state exam days 33/37

can you believe it?! it’s the final week! 💫 this is actually the exam I’m dreading the most because I’m an absolute loser when it comes to chemistry :‘)

13/7/23 // 12.23

Study day for me today aka endless hot drinks and snacks

Medblr, I think we ought to have an antibiotics bracket. Just for fun. Everyone can submit their favorite antibiotic regimens and write propaganda for them (or anti-propaganda for the ones you hate) before we crown the one true antibiotic (regimen). Doesn’t have to be a single medication, it can be a combo. Here’s some of what I’m thinking of including:

vanc/zosyn

Azithromycin

Amp/gent

Rifampin/isoniazid/pyrazinamide/ethambutol

Augmentin

Cephalexin

Vanc/ceftriaxone

Amphotericin

Nitrofurantoin

Vote however you want—what you prescribe most, best side effect profile, most interesting mechanism, vibes, whatever. Let me know what other antibiotics you think I should include!

I don’t know who needs to hear this but, while at low doses THC can relieve some anxiety, as the doses increase it destabilizes the endocannabinoid system and ultimately causes anxiety.

Plus, it has a hangover effect that, unlike with alcohol, you don’t perceive. Don’t drive the day after.

Abdominal Pain PSA

I've had a run of people admitted to the ICU after have 1-2 weeks of abdominal pain who were struggling to eat or drink that ended up having conditions leading to necrotic bowel. Dead bowel makes people incredibly sick. Like, death's door sick. Anecdotally, I'd say maybe 60% of our patients make it through such an ordeal. Every time I talk with their families, their loved ones say that they looked bad and they tried to get the patient to go get some help. Often, these people wait too long.

So.

PSA: if you're having abdominal pain and can't keep anything down for more than 48 hours (especially in the context of N/V WITHOUT bowel movements), you NEED to go to the ER. Not urgent care. Not your PCP. The ER. Please get checked out. Do not let things sit. If you have known GI disease like diverticulosis, a hernia, etc, even more of a reason to get checked out.

medicinal chemistry ☕🖤

Happy National Pharmacy Month for anyone in the US! I wanted to take some time to talk about what it's like as a third-year doctorate of pharmacy candidate because I love what I do and I love talking to y'all. I thought it might be fun to share this part of me that I don't talk about on here in detail too too often!

Today I got caught up on some lectures by listening to some recordings on Alzheimer's Disease therapeutics and pharmacology. I also spent some time preparing for a patient care simulation I have coming up, studied my Top 200 drugs, and will continue working on some DUR and CMR skills.

For anyone who is curious, here's what all those acronyms mean!

DUR - "drug utilization review" which basically means we're looking for any potential issues with a medication we're giving to a patient. This could be that there's an interaction with another medication they're already taking, or maybe dose isn't right for what we're treating, or a whole multitude of different things.

CMR - "comprehensive medication review" which is when we sit down with a patient and review each one of their medications, how they're taking it, and how it's working for them. We're looking for how well it's working, if there's any safety or adherence issues to address, or any other kind of issues to discuss with their provider. We'll also look to see if there's any way to remove medications they don't need to be on or otherwise optimize their therapy!

🎵 - LOTR movies soundtrack

Amneal levothyroxine identification sheet

Bought a notebook to register my tasks with Eisenhower method.

Bought another notebook to put on info that I'll need on handy all the time. Like this one about the law over interchangeable medicines.

Found this book on my drive, about law and practices on pharmacy. Well, it's a MUST reading, for sure. (Classified as on non urgent, but important task)

I do not care. I do not care if it's to prevent shit. Make it an option. Make it a fucking option for people like me.

Y'all never had a panic attack taking medication and it shows. Y'all never convulsed uncontrollably and cried. Y'all never picked the pain of sickness and infection over not taking meds, because you couldn't fucking take it. I have. I have just chosen not to take medication when I desperately needed it.

Make medication more accessible. Make it easier to take. I don't care if it's to prevent overdose. Y'all never experienced restraint and abuse, being forced to take shit and it shows.

my desk constantly looking like this because I need to study for biology 😬🌿

25/5/23 // 16.11

So now I’m doing pre reg tutor training? When did I become such a grown up

It's battle of the macrolides for this matchup! Both these meds work by binding the 50S subunit of ribosomes, preventing translation. So who's better?

Azithromycin: The most prescribed anti-microbial in the US. It's a derivative of erythromycin with improved gram negative coverage as well as gram positive and atypicals coverage. Azithromycin's main game is the lungs, where it's useful for almost every pneumonia as well as COPD exacerbations; it's even used off-label as post-transplant prophylaxis for bronchiolitis obliterans. It is also considered to be safer than erythromycin with fewer adverse cardiac effects.

Erythromycin: Erythromycin has some unique applications, such as prophylaxis for gonococcal ophthalmia neonatorum, for which it is the only FDA-approved drug. However, its efficacy in this role has been called into question recently, with some--like the Canadian Paediatric Society--calling for a shift to maternal screening instead. Another unique application is as a treatment for gastroparesis. Though it's far from first line (and the American College of Gastroenterologists 2023 clinical guidelines for gastroparesis treatment don't even recommend it), it's been used off-label for gastroparesis since the 1990s. It was the first macrolide demonstrated to be a motilin receptor agonist, and so it became a favored alternative to metoclopramide. There are no randomized trials as of yet directly comparing the efficacy of azithromycin and erythromycin for gastroparesis, and so erythromycin remains the favorite by default. Unfortunately, it is more likely to prolong the QT interval than azithromycin.

P.S. for more fun, check out this paper on 10 controversies in gastroparesis

Vote for the best antibiotic

An open letter to humanity from A Pharmacist

When you’re administering a medication in your nose, please inhale slowly but firmly. Do not snort it like you’re taking a hit of cocaine unless your doctor, pharmacist, or the package instructions tell you to.

Working in an ICU...

...Means that you meet people on the worst day of their lives.

A colleague of mine said this over the weekend, which was a very rough weekend for me in so many ways. My patients were complex and very sick. The families were challenging. So. Incredibly. Challenging.

I see the worst things that can happen to people. Every. Day. I am able to push it out most of the time. Some times, there is a true shit storm of circumstances that emotionally bankrupts me. That was this weekend for me.

I think it is sometimes easy to forget how vulnerable patients and families are in the ICU. It's easy to forget it is the worst day of their lives. And when these families can't control the illness of their loved one, I think they look for literally anything they can control. Sometimes that results in verbal abuse about policies, staff, and treatment. It can be so hard to deal with this. The amount of patience it takes is astronomical.

I will freely admit that I am very detached. You almost HAVE to be to a certain extent to DO the job. But even the most detached people have a breaking point.

It makes me grateful for every family that simply thanks me for my time. Every colleague that "gets it". Every person willing to listen to me when I am going home from work.

So, to all you health care people that struggle with this as I do, we've got this. Some how, we've got it.

23/07/22 - oasis

My new favourite place to study at!! Look at this, it’s perfect 🥹 I loved preparing my exam here ^^ I had this big exam a few days ago, 1 hour long oral test with two professors, and I passed 💃🏻 I’m so relieved :”) In this class we also had a interesting lab, I’m gonna post some pics from those experiences soon~

It’s so hot recently, everyone take care!! ☀️