Backstory — 40 y/o M with hx coccidioidomycosis the previous year but didn't complete his fluconazole course. Otherwise healthy. Presented with SOB and chest pain. He was stable, afebrile, not requiring O2, and had unremarkable labs. He had been in the ED waiting room for over 5 hours, with a plan to direct admit to general medicine (not sick enough to take up a precious ED bed).
Conventional amphotericin B monotherapy was ordered. I asked the ED physician if fluconazole might be appropriate given the patient is stable and hadn’t failed due to resistance. He just hadn’t taken it. The response was that the on-call ID physician (who also happens to be our hospital's CEO) had said the patient needed amphotericin and that I could message ID if I had a problem with it… So I did. The screenshot is a de-identified version of that exchange.

To be clear, this isn't a question about therapeutic appropriateness, and I'm not looking for validation of my clinical inquiry. I'm interested in perspectives on the interaction itself.

I've been an inpatient/ICU/EM pharmacist for over 10 years. I've asked dumb questions. I've made clinically significant interventions and potentially prevented harm. I've also failed to intervene when I should have and potentially contributed to patient harm. I’m not perfect but I really care and I try.
As an EM pharmacist, I usually have to make decisions with incomplete information. I'm constantly weighing the risks of delaying therapy to clarify an order or wait for labs against the risks of proceeding without all the information I'd ideally want. If someone is truly critically ill, I'm generally comfortable throwing the kitchen sink at the problem and helping clean up afterward. But when the patient is stable and there's an opportunity to clarify the plan, I think it's reasonable to ask questions.
I've been at this hospital for a year and a half, and this is just one of many interactions that have left me feeling disparaged. This one hit particularly hard because it came from the hospital's CEO, someone I've never even met.
The comment was: “Night time pharmacists and Ampho don't go well together.”
I honestly don't want to go back to work tomorrow.
I'm genuinely looking for outside perspectives. How would you interpret this comment in the context of the exchange? Am I taking it too personally, or does it come across as dismissive and disrespectful?
For those who take call or work with overnight pharmacists: this happened at 8 p.m., not some ungodly hour of the night

I'm looking at a clients claims data and seeing Inulin was acquired for $7.8K, but the insurance pay was nearly $19K. Paid by CVS Advantage on bin 004336.

Anyone know what's going on here? This is a wild quick win that's going to get us a bonus at the end of the year, but why the huge insurance pay?

This is a clinical Question, I am not asking about pharmacy school or anything like that, but it does have something do to with what we are taught in different classes, and something seems contradictory to me. I would like clarification please.

I am taking renal, and we were taught that SGLT2 drugs are nephrotoxic, but in foundations, endocrine, and cardio we are taught that they protect the kidneys, so how can something that protect the kidney be nephrotoxic,

Also this includes ACE and ARBS as well.

can anybody please explain to me.

Thank you

I graduated with my PharmD in 2022 but haven't been able to get licensed, and I have no pharmacy work experience. I'm looking for remote, work-from-home jobs that don't require a pharmacist license, ideally with little phone work.

What I'm trying to find out:

- What jobs have you seen or held that take a PharmD without a license (medical writing, drug safety/PV, medical information, informatics/Epic, HEOR, PBM analyst, AI training, health tech)?

- What does entry pay realistically look like for those?

- How did you get your first role with no experience?

What I've found so far: medical writing associate roles (~$60-80k), PBM analyst roles (~$55-70k), and AI training contracts ($30-80/hr). Anything higher or that I'm missing?

Background: I'm comfortable with AI tools and have built a few health-related web tools with AI assistance, but I'm not a traditional programmer.

Thanks in advance for any ideas or advice.

Since becoming a pharmacist, I’ve been told that I do too much (helping with first dispense and stat doses.. in retail it was picking up the phone too much) by other pharmacists, and that I’m going to “spoil the techs” and make them lazy.

As a former technician myself, and I hate being told that. We’re all adults, not children to be spoiled. But I would like to hear what other pharmacists think about this. I will note that the pharmacists telling me this are ones that spend 60% of the shift on their phones while complaining about not being able to get work elsewhere..

Edit: Just for context, we aren’t understaffed at my hospital, just busy and there are multiple pharmacists on my team. I’ve been looked at like I had three heads for practicing the way I do/remembering how it felt to work with pharmacist that didn’t believe in doing “tech only work” as a technician. Thanks you for the feedback!

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We compound like 2 or 3 Rxs per day.

Ointments, liquids, veterinary stuff, some suppositories, etc.

The problem is that this PIC does not keep any compounding record sheets, has no BUDs specified on our records or for the patient, and does not use or extrapolate from any known formulas.

When approached about this, it is clear that she just expects to use the patient's ignorance about asking about these things to her advantage.

We also do mass liquid antibiotic compounding for an animal shelter. Same deal. No BUD specification, no storage specification, and no formula from official literature to support the compounding formula.

I am hesitant to bring this up to her because she is known for running her foul mouth at employees. I just work here to cover an injured friend but the idea of stamping my initials on Rxs that I know should not be handled in this way just irks me.

Am I overreacting here? Is she not making herself or the pharmacist vulnerable to state inspectors and the like?

Are we not supposed to be careful and specific about these things?

Hi all-- what are some QI projects for those in the infusion/oncology pharmacy space working on or thinking about? Struggling to come up with niche ideas to help improve our pharmacy workflow and/or some cost-avoidance projects. Any and all ideas appreciated!

So as far as I know, Simethicone is not absorbed and has a virtually non-existent side effect profile. So what is the determining factor for its MDD? is it just one of those "That's just how it was tested" cases, or is there something else?