Elite NP would like us to look at the picture and share our thoughts
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Over and over again, these sorts of idiotic Facebook consults demonstrate that the education of nurse practitioners, or lack thereof, is akin to a house built on sand - time is no substitute for the comprehensive medical knowledge, training, and experience of physicians.
"Elite" nurse practitioner Benita Amirmazaheri asked the members of the Facebook peanut gallery to look at her picture and share their thoughts, so we figured we'd take a gander and proffer our opinion as requested. And make no mistake, our candid opinion is that it's really fucking scary that an "adult care nurse practitioner" with presumably 20+ years of experience can't recognize shingles even when it's staring her in the goddamn face.
"Cluster of rashes", "painful after a few days", "burning sensation under the skin". Like, holy shit, these might as well be buzzwords ripped straight from a question stem on the USMLE Step 2 CK board exam. We'd be willing to bet that even the dumbest medical student would have gotten this type of first-order question right, no cheating required.
Unfortunately, poor Benita still didn't know what she's doing even after more than two dozen commenters advised her that this was shingles.
James P. Smith
The liver plays a minimal role in acyclovir metabolism; instead, the drug is metabolized intracellularly and excreted in largely unchanged form by the kidneys. As such, any physician who passed their board exams would be able to tell you that acyclovir needs to be renally dosed. Does that mean the average physician know what the renal dosing for acyclovir is off the top of his/her highly intelligent head? Hell naw. But instead, we know how to locate and use reputable medical references and resources, instead of asking insanely fucking stupid questions on Facebook and coming across as a bumbling idiot.
Had Benita done some basic reading and literature review, she might have enlightened herself with several key learning points - that no dosage adjustment is indicated for her patient with a creatinine clearance of 42, that valacyclovir is generally regarded as the better option because it's dosed three times a day instead of five times a day, and that the topical formulation of acyclovir is not indicated for shingles.
MidlevelWTF
In any case, if our post history is any indication, ole' Benita certainly won't be the first or last midlevel nurse practitioner to completely fuck up the diagnosis and management of a basic, super-common medical condition that the vast majority of third/fourth-year medical students and PGY-1 resident physicians could easily recognize. Over and over again, these sorts of idiotic Facebook consults demonstrate that the education of nurse practitioners, or lack thereof, is akin to a house built on sand - time is no substitute for the comprehensive medical knowledge, training, and experience of physicians.