prescription drugs

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Recently, a patient’s widow called to cancel a routine assessment because the patient suddenly died. There had been no freak heart attack and it had not been one of those undiagnosed cancers.  He just “died, suddenly, in his sleep, I guess,” she said. That got me thinking.

The first class of drugs I think about, when I think of sudden death, are the stimulants.  I remember when someone decided that everyone who was going to get stimulants needed to have a “cardiocentric” examination first.  Doctors asked a lot of questions about chest pain, and administered an electrocardiogram.  These precautions were especially interesting because they were – of course – used before prescribing Ritalin. Many child psychiatrists had laughed at me when I cautioned usage of this job, claiming it was the safest medication ever invented. Once – at the peak of my massive weight — an endocrinologist offered me a prescription of Meridia, to get rid of my excess weight.  He did not think the fact that there had been a “few” reports of sudden death should get in the way of my using it. Read more on Sudden Death in Psych Patients — From Medicine…

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I’m nowhere near what anyone would call a “News Junkie.”  My husband, a former newspaper man, often calls my attention to articles of interest and I see headlines occasionally on various web pages, such as Yahoo or Google. But this type of story seems to come up pretty regularly any more.

Yes, most people in our country are in terrible shape.  I probably harp about it more than I need to.  But remember what Mark Twain (another newspaper man) once said:

“Everybody talks about the weather, but nobody does anything about it!” Read more on Who Needs Wonder Drugs? We Have Vitamin C!…

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The next person to see me made a dramatic entrance. First, she had gotten a head start on her crying in the waiting room. But more than the sound of her crying and sobbing, she could barely make it through the waiting room door. I am no good at guessing someone’s weight.  She later admitted to being 380 pounds.  I took her word, as our clinic’s scale only went to 300. Her general appearance was that she was swollen with water – a human sponge.  The edema bloated every part of her body, and her crying eyes were nearly swollen shut. I started by asking her when her problems began.  She was now 42, and said she had thought everything was okay until age 15, when she had been raped by a “friend of the family.” This man was not really a friend, he was a person who went to the same church.  Moreover, he was a Sunday school teacher.  You would think that by now everyone would know that being a Sunday school teacher does not make someone a saint.  But this family had not yet figured it out. In many such cases, this type of person is shielded by the religious community, and even the victim’s parents are often in denial.  This woman was lucky. Her parents told her that they were going to prosecute this sinner to the extent of the law.

There was a trial, and she had testified.  She thought everything had turned out great, and so did her parents. The rapist was convicted and sent to jail. Again, those who are experienced in these things know that this type of trauma is never over quite so easily. The woman went on with her life and ended up in a really abusive relationship — the kind where someone locks you up and won’t let you leave the house and beats you if you look out the window.  By the time she got the courage to escape this living hell and seek a shelter, had a peck of kids. They lived in this shelter for over a year before she found that she had what it takes to start over.  She went to school, gained some clerical skills, and started over. She was actually doing pretty well until something happened that triggered a demon she didn’t know had possessed her. She was called for jury duty and went, with pride, wanting to do her civic duty.  She couldn’t.  She had a panic attack as soon as she entered the courtroom.  She ran to the ladies’ room, threw up, and tried to enter the courtroom again – and it was even worse. People thought she was having a heart attack, and they sent an ambulance for her.  I do not recommend this means of getting out of jury duty, although it sure worked for her. Read more on Murphy’s Law Of Medicine At Work…

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Why would a pharmaceutical manufacturer want to change a drug from prescription to over the counter (OTC)?

Well, one thing I’ve learned in my lifetime is – When the Question is “WHY?” then the answer is “MONEY.”

Prescription Drugs Go Over The CounterIn this case, the most obvious reason is more money for pharmaceutical companies.  I certainly cannot think of anything — I mean any way shape or form — that can benefit patients.

Oh, sure – in our economically-ignorant country, many people think – “Whee!  I can buy any drug I want without spending money on a doctor’s appointment and without having to get a prescription! ”

These people are prime candidates for the Darwin Awards.

Yes, believe it or not, the “RX to OTC Switch” can actually HURT patients.

Drug patents expire relatively quickly, competitors are waiting at the gates with generic equivalents, and when a drug becomes OTC, there is a chance that insurance does not cover it.

This makes insurance companies and government programs (Medicare, Medicaid/Medi-Cal, etc.) very happy.  They are so strapped for cash that even paying for a cheaper generic is a strain on the budget.  When this kind of money is involved, you can bet that lobbyists are pressuring the government to ease their restrictions so that drugs once considered risky enough to warrant a prescription so that not just anybody can have access will be available to anyone who can walk into a drug store or click on a shopping cart on the web.

Patients will have to pay for OTC meds in cash money and doctors usually do not bother prescribing an equivalent drug.  If they do not already know of an equivalent, they will probably — and generally do — just tell a patient to go buy it over the counter.

A patient who cannot afford the drug will go off it.

OK – so what’s the big deal if a cold medicine, allergy remedy or hair-restoring pill is no longer a prescription drug?

Read more on When Prescription Drugs Go Over-The-Counter…

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A Minneapolis nurse was accused of stealing pain medicine from a patient.  She had a fentanyl habit to feed, and didn’t seem to mind that it left her patient in substantial pain. Unfortunately for her, the patient was a Dakota County Sheriff’s Deputy.

Some women just make bad choices.

The reason I bring this up is not to wonder about if this woman is guilty or not.  I can tell you that I share one opinion with the judge — that people who ask for a lot of continuances may be getting everyone angry. Read more on Addiction And Nurses…

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One of my Frequently Asked Questions is “why do you hate prescription drugs so much?”

And the answer is, I DON’T.  Not at all.  I have used, and will continue to use, prescription drugs whenever they are the best treatment for an individual.

What I DO hate is the way they are mis-used, and the way some companies push their drugs for inappropriate purposes, or in dosages that are harmful when they could be helpful in (usually lower) doses. Read more on A Remarkable Medicine And Its Champion…

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My psychopharmacology preceptor told me a long time ago that the best and most efficient way to know what is happening in pharmacology is to check out the business news.  He was right.

I want to applaud the FDA for doing something perhaps a bit audacious, surely without precedent, but something I consider correct and appropriate.

They declined acceptance of Contrave, a pill for obesity, and requested a longer term and larger study.Bravo.  It’s rare that I give the FDA a “standing O.” The folks at Orexigen pharmaceuticals concocted Contrave — an amalgam of 400mg. of Wellbutrin sustained release and a couple of different doses of naltrexone, 48 and 16 mg. Here is the clinical trials record if you are interested. Read more on Prescription Diet Drug Makes Food Taste Horrible…

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Here are some phrases that you might not expect to hear sweet, friendly Dr. G use very often:

“No, there is no way in hell I am going to renew that prescription as written.”

“Read my lips.  No more oxycodone.  We gotta get you into a rehab, sweetie.”

“Sure, you can see another doctor.  I don’t know how long it will take to get an appointment.  If I am your doctor, you go on a tapering schedule.  Today.”

“If I did what you want, I could kiss my license goodbye.  I am not prescribing outside my specialty and certainly not this crap.  Yes it is crap.  I am sorry you don’t like how I talk, but it is crap.  I can start getting you off it.”

These are all things I have actually said.  Usually loud, yelling over the patient. Read more on Pill Mills Are Death Traps — Marginally Legal…

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I was making one of my rare but periodic attempts to watch commercial television.  Sometimes I amaze myself that I have not given up, especially when I saw a few minutes of “the View.”  I mean, someone has to get in there and promote stereotypes about women, and they are doing an incredible job, what with asking women involved in politics about bathing their babies or something.

Claire Danes in "Romeo + Juliet"

Claire Danes in "Romeo + Juliet"

I admittedly learn a great deal from the commercials.

Like Claire Danes — whom I used to consider a Shakespearean-quality actress — does not seem to be getting any good roles, because she did this incredible commercial, where her eyelashes and face were photographed every couple of weeks.  Admittedly, after four to six weeks, she had pretty lush looking eyelashes compared to week 1.

Here is the prescription drug— yes prescription drug — she was advertising. On the website they have Brooke Shields, too.

Read more on … By An Eyelash…

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He was in his mid-fifties and seemed pretty clueless.  What’s more, he had more abnormal movements than any 20 people and looked like he was dancing with an invisible partner.

Prescription Drugs Should Not Be Shared

It's Dangerous To Take Drugs Prescribed For Someone Else

He sat at home all day trying to get himself involved in things like doing laundry and watching television so that he could get himself tired enough to sleep, focused enough to avoid the voices. He was safe — no forced hospitalization was necessary or even possible here. He promised that he would not harm himself no matter what the voices said, but it became clear that he lived in a world where devils and demons gave him a continuous commentary on everything from why Obamacare would never help him to — the size of his wife’s behind. There may have been some exhortations to harm self or others in the distant past, but they were indeed distant.

He said he had no medicine for the past ten years.  I asked how he lived and he said his family was no help, but his woman was. He was married to someone else but this woman was the only person who knew his day-to-day life and she had brought him to the clinic, so I got a release signed and got her in there. I told her he said he had no medicines in say, the past ten years or so.  She started laughing.

“He ought to be telling you the truth.  He gets his Mama’s old Seroquel whenever he can. Makes the voices shut up so he can sleep a little. ” Read more on Taking Mama’s Pills…

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