Pharmacopedia

As a doctor I’ve prescribed a lot of drugs but what’s it like to actually take them. Here’s the list and my opinions on all of them – completely unfounded as I was taking so many all at once so really I have no idea.

Non opioid painkillers

  • Ibuprofen
  • Paracetamol – IV is a lot better
  • Paracoxib – a cox 2 inhibitor (read super ibuprofen) worked very well but was discontinued by the Marsden

Anti emetics (anti sickness

  • Levomepromazine – the antiemetic which works on every receptor works to stop you being sick, but subcut knocked me out for 12 hours, fell asleep with the light shining in my eyes. Received some in my TTO should be prescribed as an anti insomniac
  • Cyclizine – orally didn’t do much, subcut worked but I was told it stung on the way in, literally took my epidermis (top layer of skin) which is still healing today. I finally have non allergy to annoy doctors when I’m next in hospital. (What I’m describing is an intolerance to a medication not an allergy… Point on this once a patient told me they were allergic to caffeine… I asked her what happens “well my heart beats faster, I feel anxious and I can’t sleep”)
  • Ondansetron given IV and oral – works well but constipating
  • Metoclopramide – the best but at beginning didn’t work much. The point was I was given a little bit of all of the anti emetics but not a decent dose of any, so they put the meticlopramide into the syringe driver (which I flooded)

Miscellaneous 

  • Pregabalin (for weird pain)- seemed to work moderately well at reducing my shoulder tip pain*
  • Dexamethasone (strong steroid) – taken from liver capsule pain worked really well, definitely wakes you up in the morning
  • SandoK (potassium replacement) – tastes crap eat a banana instead

Opiates (to give you an idea heroine is an opiate)

  • Oramorph (oral morphine) – works slowly tastes nice
  • Morphine IV – could definitely and worryingly see why people abuse it, with enough of it you don’t care about pain then when you get past that point you literally don’t care about anything
  • Fentanyl IV – given when having the liver biopsy – as above but fast really fast. Worked though, while I was being stabbed in the liver I didn’t give a damn.
  • Fentanyl patches – good but annoying can’t have hot showers as they increase the speed of release, all these things you never find out as a doctor.

The laxatives 

  • Lactulose – tastes rubbish does nothing
  • Laxido – 6 satchels in a jug and you’re away
  • Senna – keeps you ticking over
  • Glycerol suppository – just doesn’t do the job
  • Phosphate enema – need I say more

Anti cancer drugs

  • Dabrafenib – the braf inhibitor and the biggest pain reliever as it is hopefully attacking the cause of the pain.

Antibiotics

  • Amoxicillin – part of the Kingston protocol for acute cholecystitis (infection of gallbladder)
  • Gentamicin – as above, despite its reputation tolerated one dose well
  • Metronidazole – as above, tolerated well
  • Tazocin – for a query chest infection as I was feverish, and couldn’t tell from CT due to the tumour whether there was an underlying infection. 
  • This seems like a lot of antibiotics especially as we are trying to reduce the amount of antibiotics we dish out due to antibiotic resistance. But this is when we are stuck between a rock and a hard place. For example we know giving antibiotics in the first hour for sepsis (whole body inflammation caused by an infection) improves survival, but convincingly diagnosing an infection within one hour can be tricky. So when someone is as sick as I was, it is worthwhile treating as if they have an infection without  confirming it because it may help. However the fevers stopped after 2 doses of dabrafenib and the antibiotics were subsequently stopped.

 

*the source of my pain was that the tumours within my liver had got so large they were trying to rip it open. The liver is in a tough capsule which stops this but the tension on this capsule was causing me the unbearable pain. As the liver is inflamed at this point due to the damage it rubs against the diaphragm which is just above it, the diaphragm when irritated refers pain to the shoulder. For reasons which are beyond the remit of this blog. 

 

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