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Found 5 results

  1. PACShrink

    Benzodiazepines -RANT

    Benzodiazepines- How many of us are sick and tired of the battle of this class of medicines? Here is my rant- Alprazolam- The lipid solubility and short effect is the main problem with this drug. Although I do agree it has its place. IMHO the only time this drug should be prescribed is: Patient has an: MRI/CT and is claustrophobic, patient has a dental procedure in the AM and is nervous, flying for business and the patient is nervous, patient has Panic d/o. In the case of Panic d/o, if the patient needs more than 0.5 mg. 2-3 times per week they should be on an SSRI, NOT Xanax. What do you do in the case when a patient tells you that their pill bottle was: Lost/Stolen/Destroyed. You can’t just decline prescribing something as they could have withdrawal symptoms -at worst case seizures. Too many times I hear this one “ I had to take 1.5 or 2 tablets because 1 dose was not working. Now I am out X days early”. This is clearly abuse. ​ About 6 weeks ago I was seeing a young man who was being prescribed Xanax 1.0 mg 2-3 times per day for anxiety. This is not one of my patients, I had never seen this patient prior to that time. The staff MD had been prescribing #90 tablets per month with 2 refills and the patient has been on increasing doses for the past 7 years. I checked the PMP (As I do for 100% of the patients for whom I will likely need to write for a controlled substance) and he had filled his prescription 27 days ago and had no refills remaining. Looking at the dates he has been filling his prescription at 27-28 day intervals for the past year. He proceeded to tell me that his dosage was too low and that he was needing to take 1.5 mg on several days to get relief from his anxiety. ​ I was in the process of doing the calculation in my head -- and I was trying to figure out how much he should have remaining and he stated that he has been w/o his Xanax for 3 days. I asked him how he was feeling and he said he was anxious and he stated 'My internal organs feel like they are shaking'. He then proceeded to stare off into space, his eyes rolled back and he started convulsing. I immediately yelled out for help, removed his glasses and kept him from hitting his head on anything. His benzo withdrawal seizure lasted about 2 minutes. He was postictal for 5 minutes and the local rescue showed up. On a side note he was taken into custody by the local police BC he refused to ride in the ambulance to the hospital. The officer believed he was not safe to drive his vehicle. I have not seen this patient since. I am tired of this class of medicines. I never want to see this again but, I know that this is wishful thinking. Any comments on how we can better this situation? I feel that I need to pick my battles. I do not start my new patients on benzos, I tell the patients of the staff MDs that I will continue their meds for this appointment but, in the future I will start them on a taper down schedule. What else can I do?
  2. Hope someone can help me get my personal statement off of the ground! I have a gripping but very personal topic that I want to use for my personal statement when I apply this spring. Emotional/Verbal Abuse: I was emotionally/verbally abused by my boyfriend. We dated for 3 years, lived together, and even adopted a dog together. He drew me in until I was attached, I was then verbally/emotionally abused for the next two years. I was constantly told I was not good enough, pretty enough, smart enough, or driven enough. One of the hardest things to hear from him was that I would never become a PA because no school would ever accept me. It took me a long time, sometimes I think it was too long, to leave. But I did. Even though was the most difficult and emotional period of my life, I really believe it made me a stronger person overall and will help me help my patients in the future. I would love to one day be able to share my story of emotional abuse, especially with teens and young adults. I really would like to develop this topic further and think I could create a really great personal statement. I do have a few questions though, opinions are encouraged and welcomed! Is this a good topic for my PA school application? How can I bridge my experience so that I sound strong and empowered? The last thing I want is to sound like a victim. How can I relate my experiences to becoming a PA? Any other advice? Opinions? Comments? or Questions? Thank you (in advance) for those of you who comment for all of your input and support.
  3. Here is a dumb question- Has anyone had difficulty with patients filling Benzo's early?? Of course you have. Do you ever wonder why? I have been scratching my head about this for months now. Here comes the bullet- This is part of a draft of letter I want to send to the state board of Medicine about a particular pharmacy's business practices. This is a HUGE retail chain pharmacy. All 3 fills were at the SAME location. This is the text from the top of the letter: XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX February 11, 2015 RE: RX# 0XXXX To Whom It May Concern: Original prescription was written on 12/22/2014 for Xanax 1.0 mg. Take 1 tab three times daily #90, DS 30 According to the PMP database, the above referenced prescription was filled on 12/22/2014 for #90, refilled on 12/30/2014 for #90 and again on 1/3/2015 for #90. This spans a 12 day period where the patient was issued #270 Xanax 1.0 mg. tablets. The prescription was filled and subsequently refilled at name of Pharmacy at Address and store # of said pharmacy. How was the pharmacy able to Re-fill a 30 day prescription after 8 days then re-fill again in 4 days? I am concerned that this puts my license at risk. The pharmacy clearly did not follow the 30 day period on this prescription putting the patient in danger of overdose. Thank you for your attention to this matter. If you have any questions, please do not hesitate to contact me. Sincerely, Me, PA-C XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX Before anyone chimes in WRT the ridiculously high amount of Xanax this prescription was written for - Don't bother. This particular patient is a regular at our practice. Almost exclusively seen by 1 particular staff MD. I assure you, when I wrote this prescription I felt the pucker factor but, I was not going to reverse the treatment course that the MD was following. When I learned about the dispensed amount and dates of dispensing this medication I immediately bought it to the MD's attention. I also let the staff know I was not comfortable seeing this patient again and it was my belief that this constituted abuse. Thus violating the practice agreement. I suggested the patient be discharged from the practice. The MD was not willing to discharge this patient and agreed to exclusively see this patient. Thoughts??
  4. First, let me state that I am making this post mainly for venting, because I feel like I could vomit at any moment. So sorry if this doesn't make any sense whatsoever.... Inpt Psych.... Medical Consult for a 6 year-old who complains of "vaginal itching;" also reports from nursing staff of being hypersexual, masturbating so patient is placed in room by herself... No complaints of urinary symptoms, abdominal pain, constitutional symptoms, vaginal rash, etc. etc. Nurse in to chaperone for exam... Pt responds inappropriately. Hysterically laughing throughout exam, very very resistant. Outer labia is erythematous, (probably from self-manipulation); was not able to assess further because patient is almost impossible to examine.... very very raw excoriations immediately surrounding anus in the shape of a perfect circle, with inner erythema, appearance of superfical lacerations immediately surrounding anus, anal tears. notttttt like constipation, or rash-like. This looks like serious sexual trauma. But I'm no expert.... Urinalysis negative; urine gc/chlamydia negative. Patient denies abuse (by deny, I mean, she says no while looking at the wall, avoiding eye contact) So I alert the Nurse Supervisor, who alerts pt's social worker who usually handles all things related to DSS. Mom's BF's WERE accused of sexual abuse towards pt but apparently no investigation; however; pt is now in dad's custody for reasons unknown. So I am told SW is going to handle it and initiate an investigation, until I get a call from the clinical supervisor who says "we have already interviewed the family and they deny history of abuse, patient also denies, so we have no evidence, therefore we are not going to call DSS." WHAT?! OK, I get it. I'm the suspicious one, so I'm the one who needs to call DSS. No problem. but the SW's and Supervisors are now giving me so much shit like "you cant prove it" and "We have no right to delay discharge for this investigation" and "shes not acting like shes been abused" blah blah blah blah.... every freakin excuse in the book. I am just so sick to my stomach... of course now that I'm home... I call, and police will be coming out tomorrow. In my heart I know that this is what's going on with the child.... and I have gotten so much shit from SW because they don't believe it. But my exam findings are consistent with trauma. I feel that I'm OBLIGATED to report this.... I can't even think straight right now. Also, I'm NOT expert on this stuff.... why can't she go to some sexual abuse expert to be examined? I feel like I'm alerting the authorities and I need to be 1000000% sure, not just 99%.
  5. Lucky Shot

    PA Program in the Air Force

    Hello, My name is Marco, I recently joined the forum. I am in the Air Force, I'm enlisted and I 'm stationed in Dyess AFB (Abilene) Texas. I've been going to school since I joined but I decided to change majors, I was going into business, I thought about it and I dont really like to deal with graphs and I'm not good at it. So I finally thought about it again and I rather be helping people, I'm a really nice person, I love to help people (which I don't think many do) my hand-writing is really bad, kinda like a Doctor :P Well before I start, I have 33 credits so far from schooling, plus the ones in the military which I don't think many school accept. I need a starting point, where to begin, on which classes I need to take in order for me to become a Physician Assistant, which school to attend to and what is it that I get a Bachelors or a Masters, how long does it take to become a PA? I am really confuse about what classes I need and what is that I'm geting, a Masters or Bachelors, I've read that I need to go into a Bachelors in Health and then become a Physician Assistant? how long will this take? Now the school is confusing at this point and it gets more confusing because I don't know which school to attend to! I can only be a part-time student and the schools (colleges) here (Abilene, Tx) do not have any PA programs or health programs and the semesters are 5 months long! and I can only take 2 classes and I have no clue if I can take online classes to finish all the pre-req. Please I really need a good start, I would like to know how to begin, I am really wanting to finish my education. Which classes should I take to become a Physician Assistant, where should I enroll too and how long do they take? Any help will be really appreciate it, thank you!
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