One of the requirements of any of my rotations are Drug Information questions. Generally, it is something that the preceptor will give me such as "Why can't you give a high initial loading dose of warfarin to a patient.? My preceptor here doesn't really care where I get them as long as they are meaningful. So I now turn to you my loyal readers. What are some drug related questions you have had recently that you might want answered? A couple, who shall remain nameless, had a great one for me last week about epidurals. I benefitted from the learning since I wasn't too familiar with it and I think they appreciated the answer as well. I might not be able to answer them all (wishful thinking, I probably won't get any questions at all!) but I will certainly do my best. Don't post anything that you wouldn't want others to know. It can be about anything, kids drugs, your drugs, pain killers, cold medicine, etc. Even general curiosity questions. Maybe you have a "friend" who is having some health issues. The sky is the limit.
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Awesome! My question is about prenatal vitamins...and postnatal I suppose since I'm taking them while breastfeeding. I am on my last prescription for a prenatal called Precare Premier which supposedly is good for vegetarians because it has more B vitamins. But I think perhaps my doc prescribes them to everyone. Is it a good prenatal and does it have extra value for nonmeat eaters? Also I buy Expecta DHA supplement from Target each month. Is it really heping?
Oooo good question Heather! I am interested to know why people take DHA supplements as well. My doctor hasn't said anything about them to me, but I know women take them. What does it do for you that a normal pre-natal vitamin doesn't? (And thanks for your awesome help last week with our questions! You were so great to look up so many things for us! And I can honestly say that you really know your stuff!)
Two questions:
Question One: I was on a brand-name drug and then switched to a generic when it became available. I notice less of a benefit on the generic even though the dose is the same. Is that possible? Also, are there different manufactureres of generics? If so, could a different generic of the same drug be more effective than the one I'm on?
Question Two: I've heard lots of different opinions about what is safe during pregnancy/lactation. Is there a way to get a difinitive answer? Or is there an up-to-date list you have? All three OB's I've had have said different things and the peditrician has his own opinion too.
I know the max dose of acetaminophen is 4g per day. What's the toxic dose? Is it by kg of patient? Is it different person to person? I had a patient the other day that took about 8g in a day. I tried to find this info, but maybe you'll have a better idea.
Here's a non pregnancy related question for you, Greg is on oral concentrated oxycocone from his tonsillectomy. Lately he has been getting a feeling of numbness and loss of taste and dryness in his mouth as he approaches his next dose. Are these symptoms typical side effects of the drug? Any connections? Do grace us with your wisdom AJ :)
Great questions everybody. Here's how things will proceed. I may contact some of you for more specifics, others I can answer without more details. I will do the research today and tomorrow, run it by my preceptor to ensure I'm not spreading "false doctrine" and e-mail you the full answer. Here are some of my thoughts thus far...
Heather - I'll have to look up info about the vitamin info and supplement. Couldn't really way off the top of my head.
Sarah - The brand/generic thing is a longer explanation that I want to put in a comment. I will say that yes, there are different manufacturers and you are not alone in noticing that some generics don't work as well brands. That is not to say that ALL generics are "worse" than brands. There are a number of factors related to their efficacy that I'll get into in your e-mail in addition to the pregnancy/lactation safe list.
Joe - anything above 4 grams is considered "toxic". Tell that patient to stop taking so much ASAP. Perhaps one day might not affect him but it certainly isn't something he/she wants to continue. More questions and info to follow.
Meg - off hand it seems like a possibility. I'll look into it and also what you may be able to give to reduce those side effects.
Pregnancy question - Why is it that you can take tylenol and percocit when you're pregnant but not ibprophen? And yet you can take ibprophen when you're nursing? What is it about ibprophen? (Pardon my spelling)
Hey Carissa,
Ibuprofen is actually "safe" to take during the first trimester at OTC doses (less than 400 mg 3 times a day) but not in the 2nd or 3rd trimester. That is according to one of my lectures from last year. That being said however, still take tylenol before anything else. The reason for this is that high doses of ibuprofen has been linked to increased miscarriage. Ibuprofen and other NSAIDS inhibit prostaglandins to dull pain. Prostaglandins have a role in implantation early on and maintaining the integrity of the placenta later in pregnancy. Tylenol and opioids containing tylenol such as Percocet stop pain by other mechanisms.
Ibuprofen is fine when nursing because only trace amounts of it pass into the breast milk. There have also been concerns of congenital heart defects from taking ibuprofen during pregnancy, but those are largely unfounded.
hope I'm not too late on this question asking. My question is, is there anything you can give a 2 year old for diarrhea? Cormac has a "nervous stomach" so with the move his diapers have been less than pleasant. And it's not just the move, anytime he is in an unfamiliar situation it happens. I feel bad for him, but worse for me.
Here's a somewhat related question: What is a safe way to dispose of old and expired medicine? I've heard conflicting advice and am here seeking of your wisdom, oh great AJ...
I got one that came up today. We normally prescribe a steroid (medrol (methylprednisolone)) for patients conjunctively with antibiotics and narcotics to get them out of pain when they have infected teeth. The steroid is to reduce the swelling. Anyway, I had a patient who had severe throbbing pain from a bad tooth. I wanted to prescribe a steroid to help with the pain reduction (less swelling=less pain). The problem is that she claims to have had bad reactions in the past to prednisone and medrol. I have never encountered what to do or prescribe if they have sensitivity to these steroids. Is there such thing as allergies to steroids? Are there different steroids that I could use? Is there any anti-inflamatory that would be recommended in this situation? Feel free to email me the answers if you want, my email is a gmail account, send it to drcalderwood. (i don't want any bots grabbing that address and spamming me but it is @gmail.com)
Here you go Sarah and anybody else that wants to know.
http://www.whitehousedrugpolicy.gov/drugfact/factsht/proper_disposal.html
Hey AJ, thought I would join the group of questioning people and ask away as well...
Two years ago, my sister became pregnant while taking antibiotics. She was on the pill, but her doctor said that antibiotics can make the pill less effective (I feel like either he should have made this a little more clear to her, or she should have listened better. But I can't complain because now I have an awesome nephew!) Anyway, down here on the island recently I had strep throat, and when the doctor gave me antibiotics, I wanted to confirm with him that they would change my birth control's effectivness, and he said no. He said it is only with certain kinds of antibiotics. My sister was told it is with all of them...who is right? Just curious (and not pregnant...yet). Thanks AJ!
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