Borrowing Some Common Sense’s account again:
Sparky: how hard is pharmacy school? Remember tthat sense of “why this class is so hard” that you just expressed – that’s about standard for all clinical courses. Imagine two or three of those kinds of classes with two others that are only a bit easier and you have a reasonable expectation for what a semester is like. Find a job in a pharmacy and you’ll have a better idea of what happens.
Winnie: nice line about acridine orange. Current data is unclear about the effects of resvertrol metabolites but I still have a thirty some odd studies to sift through to find some info. Where did you look for literature?
Ironpenguin: niacin has a histamine related reaction and that is indicative of efficacy (one other drug will cause a headache and if it doesn’t the medication expired – which one?) but that reaction is very troublesome and usually requires premedication for a period of time. Few people take it, beside for the fact that many insurances will usually not cover it. So fenofibrate. Pop quiz – What wrong with gemfibrozil?
Antipsychotics – which class? There are several classes of antipsychotics – typicals, atypicals, SSRIs, SNRIs, mixed – which do you mean?
Health – foreigners are no different from American trained prescribers. They all try to be accurate but everyone makes mistakes. Dosing is only one of a battery of things we check for before a prescription leaves out hands. Rest assured, your prescriptions undergo a through review before you get them.
My experience is that prescribers try to titrate up a dose and exceed recommended levels (what’s wrong with Valtrex 2g twice daily for ten days? What should it be?). And we will call you out on it. It stems from a lack of knowledge of how far a certain drug can be pushed before becoming dangerous. What’s the maximum amount of Tylenol you can give in a day? Foreign trained or not, it’s the same issue across the board.
Remember – all substances (yes, even water) can be poisons, it’s the dose that matters. Nitroglycerin is an explosive but when dosed in micrograms, it is very helpful for reducing cardiac preload. Warfarin was originally designed as a rat poison but is extremely widely used as an anticoagulant. Even drinking alcohol has its place (what do you use it for?). Dose is extremely critical.
Ubiquitin – the doctors use the CrCl that shows up in the computer system and is automatically calculated from the patient’s height and weight. This can be erroneous because some CrCls need to be adjusted for various reasons as you pointed out. Medicine and Pharmacy use the same number, except that occasionally Pharmacy will hand calculate CrCl when doing high-risk medications (phenytoin, heparin, vancomycin…) Also, drugs are given dosing ranges precisely because of the factors you mentioned.