I GET SMASHED. YEAH!

So why in the world would I write about getting smashed on a professional pharmacy rotations blog?! Cause it has to do with pharmacy!!

Pancreatitis
I GET SMASHED are the causes for pancreatitis, and as pharmacists, it's important to know these, since some of the causes are drugs. Idiopathic Gallstone Ethanol Trauma Steroids Mumps Autoimmune Scorpion sting Hypercalcemia ERCP Drugs (Sulfonamides Azathioprine NSAIDS Diuretics). The treatment for pancreatitis is palliative care and the patient should be NPO for a while, since eating will aggravate the pancreas.Palliative care...so that would be treating the pain (cause apparently it's very painful), and using narcotics, correct? Well, narcotics are known to cause spasm of the sphincter of Oddi. Take a look at this picture:

Basically, the gall bladder and the pancreas share a duct that leads into the duodenum. The opening to the duodenum is the sphincter of Oddi. If narcotics, specifically morphine, is used, you would think that the spasm of the sphincter of Oddi would cause increased pressure inside this duct, and cause bile to be kinda back washed back into the pancreas. The other option would be to use meperidine, but the metabolite (nor-meperidine) has an increased half life, and can build up to cause seizures. In this case, it seems that the risk of causing a clinically significant spasm of the sphincter of Oddi outweighs the risk of having a seizure. SO... use morphine for pain in pancreatitis!

Psych
Black Box Warning for quetiapine is increased risk of death (well that sucks). Also, phenytoin can cause nystagmus. The attending on our team said that even if she senses slight side effects of Aricept (donepezil) in a patient, she'll D/C it. Oxybutynin is an anticholinergic that can cause mental problems. Remember...anticholinergics...red as a beet, dry as a something, *mad as a hatter*....

Infectious
Cephalexin is usually dosed every 6 hours. Diverticulitis is inflammation of a pouch in the intestinal wall. This patient was treated with cipro and metronidazole in order to cover anaerobes, enterococcus, and gram negatives. Check, check, and check! Vancomycin toxicity is usually related to peak concentrations. So, if a patient was on 1g vanco q12h, and being treated for hospital-acquired pneumonia, and had a trough concentration of 8mg/mL, what would you do? First of all, the goal concentration here is 15-20mg/mL. You could either increase to 1500mg BID, or 1000mg TID. The latter could decrease toxicity associated with higher peak concentrations, and if the hospital had pre-made bags of 1g vancos sitting around, then why not! For aspiration pneumonia, use clindamycin or Unasyn.

Anticoagulation
If someone is suspected of having a DVT, then try doing a Ddimer test (to rule it out). The problem with this test is that it's useless when it comes out positive, since there are a ton of false positives. For example, if a patient were pregnant or had an infection, the Ddimer would likely come out positive. So, it's only useful if it's a negative result. Also, introducing the FAB Four! Fluconazole, Amiodarone, Bactrim, and Flagyl...if any of these drugs are given with warfarin, then the dose of warfarin must be HALVED so the INR doesn't become supratherapeutic. Also, what's the reversal for bleeding with heparin? PROTAMINE!

That's it for today. I was assigned a DI for IV iron dosing, so I'll have a nice summary about that tomorrow. THEN, off to Vermont for my BFFs wedding!!