guys think?

I am a God damn good pharmacist. I can't even answer any one of the questions you just posted.

Maybe you are forgetting that when PHARMACY students go on clinical rotations, they are there to LEARN. You have to TEACH THEM. Now, when you finally teach them these things, and 2 weeks later they can't give you answers to any of these questions, then its a problem.

But seriously, the questions you ask are like non-sense. The only possible time you need to know the answers to your questions are in your pharmacy setting. There are a million pharmacy settings. Maybe a good idea would be to straight up teach the kids or give them a cheat sheet in the first 2 days, have them memorize it, and then they will be good to go for the rest of the rotation.

The rotations where I learned the most was where my preceptors taught me the most. Rotations where preceptors expected me to know everything, I quit. I literally quit like I was quitting a job. Of course my school got mad at me, but thats besides the point.

 

[type b pharmD]

I am a God damn good pharmacist. I can't even answer any one of the questions you just posted.

Maybe you are forgetting that when PHARMACY students go on clinical rotations, they are there to LEARN. You have to TEACH THEM. Now, when you finally teach them these things, and 2 weeks later they can't give you answers to any of these questions, then its a problem.

But seriously, the questions you ask are like non-sense. The only possible time you need to know the answers to your questions are in your pharmacy setting. There are a million pharmacy settings. Maybe a good idea would be to straight up teach the kids or give them a cheat sheet in the first 2 days, have them memorize it, and then they will be good to go for the rest of the rotation.

The rotations where I learned the most was where my preceptors taught me the most. Rotations where preceptors expected me to know everything, I quit. I literally quit like I was quitting a job. Of course my school got mad at me, but thats besides the point.

Agree completely.

Also...Who the **** memorizes which generation each of the 50 identical sounding cephalosporins belongs to? Isnt knowing top 5 spectrum of activity enough?

People also have a variety of interests .. I didn't do too well in areas I hated in pharmacy school .. when I got to rotations.. some preceptors ****td on me cause they wanted to feel high and mighty cause i didnt know squat about their pet projects and *their* interests.. some on the other hand . In my areas of interest , told me I already knew everything they could teach me on day 1.
Its my view that students on rotation are not there to be or to become experts like clinical subspecialists. Half of any given student's rotations are going to be like shadowing for them and are meant to be informative and provide exposure. Preceptor is supposed to help. .

I think OPs question is mildly amusing because there are some dumb ****s out there lol . But beyond that .. give people a bit of a break.. maybe they know the answers but your questioning process is the problem? A lot of people don't do well with confidence and recall if they are nervous.

 

[Corpseman]

OP just goes to show that there are just as many dumbf**ks as preceptors as there are students.

 

[PharmdA07]

OP just goes to show that there are just as many dumbf**ks as preceptors as there are students.

LOL.. my 2 cents for tygacil (as I was taught by an extremely smart but nice and humble preceptor when I was a student): its Vd is large so it goes everywhere (just like the "tiger" running around to every corner of the jungle), so it should not used for any type of systemic bacteremia.

The thing about students just that they are just like your regular patients (speaking in a context of retail as I've been doing it for almost three years): take them as they are; some are great, some are not; just like your walk-in regular joes: some are nice, some are nasty to deal with. I agree with the other poster that they are there to learn and you should be teaching them, not showing them how smart you are.

I still remember my first day precepting, although it was a retail setting, I was mad that my intern did not know what OTC allergy meds to recommend for a BPH patient. I later found out although she was P3, but it was her beginning semester and they hadn't learn all about BPH yet. And then in my hospice setting, I was irritated when a student couldn't come up with a recommendation for skin abscess case in which pt complained of n/v with Bactrim DS; I got even madder when I asked him what common bug to cover when dealing with skin abscess and he answered Pseudomonas (?!) Oh well, I found out towards the end of the rotation that he was really weak with ID and always picked a serious and most common bug to answer when asked about bugs (hence, Pseudomonas), but it led me to spend more time with him on bugs and coverage at least.

I guess my point is that you just need to be patient with them as they are still learning. Now I only take student occasionally but every time when I am about to snap, I'd always imagine my time being a student and calm down slowly and tell them that if they don't know, it's ok but please look it up and get back to me by the end of the day. Now for the know-it-all interns or those who have no respect for me (the ones going to retail and don't care much about learning cause they will graduate anyway), then it's a different story

 

[thephoenician88]

My hospital is not a teaching hospital. However, we do have students from various schools rotating for internship. I've noticed that the quality of students has been going down tremendously. I usually ask questions to see how much a student know. I was in shocking mode last week when asking a group of students (3 of them) from 2 different schools and found out they had no clue what Tygacil is for...what generation of cephalosporin will cover Pseudomona, if Acinobacter is covered by Levaquin or not, if Vanco trough of 10 is okay for Pneumonia patient, normal dosage for Lovenox in ACS prophylaxis etc....all came up with wrong answers.

Of couse, I can't just judge everyone by just 3 of these students...but I'm seeing a trend here. I proceeded to ask a couple more other students other easy questions, such as common dosage of tylenol/frequency, motrin, mucomyst, etc...and I got so irritated with their answers. Worse, some don't even know if motrin has anti pyretic characteristic....How sad.

What are students learning in schools these days? Or has our profession been too easy to accept low qualified students? What do you guys think?

I didn't know the answers to some of those till after rotations.


my old school professors wouldn't dare discuss tygacil. Even on my rotations, no one really mentioned it.

 

[lisinopril]

I strongly believe that the standard of our profession has gone down for the past five years. This is now more like a quantity vs quality issue. I soon realize the pharmacy schools accept very poor qualified indivituals. Of course, I am not saying all pharm students are dumb f*, but these indivitual students' ability really raise the issue.

As a soon to be pharmacist, how can you not know what Tygacil is for, or normal dosage of Lovenox for ACS/DVT prophylaxis. I swear I just asked one student on spot from this school the maximum dosage of Tylenol and this student does not even have a clue. (Granted she was 2nd year, but still...wtf?). How could we have such low qualified students nowsaday?

As you all know, we have more than 120+ pharmacy schools now across nationwide. The number will be even higher in future. Accepting low qualified students also means producing low qualified pharmacists. GARBAGE IN = GARBAGE OUT.

 

[rph3664]

The one time I've seen Colistin given IV was for a child with CF who had a pseudomonas flare. I've seen it used many times in a nebulizer.

 

[BMBiology]

Just look at the pre-pharmacy forum. You will read things like "I have a 2.6 GPA. I can't believe after 5 years of applying I finally got accepted. It must have been my personal statement".

Of course GPA is not everything but why did he get accepted this year and not the previous 5 years?

Record number of schools = low admission standards.

 

[awval999]

Just look at the pre-pharmacy forum. You will read things like "I have a 2.6 GPA. I can't believe after 5 years of applying I finally got accepted. It must have been my personal statement".

Of course GPA is not everything but why did he get accepted this year and not the previous 5 years?

Record number of schools = low admission standards.

Of course this is true. More schools, lower quality candidates.

 

[BMBiology]

The sad part is that many of these students will graduate and they won't be able to find a job. By then I am sure even Barrow, Alaska will be swamped with pharmacists (if it hasn't already).

 

[confettiflyer]

My UCSF students have been pretty good. I'm 4 for 4 in giving them my work by the end of week 1 and requiring minimal intervention.

Actually no it's 4 for 5....that 5th one was horrible, I nearly failed her for violating hospital policy multiple times and just being a general airhead. Oh well. Can't win 'em all.

 

[xiphoid2010]

The one time I've seen Colistin given IV was for a child with CF who had a pseudomonas flare. I've seen it used many times in a nebulizer.

Mostly have seen it few times in MICU, and eg. Septic patient with pan resistant pseudo. In general, the gram negative sepsis generate higher and faster mortality than gram positive ones. So if the patient doesn't look like will make it, colistin suddenly doesn't look that ugly. It does take a doc who has some experience/balls to order it, and it helps if the patient is on the younger side.

 

[clerkmaxwell]

My hospital is not a teaching hospital. However, we do have students from various schools rotating for internship. I've noticed that the quality of students has been going down tremendously. I usually ask questions to see how much a student know. I was in shocking mode last week when asking a group of students (3 of them) from 2 different schools and found out they had no clue what Tygacil is for...what generation of cephalosporin will cover Pseudomona, if Acinobacter is covered by Levaquin or not, if Vanco trough of 10 is okay for Pneumonia patient, normal dosage for Lovenox in ACS prophylaxis etc....all came up with wrong answers.

Of couse, I can't just judge everyone by just 3 of these students...but I'm seeing a trend here. I proceeded to ask a couple more other students other easy questions, such as common dosage of tylenol/frequency, motrin, mucomyst, etc...and I got so irritated with their answers. Worse, some don't even know if motrin has anti pyretic characteristic....How sad.

What are students learning in schools these days? Or has our profession been too easy to accept low qualified students? What do you guys think?

 

[BidingMyTime]

I disagree with those who think the OP is asking hard-ball questions. I think those were all very reasonable questions. Really, someone in their last year of pharmacy school who doesn't know that ibuprofen can reduce a fever???? Really???? I haven't worked hospital for several years, since before Tygarcil was approved, and even I know its a broad-spectrum antibiotic (granted I couldn't name off specific bugs it deals with, but from the OP it sounds like his students didn't even know it was an antibiotic.) All the op's questions sound like something a soon to be pharmacist fresh from school should have a reasonable idea about. It's not like he's asking someone on the spot to name chemotherapy dosing in a pediatric patient or treatment for cholestasis in a pregnant lady--that's specific stuff, that only people working with that population would know.

But, I also agree with those who say the best course of action is to teach. That is what a preceptor does. Ultimately, its the schools fault (not the students) for passing these students through courses without ensuring they have a reasonable knowledge base. Granted, it's not really fair to ask the preceptor to teach basic knowledge sets....but it is what it is. Lisinopril, I hope you will do what you can to help these students learn what they need to know (and hopefully the students will be smart enough to appreciate what you are doing for them.)

 

[Sparda29]

We give out Colistin like almost every ****ing day here. Usually it's just one or two patients who are in the ICU. The ID docs love it.

 

[MackandBlues]

Tygacil --- It's an antibiotic, treats gram +, I believe. It's non-formulary here.
Cephalosporin to treat Pseudomonas --- Cefepime and cefotaxime
Levaquin and Acinobacter--- I have no idea
Vanco trough --- We aim for 15-20
Lovenox in prophylaxis --- 40mg q24hours (30mg q24hours if CrCL<30mL/min)

How'd I do?

Those questions are hard by the way.

all these are appropriate questions a pharmacy student should be learning how to answer in their 4 year rotations in a hospital setting. When I help precept medical students or pharmacy students I always ask: what drugs cover pseudomonas, what drugs cover MRSA, which abx do not require renal dose adjustment, and what drugs cover anaerobes?

 

[naseuy]

all these are appropriate questions a pharmacy student should be learning how to answer in their 4 year rotations in a hospital setting. When I help precept medical students or pharmacy students I always ask: what drugs cover pseudomonas, what drugs cover MRSA, which abx do not require renal dose adjustment, and what drugs cover anaerobes?

My recommendation for students on rotation would be to list all the drugs with pseudomonal coverage on one side of an index card, and MRSA on the other (if only the answer questions from your preceptor)

 

[Lubeckd]

My hospital is not a teaching hospital. However, we do have students from various schools rotating for internship. I've noticed that the quality of students has been going down tremendously. I usually ask questions to see how much a student know. I was in shocking mode last week when asking a group of students (3 of them) from 2 different schools and found out they had no clue what Tygacil is for...what generation of cephalosporin will cover Pseudomona, if Acinobacter is covered by Levaquin or not, if Vanco trough of 10 is okay for Pneumonia patient, normal dosage for Lovenox in ACS prophylaxis etc....all came up with wrong answers.

Of couse, I can't just judge everyone by just 3 of these students...but I'm seeing a trend here. I proceeded to ask a couple more other students other easy questions, such as common dosage of tylenol/frequency, motrin, mucomyst, etc...and I got so irritated with their answers. Worse, some don't even know if motrin has anti pyretic characteristic....How sad.

What are students learning in schools these days? Or has our profession been too easy to accept low qualified students? What do you guys think?

Tigecycline is for MRSA and vancomycin resistant mrsa. You can try to use daptomycin for vancomycin resistant mrsa or LineZolid. 3rd and 4th gen covers pseudo. For acinobact, I'm not sure, Levo covers a negative spectrum... Vancomycin trough is higher in spinal cord infected patients with meningitis which is above 20...

 

[Praziquantel86]

Tigecycline is for MRSA and vancomycin resistant mrsa. You can try to use daptomycin for vancomycin resistant mrsa or LineZolid. 3rd and 4th gen covers pseudo. For acinobact, I'm not sure, Levo covers a negative spectrum... Vancomycin trough is higher in spinal cord infected patients with meningitis which is above 20...

I'd quote Billy Madison here...all of those answers are pretty off the mark.

Tigecycline, in theory, would cover vancomycin resistant MRSA. However, given the number of cases that have been reported (think single digits), it is not the main use. I think you're confusing Staph with Enterococcus. Some, not all, 3rd generation cephalosporins cover Pseudomonas. Levofloxacin has a Gram-negative and Gram-positive spectrum. Vancomycin troughs per guidelines are higher in meningitis (which is I suppose by definition a patient with an infected portion of the spinal cord), but are certainly not higher than 20.

 

[trailerpark]

Unrelated question, does anyone know why a patient would be on both a conventional and atypical antipsychotic? Why not just make the complete switch to the atypicals if the movement disorders become too problematic with just a conventional?

 

[farmadiazepine]

We give out Colistin like almost every ****ing day here. Usually it's just one or two patients who are in the ICU. The ID docs love it.

I had no idea what colistin was until a kid who was getting TOBI came into my retail independent and needed colistin for his nebulizer machine 2 weeks on 2 weeks off. it was insane the prep work for it, getting colistin vials, swfi, ns, syringes, swabs, and teaching the nurse how to reconstitute all this stuff and using it in the nebulizer. very rewarding. never thought i would be dispensing something like that in retail.

 

[xiphoid2010]

I had no idea what colistin was until a kid who was getting TOBI came into my retail independent and needed colistin for his nebulizer machine 2 weeks on 2 weeks off. it was insane the prep work for it, getting colistin vials, swfi, ns, syringes, swabs, and teaching the nurse how to reconstitute all this stuff and using it in the nebulizer. very rewarding. never thought i would be dispensing something like that in retail.

Colistin nebs is relatively harmless, might cause some bronchospams that can be helped with pred-medicate with bronchodilators. It's the IV colistin that tend to box your kidney, I almost want to say more than 1 in 2. Hadn't seen many CF patients outside of university medical center, but if if you think pan-resistant pseudo is bad, wait until you see a pan-resistant burkholderia, you pretty much just throws your hands up at that point.

 

[confettiflyer]

Colistin nebs is relatively harmless, might cause some bronchospams that can be helped with pred-medicate with bronchodilators. It's the IV colistin that tend to box your kidney, I almost want to say more than 1 in 2. Hadn't seen many CF patients outside of university medical center, but if if you think pan-resistant pseudo is bad, wait until you see a pan-resistant burkholderia, you pretty much just throws your hands up at that point.

I once saw a case of pan-resistant acinetobacter, needless to say the pt expired. You get chills seeing the row of "R's" on the C&S.

 

[zelman]

Unrelated question, does anyone know why a patient would be on both a conventional and atypical antipsychotic? Why not just make the complete switch to the atypicals if the movement disorders become too problematic with just a conventional?

$

 

[Lubeckd]

Double post.

 

[Lubeckd]

I'd quote Billy Madison here...all of those answers are pretty off the mark.

Tigecycline, in theory, would cover vancomycin resistant MRSA. However, given the number of cases that have been reported (think single digits), it is not the main use. I think you're confusing Staph with Enterococcus. Some, not all, 3rd generation cephalosporins cover Pseudomonas. Levofloxacin has a Gram-negative and Gram-positive spectrum. Vancomycin troughs per guidelines are higher in meningitis (which is I suppose by definition a patient with an infected portion of the spinal cord), but are certainly not higher than 20.

You are getting very deep with the answers. I know Levo has a gram negative coverage. Only one 3rd gen covers pseudo, colistin is used for multiple resistant bacteria including bio films. I never heard of tigecycline being covered for so many other bacterias. Vanco trough are higher in meningitis patients because its not first line and takes more dose to penetrate the cns of the brain.

 

[njac]

You are just getting in deep with the answers. The trough is Higher in meningitis patients because vancomycin isnt a first line therapy, and it takes longer to diffuse into the brain, this is usually used for someone with a gunshot as my professor said.

Do we need to give abx prophylaxis for GSWs?

Overall, I've been underwhelmed by the majority of the students I've had in the last 2 years since finishing residency and working at a community hospital. I will say that the good ones (and I get students from all over the country, people like to come home for rotations) have been PHENOMENAL.

Precepting at a teaching hospital associated with a pharmacy school was much easier as a preceptor. All of my students came from the same program, so I could have standard expectations.

I'm learning as a preceptor to adapt my expectations to the student. I'm considering developing a pretest/posttest so I can know what I'm getting to work with from day 1.

 

[Lubeckd]

Do we need to give abx prophylaxis for GSWs?

Overall, I've been underwhelmed by the majority of the students I've had in the last 2 years since finishing residency and working at a community hospital. I will say that the good ones (and I get students from all over the country, people like to come home for rotations) have been PHENOMENAL.

Precepting at a teaching hospital associated with a pharmacy school was much easier as a preceptor. All of my students came from the same program, so I could have standard expectations.

I'm learning as a preceptor to adapt my expectations to the student. I'm considering developing a pretest/posttest so I can know what I'm getting to work with from day 1.

No idea, didn't learn it. I suppose you would give prophylaxis with a broad spectrum abx for empirical therapy. Just giving a example of how troughs aren't always 15 to 20. My answers aren't the best, but it's not incorrect.

 

[njac]

No idea, didn't learn it. I suppose you would give prophylaxis with a broad spectrum abx for empirical therapy. Just giving a example of how troughs aren't always 15 to 20. My answers aren't the best, but it's not incorrect.

You are the one who specifically mentioned gunshot, which is why I asked that question.

 

[Carboxide]

Do we need to give abx prophylaxis for GSWs?

Overall, I've been underwhelmed by the majority of the students I've had in the last 2 years since finishing residency and working at a community hospital. I will say that the good ones (and I get students from all over the country, people like to come home for rotations) have been PHENOMENAL.

Precepting at a teaching hospital associated with a pharmacy school was much easier as a preceptor. All of my students came from the same program, so I could have standard expectations.

I'm learning as a preceptor to adapt my expectations to the student. I'm considering developing a pretest/posttest so I can know what I'm getting to work with from day 1.

I would hazard a guess that it depends on where it is. Frequently they're abdominal, in which case absolutely. If it's a brush on the outer arm or a skin nip and not a deep puncture, probably not. If it's a shotgun shell to a non-organ area (buttocks, arm, leg) and they are cleanly removed, again probably not.

Regarding the original questions:

what Tygacil is for...what generation of cephalosporin will cover Pseudomona, if Acinobacter is covered by Levaquin or not, if Vanco trough of 10 is okay for Pneumonia patient, normal dosage for Lovenox in ACS prophylaxis etc....all came up with wrong answers.

Tygacil is a relatively broad-spectrum abx that would be much better if it covered PSA. I don't see it used much except against MDR gram negatives.

3rd and 4th gen cefs cover PSA.

Acinetobacter can be covered by Levaquin. Resistance in my area is pretty high, though. Drug of choice in my hospital is meropenem.

Vanco trough for PNA should be 15-20. But it's not an idea PNA drug unless pt is b-lac allergic.

ACS prophy: 30 mg Lovenox BID.

I only had to look up one of those.

 

[njac]

3rd and 4th gen cefs cover PSA.

Acinetobacter can be covered by Levaquin. Resistance in my area is pretty high, though. Drug of choice in my hospital is meropenem.

Vanco trough for PNA should be 15-20. But it's not an idea PNA drug unless pt is b-lac allergic.

ACS prophy: 30 mg Lovenox BID.

I only had to look up one of those.

Double check some of these...

But you're right on the gsw question. It's not a yes/no answer, location is a huge determinant.