All retail pharmacists see this on a daily basis.
A 1 year old get an Rx for some Amoxicillin 250/5. Standard issue. However the sig is “3.4mL tid x10d”.
Now what mother with half a fucking brain is going to know how to measure out 3.4mL? Its Amoxicillin for gods sake, not digoxin or something with a super narrow therapeutic index. 99% of the time these are from a NP or PA.
Let me spell it out for you. Round up or down in 1/2 teaspoon measurements. Why? Its because its what our dosing spoons/droppers have HUGE markings for, and there is a less chance of some dumbass mother giving her crotchfruit 4 teaspoonfuls instead of 4mL.
I know exactly how they get these weird doses. Rather than KNOW the drug or use common sense, they have a little book that says that the ‘dosing for amoxicillin is 22mg/kg/day (or some bullshit like that)’. With calculator in hand (and huge erection in pants) they determine that the proper dose is 3.4534mL of the 250mg/5 solution. They write this magical number down, and send their patients away with a medical hard-on the size of Florida.
I take one look at this, and round up to 1 teaspoonful. Seriously, its Amoxicillin. Its like the douches who write an actual sig for pedialyte. As if you are going to force the baby to drink pedialyte or shove a tube up its ass and dump it in that way.
You think that when we reconstitute the Amoxicillin I count the number of drops in the graduated cylinder? Hell no, I just eyeball it, dump it in, shake, and send it to the mother who’s child is either screaming his/her head off or running around tearing shit off of my shelves (Amoxicillin reconstituted with choral hydrate would be interesting). So your magical 5 digit significant figure dose just got horked out the window by a $4 graduated cylinder.
Reminds me of the time I had my intern calculate a Flagyl compound. She was so proud when she told me that she needed to crush 5.4 tablets of the 500mg Flagyl and mix it with x amount of OraPlus/Choclate Syrup (Flagyl has an ass after-taste. Gotta mask it with Hershey Syrup). I look her square in the eyes, and say “I’ll let you make it if you tell me how the fuck you are going to get 0.4 of a tablet”. InternEgo, meet AngryFist. “Round up to the nearest tablet, and recalculate how much solution to add based upon that “. And who says that I don’t teach anyone anything.
Much like during your crusades in retail, you need to choose your battles. You are exact on the things that count, and you roll your eyes and swear at the NP/PA/CNM/Janitor when they write a stupid sig for a drug that it really doesn’t matter with.
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