Immunization_CDC 2017

CHILDREN vaccines

ADULT vaccines

Lithium monitoring or SE for patient education

Read this:
http://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/bipolar-guide.pdf

Grain to mg or gram??

Phenobarbital comes in grains or mg, and it's VERY CONFUSING

1/4 grain = 16.2mg = 15mg
1/2 grain = 32.4mg = 30mg
1 grain = 64.8mg = 60mg
1 & 1/2 grain = 97.2mg

Passing of a medical pioneer

Tianhang's grandpa :(....

SSRI major warning *** to be cont ***

NOTE: I want to start by saying there are TOO MANY SSRI, but think about it, there are ONLY so many :P

ZYBAN - smoking cessation *** to be cont ***

HIV meds *** to be cont ***

NOTE: how do I even begin because this is a vast field of unfamiliar names!!! Anyway, small step once at a time :)


One tablet regimen (6 so far)

Resources
HIV Drug Chart - POZ

Drug Info on the website

DailyMed - US National Library of Medicine

Not-my-day kind of day *** to be cont ***

NOTE: first, I overlooked a gabapentin 3 caps daily rx (should have been 1 cap three times daily), and there were 60-tabs of Norco 10mg missing :( I was distracted, and despondent all day...Well, life goes on, and I need to take some notes, and keep this a habit! You'll get there! Believe, and faith!!

• GABAPENTIN
• Indication
• PostHERPETIC neuralgia
• Dose
• 300mg QD x 1 day → 300mg BID x 1 day →  300mg TID x 1 day, then dose can be titrated as needed for pain relief up to 1,800mg
• TRIUMEQ
• NOTE: first time counseling, what should I say??
• Oral Contraceptive counseling
• Estrogen + Progesterone 
• Progesterone only
• Emergency Contraceptive
• Pulmicort  

Stimulants for ADHD or Narcolepsy *** to b cont ***

NOTE: a patient is on DEXEDRINE XR (DEXTROamphetamine) 60mg total a day. Because he's taking 10mg cap x 6 caps daily x 90 days = 540 caps, a floating pharmacist refused to fill unless a doctor re-confirmed! So it turns out that the max daily dose is 60mg!! Here prompts my inquiry into what other stimulants are there, and was DEXEDRINE indeed for ADHD??

Schedule II stimulants

• NARCOLEPSY
• DEXEDRINE (DEXTROamphetamine) (Available = tabs; ER caps 
• 
  
• ADHD

Let's quit smoking and get some CE credit *** to be cont ***

CE - PowerPak - Overactive Bladder

Two drug classes are for treating Overactive Bladder (OAB) per AUA

• Antimuscarinic agents
• Older
• Oxybutynin (DITROPAN XL, OXYTROL; available = Oxytrol Patch (twice weekly), 5mg tab;  5, 10, 15 XL tab, approved by FDA 1988)
• Side Effects (marked anti-cholinergic effects everywhere)
• CNS
• somnolence / confusion / dizziness
• GI
• Dry mouth / constipation
• CV
• Tachycardia / arrhythmia
• Tolterodine (DETROL / available = 1,2mg IR tab; 2, 4mg LA cap / FDA 1998)
• Newer
• 

• ENABLEX (DARIfenacin / available = 7.5, 15mg / FDA 2004) 
• TOVIAZ (FESOterodine / available = 4, 8mg / FDA 2008) 
• TROspium (SANCTURA / available = 20mg IR tab, 60mg XR cap / FDA 2004) 
• 
• VESICARE (SOLIfenacin / available = 5, 10mg / FDA 2004) 
• Beta 3 adrenergic agonist
• 
• MYRBETRIQ (MIRAbegron / available = 25, 50mg / FDA 2012) 
• Side Effects
• CV
• Increased BP / palpitation
• CNS
• Dizziness
  
  
  

Hypotension - Pharmacist Letter *** to be cont. ***

NOTE: another CE quiz question on Pharmacist Letter :)

• Causes for hypotension
• Meds
• Parkinson
• BPH, including selective and non-selective alpha
• DOXAZOSIN (alpha1 adrenergic blocker, Available = 1, 2, 4, 8mg tab, Cardura XL = 4, 8mg) 
• TERAZOSIN (alpha1 adrenergic blocker, Available = 1, 2, 5, 10mg cap)
• TAMSULOSIN (alpha1 adrenergic blocker, Available = 0.4mg cap)
• ALFUZOSIN (UROXATRAL, alpha1 adrenergic blocker, Available = 10mg ER tab)
• RAPAFLO (siloDOSIN, alpha1 adrenergic blocker, Available = 4, 8mg cap with meal)
• Diuretics
• Treatment for hypotension
• Non-med
• Adequate fluid 
• Increase salt intake
• Med
• Fludrocortisone (Available = 0.1mg tab)
• Monitor
• Edema
• High BP
• ↓ potassium
• Midodrine (alpha1 agonist; Available = 2.5, 5, 10mg tab)
• Dose
• 10mg TID during daytime hours when patient is upright

Working with canker soresssss :( *** to be cont. ***

THOUGHTS: canker sores are always a nightmare especially when they are at the back of the throat AND on the lower lips :( Even a simple act of opening the mouth to speak raises the level of pain :( Well, life goes on, and work definitely goes on!!!

• ENTRESTO (SACUbiTRIL / valsartan) (Available = 24/26mg, 49/51mg, 97/103mg tab)
• NOTE: I saw this med ENTRESTO coming up refill too soon, and so I called the patient about it. However, I had no clue what this med is for!

Are EpiPEN all the same?

NOTE: another CE course brought me to the fountain of knowledge...indeed, I do not know if ALL EpiPEN are all the same?? Let's find out...


MYLAN brand ↓

 

LINEAGE brand ↓

IMPAX brand ↓

• 2 brands EpiPEN vs. ADRENAclick (intramuscular IM shot), and both have generic version
• Dose
• 0.3mg for >66 lb (30kg)
• 0.15mg for 33-66 lb (15-30kg)
• 0.01mg/kg
• May repeat dose in 5-15mins
• ADRENAclick vs. EpiPEN
• ADRENAclick
• 2 caps to remove
• Inject for 10 seconds
• Needle exposed from end red cap
• EpiPEN
• Blue cap to remove
• Inject for 3 seconds
• Needle never exposed

CE - diabetes drugs that also help CV outcome ... to be cont

NOTE: I'm just looking into satisfying my CE requirement (now I still need 18 units), and found this quiz question, which diabetes drugs also improve cardiovascular outcome? Looks like an interesting article!! So Let me summarize this article :)

• Improving CV outcomes
1. METFORMIN (Available = 
2. VICTOZA (liraglutide) (Available = 
3. JARdiance (EMPAglifloZIN) (Available =
4. ACTOS (pioGLITAZONE) (Available = 

List of GLP-1 Receptor Agonist

NOTE: so patient asked how to use TRULICITY (dulaglutide), and I remember it's a weekly dose, but how to use...not a clue :( Here is the answer :) By the way, they all belong to Glucagon-Like Peptide-1 (GLP-1) Receptor Agonist

• TRULICITY (dulagluTIDE)
  
  
  
  (Available = 0.75mg or 1.5mg per 0.5ml)
• How to use from the manufacturer
• Dose
• 0.75mg SQ once weekly; may ↑ to 1.5mg
• Missed dose if < 3 days from next dose, wait until the next dose
• Mechanism of Action
• TRULICITY contains dulaglutide, which is a human GLP-1 receptor agonist with 90% amino acid sequence homology to endogenous human GLP-1 (7-37). Dulaglutide activates the GLP-1 receptor, a membrane-bound cell-surface receptor coupled to adenylyl cyclase in pancreatic beta cells. Dulaglutide increases intracellular cyclic AMP (cAMP) in beta cells leading to glucose-dependent insulin release. Dulaglutide also decreases glucagon secretion and slows gastric emptying.
• TRULICITY lowers fasting glucose and reduces postprandial glucose (PPG) concentrations in patients with type 2 diabetes mellitus. The reduction in fasting and postprandial glucose can be observed after a single dose.
• Storage
• Refrigerator or RT x 14 days
• BYDUREON (exenaTIDE) (Available = 2mg)
  
  
• How to use Bydureon
• Dose
• 2mg SQ once weekly
• TANZEUM (albigluTIDE)
• http://www.tanzeum.com/how-to-use.html

Cheratussin (Codein / Guaifenesin) vs. Codeine / Promethazine kind of day __to be cont

It's a no memory, just wanna leave type of day...
However, ALWAYS pay attention of what you do :)

• Codeine + Guaifenesin vs. Codeine + Promethazine





• NOTE: get it correct!! DO NOT mix the two EVER!!
• Dose
• Codeine / Guaifenesin
• Dose
• Adult (≥ 12 years old)
• 2 teaspoonful (10ml) every 4 hours (do not exceed 6 doses in 24 hours)
• Pediatric (> 6 years old)
• 1 teaspoonful (5ml) every 4 hours
• Codeine / Promethazine
• Mechanism:
• Codeine: Narcotic analgesics, including codeine, exert their primary effects on the central nervous system and gastrointestinal tract. The analgesic effects of codeine are due to its central action; however, the precise sites of action have not been determined, and the mechanisms involved appear to be quite complex. Codeine resembles morphine both structurally and pharmacologically, but its actions at the doses of codeine used therapeutically are milder, with less sedation, respiratory depression and gastrointestinal, urinary and pupillary effects. Codeine produces an increase in biliary tract pressure, but less than morphine or meperidine. Codeine is less constipating than morphine.
• Codeine has good antitussive activity, although less than that of morphine at equal doses. It is used in preference to morphine, because side effects are infrequent at the usual antitussive dose of codeine.
  Codeine in oral therapeutic dosage does not usually exert major effects on the cardiovascular system.
  Narcotic analgesics may cause nausea and vomiting by stimulating the chemoreceptor trigger zone (CTZ); however, they also depress the vomiting center, so that subsequent doses are unlikely to produce vomiting. Nausea is minimal after usual oral doses of codeine.
  Narcotic analgesics cause histamine release, which appears to be responsible for wheals or urticaria sometimes seen at the site of injection on parenteral administration. Histamine release may also produce dilation of cutaneous blood vessels, with resultant flushing of the face and neck, pruritus and sweating.
  Codeine and its salts are well absorbed following both oral and parenteral administration. Codeine is about 2/3 as effective orally as parenterally. Codeine is metabolized primarily in the liver by enzymes of the endoplasmic reticulum, where it undergoes O-demethylation, N-demethylation, and partial conjugation with glucuronic acid. The drug is excreted primarily in the urine, largely as inactive metabolites and small amounts of free and conjugated morphine. Negligible amounts of codeine and its metabolites are found in the feces.
  Following oral or subcutaneous administration of codeine, the onset of analgesia occurs within 15 to 30 minutes and lasts for four to six hours.
  The cough-depressing action, in animal studies, was observed to occur 15 minutes after oral administration of codeine, peak action at 45 to 60 minutes after ingestion. The duration of action, which is dose-dependent, usually did not exceed 3 hours
• Promethazine is an H1 receptor blocking agent. In addition to its antihistaminic action, it provides clinically useful sedative and antiemetic effects. Promethazine is well absorbed from the gastrointestinal tract. Clinical effects are apparent within 20 minutes after oral administration and generally last four to six hours, although they may persist as long as 12 hours. 
• DOSE
• Adult (≥ 12 years old)
• 1 teaspoonful (5mL) every 4 to 6 hours, not to exceed 30 mL in 24 hours (do not use for more than recommended dose)
• Pediatric
• Contraindicated in < 6 years old
• ½ to 1 teaspoonful (2.5 mL to 5 mL) every 4 to 6 hours, not to exceed 30 mL in 24 hours (do not use for more than recommended dose)
• Piracetam (OTC stimulant)

Proair Respi-click

days gone by like they are never here ...

I do not even know what day this is since I've skipped a few days without diary :( Here we go, it's Thursday (2/9) night...

• Called Caremark about 趙叔叔的 LANTUS, the representative told me that the limit of $3,700 this year for Medicare Part D only takes into account "co-payment". However, it might actually include "drug cost" I have to look it up!!!
  

DRUGS

• KERYDIN (tavaborole) (available = 5% solution (4, 10mL) 
  
• NOTE: What is this? How do you even pronounce it??
• Indication 
• Onychomycosis (toe nail fungus) - apply once daily x 48 weeks (almost a year)

• CLINDAMYCIN (available = 75, 150, 300mg)
• NOTE: We see this prescribed a lot, and indeed it has many indications, but when exactly do you need to prescribe this?
• Dose
• Usual dose = 150-450mg q6 (max = 1800mg or 3 caps (150mg) q6)
• Indications
• CYCLOPORINE (available = 25, 50, 100mg)
• NOTE: looks like an interesting drug at the first glance, and also look like it can be a lot of other drugs, too. 
• Indications
• Psoriasis
• Rheumatoid arthritis
• Solid organ transplant
• off label - 
• Interstitial cystitis
• Immune thrombocytopenia
• Focal segmental glomeruloscerosis
• Acute graft vs. host disease
• Nephrotic syndrome
• Lupus nephritis
• Ulcerative colitis, severe
• Uveitis
• RENOVA (tretinoin) (available = 0.02% cream or pump)
• NOTE: sounds like tretinoin, or some sort of make-up product. Indeed, it's for lessening wrinkles
• Indication
• Palliation of fine wrinkles
• FROVATRIPTAN (FROVA) (Available = 2.5mg)
• NOTE: you know it's a triptan, for migraine headache, but not sure of its available dosage form and how to take them, and max dose; also just found out that it's a serotonin 5-ht 1b/1d receptor agonist
• Indication
• Migraine, 2.5mg orally, can re-dose in 2 hours (max = 7.5mg daily; 3 doses daily)

Friday before the weekend...not the best :(

Super female boss visit (in a negative tone) 

Arjeta showed up today, looking sharp and also looking for trouble! She shared how to make the M5 calls (request call to confirm that the doctor's clinics have received the refill request, and whether the request was reviewed or being reviewed, → inform the patient of the status of the request. PCQ calls (tech + RPh).



M5 calls have deadline at 12noon!!

We'll win :) No one will bully us!!! Not even this super female boss!!!

So our strategy is we will divide and conqure. Divide up the call among available techs
1) How many M5 calls in the AM (9-12noon) → how many techs in the AM → total calls divide by available techs + me
  : 50% is success rate, and so I only need to make 1/2 of the total calls

• Triamterene-hydrochlorothiazide (DYAZIDE) (Available = cap; tab)
• 
  
• Nystatin oral caps, its use?
• Indication - intestinal infection
• RANEXA (available = 500, 1000mg)
• Indication - chronic angina, initial 500mg BID → max 1000mg BID
• HYDROXYUREA (available = )
• Indication -
• AZATHIOPRINE
• Indication -
• Sickle Cell Anemia
• CONTRAVE
• Indication - Weight management
• MISOPROSTOL
• Indication -
• Oral
• Intravaginal
• 
  

Random thoughts on meds

Today was a good day, thinking that I only have to work 2 more days before my weekend :)

Let's go:

• What are the typical doses for ZENATANE (isotretinoin)?
• Available in 10, 20, 30, 40mg 
• Weight base dose:
• Adult 
• Manufactured: 0.5-1mg/kg/day in 2 divided dose x 15-20 weeks
• Alternative: 0.5mg/kg/day in 2 divided dose x 1 month ⟹ then ↑ 1mg/kg/day in 2 divided doses as tolerated until a cumulative dose of 120-150mg/kg
• Pediatric
• Manufactured: 0.5-1mg/kg/day in 2 divided dose x 1-20 weeks
• Alternative: 0.5mg/kg/day in 2 divided doses x 1 month ⟹ ↑ 1mg/kg/day in 2 divided doses as tolerated until a cumulative dose of 120-150mg/kg
• Monitoring:
• CBC with differential and platelet count
• Pregnancy test
• Lipids
• Liver function test
• Adverse reactions:
• ↑ serum triglycerides
• Warnings/precautions:
• Many many many...
• ZOMIG (zolmitriptan)
• Dose
• Nasal (available 2.5, 5mg)
• 2.5-5mg (may repeat in 2 hours; daily MAX = 10mg)
• Oral (available 2.5, 5mg PO & ODT)
• PO: 1.25-5mg (may repeat in 2 hours; daily MAX = 10mg)
• PO ODT: 2.5-5mg (may repeat in 2 hours; daily MAX = 10mg) 
• KETOCONAZOLE topical
• Indications
• Cutaneous candidiasis
• Dandruff
• Seborrheic dermatitis
• Tinea corporis (general skin fungal infection), tinea crusis (jock itch), tinea pedis (athlete's foot)
• Protect from light
• How about feet? Still protect from light?
• FELBAMATE (anticonvulsant; available - suspension (600mg/5ml), tablets (400, 600mg)
• What is this??? 
• Dosing
• Inital = 1,200mg/day in 3-4 times daily (MAX = 3,600mg/day)
• Side effects
• Drowsy, dizzy, fatigue
• GRISEOFULVIN 
• Microsize (Grifulvin V; available - not anymore)
• 500mg/day in single or divided doses
• Ultramicrosize (GRIS-PEG; available - 125, 250, 500mg)  
• 375mg/day in single or divided doses
• SENSIPAR (cinacalcet; available = 30, 60, 90mg)
• Indications - hyperparathyrodism 
• Dosing
• 30mg BID upto 90mg 3-4 times daily as necessary to normalize calcium levels
• Adverse reactions
• parasthesia (tingling sensation)

Opioid Med Flyer for patient

This is a pdf file from Mendocino county opioid coalition. It's meant for patients. It makes me wonder about its claim:

Side Effects of Opioids include these following peculiar ones:

• Loss of strength
• Decreased sex drive
• Infertility
• Low testosterone in males
• More pain and pain sensitivity
• Compromised Immune System
• Memory loss

How in the world do I explain these side effects??

Monday, Happy Monday...

I feel like an outsider inside the pharmacy, and so I'm going to keep writing until I can rise above :)

It was manageable all day until the afternoon until flood gate opens and everything just sort of spirals out of order...

• INTUNIV (guanfacine ER)
• ADHD - there is a target dose, increase weekly by clinical response and tolerability
• MALARONE (atovaquone & proguanil) 
• MINOXIDIL 
• Indicated for HTN
• DOXEPIN (SILENOR)
• Indicated for SLEEP, 3-6mg 30-min before bed (MAX = 6mg daily)
• PYRANTEL PAMOATE 
• Indicated for PINWORM
• Other treatment options for PINWORM
• PENTOXIFYLLINE
• Indicated for INTERMITTENT CLAUDICATION, 400mg TID

SUNDAY...oh, SUNDAY...

SUNDAY is busy...I guess I'll have to get used to that fact it'll never be like Ft Bragg's Sunday :(
Here we go:

• ADDERALL side effects are...
• OMNITROPE equivalent (from the perspective of the insurance company) 從沒聽過 :(
• GENOTROPIN
• HUMATROPE
• NORDITROPIN flexpro
• LIDEX cream
• SERTRALIE side effects are...
• What about other SSRI??

Saturday minus 1 person

➞This sounded like a disaster to begin, but Ashton is totally amazing in his super energetic and caring demeanor! We have lots things to go over, and so here we go:

• 
  
• BASAGLAR (insulin glargine)  VS. LANTUS (from Sanofi Aventis)
• Another long acting insulin, from LILLY
• A biosimilar drug to LANTUS, might be cheaper
  
  
  
  
• LOTRISONE (betamethasone & clotrimazole)
  
• PROVIGIL (modafinil) vs. NUVIGIL (armodafinil)
• 
  
• METRONIDAZOLE 0.75% (cream, gel, lotion) for the ACNE ROSACEA
• Apply BID
• AVENOVA 
• OXYTROL vs. OXYBUTYNIN ER
• HYDROQUINONE 
• Indicated for - bleaching for areas on the skin where there are changes in color; 
• MOA - reversible suppression of melanocyte metabolism --> so UV/sun light can produce re-pigmentation of the bleached area 
• METHENAMINE hippurate
• Indicated for - UTI prophylaxis/suppression to keep urine acidic
• 1,000mg AM & PM
• CEFDINIR (3rd generation cephalosporin)
• stored reconstituted suspension at room temperature x 10 days (so need to pay attention of how to dispense to patients so that in case the dose needs to be > 10 days; however, most direction call for 10-day treatment)
• CLEOCIN / CLINDAMAX (clindamycin 2% vaginal cream)
• 7 Disposable plastic applicators are provided with this package. They are designed to allow proper vaginal administration of the cream.
• 
  

  

  Remove cap from cream tube --> Screw a plastic applicator on the threaded end of the tube --> Rolling tube from the bottom, squeeze gently and force the medication into the applicator.
  

  The applicator is filled when the plunger reaches its predetermined stopping point.
  Unscrew the applicator from the tube and replace the cap.
  While lying on your back, firmly grasp the applicator barrel and insert into vagina as far as possible without causing discomfort.
  Slowly push the plunger until it stops. Carefully withdraw applicator from vagina, and discard applicator.
  

  

• Indicated for - bacterial vaginosis
• Nightly for either 3 or 7 nights for non-pregnant, 7 nights for pregnant women
• 
  

Happy Friday

Nothing out of ordinary today.

I did chat with a co-worker at lunch break about balancing life and work. I feel like it's one or the other, and it might not EVER be balanced!

And Tianhang kept wanting to visit grandpa in China :( 

• What exactly differs between ADVAIR HFA vs. ADVAIR DISKUS??
• ADVAIR HFA 
• (+) uses propellent, so less effort to inhale
• (-) breathe and hand coordination needed to maximize effectiveness
• ADVAIR DISKUS
• (+) no need for coordination; ready to use
• (-) expired after unwrapped from foil for 1 month / need to forcefully inhale
• SOOLANTRA 1% cream, my first reaction is "what is this?" Sounds like a start-up company :P
• Indicated for ROSACEA
• Apply each affected area on face daily
• ELMIRON (pantosan)
• 
• Indicated for interstitial cystitis
• Dose - 100mg TID with water, 1 hr before or 2 hr after meals
• What is better than SINGULAIR (montelukast)?
• Cannot say because the only other leukotriene receptor antagonist is ZAFIRLUKAST (ACCOLATE), which is indicated for 1) asthma (20mg BID), 2) chronic urticaria  (20mg BID), and zafirlukast has no indication for allergic rhinitis, which MONTELUKAST (SINGULAIR) has indication for 
• MONTELUKAST has indications for
1. allergic rhinitis (perennial or seasonal)
2. Asthma
3. Bronchoconstriction, exercise-induced (prevention)
4. Chornic urticaria (hives)
• What is an alternative to RESTASIS (cyclosporine)??
• XIIDRA (lifitegrast)
• NIACINAMIDE vs. NIACIN??
• NIACINAMIDE is a form of water-soluble vitamin B3
• Indication -  prevent and treate pellagra (niacin deficiency); CANNOT be used in place of NIACIN to treat hyperlipidemia
• (+) better tolerated than NIACIN for flushing

Post 7-9pm shift

Luckily, the day starts at 3:15pm :)

• Dispensed a BUTRANS (buprenorphine) patch pack, weekly dose
• NEED to learn about SYNCING up medications of a patient 
• Why do AZITHROMYCIN / AMOXICILLIN need a loading dose while others need not??
• Also, AUGMENTIN suspension expired in 10-days
• CEFDINIR suspension is room temp storage
• FLUOCINONIDE gel to replace UREA cream for a small bump on the skin of the arm
• Long term side effect of steroid topical?
• What is TRANDOLAPRIL?? It is ACE inhibitor, approved in 1996, indicated for hypertension, heart failure, or post-MI heart failure or LV dysfunction
• TRIUMEQ 
• Triumeq is a combination of three drugs: Tivicay (dolutegravir), Ziagen (abacavir) and Epivir (lamivudine).
• Administration
• with or without food
• 
  

Tianhang first day home

Today's unusual that I'm working from 7-9pm, and surprisingly I got to go home at around 11:40pm

• A girl came in with pink eye that's been bothering her. Doctors from urgent care did not seem to offer her good advice. One prescribed VIGAMOX (moxifloxacin) while another prescribed POLYTRIM (trimethoprim / polymyxin B). I had to look up, but turns out that both are indicated for bacterial conjunctivitis. The difference is $$$
• A pediatric patient, 3 year old, was taking RANITIDINE syrup with dose of 0.75ml (15mg/mL); makes me wonder why?!!?
• PILOCARPINE was prescribed for dry mouth
• CLOTRIMAZOLE has vaginal dosage form!! (GYNE-LOTRIMIN)  

Unusual Morning

1/19


--------------------------------------------------------------------------------------------------------------------------

1/20
Last night I felt feverish :( Slept all night, but still was down! All day I could not focus, and there was so much negativity...

HABIT

• STEROID - need to figure out the exact tablets to dispense in order to satisfy the direction :)
• CII - need pt's address written

DRUGS
ESCITALOPRAM - can complicate bleeding

AXERT (almotriptan)

Felton Night

4:30-9pm tonight I'll be at Felton CVS. Hope for the best :)

Also I need to really really know how to administer ALL the inhaler and ALL insulin products!

ProAir RespiClick

-- It's the next morning...

Somehow, when a partial is SOLD, and if the remaining is COMPLETED, cannot be put on QI again :(

NEW NEW NEW drugs:

1. AMRIX
2. STIOLTO respimat (indication: COPD)
3. DICLEGIS (indication: n/v assoc. pregnancy)

Chat later...

Dark morning

Another DARK morning in Santa Cruz...

Well, learned that BOB, our 20-plus-year veteran working night-shift has decided to go to New Leaf, a grocery store in Capitola. I do not know Bob well enough, but he seemed like a genuine person. Last straw on the camel's back, I guess...

Man thanked me for allowing him to pick up his med when the pharmacy was closed, and offered to give my supervisor good words about me. I said since we were not allowed to sell prescriptions, "thank you", but do not let anyone, especially my supervisor know :)

A HYSINGLA (hydrocordone ER) prescription was dropped off. Made me wonder does it really work with the aid of APAP?? Can it really be a solo act?? I need to read the trial :)

BETHANECHOL was prescribed for a cat. A what?? YES, BETHANECHOL!! The cat cannot pee...poor cat 😞

Found an AMOXICILLIN suspension for a little boy to be extremely high dose. Turns out I was right!! Amazing!!

Electrician came to attend a call about DARKNESS at the front of the pharmacy. He played around while we slaved away. Then he came back to the back wall, and flicked a switch! Light there is 🙏



Young Asian boy came to pick up his CANASA suppository (Dosage

The recommended adult dosage is 1000 mg administered rectally once daily at bedtime for 3 to 6 weeks. Safety and effectiveness beyond 6 weeks have not been established.) Our clerk showed that the package was found in the room-temp waiting bin. However, the storage info shown on the package said to "STORE BELOW 25C (77F)". So that printed line saved us a new package :)

Closing Shift

At my pharmacy, working towards sanity is my main objective. I'd learned that:

• Benadryl for children does NOT have a recommended dose for 5 years and younger kids (need a pic)
• Another AIDS med, ISENTRESS , makes me feel a bit uneasy that there is another AIDS patient, cautiously trying to live a normal life, silently.
• A patient's dad, who happened to be a doctor, showed up to want to pick up his son's TAMIFLU caps .  Somehow we selected a wrong insurance, and the flu med was not being paid for. I offered the doctor and also the father the phone to call the insurance. He did and for about 5 minutes on the phone. Eventually, we both found out that we had selected the incorrect insurance. TAMIFLU was paid for after all. I felt sorry for wasting the doctor's time. For the father, I did not have any feeling :P
• Express Script and Anthem are the same PBM processor?!
• This college student dropped by, seeking advice on how to lessen the swollen cold sore spot. He contracted the cold sore at his gym, he suspected. I should have said that cold sore cannot be passed from another dude's sweat gland!! Can it??
• A relatively young man came asking us to process a cream, that had been faxed to us a while back. It was EFUDEX (fluorouracil) 5% cream. He said he had been putting this med off. Wondering why? So I processed the prescription. Too much money he would have to pay, he hesitated, and said would have to re-consider. Reconsider what?? A few more minutes later, he came back, and paced in front of the pharmacy, waiting for me to call his name to pick up the cream. What brought him back? Imminent danger, I assume??