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Pharmacology


 
I am a dental hygienist and the dentist I work for and I would like more information on a condition Dr. French mentioned that involves caucasian women and the inability to metabolize Vicodin.

Dr. French has provided 2 articles, one on the Amplichip and another that reviews pharmacogenomics, that may be helpful as a start. Anything that mentions or applies to codeine is also relevant to hydrocodone (Vicodin) which is more widely prescribed than codeine.

Do you have some guidelines on drug disposal?

Yes, Dr French does.

For years a plant based drug has been approved for use in Europe that controls the thinning of blood. It does not require the monthly INR blood test like Coumadin (rat poison). What is the name of this drug? Why is it not FDA approved?

The drug you are referring to is probably Ximelagatran (Exanta®). It has been approved for use in thromboembolic disorders in 7 European countries. It was submitted to the FDA, but approval was denied due to significant liver toxicity (1 in 200 patients, twice the rate of liver toxicity that forced the diabetes drug Rezulin off the market). A similar drug, that doesn’t require INR monitoring, is undergoing clinical trials in the US at this time – Rivaroxaban. It does NOT appear to have liver toxicity but an approval and release date has not been announced, maybe within a year. Stay tuned.

Do toxic medications store in your fat cells such as isotretinoin (acutane)? How does a drug like this affect your brain? One of the side effects is suicide and delusions, why would it affect people in this way?

Whether drugs undergo significant storage in fat cells depends not on their toxicity, but on whether they are lipid (fat)-soluble. Isotretinoin is fat-soluble and can undergo significant binding in fatty tissue. Because this binding helps them remain in the body longer, whatever toxicity they do have may be enhanced by this potential accumulation. Little is known about the effects of isotretinoin on the adult brain. There are warnings about depression / suicidal thoughts / suicide (med guide attached), but the link is controversial as epidemiological studies have NOT shown an association. Acne itself may be a risk factor for depression.

Why are some drugs taken before food or say with food?

Many reasons, two of the most common are: Take before food (empty stomach) is most commonly advised for drugs that are broken down by stomach acid (penicillin G) as a full stomach has more acid to aid in food digestion. Take with food or water is often recommended for drugs that are irritating to the stomach or tend to cause nausea and vomiting. The presence of food can moderate these problems. Also, some antibiotics (tetracycline) are not to be taken with dairy products or antacids because they contain calcium, which may bind the tetracycline and reduce its absorption in the blood.

Are we moving towards a time when controlled substances will be handled in such a way that patients will not be able to go from doctor to doctor to maintain their addiction? Is there an effective way to manage this? If not what would be recommended to prevent this abuse?

We are at this time now. Colorado is one of 38 states that has a “Prescription Drug Monitoring Program” to track the prescribing (MDs and Dentists) and dispensing (Pharmacists) of Controlled Substances. All prescriptions for controlled substances in Colorado are required to be entered into a statewide data base. This can then be accessed by prescribers and pharmacists when there is concern that a patient may be receiving multiple prescriptions from multiple prescribers. This system has had a major impact in reducing drug abuse and diversion.

Lately we have had issues with using acetemetephin and something like pamprin to alleviate discomfort, are there liver side effects?

Yes, I've attached an excellent patient info sheet that should address this very issue.