metformin+CHF= :(

So whats up in Scott land? Ohhhhh not so much… I’ll concentrate on today because it was eventful. We had class… we had community acquired pneumonia for two hours and then had a pharmacogenomics review… that was fun… I went to my two hour Clinic visit and had a 30 minute patient presentation (5 minutes of me presenting, and 25 minutes of the preceptors asking me questions about the case while I stand in front of the group)… that was fun… I think I’m doing well in there… I remember saying last year how crazy it was what the upperclassmen were talking about, and now I’m… well.. talking about the same things I thought were crazy last year… and it doesn’t seem so crazy any more, and that’s good. I think it went ok… part of the presentation is making recommendations against or in addition to the current chart… so in other words… the MD saw the patient and worked out any drug problems with the pharmacist and then me, a p2, is supposed to come in and make SUGGESTIONS to that? I usually do ok with that, but I goofed up today… the patient had heart failure and diabetes, both of which were not under control, and I recommended the addition of another hypoglycemic agent to compliment the one she was taking, and I started her out at a modest to low dose and made sure it didn’t conflict with any of her other therapies, and I felt good about it… and when the preceptor asked me about the mechanism of action I replied “it decreases gluconeogenesis in the liver and decreases glucose absorption from the GI tract, thus lowering blood glucose levels”… and she said “good” and then she said “what two conditions is it contraindicated to give metformin (the drug)” and I was like…”umm… wow…” and I guessed a few things, that weren't really contraindications … and she said “well for starters… heart failure”… and I was FLOORED… how did I miss that?! I felt better when I asked my honors friend and he didn’t know that either and also my roommate who was there for the presentation said he didn’t know either, so I felt better… and I’m ok, I’ll know never to make that mistake again… oh well…

THEN I went and did 3+ hour window display in Germantown and that went ok, I knew the pharmacist from a previous working experience and that was nice and we talked a lot, she said she wanted to get me working for her again… and I said “well if the price is right…!”… ha… but the event went fine, I checked about 10 blood pressures and actually talked to several people about the avain flu… and people seem to be able to learn a lot because many things about the avian flu are not common knowledge… so that’s fun… ok… more to tell, but no time to tell it… sleepy time!