Fun with drugs

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    I am sure that a lot of you already know this stuff, but I thought that I would share it anyway. Of course, this is for informational purposes and I would never endorse using any medications except as the manufacturer recommends.

    Pain

    ibuprofen (Advil, Motrin) is sold over the counter in 200mg tablets. 4 of these are the same as one 800mg prescription strength tablet (which you could take every 8 hours). 800mg of ibuprofen and 1000mg of acetamenophen (2 Tylenol extra strength tablets) taken at the same time provide the same degree of pain relief as 4 mg of morphine. Just without the buzz. Can be repeated every 8 hours. Take with food (the ibuprofen will upset your stomach otherwise) and avoid alcohol (with the acetamenophen/Tylenol you will kill your liver).

    Nausea and Vomiting

    For some reason, the FDA does not allow any effective anti-nausea medications to be sold over the counter in the U.S. There are some anti-nausea medicines sold…but they don’t work that well (ever try and swallow some Pepto Bismol when you are trying NOT TO PUKE? Now, in Canada, they sell a fairly effective anti-nausea medication over the counter just about everywhere. It is called Gravol (dimenhydrinate) and for an adult 50mg of this (up 100mg) every 4 to 6 hours (no more than 400mg by mouth in 24 hours) is fairly good at controlling nausea and vomiting, comparable to Phenergan from what I have heard. While the FDA will not permit OTC sales of an effective anti-nausea medication, they will allow the sale of anti motion sickness medications, such as Dramamine Original Formula (dimenhydrinate 50mg per tablet). Compare the generic names and go figure.

    Now, please don’t confuse Dramamine Original Formula (containing dimenhydrinate) with Dramamine Less Drowsy Formula (containing 25mg of meclizine per tablet). Meclizine, oddly enough, is the same medication that is in Antivert, the prescription medication for vertigo.

    Diarrhea

    I like Immodium, and studies have shown that it can work as well as prescription anti-diarrheals such as Lomotil. However, both of these work by “freezing” or “stunning” the gut. There really is a fine line between diarrhea and constipation, and it is possible for such medications to stop you up too much to the point where you will need medical attention (never take more than 6-8 of those little Immodium tablets in 24 hours).

    A doctor that I used to work with had a more natural recommendation for diarrhea: Metamucil, or other fiber supplements. Usually, these work by stimulating the bowel to promote more moist/soft stools. However, they will add bulk to the poo also. If you have diarrhea, the extra fiber can act like a sponge to soak it up so that your stools will be more formed/less liquid. He recommended taking two of the Metamucil tablets after every loose/liquid stool.

    Be careful with treating diarrhea…it can be the body’s way of getting rid of toxins. If there is any blood or pus in the stool, or fever is present, or the diarrhea lasts more than a day or two, you should seek medical attention before trying to stop it as antibiotics may be needed. If the gross (no pun intended) volume of the diarrhea is too great, you will probably be wasting your time trying to stop it up and should focus on keeping the person well hydrated. With something like cholera the patient can poop gallons at a time.

    Don’t forget that baby butt pastes (like Boudreaux’s Butt Paste) and diaper rash ointments will work for an adult with a sore behind too.

    Allergies

    When trying to stop an allergic reaction in the emergency room, we often give several different kinds of drugs to try and do different things. An allergic reaction involves the body releasing a lot of different chemicals, such as histamine. So we give drugs to block the effects of the released histamine. There are two types of histamine receptors in the body, labeled one and two.

    The most common histamine one (H1) blocker is Benadryl (diphenhydramine). 25 to 50mg of this by mouth every 4 to 6 hours (no more than 300mg in 24 hours), is usually enough to slow, halt, and/or reverse most allergic reactions in most adults (for kids, same with all drugs, smaller doses). The tablets and the capsules work good, but consider keeping some of the liquid suspension too. The liquid may be easier to swallow if you feel your throat closing up.

    The histamine two (H2) blockers are most commonly used for upset stomachs, but they work well for allergic reactions too. They are not as effective as Benadryl, but they compliment it (we usually give them together) and are much less likely to cause drowsiness. These drugs include: Tagament (cimetidine), Pepcid (famotidine), and Zantac (ranitidine). We usually give these in the same doses as you would give for heart burn. Drugs like Prilosec (omeprazole) and Nexium (esomeprazole) and such, and antacids, are not useful in treating allergic reactions.

    For severe allergic reactions (the person’s throat is closing up, they are going into shock, in other words they are really sick) we will give epinephrine as a shot. Epinephrine (the same as adrenaline) stops the production of, and reverses the effects of, many of the chemicals released by the body during an allergic reaction. It is a very powerful drug and should be avoided/used with caution in persons with high blood pressure and heart disease as it can cause the heart rate and blood pressure to go up. It has saved many lives, but has also caused many heart attacks and strokes. Epinephrine is sold over the counter as Primatene Mist (the inhaler, not the tablets). Each hit from the Primatene Mist inhaler provides 0.22mg of epinephrine. This is a fairly good dose of epinephrine, usually I will give 0.3 to 0.5mg as a shot in the arm for someone having an allergic reaction. However, inhaled from the lungs the effects of the epinephrine on the rest of the body are lessened somewhat. In Wilderness Medicine (a very good medical textbook), Auerbach actually recommends (if I recall correctly) using 25 or more puffs from a Primatene Mist inhaler to treat an allergic reaction. That is a lot of epinephrine…not sure if I would go that far with it…5 puffs (more than 1mg) is a lot to me. I would only use epinephrine for an allergic reaction if I felt that the person’s life was in danger.

    Remember than an allergic reaction can last for days (usually about 3-5), until the body’s immune system calms down. So, drugs like Benadryl and Zantac may have to be taken repeatedly. Personally, I prefer to take Zantac twice a day (less likely to make me drowsy) and save the Benadryl for breakthrough or worsening symptoms. In the event of any emergency, please seek professional medical attention.

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