Saturday, February 11, 2017

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

Friday, February 10, 2017

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 θΆ™ε”ε”ηš„ 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)

Sunday, February 5, 2017

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