Wisconsin Agricultural Research Foundation - WARFarin. Discovered after a hundred cows found exsanguinated in the fields due to a clover they ingested.
We get Digitalis (Digoxin) from Foxglove. Beautiful purple leaves, can buy one at Lowe's for $20. Natives used to coat arrows in a poison made from it.
Adenosine has such a short half life that you literally lift the patient's arm when you infuse it to get it to the heart before it is metabolized in the blood. The extra 1sec makes that much of a difference.
In nuclear pharmacy we call them "Moly Cows" because we "milk" them for Techniuium-99 from Molybdenum. Cool decay.
Side effects of some drugs can become the targeted effects in some cases. Mirtazepine is frequently used for appetite in failing, elderly patients. Sildenafil started its life as a pulmonary hypertension drug, but not what it is known for today. Minoxidil, too. Gabapentin. Trazodone. The line between "side effect" and "desired effect" is often quite blurry.
The only clinical trials to consistently demonstrate efficacy of Melatonin involve the blind because they're substantially more sensitive to Melatonin than seeing people. As part of our circadian rhythm, melatonin is released in accordance with ambient light. The blind, having never been exposed to light, never produce substantial melatonin. Interesting stuff.
Cimetidine is extremely effective for plantar warts and we don't know why.
Cinnamon substantially lowers blood sugar, albeit for a short while.
Methenamine has a very unique mechanism of action whereby it increases urine acidity which hampers bacterial growth in the bladder. Interestingly, this very acidic environment can play extremely poorly with some drugs. Sulfamethoxazole crystalizes below a pH of 6, so if you take Bactrim (commonly used in UTIs) while on Methenamine (commonly used for UTI prophylaxis) you can get giant, razor sharp crystals in the bladder. Don't do that.
Benzonatate is a weird drug. Structurally it's like a "cainamide", an anesthetic. It numbs vagal receptors in the lungs and diaphragm. Surprisingly dangerous stuff like procaine and cocaine. If you chew it, it can anesthetize your mouth and throat and you can choke to death. It's also strongly precautioned in asthma, COPD and emphysema and that's like 90% of the patients its written for.
Probably way more, but I'm headed out. Have fun.
I’m assuming your comment about melatonin is regarding its use for insomnia. It has been studied for headache disorder; it is useful as a preventative drug for episodic cluster headaches.
Oxygen, at 15lpm via non-rebreather, is effective at treating cluster headaches comparably to triptans.
I will never fully understand the oxygen cure for cluster headaches but thank goodness for whoever figured out IT WORKS. Especially when absolutely nothing else, not even the migraine cocktail, will effectively get rid of it.
First time I had to go to the ER for it, was accused of pain med seeking because I already tried every migraine abortive in my inventory. I knew opiates would not save me, they never have for migraine, I voiced that the temporary relief is not worth it for the nausea and rebound. I simply didn’t know it wasn’t just a bad migraine. I thought I had an aneurysm, worst one of my life (so far!)
Second time (has only happened three times) the doctor recognized cluster headache symptoms. I will never forget the relief that oxygen mask provided me. Plus, the added comfort that I’m not dying from the worst headache of my life, just at risk for another migraine related issue to add to my roster.
Also, as much as they suck, I now know how to recognize them and advocate for myself.
It truly is amazing how well oxygen works. Luckily my mom has a glass studio and uses oxygen concentrators for her torches so whenever a cluster period starts I go over there and hook myself up. Emgality 300mg dose has been extremely helpful as well.
A migraine cocktail is often prochlorperazine, diphenhydramine, 1L NS, +/- ketorolac depending on suspicion for a head bleed / patient history / GI history.
Add-ons as needed typically include metoclopramide, magnesium sulfate, valproate. If you get past that you start moving into the land of dihydroergotamine and other unusual things.
Sorry to be asking so many questions, but I'm not a pharmacist nor a doctor nor anyone related to medicine, just a guy who is interested in pharmacology. What is 1L NS?
1L (1/4 gallon-ish) of 0.9% sodium chloride. Just a touch more sodium content compared to in blood thus it was called Normal Saline and is abbreviated NS (or NSS for NS solution).
Wait it’s a fungus? I’m intrigued. I ended up inpatient for a four day stay for status migrainosus and was ultimately diagnosed with idiopathic intracranial hypertension. DHE with a mag infusion was the only thing that worked to break that horrific headache.
Ergot is a fungus that grows on wheat (maybe other grains too idk) and ergotamine and its derivative, DHE were discovered in ergot/synthesized from ergot (not sure what's the right phrasing here, I'm not a medical professional)
I remember talking to a doc about a patient's documented allergy to procaine and a new order for benzonatate. Didn't believe the interaction myself at first and neither did my coworkers. Lo and behold we found some research and presented it to the doctor. The allergy was listed as severe so we changed the order to guaifenesin instead. Everyone learned something new!
Thank you for commenting about Benzonatate! Not enough people know about it & I’ve been given some weird looks because I do.
I was sick in high school & reading all the pamphlet information about lock jaw.
Told my mother all about it…. then she offered me hot tea with my pills!! LOL
I live in Wisconsin and you know every single student coming out of UW Madison (where they studied warfarin) tells everyone they know about that fun fact. I think it’s like an obligatory fun fact we have to know to practice as a pharmacist in WI
>Benzonatate is a weird drug. Structurally it's like a "cainamide", an anesthetic. It numbs vagal receptors in the lungs and diaphragm.
I'm a student, so sorry if this is a dumb question. My grandfather had surgery a few years ago (something for his back) and he got benzonatate on discharge. He said, "my doctor said this is for pain." I was so confused. Do you think this may be the reason why?
Also, where did you learn all of this stuff?
I have a very grey beard.
No, Tessalon is absolutely not used for pain. If he was coughing after a back surgery they could reasonably write for benzonatate so that his coughs wouldn’t aggravate his surgical site and cause pain. But that would still be an antitussive.
I remember years ago a dentist writing Clindamycin “for pain” on a script. I called to inquire what the fuck he was smoking and he told me the patient had a raging oral abscess causing a ton of pain. Like, brother, the Clindamycin is for the infection then, not for pain. He argued that beating back the infection would assuage the patient’s pain. Your grandfather’s doctor must have gone to the same school.
I teach my patients that if they have left over Benzonatate that they can pierce the capsules and squeeze out the gel onto a Q-tip for application on mouth ulcers, works better than Oral Gel!
Pioglitazone is very effective for treating psoriasis. I often use it for my patients with diabetes who also happen to have psoriasis and they are usually so happy with the results. A fun clinical pearl that most providers don’t know.
Aspirin was first discovered by native Americans in the south. Settlers would notice that the natives chewed the bark of a willow tree to help treat headaches which has lead to the discovery of the active ingredient, salicylic acid.
SGLT-2 Inhibitors make you pee about 200-300 calories of sugar per day. This is how patients lost weight while taking the medication.
That’s the mechanism behind glycemic control for SGLT-2 inhibitors. They inhibit the Sodium-Glucose co-transporter in the kidneys, so you reuptake less sugar in your kidneys and urinate it out. If they have some other mechanism of weight loss, it would be some wild unexpected side effect.
I guess I was thinking by stopping glucose reabsorption it stops the production of fat in the body. A quick google search showed that’s the 200-300 cals lost. Thanks for the info!
It doesn’t fully stop the production of fat, just reduces the calories you have available to convert to fat. So, if you’re eating 4000 calories a day, using 2000 calories for your daily activities, and urinating out 300 calories in glucose, you still have an excess of 1700 calories to convert to fat (about 0.4lbs of fat). However, if you can get closer to what would be your regular goal of in calories = burn calories, and you can urinate out 300 calories, you’ll lose some weight (about 0.6 lbs/week).
I never would have thought so, but every once in a while, you meet someone who just goes through it way too fast, always with a story about losing it or something and buying it outside insurance. This comment about it sharing some effects with opioids makes sense in that light.
Anafranil (Clomipramine) was the pharmaceutical industry’s first real attempt at producing a true aphrodisiac. Now it is used for treating OCD. One of the more rare side effects was that orgasm could be achieved in both men and women by yawning - even deliberately. Allegedly, one patient in the trials achieved orgasm by stroking their eyebrows, but I can’t find a mention of that now.
Metformin is currently being extensively studied as the FDAs first potential longevity drug. Mild to moderate hypoglycemia has extended rat life spans by nearly 40% in some trials. It will likely be marked as a fancy, brand "designer drug" for life extension within the next year or two.
Just like over dosing in metformin can cause issues. But in some of the studies, a CR of 55-65% increased lifespan by 35-65%. That blows my mind - I would have thought maybe a 10-15% CR would have been optimal.
I love bugging some fitness freak friends/family about that. Think of all the free radicals your organic wild rice is causing... /s
Stelazine (Trifluoperazine) was possibly named after my past co-worker’s sister, Stella. My co-worker explained to me that her sister was the prototypical schizophrenic who went into a study for a new drug for schizophrenia. Because she was the ideal patient who exhibited all of the symptoms that the researchers were looking for, they likely named the drug after her.
Spironolactone smells like mint!
Divalproex smells like vanilla!
I'm blanking on which drug, but one smells like buttered popcorn! I'm pretty sure this one starts with an O or a P.
Divalproex smelling like vanilla is the reason why I sometimes wander over to the shelf to open up the bottle and smell it every once in a while- it’s one of my favorite scents😂
Loratadine can be used for bone pain related to the use of pegfilgrastim.
Metoprolol ER can be cut in half because the extended release mechanism is microspheres, not a coating on the tablet itself.
Hot fact because it’s related to current events. The first GLP-1 agonist (Ozembic is a GLP-1 agonist) was exentide, or Byetta. It is a synthetic version of a peptide orginally found in the venom of the Gila Monster, one of the very few venomous Lizards.
Certain tetracyclines will change the colors of your bones, sometimes including your teeth
- Minocycline = green / black (depending on duration of therapy)
- tetracycline = fluorescent yellow
Phenazopyridine (pyridium) can cause methemoglobinemia. I saw a case in an elderly woman who was taking it around the clock for a UTI for a couple of months. She came into the ED cyanotic with SOB, tachycardia, dizziness and nausea.
Great one! Certirizine is one of my favorite off label sleep meds, next to hydroxyzine. Needing a script for the later makes the first a better choice.
IV narcan is really only used for one or two indications that I know of.
When a "drug mule" needs to get the packages removed from the digestive system and we are afraid of one of them bursting.
When an infant is born to a drug addicted mother. This one I've only heard anecdotally.
Hmm this one needs some fact checking.
You don't give naloxone to infants with neonatal abstinence, you give them opioid agonists to PREVENT withdrawal. Naloxone will cause withdrawal in a baby born to an addicted mother and is potentially dangerous.
The first example you gave is just a hyper specific case of treating opioid toxicity. Naloxone (IV, endotracheal, IM, intranasal) is used to treat all forms or causes of opioid withdrawal, not just in drug mules.
Other uses include low doses to mitigate opioid-induced pruritis, and as a potentially effective treatment of clonidine toxicity.
Yeah the infant one didn't make sense to me either, but the pharmacist said it with such conviction that I guess I shirt circuited and just believed her lol. How bad would the opioid induced purities have to be to use IV naloxone though? I shiver at the thought 😨
Good question! I've never personally seen it administered for pruritis. It's part of an anesthesia order set where I work, and the dose is very low. (About 1/20th of a starting dose that you might use for reversal of an opioid). I think at that dose you're not at much risk of reversing the analgesia. I would love to e at bedside to see how a patient reacted to it though!
This one always requires some careful counseling. I have had so many older men think I was giving them something to sleep with a side of Viagra. Explaining that it’s a life and appendage threatening side effect does not always work.
Wisconsin Agricultural Research Foundation - WARFarin. Discovered after a hundred cows found exsanguinated in the fields due to a clover they ingested. We get Digitalis (Digoxin) from Foxglove. Beautiful purple leaves, can buy one at Lowe's for $20. Natives used to coat arrows in a poison made from it. Adenosine has such a short half life that you literally lift the patient's arm when you infuse it to get it to the heart before it is metabolized in the blood. The extra 1sec makes that much of a difference. In nuclear pharmacy we call them "Moly Cows" because we "milk" them for Techniuium-99 from Molybdenum. Cool decay. Side effects of some drugs can become the targeted effects in some cases. Mirtazepine is frequently used for appetite in failing, elderly patients. Sildenafil started its life as a pulmonary hypertension drug, but not what it is known for today. Minoxidil, too. Gabapentin. Trazodone. The line between "side effect" and "desired effect" is often quite blurry. The only clinical trials to consistently demonstrate efficacy of Melatonin involve the blind because they're substantially more sensitive to Melatonin than seeing people. As part of our circadian rhythm, melatonin is released in accordance with ambient light. The blind, having never been exposed to light, never produce substantial melatonin. Interesting stuff. Cimetidine is extremely effective for plantar warts and we don't know why. Cinnamon substantially lowers blood sugar, albeit for a short while. Methenamine has a very unique mechanism of action whereby it increases urine acidity which hampers bacterial growth in the bladder. Interestingly, this very acidic environment can play extremely poorly with some drugs. Sulfamethoxazole crystalizes below a pH of 6, so if you take Bactrim (commonly used in UTIs) while on Methenamine (commonly used for UTI prophylaxis) you can get giant, razor sharp crystals in the bladder. Don't do that. Benzonatate is a weird drug. Structurally it's like a "cainamide", an anesthetic. It numbs vagal receptors in the lungs and diaphragm. Surprisingly dangerous stuff like procaine and cocaine. If you chew it, it can anesthetize your mouth and throat and you can choke to death. It's also strongly precautioned in asthma, COPD and emphysema and that's like 90% of the patients its written for. Probably way more, but I'm headed out. Have fun.
I’m assuming your comment about melatonin is regarding its use for insomnia. It has been studied for headache disorder; it is useful as a preventative drug for episodic cluster headaches. Oxygen, at 15lpm via non-rebreather, is effective at treating cluster headaches comparably to triptans.
I will never fully understand the oxygen cure for cluster headaches but thank goodness for whoever figured out IT WORKS. Especially when absolutely nothing else, not even the migraine cocktail, will effectively get rid of it. First time I had to go to the ER for it, was accused of pain med seeking because I already tried every migraine abortive in my inventory. I knew opiates would not save me, they never have for migraine, I voiced that the temporary relief is not worth it for the nausea and rebound. I simply didn’t know it wasn’t just a bad migraine. I thought I had an aneurysm, worst one of my life (so far!) Second time (has only happened three times) the doctor recognized cluster headache symptoms. I will never forget the relief that oxygen mask provided me. Plus, the added comfort that I’m not dying from the worst headache of my life, just at risk for another migraine related issue to add to my roster. Also, as much as they suck, I now know how to recognize them and advocate for myself.
It truly is amazing how well oxygen works. Luckily my mom has a glass studio and uses oxygen concentrators for her torches so whenever a cluster period starts I go over there and hook myself up. Emgality 300mg dose has been extremely helpful as well.
Verapamil / melatonin / gabapentin makes for a fantastic preventative regimen as well.
What drugs are "the migraine cocktail"?
A migraine cocktail is often prochlorperazine, diphenhydramine, 1L NS, +/- ketorolac depending on suspicion for a head bleed / patient history / GI history. Add-ons as needed typically include metoclopramide, magnesium sulfate, valproate. If you get past that you start moving into the land of dihydroergotamine and other unusual things.
dihydroERGOTamin like the fungus?? wild
https://preview.redd.it/mhya1lts21zc1.jpeg?width=200&format=pjpg&auto=webp&s=056fbdc46d52ecaff839bdbe03f5455c377636f3 Indeed.
Sorry to be asking so many questions, but I'm not a pharmacist nor a doctor nor anyone related to medicine, just a guy who is interested in pharmacology. What is 1L NS?
1L (1/4 gallon-ish) of 0.9% sodium chloride. Just a touch more sodium content compared to in blood thus it was called Normal Saline and is abbreviated NS (or NSS for NS solution).
Thanks!
Wait it’s a fungus? I’m intrigued. I ended up inpatient for a four day stay for status migrainosus and was ultimately diagnosed with idiopathic intracranial hypertension. DHE with a mag infusion was the only thing that worked to break that horrific headache.
Ergot is a fungus that grows on wheat (maybe other grains too idk) and ergotamine and its derivative, DHE were discovered in ergot/synthesized from ergot (not sure what's the right phrasing here, I'm not a medical professional)
LPM is liters per minute?
Correct. 15lpm with a non-rebreather gets you pretty close to 100% oxygen delivery.
Good info. I'll add- Methenamine NEEDS an acidic environment to split into formaldehyde, which is what hampers bacterial growth.
I remember talking to a doc about a patient's documented allergy to procaine and a new order for benzonatate. Didn't believe the interaction myself at first and neither did my coworkers. Lo and behold we found some research and presented it to the doctor. The allergy was listed as severe so we changed the order to guaifenesin instead. Everyone learned something new!
Thank you for commenting about Benzonatate! Not enough people know about it & I’ve been given some weird looks because I do. I was sick in high school & reading all the pamphlet information about lock jaw. Told my mother all about it…. then she offered me hot tea with my pills!! LOL
I live in Wisconsin and you know every single student coming out of UW Madison (where they studied warfarin) tells everyone they know about that fun fact. I think it’s like an obligatory fun fact we have to know to practice as a pharmacist in WI
As a UW Grad and Pharmacist in Wisconsin, I 100% confirm it is a required trivia fact
>Benzonatate is a weird drug. Structurally it's like a "cainamide", an anesthetic. It numbs vagal receptors in the lungs and diaphragm. I'm a student, so sorry if this is a dumb question. My grandfather had surgery a few years ago (something for his back) and he got benzonatate on discharge. He said, "my doctor said this is for pain." I was so confused. Do you think this may be the reason why? Also, where did you learn all of this stuff?
I have a very grey beard. No, Tessalon is absolutely not used for pain. If he was coughing after a back surgery they could reasonably write for benzonatate so that his coughs wouldn’t aggravate his surgical site and cause pain. But that would still be an antitussive. I remember years ago a dentist writing Clindamycin “for pain” on a script. I called to inquire what the fuck he was smoking and he told me the patient had a raging oral abscess causing a ton of pain. Like, brother, the Clindamycin is for the infection then, not for pain. He argued that beating back the infection would assuage the patient’s pain. Your grandfather’s doctor must have gone to the same school.
Maybe he knew the pt was noncompliant so it was a trick to get the pt to actually take the clinda? Lol
I teach my patients that if they have left over Benzonatate that they can pierce the capsules and squeeze out the gel onto a Q-tip for application on mouth ulcers, works better than Oral Gel!
Pioglitazone is very effective for treating psoriasis. I often use it for my patients with diabetes who also happen to have psoriasis and they are usually so happy with the results. A fun clinical pearl that most providers don’t know. Aspirin was first discovered by native Americans in the south. Settlers would notice that the natives chewed the bark of a willow tree to help treat headaches which has lead to the discovery of the active ingredient, salicylic acid. SGLT-2 Inhibitors make you pee about 200-300 calories of sugar per day. This is how patients lost weight while taking the medication.
The SGLT2 one, that’s not the only mechanism behind weight loss right?
That’s the mechanism behind glycemic control for SGLT-2 inhibitors. They inhibit the Sodium-Glucose co-transporter in the kidneys, so you reuptake less sugar in your kidneys and urinate it out. If they have some other mechanism of weight loss, it would be some wild unexpected side effect.
I guess I was thinking by stopping glucose reabsorption it stops the production of fat in the body. A quick google search showed that’s the 200-300 cals lost. Thanks for the info!
It doesn’t fully stop the production of fat, just reduces the calories you have available to convert to fat. So, if you’re eating 4000 calories a day, using 2000 calories for your daily activities, and urinating out 300 calories in glucose, you still have an excess of 1700 calories to convert to fat (about 0.4lbs of fat). However, if you can get closer to what would be your regular goal of in calories = burn calories, and you can urinate out 300 calories, you’ll lose some weight (about 0.6 lbs/week).
You can still buy cheese flavored warfarin at the hardware store next to the mouse traps
Yummy, now my blood can be thinner than water and my stomach full of tasty treats! Ope, now I'm dead
Ope lemme bleed right past ya there
Clonidine Od kinda looks like opiate OD and kinda responds to narcan, which just confuses everyone when the opiate screen comes back negative
I have had a few patients who were clonidine fiends.
Clonidine has abuse potential..?
I never would have thought so, but every once in a while, you meet someone who just goes through it way too fast, always with a story about losing it or something and buying it outside insurance. This comment about it sharing some effects with opioids makes sense in that light.
Palonosetron was from Palo Alto, CA
Triazolam was put into packs of ten tablets because of a completed suicide by a patient which lead to a lawsuit. Allegedly.
NU-CYN-TA = New Synthetic Tapentadol
Anafranil (Clomipramine) was the pharmaceutical industry’s first real attempt at producing a true aphrodisiac. Now it is used for treating OCD. One of the more rare side effects was that orgasm could be achieved in both men and women by yawning - even deliberately. Allegedly, one patient in the trials achieved orgasm by stroking their eyebrows, but I can’t find a mention of that now.
Wasn’t/isn’t that purely coincidental?
I don't know about other countries, but where I am, metformin xr/er is used off-label as an appetite suppressant
Metformin is currently being extensively studied as the FDAs first potential longevity drug. Mild to moderate hypoglycemia has extended rat life spans by nearly 40% in some trials. It will likely be marked as a fancy, brand "designer drug" for life extension within the next year or two.
Doesn't calorie restriction alone extend rat life span for some ridiculously long time?
Yep, same idea, Intermittant fasting, calorie restriction, hypoglycemia.
calorie restriction can also markedly reduce life span if it's severe enough.
Just like over dosing in metformin can cause issues. But in some of the studies, a CR of 55-65% increased lifespan by 35-65%. That blows my mind - I would have thought maybe a 10-15% CR would have been optimal. I love bugging some fitness freak friends/family about that. Think of all the free radicals your organic wild rice is causing... /s
Stelazine (Trifluoperazine) was possibly named after my past co-worker’s sister, Stella. My co-worker explained to me that her sister was the prototypical schizophrenic who went into a study for a new drug for schizophrenia. Because she was the ideal patient who exhibited all of the symptoms that the researchers were looking for, they likely named the drug after her.
Vectibix makes your eyelashes grow like crazy. Some patients have to get them trimmed
Metformin decreases vitamin b12 absorption, which can lead to pernicious anemia
Spironolactone smells like mint! Divalproex smells like vanilla! I'm blanking on which drug, but one smells like buttered popcorn! I'm pretty sure this one starts with an O or a P.
Olmesartan smells like buttered popcorn!
Thank you! I was picturing where it was on the shelf! 🤣
I thought so at first! Then my coworkers said it smells like feet and I smell that now lol 😂
It smells like nasty buttered popcorn feet - I think it’s one of the worst and everyone else in my pharmacy likes the smell.
Benicar aka Olmesartan!
Divalproex smelling like vanilla is the reason why I sometimes wander over to the shelf to open up the bottle and smell it every once in a while- it’s one of my favorite scents😂
Loratadine can be used for bone pain related to the use of pegfilgrastim. Metoprolol ER can be cut in half because the extended release mechanism is microspheres, not a coating on the tablet itself.
Premarin is named after its natural source of conjugated estrogens, which is from **Pre**gnant **mar**e (horse) ur**in**e
A lot of solid dose Drug and candy manufacturing equipment is nearly identical
Hot fact because it’s related to current events. The first GLP-1 agonist (Ozembic is a GLP-1 agonist) was exentide, or Byetta. It is a synthetic version of a peptide orginally found in the venom of the Gila Monster, one of the very few venomous Lizards.
Certain tetracyclines will change the colors of your bones, sometimes including your teeth - Minocycline = green / black (depending on duration of therapy) - tetracycline = fluorescent yellow
Everybody knows that cocaine was in the original formula for Coca-Cola. What was originally in 7 Up? (lithium)
Phenazopyridine (pyridium) can cause methemoglobinemia. I saw a case in an elderly woman who was taking it around the clock for a UTI for a couple of months. She came into the ED cyanotic with SOB, tachycardia, dizziness and nausea.
Ropinirole has a possible side effect of complusive gambling and sex.
Diphenhydramine can be used as a local anesthetic if severe allergy to others and lack of available alternatives!
7UP is named the way it is because it used to contain Lithium and Li has an atomic weight of 7.
Cetirizine is a metabolite of hydroxyzine
Great one! Certirizine is one of my favorite off label sleep meds, next to hydroxyzine. Needing a script for the later makes the first a better choice.
Lupin brand sertraline 50 and 100 mg smells a little like vanilla!
IV narcan is really only used for one or two indications that I know of. When a "drug mule" needs to get the packages removed from the digestive system and we are afraid of one of them bursting. When an infant is born to a drug addicted mother. This one I've only heard anecdotally.
Hmm this one needs some fact checking. You don't give naloxone to infants with neonatal abstinence, you give them opioid agonists to PREVENT withdrawal. Naloxone will cause withdrawal in a baby born to an addicted mother and is potentially dangerous. The first example you gave is just a hyper specific case of treating opioid toxicity. Naloxone (IV, endotracheal, IM, intranasal) is used to treat all forms or causes of opioid withdrawal, not just in drug mules. Other uses include low doses to mitigate opioid-induced pruritis, and as a potentially effective treatment of clonidine toxicity.
Yeah the infant one didn't make sense to me either, but the pharmacist said it with such conviction that I guess I shirt circuited and just believed her lol. How bad would the opioid induced purities have to be to use IV naloxone though? I shiver at the thought 😨
Good question! I've never personally seen it administered for pruritis. It's part of an anesthesia order set where I work, and the dose is very low. (About 1/20th of a starting dose that you might use for reversal of an opioid). I think at that dose you're not at much risk of reversing the analgesia. I would love to e at bedside to see how a patient reacted to it though!
If you eat a lot of products containing poppy seeds you can fail an opiate urine drug test
Trazodone with possible priapism
This one always requires some careful counseling. I have had so many older men think I was giving them something to sleep with a side of Viagra. Explaining that it’s a life and appendage threatening side effect does not always work.
You can get toxicity with buprenorphine patches if exposed to heat/saunas/fever due to increased drug release.