I really don't know if I'll ever post here consistently or not, but we'll give it a try.  Many things to talk about.  But today, I just feel like focusing on the stupidity of things that happened...today. 

Got a call in Drug Info from a pharmacist (or maybe a doc, I actually never got that information) at an unnamed hospital (well, sorta unnamed I guess...it was a Veterans Affairs hospital) who was asking if they could borrow some Acetadote from us.  For those who don't know, Acetadote (also known as acetylcysteine) is used in the treatment of Tylenol overdose, and comes in an injectable form.   There's also an inhalation product called Mucomyst, which is used to break up thick secretions, but it can be used orally for treating Tylenol overdose.  Apparently, the patient wasn't tolerating the oral form.  I don't know exactly what the called meant by "not tolerating", but my guess would be that he/she didn't want to take it because it tastes like ass.  Acetylcysteine contains sulfur, which means it smells (and presumably tastes, I don't know) like rotting eggs.  So I can understand not wanting to take it.  But look, if my choice was between drinking some rank-ass crap and dying of acute liver failure, I think I'd suck it up and choke it down.  I also have a lot of trouble feeling bad for this person because I would suspect that most Tylenol overdoses in this country occur in Vicodin abusers.  I don't think the FDA has done an especially good job warning the public of the danger of taking large doses of acetaminophen, but you have to take >4 grams a day (8x500 mg tabs or like 12x325 mg tabs) before you start to get into overdose territory, and for most of us that's pretty tough to do.  But since Vicodin has anywhere between 500 and 750 mg acetaminophen per dose, and since druggies pop those things like candy, it's pretty easy to do. 
Now, I'm jumping to a lot of conclusions...it's entirely possible that the person was taking Vicodin for some acute or chronic pain issue (which isn't out of the question since this WAS a VA hospital), or that Vicodin had nothing to do with it at all.  But still, unless you physically can't take the oral form, which is cheaper and easier to give, just suck it up.
So anyway, I connected this person with the people who had the ability to loan (or not) the drug to them.  Minutes later they called back with a few questions that led me to believe they were not that smart.
1) They asked if Mucomyst could be given IV-The answer is no.  It says on the freaking bottles "Not for Injection".
2) They asked me how to dose the IV acetylcysteine-Dude, you're a pharmacist (or a doctor).  Look it up!  That's what I'm gonna do.  Turned out they were staring at the Micromedex (drug info software) page so I'm not sure what exactly they thought I was gonna tell them.
Finally...what the hell is a large, government run hospital doing not keeping an important antidote in stock?  Ugh.  Fantastic.

Later, when I was covering in our Neuropsychiatric hospital, I got this fun order: Advair 250/50, 1 puff twice daily as needed for shortness of breath.  Now, as impressed as I was that the doctor actually wrote for the Advair strength (usually they just write Advair, even though it comes in three strengths), this order was completely retarded.  Advair is a combination of fluticasone (an inhaled steroid) and salmeterol (an inhaled beta-agonist) used for treating chronic asthma.  Basically it helps prevent asthma attacks from occurring.  It is not used to treat acute asthma attacks or shortness of breath.  If you don't take it regularly, it basically does nothing.  Thus, the order is retarded...not only does it not make sense to give it for shortness of breath (because it won't do shit...that's what albuterol is for), it's just a waste of money because it isn't effective when only given periodically.  Sometimes I wonder if these doctors really took pharmacology/therapeutics classes...I mean, this is basic basic stuff.

Actually, this brings me to a huge pet peeve about our house staff.  Since I work at a teaching hospital, we have tons and tons of medical residents.  They're learning and so they make mistakes and we have to call them and correct that mistakes.  That in itself isn't a problem.  The problem, though, is that after a while, they start to get savvy about it.  They realize that they can pretty much write whatever they want, because they know we're going to catch it before entering the order and fix it.  This leads to, in some cases, extremely sloppy order writing.  One time I got an order that read: nicotine patch.  That was it.  No dose.  No schedule.  Nothing.  Clearly, the doc had no clue how to write the order.  But instead of calling the pharmacy (or looking it up online) to figure out how to dose it, they wasted their time and mine by scribbling some random stupidity onto the order sheet.  When they called the pharmacy after I paged them, they were like "Oh, yeah, I didn't think that I ordered that right."  Really?  Wow, glad you were able to figure that out.  And sadly, things like this aren't exactly isolated incidents.

Ok, enough anger for today, I think.  I'm sure more stupidity will rear its ugly head tomorrow...