- Aug 2018
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pharmd.umc.edu pharmd.umc.edu
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Monitoring
You discussed side effects of LR"s and the BZD, but what side effects should we monitor for meropenem?
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If presents
Not sure what you are trying to say here with these two words.
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WBC
What should/would you recommend if the patient does not respond ideally to your fluid and antibiotic regimen?
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segmented
Would say neutrophils (segmented 44-65%, bands 0-5%) just for additional clarity.
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electrolyte
Will Lactated Ringer's completely correct all electrolyte imbalances?
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CIWA
Good job mentioning this and how to use it!
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20 ml
I would check this number out with the package insert. I have seen 100 mL normal saline minibag snaps commonly used for meropenem in the hospital.
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Therapy
Are there any other therapy options that may be beneficial in patients with a history of alcohol use/alcohol withdrawal?<br> Hint: What are major complications that can be seen in patients with chronic alcohol use?
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pancreas
Is that the only reason why Bactrim DS should not be continued? What drugs can induce acute pancreatitis?
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OTC
Are you sure about all of these being continued?
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will
You have told me how treatment will help his current S/S, but you haven't told me how it will directly impact the patient's life. (ie. quality of life, work, etc.)
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alieving
Check spelling on this
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pharmd.umc.edu pharmd.umc.edu
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carbopenems
Check spelling on this
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meropenem just
Typo - "meropenem is just"
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q8hrs
What does MH's renal function look like? Based on your findings, is this an appropriate dosing interval?
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Pepcid
Is Pepcid okay to use in patients with acute pancreatitis and if so, what route is best for this patient at this time?
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life
Good job mentioning quality of life!
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Goals
If you get close to the 1 page limit, you can consider taking the numerical values out of this section since they would fit better in the Therapeutic Monitoring section.
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pharmd.umc.edu pharmd.umc.edu
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physician
He is in the hospital already, so he may or may not be able to recognize and communicate these issues to his doctors. So, it is up to you to determine how frequently someone should be checking these things for him and what changes should be made if they occur.
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adjusted
Is there a certain number/cutoff that you could mention?
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renal
Good! But, what lab value do we use to monitor renal function?
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Monitoring
Be sure to mention how frequently all of these should be monitored.
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opioid
Was he previously taking the Tylenol ES for his HAs? Do we use opioids for HAs? Also, would we want to start an opioid in someone who already has a history of substance abuse (ie. alcohol)?
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output
If you mention this, they may expect you to mention what is considered normal urine output for a patient in this setting.
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Alcohol
Like that you mentioned this assessment, but how would I use it in modifying MH's care? What would the score mean?
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Monitoring
Be sure to mention how frequently all of these should be monitored. Also be sure to include critical values (ie. the range for WBC, the range for the specific electrolytes you want to monitor, etc.)
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pancreatic
Typo
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8 to 12
Pick one: either 8 or 12 How long will MH be on the meropenem?
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50 tablets
50 tablets?? I would rethink this wording :)
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multivitamin
Route?
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Ringer
Route?
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Therapy
Be sure to use the correct format for the drug names. --> Correct naming format (Brand + generic unless using specifically generic version and will write generic name (generic) ex: lisinopril (generic) or Januvia (sitagliptin).
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malabsorption
Is the patient on Pepcid?
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References
Make sure to include in-text citations!
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pharmd.umc.edu pharmd.umc.edu
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work
Never hurts to mention "improved quality of life"
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lorazepam
How frequently would you monitor for this?
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50
How frequently should you monitor for WBC and temp changes?
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Monitoring
What is your plan if the patient does not respond ideally to your current recommendations?
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given
What route?
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should
Typo - do not need the word "should" here.
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doses
Are there any other concerns in patients who present with alcohol withdrawal? What medications could be used to address these concerns? If you find anything, be sure to add to your rationale section.
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electrolytes
Will the LR's cause his electrolytes to normalize without using any additional agents?
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Therapy
Be sure to use the correct format for the drug names. --> Correct naming format (Brand + generic unless using specifically generic version and will write generic name (generic) ex: lisinopril (generic) or Januvia (sitagliptin).
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Pepcid
Oral or IV? He is nauseated and vomiting.
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normal
If you start to get close to 1 page, you may consider taking the critical values/actual numbers out of this section since these really fit better in the therapeutic monitoring section.
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pharmd.umc.edu pharmd.umc.edu
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brand
Be sure to use the correct format for the drug names. --> Correct naming format (Brand + generic unless using specifically generic version and will write generic name (generic) ex: lisinopril (generic) or Januvia (sitagliptin).
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immediately
What should you do if a critical value is met? In order to answer this question, I would assume that the physician is going to ask the pharmacist what their recommendation would be. Also note that MH is already in the hospital, so MH may or may not be able to recognize and communicate these adverse events to a nurse or doctor.
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monitored
For all adverse events listed, how frequently should MH be monitored?
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potassium
Was potassium replenishment addressed in New Drug Therapy? If so, is that enough to get MH back into the normal range?
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who chlordiazepoxide
who "used" chlordiazepoxide
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(
May need a closing parenthesis since you have an opening one.
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resume
Do any of MH"s current medications have the potential to induce acute pancreatitis? If MH is vomiting, should oral medications be used? Will elevated liver enzymes affect your choice of medications used?
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electrolytes
Is correcting electrolytes/fluids a goal of therapy? Which ones are abnormal?
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