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Patients are always happy to leave with an rx. Our pharmacists are filling in the ER. Pretty much everyone qualifies just on BMI....
Unfortunately, present availability is only through ER (PCPs sending to us--I shouldn't complain, these folks have insurance if they have a doc!). And we lean heavy on the pharmacists to go through all contraindications and EUA.
Havent seen an exodus of pharmacists...yet.Comment
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China? really? You believe all their lies and propaganda that comes from there.
NZ has a population of <5M Vs. 65M for UK. NZ is far away from any country and its closest neighbor is Tasmania. UK is right in the center of Europe, financially and geographically. It has a far diverse population. Its economy (GDP) is 2.5Trillion compared to 220billion for NZ ( less than Musk wealth). So comparing the two is not realistic.
USA is USA. It is what it is. We have ultradiverse population, huge land mass with spread out population ( unlike Canada or Russia) and diverse views. That is what makes this country great and also leads to mess that we sometimes get into. It sometimes behaves like this
I was not born here but am a naturalized citizen. Compared to the two other countries I have lived and worked and also the many countries I have visited, I would any day take USA over others, warts and all. It is not perfect but far above others in the way its treats outsiders. It has great diverse climate.Love and marriage, love and marriage,
Go together like a horse and carriage.
This I tell ya, brother, you can't have one without the other.
Please don't take this the wrong way but it looks you are always unhappy about your work or the country in general. You seem to be in despair or putting US down. Maybe you should try and practice in a different state or even take a year off and practice in NZ or Australia. Some of these places have long term locums that US trained physicians, board certified, can easily get. You might like it and it might jive with you or you might find that your idealized dreams of distant nations are far removed from reality.
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We still have monoclonals/Sotrovimab and are dishing it out quick. Our patient volumes have plummeted the last few days. The last shift I worked was actually slow. That hasn’t happened for a long time.
the new drugs will be interesting…. Haven’t given any yet but take a peek at the contraindications and cautions….
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The list of contraindicated drugs and possible drug interactions in ridiculous. It’s going to be hard to find a patient with proper comorbid conditions to qualify for this drug who isn’t already taking one of the meds on the list.
We still have monoclonals/Sotrovimab and are dishing it out quick. Our patient volumes have plummeted the last few days. The last shift I worked was actually slow. That hasn’t happened for a long time.
the new drugs will be interesting…. Haven’t given any yet but take a peek at the contraindications and cautions….
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Correct cytochrome issues. the main ones where most at risk will be on: statins. -- includes most of the common, not just lova and simva as posted -- crestor and lipitor both also on the contraindicated list.
Same for CCBs -- amlodipine
Other really common ones: wellbutrin and trazodone.
And PrEP
Then there's the renal dosing.
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I don't really care how many cases of covid China had. Medical statistics are fungible, just like how you can claim that you have very few nursing home deaths because the nursing home patients died in the hospital. I just believe them when they said that they had controlled the virus, just like how now they are saying that they have cases again. They may not have a free media there, but it's hard to hide when you confine everyone indoors and start spraying the streets every time you have a positive case. That was my point, you can't "eradicate" the virus because we are an interconnected world. I suspect that the only reason that the US is probably number one in the number of viral cases is because we do the most pcr's and testing. I just wish these stupid governments would realize that we are way beyond "containment" or "eradication". When you have some 40% of deer showing evidence of prior covid infections, you should probably step back and realize that the disease isn't going away by instituting mandatory testing and quarantining at your artificial "borders".
On a side note, my hospitals have been using a lot of barcitinib for covid which I have been telling them to stop or decrease the dosage when I see them. Early in the pandemic, I used to tell everyone to stop remdesivir when I saw them, but lately I usually just write weigh risks vs benefits given their diminished gfr. I don't want to deny anyone an efficacious covid treatment, but I feel obliged just to point out whatever the fda says about renal dosing of the medication. One of my icu attendings is still putting everyone on ivermectim which I gather is not renally dosed.Comment
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Renally dose ivermectin?? That’s crazy. You dose it based on the patients shoulder height measured in hands. Here’s a conversion chart I found last time I was on service
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For covid, wow. Ok then.
Back to more mainstream peer reviewed data:
Attached simple table on the benefits. the NNT is striking and nice to see oral med equal to the monoclonals at least based on the current studies.
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