Clincal Pharmacy: answer a question, pose a question

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hope you guys don't take me too seriously. And trust me...I don't know everything and no one knows everything. In fact, I really do have a limited knowledge in pharmacotherapy.

But I know where to find the answer. And find it quickly and understand it. And utilize it in practice. And this skill comes from practice. I hope every one of you will one day feel confident in knowing that the answer is at your fingertips.

Please don't let me offend you in anyway..


:D
 
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KARM12 said:
What is the role of antibiotic prophylaxis in patients with neutropenic fever?
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Epic said:
afebrile or febrile?

For afrebrile.... bactrim for PCP

For febrile...use of prophylaxis abx reduces GCSF usage.

Do we need to get into Antifungal and antiviral too?
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I know it's a long shot, but I'm going with febrile. :smuggrin:
 
bananaface said:
I know it's a long shot, but I'm going with febrile. :smuggrin:
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hmmm... prophylaxis in febrile is not so common... once febrile.. may initiate treatment instead of prophylaxis..
 
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bananaface said:
Dude. He asked "What is the role of antibiotic prophylaxis in patients with neutropenic fever?" Thus the :smuggrin:
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dudette...it's not that simple.. prophylaxis is really geared for while afebrile.. so I wasn't sure if Karm meant febrile neutropenia as a common term.. but in fact meant afebrile. At the point of Febrile Nutropenia, it's appropriate to start empiric therapy... no longer a matter of prophylaxis.
 
Epic said:
dudette...it's not that simple.. prophylaxis is really geared for while afebrile.. so I wasn't sure if Karm meant febrile neutropenia as a common term.. but in fact meant afebrile. At the point of Febrile Nutropenia, it's appropriate to start empiric therapy... no longer a matter of prophylaxis.
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If you thought he may have misspoken, fair enough. But, for those who took his question at face value, it's still amusing. I don't see anything wrong with taking it at face value either. She could be looking for "none". *shrug*
 
Its a she
 
Why would you combine a K-sparing with a K-wasting diuretic? An example would be Triam/HCTZ. They should only be prescribed to with patients "normal" potassium levels, right? A little lost plus a little wasted should balance out, right?

I didn't get a thorough explanation from my professional. The only thing that I know is that this combination exists.
 
Wouldn't be a bad idea for hypokalemic pts either
 
Epic said:
Wouldn't be a bad idea for hypokalemic pts either
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That's what the mock scenario was about. Diabetic plus hypokalemic.

If you're hypokalemic, why would you need the K-wasting at all? Is the K-sparing too strong?
 
PharmDstudent said:
If you're hypokalemic, why would you need the K-wasting at all? Is the K-sparing too strong?
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The K-sparing diuretics are very weak on their own--they won't pull off enough fluid to really diurese a patient. So you use something stronger, which will have the side effect of K-wasting...then you add on the K-sparing to balance out the potassium, not to really increase diuretic action.
 
Thanks for the answers everyone! They were helpful.


Is there a bisphosphonate or an alternative that can be used for a patient who has been ordered to bedrest? Do they have to halt therapy until they can stand up again?
 
PharmDstudent said:
Thanks for the answers everyone! They were helpful.


Is there a bisphosphonate or an alternative that can be used for a patient who has been ordered to bedrest? Do they have to halt therapy until they can stand up again?
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That's the idea. Some of my hospitals actually took bisphosphonate off the formulary.
 
Switch to IV Boniva?
 
OK... this is actually a great great topic: Oral bisphophonate in hospitalized patient. A hot 25 year old drug rep with all legs, short miniskirt and high heels brings lunch for staff of 10 at Dr. Pervert's office who's now smittened by her. She sell Boniva.

Now Dr. Pervert runs over to the pharmacy and wants to speak to the clinical pharmacist..."hey I think it's a great idea to add Boniva to the formulary...it'll be good for those patients who are bedridden... you know, it's all about patient care..."

Ms. Boniva tells her friends.."you know...that stupid Doctor is creepy..but heck, he's going to help me add Boniva to the formulary at the medical center.. man, my bonus is going to be huge.. I've been looking at that BMW convertible.."

Now, the clinical pharmacist has work to do...

Can somebody run a pharmacoeconomics analysis? I've already done one...but maybe you guys can help me confirm what I've done.
 
SpirivaSunrise said:
Well, then here's another one. You also take into consideration cost of treating GI events in your analysis? I would.
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That's cost avoidance.. otherwise known as "soft dollar"... in my world, that doesn't count since most CFO will laugh at it.
 
Epic said:
That's cost avoidance.. otherwise known as "soft dollar"... in my world, that doesn't count since most CFO will laugh at it.
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Interesting. Even if "the estimated average annual GI-related cost for patients treated with alendronate was approximately $72 000 per 1000 patients". Although that's probably pennies to the CFO.

What were your hospitals using QD or QW bisphosphonate?
 
SpirivaSunrise said:
Interesting. Even if "the estimated average annual GI-related cost for patients treated with alendronate was approximately $72 000 per 1000 patients". Although that's probably pennies to the CFO.

What were your hospitals using QD or QW bisphosphonate?
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So $72 per patient.. but what does that consist of? Supplies and Labor? Does it account for extra length of stay? If labor, can we really say because nurse spent additional 1 hour, we've spent additional money?

Is that 1000 patients who were on Bisphosphonate therapy or per all patients in the hospital? Can that apply to your institution with different critical index?
 
Epic said:
So $72 per patient.. but what does that consist of? Supplies and Labor? Does it account for extra length of stay? If labor, can we really say because nurse spent additional 1 hour, we've spent additional money?

Is that 1000 patients who were on Bisphosphonate therapy or per all patients in the hospital? Can that apply to your institution with different critical index?
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No sé. I'll pull the article later...

Last I checked, these drugs had pretty decent half-lives...so my gut still says, tell the rep to take a hike...skirt and all. I'll look at the numbers before work if I get a minute.

Enjoy the game! :D
 
Epic said:
So $72 per patient.. but what does that consist of? Supplies and Labor? Does it account for extra length of stay? If labor, can we really say because nurse spent additional 1 hour, we've spent additional money?

Is that 1000 patients who were on Bisphosphonate therapy or per all patients in the hospital? Can that apply to your institution with different critical index?
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Supplies count. Tubes, bags, and needles can not be reused.

The nurse works her shift regardless of what she has to do during it. Therefore, the extra labor doesn't actually "cost" anything. If the task was more involved, then maybe the labor would "cost" more if the nursing staff had to be increased, because they were overburdened by the IV bisphosphonate therapies.

It doesn't count for a longer stay if the patient can leave on time. The only patients who need the IV medication are those who can not go home and must stay, because they need assistance that can not be fulfilled by a home health group.
A patient who is in the hospital for a couple of nights will have to wait until they can take it at home. It's not of an immediate concern like a maintenance HBP medication or antibiotics for infections.

The hospital has to think of all of the patients in the hospital collectively. They have to shell out the medicine regardless of who actually gets it. It's like a jar of peanut butter--> you can make 50 PB&J sandwiches for yourself or 1 sandwich for 50 people; either way, you will use the same amount of peanut butter.

There's always Fortical or Miacalcin (although, those are expensive too). Fosamax should be losing its patent soon.
 
Epic said:
So $72 per patient.. but what does that consist of? Supplies and Labor? Does it account for extra length of stay? If labor, can we really say because nurse spent additional 1 hour, we've spent additional money?

Is that 1000 patients who were on Bisphosphonate therapy or per all patients in the hospital? Can that apply to your institution with different critical index?
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A'ight. That figure consists of direct GI-related costs in patients who were started on the bisphosphonate with no prior history of a GI event. So they tracked costs for 4 months post-initiation of either Fosamax or Actonel. But that figure includes all GI-related direct costs...inpatient and outpatient...meds...and labor.

If you want inpatient numbers: it's $2691 per 1000 per month for Alendronate and $436 for Risedronate. That doesn't include about $750 in GI meds and "other" costs (i.e. labor). So...significantly higher for Alendronate.

But you're right, these are definitely soft savings and hard to quantify. Worth considering if you're looking at it clinically though.

Here's the article: Am J Manag Care. 2004;10:S216-S226

And someone else'll have to check your econ analysis...I don't have the numbers :D
 
SpirivaSunrise said:
Hey! What are critical indices? Not familiar with the term...
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Just found this thread. Great idea. :) I'll post some questions I've encountered over my years working and on rotations.

I'm not sure what critical indices are. I can't seem to find a definition.

A patient comes into your pharmacy with a prescription for Cortisporin Otic Solution to be applied to his/her right great toenail. Is this a valid indication, and if so, why?
 
Glycerin said:
Just found this thread. Great idea. :) I'll post some questions I've encountered over my years working and on rotations.

I'm not sure what critical indices are. I can't seem to find a definition.

A patient comes into your pharmacy with a prescription for Cortisporin Otic Solution to be applied to his/her right great toenail. Is this a valid indication, and if so, why?
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Depends on if they had an ingrown toenail or some other type of weird toenail surgery and needed some inflammation control. Just cause it's otic don't mean it's not usable elsewhere, I suppose...
 
WVUPharm2007 said:
New question:

Pharmacologically, what do rimonabant and rosiglitazone have in common?
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Both start with "r". Both are probably too dangerous to recommend for first line use (or ever line use for rimonabant). Both have something pharmacologically to do with the peroxisome proliferator activated receptor system.....this is just off the top of my head.

Just wanted a reason to jump in and say that I went to Dave and Buster's tonight, accumulated 2,000 tickets on $25. I am a sucker for the tower of power and the smart stop machine.....I did case the trivia area though, there just were not many people partaking tonight I guess.
 
Priapism321 said:
Just wanted a reason to jump in and say that I went to Dave and Buster's tonight, accumulated 2,000 tickets on $25. I am a sucker for the tower of power and the smart stop machine.....I did case the trivia area though, there just were not many people partaking tonight I guess.
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That's because you went on Thursday....
 
What is the reason Recothrom is sometimes used over human or bovine thrombins, and why isn't Recothrom used more often?
 
both can inhibit T-cell activation

Organic nitrate have vasodilatory effects. What other pharmacologic effects do they possess which are also beneficial in agina
 
npage148 said:
both can inhibit T-cell activation

Organic nitrate have vasodilatory effects. What other pharmacologic effects do they possess which are also beneficial in agina
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#1: Reduces preload and afterload --> reduced oxygen demand
#2: Improved circulation to coronary vessels --> improved oxygen supply
They are both related to the vasodilatory effects, so not sure what you're getting at.

In what kind of coronary ischemia should you avoid nitrates?
 
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Gosondth said:
#1: Reduces preload and afterload --> reduced oxygen demand
#2: Improved circulation to coronary vessels --> improved oxygen supply
They are both related to the vasodilatory effects, so not sure what you're getting at.

In what kind of coronary ischemia should you avoid nitrates?
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It's not related to vasodilation.
 
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