What do pharmacy students learn these days?

[MackandBlues]

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:



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.

try again

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[MackandBlues]

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.

Just to be complete for the pharmacy students reading this, vancomycin IS first line for meningitis patients along with at least one other abx.

 

[Carboxide]

try again

the only one of those I am seeing any change in after looking up is the vanco one...and I maintain it is not first line treatment. It might be used empirically if the patient is at risk for MRSA, but b-lacs are better at treating PNA and if the patient is not b-lactam allergic and not at risk for MRSA pneumo then I would never use vanco.

Well, thinking more about the Lovenox question...I may have misunderstood your term 'prophylaxis.' If you mean bridging to warfarin/active anticoag dosing, it is of course 1 mg/kg BID or 1.5 mg/kg QD. Is that what you meant?

 

[Sparda29]

the only one of those I am seeing any change in after looking up is the vanco one...and I maintain it is not first line treatment. It might be used empirically if the patient is at risk for MRSA, but b-lacs are better at treating PNA and if the patient is not b-lactam allergic and not at risk for MRSA pneumo then I would never use vanco.

Well, thinking more about the Lovenox question...I may have misunderstood your term 'prophylaxis.' If you mean bridging to warfarin/active anticoag dosing, it is of course 1 mg/kg BID or 1.5 mg/kg QD. Is that what you meant?

Think he meant for DVT prophylaxis.

CrCL > 30 = 40 mg q24h
CrCL < 30 = 30 mg q24h

 

[knight on horse]

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.

Whoa, whoa, whoa. Do NOT give empiric broad spectrum just like that

It merits some thought before we use what is with little exaggeration the last line of defense of civilization

 

[MackandBlues]

Go read the hospital acquired and ventilator associated pneumonia guidelines. MRSA always needs to be covered empirically in a hospital setting for HCAP and VAP.

 

[MackandBlues]

Also all 3rd generation cephs do not cover PSA.

 

[joetrisman]

Also all 3rd generation cephs do not cover PSA.

but but but...that's not what sanford says (actually, I dont recall if its says +/- for a 3rds but it definitely does for rocephin )

 

[njac]

but but but...that's not what sanford says (actually, I dont recall if its says +/- for a 3rds but it definitely does for rocephin )

Rocephin did when it first came out. Notsomuch these days.

 

[joetrisman]

Rocephin did when it first came out. Notsomuch these days.

I'm not that old

 

[Carboxide]

Go read the hospital acquired and ventilator associated pneumonia guidelines. MRSA always needs to be covered empirically in a hospital setting for HCAP and VAP.

Like I said...not first choice unless they're at risk for MRSA....

Also all 3rd generation cephs do not cover PSA.

No, but some do...you asked generations, not specific ones. You have to include 3rd gen in that because some do.

 

[njac]

I'm not that old

Lol, me neither, it's one of those hearsay things.

 

[DiomedeaExulans]

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?

With the out-of-control increase in pharmacy schools, the overall quality of accepted students has gone down. Also, in the curriculum, there now seems to be more busy work such as reflective portfolio which eats up a lot of study time without increasing the students' knowledge. Finally most students forget a good chunk of what they have memorized for the exams by the time they get to rotations. Doses and brand names are usually the first to go.

 

[radio frequency]

With the out-of-control increase in pharmacy schools, the overall quality of accepted students has gone down. Also, in the curriculum, there now seems to be more busy work such as reflective portfolio which eats up a lot of study time without increasing the students' knowledge. Finally most students forget a good chunk of what they have memorized for the exams by the time they get to rotations. Doses and brand names are usually the first to go.

This is true. There is *way too much* busy work in the curriculum that eats up valuable time. So many students come to pharmacy with 4 year degrees already; why make them do undergrad-type reflection work on feelings/etc?

 

[joetrisman]

This is true. There is *way too much* busy work in the curriculum that eats up valuable time. So many students come to pharmacy with 4 year degrees already; why makes them do undergrad-type reflection work on feelings/etc?

I have an unsubstantiated hunch that educators are trying to remain relevant in the age of the internet through facilitating more abstract conduits of "educating". We live in interesting times.

 

[croquemonsieur]

This is true. There is *way too much* busy work in the curriculum that eats up valuable time. So many students come to pharmacy with 4 year degrees already; why make them do kindergarten-type reflection work on feelings/etc?

Fixed that for you.

 

[radio frequency]

Fixed that for you.

 

[KARM12]

ID is taught poorly in pharmacy schools...heck most non-ID/ICU pharms in hospital are pretty bad at ID.

It also scares me that someone mentioned meropenem is the drug of choice for empiric therapy.

I also hate the reflection/tell me how you feel assignments. I don't give a crap, how you feel, I need you to not kill patients. I'm more concerned that your student can't tell me what drugs have anti-MRSA activity...

 

[Carboxide]

ID is taught poorly in pharmacy schools...heck most non-ID/ICU pharms in hospital are pretty bad at ID.

It also scares me that someone mentioned meropenem is the drug of choice for empiric therapy.

I also hate the reflection/tell me how you feel assignments. I don't give a crap, how you feel, I need you to not kill patients. I'm more concerned that your student can't tell me what drugs have anti-MRSA activity...

For acinetobacter? Until we get sensitivities, yeah. It's frequently highly resistant and is intrinsically resistant to B-lacs, aminoglycosides, etc. Fluoroquinolones are not ideal for treating serious infection because they don't work that fast. What would YOUR drug of choice for acinetobacter without sensitivities be?

 

[joetrisman]

For acinetobacter? Until we get sensitivities, yeah. It's frequently highly resistant and is intrinsically resistant to B-lacs, aminoglycosides, etc. Fluoroquinolones are not ideal for treating serious infection because they don't work that fast. What would YOUR drug of choice for acinetobacter without sensitivities be?

I've not followed the discourse, but at you, a student, trying to teach Karm, a seasoned ID pharmacist, something about ID.

 

[xiphoid2010]

I've not followed the discourse, but at you, a student, trying to teach Karm, a seasoned ID pharmacist, something about ID.

Carbapenem has been traditionally and still is a first line. Karm is thinking about unasyn, which is another first line option, but there is several practical limitation to using it empirically.

For one thing, the first result that comes back from the lab that suggest acinetobacter is a possibility is something like this: gram negative bacilli, non-lactose fermenter. So pseudomonas, acinetobacter, and stenotrophomonas are the 3 bugs that comes to your mind, with pseudo > acineto > steno in terms of frequency. Unfortunately unasyn doesn't do a thing for pseudo, that hence most docs will start with a carbapenem first.

 

[Carboxide]

I've not followed the discourse, but at you, a student, trying to teach Karm, a seasoned ID pharmacist, something about ID.

Lol. Good point.

Edit: Unasyn is not on formulary at my hospital.

 

[68quebec]

I can't believe that you are just bullshxting about students who do not know the answer of your questions.. guess what? a lot of pharmacists cannot give you the right answer at the moment when I asked. However, they are willing to find from resources and come back to me..how about this? if students had attitude like 'whatever, he's such a doxchbag', then yes, students fault. But if they are willing to learn, then your job is to TEACH them, not bullshxitting in the forum.

 

[Corpseman]

This is what I feel when I read this thread.

*Pushes glasses up nose and uses most nerdiest of voices*


"My level 7 sword is bigger than your level 6 sword" *snort*

 

[68quebec]

This is what I feel when I read this thread.

*Pushes glasses up nose and uses most nerdiest of voices*


"My level 7 sword is bigger than your level 6 sword" *snort*

hey my level 4 sword is still worth it and it has 20% increase of mana regeneration! ...jk. I so miss world of warcraft =/

 

[Praziquantel86]

I can't believe that you are just bullshxting about students who do not know the answer of your questions.. guess what? a lot of pharmacists cannot give you the right answer at the moment when I asked. However, they are willing to find from resources and come back to me..how about this? if students had attitude like 'whatever, he's such a doxchbag', then yes, students fault. But if they are willing to learn, then your job is to TEACH them, not bullshxitting in the forum.

But why is it acceptable for "let me get back to you" to be the right answer for even basic questions (I'm talking about pharmacists, not students). I'm not saying that we should know everything, but at some point, you should be expected to know the information before it is actually asked of you.

 

[KARM12]

For acinetobacter? Until we get sensitivities, yeah. It's frequently highly resistant and is intrinsically resistant to B-lacs, aminoglycosides, etc. Fluoroquinolones are not ideal for treating serious infection because they don't work that fast. What would YOUR drug of choice for acinetobacter without sensitivities be?

Missed the part about acinetobacter...I thought meropenem was your empiric GNR drug of choice.... that is what scared me!!!!

 

[Carboxide]

Missed the part about acinetobacter...I thought meropenem was your empiric GNR drug of choice.... that is what scared me!!!!

Haha no, definitely not. Glad we agree...because I honestly did not see what a better choice would be...

 

[Sparda29]

The one thing I can never remember is usual concentrations and infusion times of IV drugs. Always have to look that stuff up.

 

[rxlea]

I think the smartest thing to do before a rotation is to read up on the rotation specific material.

On an ID rotation? Read the damn guidelines, get the institution bio gram, ask where you can access the formulary, and get a copy of the dosing protocol(s). Read that **** everyday and/or use your resources everyday.

I show up at rotation every morning 1-2 hours before rounds depending on patient load, look at my patients' charts/labs, read up on **** I can't remember or don't know, and move on with my day.

Seriously, go in prepared so you don't look like a complete ***** when they ask you if your patient needs synercid.

 

[samisab786]

I'm a P4 in a long standing 0-6 program and I don't know a lot of the answers to your abx questions. We were re-learning abx today and I forgot a lot of stuff that I know I have to review bc we learned it 2 years ago. I'm assuming a lot of P4s might also be nervous and taken aback on the spot. But the motrin/tylenol question was pretty basic, so that is a little alarming...

 

[samisab786]

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.

this makes me feel a whole lot better lol ty

 

[rph3664]

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.

At least something like that isn't easily transmitted. I lived for a while in an area that had a lot of multi-drug resistant tuberculosis, and we had a couple of patients who responded to absolutely nothing and were kept in isolation until they died. And THAT is transmissible through casual contact.

Haven't seen chloramphenicol mentioned here yet. I've seen that ordered a few times too.

 

[confettiflyer]

The one thing I can never remember is usual concentrations and infusion times of IV drugs. Always have to look that stuff up.

this, along with renal dosing, just isn't worth committing to memory. I tell my students not to bother ever remembering renal dosing...even when you know it 100% through repetition and experience, you'll still double check.

 

[joetrisman]

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.

RIP tigecycline #newfdabbwformortality

 

[njac]

RIP tigecycline #newfdabbwformortality

Yeah, but cefepime had one too, and some places still
Use it for FN.

 

[Praziquantel86]

Yeah, but cefepime had one too, and some places still
Use it for FN.

It's just fine if you use the correct dose...which is not 1g q12h. CLSI is changing the breakpoints and making 4 and 8 dose-dependent. Finally 2g q8h for all, and only five years or so behind the Europeans.

 

[njac]

It's just fine if you use the correct dose...which is not 1g q12h. CLSI is changing the breakpoints and making 4 and 8 dose-dependent. Finally 2g q8h for all, and only five years or so behind the Europeans.

Woot!!

 

[BeLikeBueller]

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 don't want to resurrect a days-old thread, and I know it kind of morphed there at the end, but depending on how far out of school you are, I think you lose track of two things - 1) what you didn't know near the end of your education and 2) the number of advancements in medicine/the number of new drugs on the market today.

I'll give you a perfect example - my pharmacotherapy class just went over anti-epileptic drugs. What did our professor tell us? Before 1995, there were five anti-epileptic drugs. Now there are over 20. I know that not every area has had this much growth in recent years, but (depending on how far out of school you are), there is definitely more that students are expected to know and learn now. In addition, I think that because of the shift in education focusing more on the clinical aspects of pharmacy, students aren't being taught enough of the pharmacy "basics." For instance, today we went over MS (in 40 minutes, I might add). Did we go over the pharmacology of the medications? No. Did we go over dosing? Minimally. What was the focus? Treatment algorithms and side effects. On our next exam we have MS, muscle spasticity, meningitis, pain, headache, and a little bit of gout. When you're trying to study for a hodge-podge of material like this, things just don't stick like you would like them to.

In addition, students don't have the day-to-day hands on experience that you have. Sure these things have become second nature to you, but we aren't at your level just yet. It's not because we're stupid. We're doing the best we can with what we're given and in the environment we've been placed in. When you ask a question about a drug that we studied over a year ago and have never actually seen used in the real world, of course we're not going to impress. But that's why we're standing there in front of you, so that you can show us what we need to know...so that we can get the hands on experience that will help us remember all the things that we need to know. Unless you have a photographic memory, you simply cannot remember everything in pharmacy school without repeated exposure and hands on experience (two things that you don't get in a classroom, but you should be getting on rotation).

But I certainly understand your frustration. Just know that as a student on rotation, we feel just as stupid as you likely think we are. And you should also be aware that, as long as your students are willing to put in the effort and work hard, you can use that month to make a huge difference in the understanding of a future pharmacist.

 

[confettiflyer]

RIP tigecycline #newfdabbwformortality

Pfff...off label refractory c. diff will help pay some of the bills

 

[BookMDanno]

Great points, BeLikeBueller. I really think there should be more pharmacotherapeutics covered just before a semester of rotations, and off to graduation!

I also think a lot of us who graduated over 20 years ago and are preceptors at these rotations forget that we were green too.

Sometimes, we do see P6 students using their iPhone/Android apps as a crutch to answer pretty basic stuff. We try to encourage them not to run for their apps with EVERYTHING, but use it for the important detail stuff.

All the best to BeLikeBueller and other students out there.