CDCR Interview Questions Flashcards
(9 cards)
What do you do when you have a disagreement with the doctor?
Stay calm
Maintain your professionalism
Address your concern, the problem is not the doctor
As healthcare providers: the doctor and my main goal is safety, effectiveness and positive outcome for the patient.
I would tell the doctor why I’m uncomfortable and be prepare to offer an alternative.
Sometimes you run into situation where you never experience in real practice. One time I had an orde for suboxone 40 mg daily. In this situation my only reference was clinical pharmacology. I told the prescriber that under clinical pharmacology, the recommended max was 32 mg/day.
The provider told me that they are calling me from a suboxone clinic, and they have clinical experience dosing as high as 40 mg per day. The doctor basically said, “if I’m uncomfortable dispensing it, they can send the prescription to another pharmacy.”
At this point, there’s 2 options for me:
First option: I realized this is a suboxone clinic. These prescribers have clinical experience which I don’t have. I just need to document and dispense it.
Second option: I can tell the prescriber that I’m not comfortable dispensing it and offer them to send to the prescription to another pharmacy.
As far as escalating, I can tell you that in my 20 years of experience, I never had to escalate or made a complaint. As a pharmacist, including all of you here, we all know that it is not illegal to refuse to fill a prescription. If I do refuse to fill a prescription, I just have make I’m able to defend my decision.
Epclusa and Omeprazole
Epclusa requires an acidic enviroment for absorption
If taken together, omeprazole can decrease the effectiveness of epclusa.
If omeprazole is medically necessary, take epclusa first and then omeprazole 4 hours later
Limit to omeprazole 20 mg max
Epclusa drug interaction:
Amiodarone
Digoxin
St John’s Wort
Statin
HIV meds
Amiodarone –> risk of bradycardia, monitor if use together
Digoxin –> can increase digoxin level, monitor drug level and dose adjustment, digoxin is a narrow therapeutic index drug
St John’s Wort –> St. John’s Wort is a strong CYP Inducer
Decrease eplcusa level
Statin: increase risk of myopathy, monitor and dose reduction may be needed
HIV meds (efavirenz, ritonavir) –> decreases epclusa drug level
Identify STRONG CYP Inducer
PS PORCS
P = phenytoin
S = smoking
P = phenobarbital
O = oxcarbamazpine
R = Rifampin
C = Carbamazepine
S = St. John’s Wort
P = Potentiate (more)
Identify STRONG CYP Inhibitor
G❤️PACMAN
G = Grapefruit
P = Protease Inhibitor
A = Azole Antifungal
C = Cyclosporine, Cobicistat
M = Macrolide (x azithromycin)
A = Amiodarone
N = NDP CCB (diltiazem and verapamil)
Wegovy Side Effects How to manage it
Main SE: GI (nause, vomiting, diarrhea)
Serious SE: thyroid tumor, vision change, pancreatitis, gallbladder
Start slow and increase gradually, if unable to tolerate side effects with dose increase, can always back down again
Focus on 3 things: eating habits, food compositon, and life style
Eating habits:
* Eat slowly
* Eat smaller portions and more frequent meals
* Avoid lying down after eating
* Stop eating once satisfy, not to fullness
Food:
* Choose easy to digest food: rice, toast, something with water (soup)
* Avoid spicy food
* Avoid sweet meals
* Stay hydrated
Life style:
* Go outdoor, get some fresh ari
* increase physical activity, just not right after eating
Treating side effects:
* Nause and vomiting: can use zofran
* Diarrhea: probotic or loperamide as needed
* Constipation: stool softners as needed
* Can always go back to lower dose if unable to tolerated side effects
Metformin and egfr?
if eGfr is 30 to 45: not recommended to start therapy
if eGFr is 60, okay to stay at current dose and monitor
if eGFr is below < 45, reassess and may decrease dose
if eGFr is < 30; it is actually listed as a contraindication
Which vitamin B is affected with metformin?
Vitamin B12 deficiency
- Peripheral neuropathy
- cognitive impairment
