Monthly Archives: March 2013

Aside

What is currently happening with the proposed prohibition of inducements/loyalty point bylaw change?

What sort of changes do I want to make in my career as a pharmacist?

After several months of working, I believe as pharmacists our biggest task is to problem solve. I need to focus on the kind of questions I should ask every time I am faced with a problem. Am I making an effort to collect all the pieces of the puzzle or am I taking shortcuts?

I should endeavor to do the best that I can at the task at the hand. I need to commit to doing the best job I can.

Two of the basic principles that made a significant difference to Bob Nakagawa: Take the Initiative to Make Things Better and Lead by Example. “Taking the initiative to make things better is what I think about when I encounter a challenging situation. I think  about my mentors who served as great examples for me to emulate as I advanced” 

In the Drug Schedules, a Schedule 2 Vaccine is defined as follows:

Influenza

vaccines which are a part of routine immunization program

vaccines requiring special enhanced public access due to disease outbreaks

cholera vaccine (oral, inactivated) when used for prophylaxis against traveler’s diarrhea due to enterotoxigenic escherichia coli (ETEC)

For example: Zostavax is presently not part of the BC’s publicly funded program, however the BCCDC does recommend Zostavax for individuals over 50 for the prevention of herpes zoster in patients with prior chickenpox infection. Therefore, it could be considered Schedule 2 for this indication. 

Therapeutics Letter: July/August 2012

Because of the lack of effect on mortality and total SAEs (serious adverse events) there is no net health benefit from prescribing high dose statins over standard dose statins. 

Neat quote I found:
“I never think anything will be done for me (unless I do it for myself) and I’m fiercely determined. I carved my way into the hip-hop music industry at a time when it was unreceptive to white girls (mid-’90s) and against my father’s furiously expressed wishes. What my father’s lack of nurturing taught me is that underestimating myself is far better than overestimating myself. I tend to assume that I won’t land an exciting new client, which means that I’m thrilled when it actually happens. But mostly, when things don’t go my way, I know how to pick myself up and try again, on my own.” Nicole Balin

Antibiotic Abyss

Standard

This is a summary of the presentation one of the pharmacists at the hospital shared with me:

Antibiotic resistance is increasing, so we have the same bugs but new drugs. Do all infections need antibiotics?
presentation by Fredrick M. Abrahamian. Associate Professor of Medicine, UCLA School of Medicine

Antibiotics are not indicated for simple, first time, uncomplicated cases. Indications:
1. Surrounding cellulits
2. Signs of systemic toxicity
3. Immunocompromised host
4. High-risk locations (hands, face)
5. recurrent abscesses or lack of response to I&D
6. Multiple or large abscess ( greater or equal to 5 cm)

In vitro CA-MRSA is susceptible to TMP/SMX, Rifampin, Vancomycin and Linezolid
variable to Clindamycin 300-600 mg PO TID or QID (94%): Covers staphylococci, streptococci, anaerobes. Inducible resistance ( D-zone disk-diffusion test)
doxycycline (100%) 100 mg PO BID excellent tissue penetration, levofloxacin (45%), erythromycin (10%)
Rifampin 300 mg PO BID: Numerous drug interactions, risk-to-benefit ration does not justify routine use, best reserved for decolonization purposes

Rifampin drug interactions: decreases the effect or levels of beta-blockers, digoxin, ACE-inhibitors, diltiazem, nifedipine, corticosteroids, methadone, oral anticoagulants, phenytoin, sulfonlyureas, oral contraceptives
Linezolid inhibits toxin production. Tigecycline: First dose ( 100 mg IV then 50 MG IV q12 H) also covers gram negative and anaerobes, does not cover Pseudomonas plus minus Proteus. Complicated SSTIs, intra-abdominal infections, CAP (not for DRSP)

New FDA approved antimicrobial therapies: Telavancin (10 mg/kg day), Ceftaroline 600 mg q12hrs (given over 60 min)

Complicated infections: more likely mixed aerobic and anaerobic infections
Consider in patients with chronic infections, peri-rectal infections, wounds involving lower extremities (e.g. feet), vascular insufficiency (venous stasis ulcers), immunocompromising conditions example diabetes mellitus, bite-related wounds, post-operative wounds, infected burns
Evernote 20130313 15-11-15

What works on Pasteurella or E corrodens

Necrotizing skin and soft tissue infections:
Antibiotics:
Vanco + Pip/tazo + Clinda

Alternative: Linezolid + Pip/taz

First generation cephalosporins are inactive against Pasteurella or Eikenella

2012 Infectious Diseases Society of America Clinical Practice Guideline for the Diagnosis and Treatment of Diabetic Foot Infections
http://www.idsociety.org/uploadedFiles/IDSA/Guidelines-Patient_Care/PDF_Library/2012%20Diabetic%20Foot%20Infections%20Guideline.pdf