Script Pharmacist

Hi! I am a student pharmacist hoping to help anybody writing with their pharmacy questions! 

[scriptmedic]

So, when my sister was hospitalized for severe pain (turned out to be cancer and she's in remission now), the doctors put her on Morphine. Turns out one of the side effects of Morphine is that it makes your nose itch and so I heard quite a few stories from my mom about how she was constantly scratching her nose. Are there any other weird/funny side effects of drugs that a doctor would give you like that? And what situations would they be for? Thanks!

There are quite a few strange side effects like this, and it would be an interesting idea for a post. One that I’m intimately familiar with (and you’ll get the pun in a second) is a side effect of the intravenous injection of a steroid called dexamethasone, which is useful in asthma, COPD, anaphylaxis, allergic reactions, etc.

If the medication is given too quickly, it causes an intense burning in the groin of females receiving it. (I’ve never seen it happen to males, but I’ve definitely seen women get it). The effect passes quickly, but it is noticeable.

Other side effects that I know exist but have not personally seen:

A great deal of medications can cause hallucinations (Lunesta [sleep aid], Lexapro [antidepressant]). Chantix / varencline (smoking cessation) has been known to cause really wild and vivid dreams, and Ambien / zolpidem is known to cause sleepwalking, sleep cooking, sleep driving, and sleep sex.

Some medications cause blue or green urine, such as amitryptiline (antidepressant) and indomethacin (analgesic). Metronidizole (antibiotic) can cause urine to come out black.

Many SSRIs can cause decreased sex drive and other issues.

Viagra / sildenafil (erectile dysfunction) can cause blue vision, while dangerously high doses of digoxin (antiarrhythmic) can cause yellow vision and “ghosts” when looking at lights.

Statins are a common class of cholesterol reducers (including Lipitor, Crestor, etc.), and can cause very strange memory issues due to demyelination in the brain – there was a former astronaut who went for a walk, came home, and didn’t recognize his wife as a side effect of Crestor.

GlaxoSmithKline, makers of Requip / ropinirole (treats Restless Leg Syndrome, Parkinson’s), say that their product may cause compulsive gambling and sex.

If you’re looking for your character to have some interesting side effects of a medication, there are a few options. First is to Google “Medication” + “side effects”. You could also try googling “Side effects” + “effect” and see what drugs might cause a given effect.

I’m sure my good friend @scriptpharmacist probably has a LOT to say about side effects, so make sure you check them out too!

I hope this was useful :)

xoxo, Aunt Scripty

disclaimer    

Becoming a Patron lets you see the freaking future. Have youconsidered becoming a clairvoyant?

FreeeBook: 10 BS “Medical” Tropes that Need to Die TODAY!  

[scriptmedic]

It is very much worth reading through the comments and reblogs on this. Thanks to everyone who has contributed!!

[scriptpharmacist-blog]

I really love this post! All the interesting notes are my jam! I just wanted to add a small note. ACE Inhibitors (-prils) are liable to cause a dry cough which can get irritating very quickly

[scriptpharmacist-blog]

Hi, I was wondering if there are some drugs that cause someones organism to be hypersensitive? Like for light, sounds and touch. Aaand thanks in advance! You have a great blog!

Hi there!

I think I understand that you mean a drug that makes your senses extra sensitive to stimuli, but when you wrote hypersensitive, I read ‘life threatening allergic reaction‘.

Any drug that causes the pupils to dilate will make a person sensitive to light. This includes many antimuscarinic drugs like Atropine and scopolamine. Central nervous system (CNS) stimulants can also cause dilated pupils. This list includes drugs to treat ADHD, narcolepsy, and obesity.

I’ve been looking but I’m not 100% sure that there are drugs that make you sensitive to sound exactly. there are drugs that cause tinnitus/ringing/noises etc, which can lead you to hearing loss which is no good. Some drugs that can do this are quinidine, platins (chemotherapy), gentamycin (antibiotic), aspirin (high doses), and amitriptyline (antidepressant). Mayoclinic has a nice place to start.

There are also some drugs that can make you go colorblind! For example ethambutol (for tuberculosis). While prednisone can cause cataracts with prolonged use.

As for sensitivity to touch… I’m not 100% sure, but there are some chemotherapy drugs which cause peripheral neuropathy such as cyclophosphamide and cisplatin. I’m sure there are also some illicit drugs which can cause sensitivity, but I am not really knowledgable in that corner.

Disclaimer

[scriptpharmacist-blog]

I have a character who is a recovered (35yr old male, sober 12yrs) heroin addict who ends up needing emergency surgery -- the recovery of which is painful. I plan on having him refuse morphine or any other potentially addiction habit-forming opiates for fear of triggering his addiction. So I was wondering what his options are in the way of non-opiate pain medication that's still strong enough to do some good? Thanks!!

Anonymous 2: Hi! Thank you so much for making this blog – it’s so helpful!  I have a character who has had an emergency operation and now has a painful recovery ahead of him. I was wondering if there are any non-opiate pain management medications that he could take in place of things like morphine?  Thanks!!

Hello there!

I’ve tried to do some research on this, and talked to a few people, but since I don’t actually work in this scenario, I’m going to give an educated guess. If anyone knows more please speak up! I’m also very curious about this topic.

If your hospital has good anesthetists, they will try to give preventative analgesia to help reduce the pain for after surgery. Some possible medications include lidocaine, gabapentin, and pregabalin. There might also be pain medication such as ketamine given during the operation to help reduce post-op pain.

What the providers end up giving your character after the surgery depends on his pain level. With mild to moderate pain your character might be able to get away with no opioid, or a weaker one like codeine or tramadol with an NSAID.

But with more severe pain, while in the hospital, the staff will probably still give him some kind of opiate medication such as fetanyl, morphine, or hydromorphone. But they’ll probably give your character as little as possible and monitor him closely. They will supplement his pain treatment with non opiates such as acetaminophen or other NSAIDs to help reduce the amount of opiates needed.

Lidocaine post op is also very useful as it reduces the amount of opioids needed for pain relief, and it is especially useful for after abdominal surgeries.

After discharge, they might give your character a tramadol prescription. Your character might also try acetaminophen or ibuprofen for OTC pain relief, but they’ll have to be careful not to take too much.

This is all of course assuming they don’t have any other chronic diseases and passable kidneys and liver. Otherwise, that’s a new headache and a half.

P.S. I wrote this with the assumption that your character was not taking methadone or suboxone, nor any other medications.

Hope this helped!

Disclaimer

[scriptpharmacist-blog]

Hi! I'm not sure if this question is better suited to @scriptshrink, but I brought it here first since you seem to be the resident drug expert of the scriptx family. How many pills would it take for a 160 pound adult man to overdose on Paracetamol/Acetaminophen (I think that's Advil? Or Tylenol?) Thank you for all the work you do on this blog! Happy 2017!

Hey there! Acetaminophen/paracetamol/Tylenol are all the same-ish (if there’s Tylenol in the name there is acetaminophen. There might also be some other active ingredients mixed in depending on the actual name).  Advil is ibuprofen. I’m not going to tell you how to OD on it, but 4g can cause your character to start having problems, and going up is worse.

Here was my post on acetaminophen OD! I hope it’ll help.

Disclaimer

[scriptpharmacist-blog]

Hello, hello

Hi! I just wanted to apologize for not having answered any asks for such a long time! School has started up again, and they’ve thrown me into the deep end. I also apologize for not communicating with my wonderful followers more! I still can’t believe the sheer amount of you!

My ask box is still open, and I will try to get to them, but honestly I have a huge test coming up and I probably won’t get to answer them until at least next Wednesday!

[kasadilla11]

You're kind of an asshole, you know that? That anon about you and your wife? Hetero relationships are still considered the default, even if it's not a correct mindset. I know we're trying to be progressive in society, but not all of us live in a progressive environment and it takes TIME to adjust to new ways of thinking. Most assumptions aren't even meant maliciously. And was it necessary to have a gif of Ryan flipping off that anon? You're disgusting.

Okay first of all. “Hetero relationships are still considered the default”? This in response to a post in which someone assumed that my wife (who refers to herself as “aunt” on her blog and has never been coy about the fact that she’s a queer woman), because she has mentioned being married to a woman, must therefore be a man? And you have the audacity to call me both “disgusting” and “an asshole” while imploring me to understand that “most assumptions aren’t even meant maliciously.” Adjust on your own damn time and keep your heteronormative, transphobic, queerphobic bullshit off my blog. 

[scriptmedic]

Okay everyone. Real talk time.

This is in reaction to this ask and reply, in which someone implied that because I am married to a woman, I must be a man.

The exact ask was, “ No hate intended or anyting, but your wrote something about having ‘a wife to cuddle’ does this mean you are more of an Uncle Scripty?”

And even though that assumption is hurtful, wrong on every level, and genuinely queerphobic and transphobic, I tried to answer with grace and dignity.

I took this in stride, because people can be severely ignorant without overtly ill intentions.

My wife, however, was less than amused. She had a much more direct response, which was basically this:

And this prompted someone to go on her blog and send the ridiculously disproportionate response above.

The position of the first anon is that, if I have a wife, I must be a man, or at least be “manly”.

The position of the second anon is that straight is the default, and that we as queer people need to create a safe space for heteronormativity to adapt to the ideas that queer people exist and the cishet assumption shouldn’t be the norm.

And that second anon went on to defend the first anon’s ask, and decided to call my wife some things I am too enraged to repeat.

So I am going to take a stand on this, right here and right now.

If you do not 100%  support the rights, equality, and dignity of LGBT people, you can get the fuck off of my blog. This blog is produced by a queer woman. This blog, and a large proportion of the ScriptX family, are members of the LGBT community.

We are real. We have rights. In particular, I have the right not to be called a man because I married a woman when my sign-off is Aunt Scripty. My wife has the right to have an instinctive reaction to someone attacking her spouse.

If you have an issue, you DO NOT HAVE THE RIGHT to hate message MY GODDAMN WIFE. Whoever you are, I would greatly appreciate it if you not only unfollowed me but blocked me so that our paths will never cross on Tumblr again.

In case you needed a clearer representation of where this blog stands, this is it:

Oh, and Anon #2? One last thing.

xoxo, Aunt Scripty

[scriptpharmacist-blog]

Hi! Could a character legally buy a drug that's capable of knocking someone out? Like an over the counter one? I'm assuming not, but I want to make sure. Thanks :)

Well alcohol is a legal drug that can knock you out eventually. :)

There’s also some cold/allergy medications that can cause drowsiness and sleep.

Many allergy medications, e.g. Benadryl contain diphenhydramine, an antihistamine which causes drowsiness. It is also found in many OTC sleeping aids. Tylenol PM also contains diphenhydramine.

NyQuil contains doxylamine, another antihistamine which causes drowsiness, and is found in some OTC sleeping aids.

These medications can make your character drowsy and perhaps even knock them out, who knows. Everyone reacts differently to medication.

Apparently some people react in the opposite way to Benadryl. So that would be an interesting surprise!

[scriptpharmacist-blog]

my character is taking antidepressants (wellbutrin) and she had a depression atack and she went crazy and took like 4 pills (she wasn't trying to commit suicide, just to make the pain go away) what'd happen if she started doing that on a daily basis?

Hello there! I think you mean depressive episode instead of depressive attack.

Well it depends on the dose of the Wellbutrin (100mg, 150 mg, 200mg etc ) and type (immediate,sustained, extended release). Depending on what your character was prescribed, they could be taking the medication anywhere from  once per day or 3 times a day. I am assuming that your character is taking it once a day.

There is definitely a higher chance of having seizures. The risk of having a seizure can increase by 10x depending on the increase, mostly when you go above 450mg. Other possible side effects include

Dry mouth

Nausea

Insomnia

Dizziness

Anxiety

Indigestion

Tremor

Increase in suicidal thoughts

Overdoses can cause seizures, hallucinations, hypertension (high blood pressure), tachycardia (high heart rate), arrhythmia (abnormal heart rhythms), and death.

If your character decides that they want to downgrade their Wellbutrin to normal doses, don’t have them do it abruptly, you have to wean them off.

[scriptpharmacist-blog]

my character is taking antidepressants (wellbutrin) and she had a depression atack and she went crazy and took like 4 pills (she wasn't trying to commit suicide, just to make the pain go away) what'd happen if she started doing that on a daily basis?

Hello there! I think you mean depressive episode instead of depressive attack.

Well it depends on the dose of the Wellbutrin (100mg, 150 mg, 200mg etc ) and type (immediate,sustained, extended release). Depending on what your character was prescribed, they could be taking the medication anywhere from  once per day or 3 times a day. I am assuming that your character is taking it once a day.

There is definitely a higher chance of having seizures. The risk of having a seizure can increase by 10x depending on the increase, mostly when you go above 450mg. Other possible side effects include

Dry mouth

Nausea

Insomnia

Dizziness

Anxiety

Indigestion

Tremor

Increase in suicidal thoughts

Overdoses can cause seizures, hallucinations, hypertension (high blood pressure), tachycardia (high heart rate), arrhythmia (abnormal heart rhythms), and death.

If your character decides that they want to downgrade their Wellbutrin to normal doses, don’t have them do it abruptly, you have to wean them off.

[scriptpharmacist-blog]

Hi! I wanted to weigh in on the stage fright question? I don't know about propranolol, but if this is the person's career, learning how to overcome the stage fright without drugs would likely be a huge part of easing nervousness/trembling. There's also the problem that his insurance might not cover propranolol for an off-label use such as stage fright, citing that learning to overcome it would be a better answer to the problem.

Hi there! This is all very true, and if you are writing for this, you should take it into account! If anyone is interested in possible therapies to overcome stage fright, you should probably ask @scriptshrink.

[scriptpharmacist-blog]

Hey I was taking fluoxetine and wellbutrin, but now I'll be taking wellbutrin and valproate and I'm wondering how those pills react with each other and if that could cause me weight loss or gain thank you!!

Hi there. This is a blog for writers and stories only. If you have questions about the medications you are taking, I suggest you speak with your pharmacist or doctor.

[scriptpharmacist-blog]

Under what names are paracetamol usually sold in USA (it's Panadol in Vietnam)? And what kind of pain reliever is common for period cramps over there? Thank you!

Hi there!

Paracetamol is called acetaminophen in the US. A lot of people just say Tylenol though. Common pain relief is a toss up between Aspirin, Ibuprofen aka Advil, and Acetaminophen aka Tylenol.

Hope that helps!

[scriptpharmacist-blog]

When a pharmacist gets a question about a drug they don't know off the top of their head, what do they use to find the answer?

Pharmacists would probably use an online drug databases such as Lexicomp or Micromedex.

[scriptpharmacist-blog]

Hey!! I have a character who has to perform (dance) and he is very nervous about it. He has a doctor friend. What medication could the doc suggest that could ease nervousness/trembling without side effect to motor skills or attentiveness ? Cheers! :3

Well, looking at a lot of medications, most of them cause sedation which is not what you want. One which does not is propranolol.

Propranolol is a nonselective beta blocker which can be used for stage fright. It is prescription only. It should be taken with caution if your character has breathing problems, as it can cause bronchoconstriction.

[I was taught in class to never give beta blocker to a patient, but all the upper classmen are like no, go right on ahead]

Beta blockers can also have issues with other disease states, and many other medications.

Since beta blockers also lower the heart rate, I would be a bit worried about light headedness… but hopefully your character will be able to be alright.

If any of my followers have anything they want to add, please do so!

[the-moon-in-the-water]

Go for 5-10mg propanolol but expect breathlessness with exertion. It does affect your breathing a bit when you try to dance, jog or do something more physically exerting than walk to the kitchen so keep that in mind. If they’ve never taken something like it before, lightheadedness and sleepiness are also possible (I’ve had all three happen). The breathlessness-with-exertion-thing is not just reserved for asthmatics (which I am) by the way, it’s kind of common with propranolol as @scriptpharmacist mentioned.

[scriptpharmacist-blog]

Thanks for your input!

[scriptpharmacist-blog]

Not sure whether to ask you or scriptmedic, but, uh. Do you know how Polymyxin B could be used against MDR ventilator-associated pneumonia, specifically caused by pseudomonas aeruginosa? Like, would it be injected, how much would be used, etc etc. Sorry if this is too specific.

(Pseudomonas aeruginosa anon again) ALSO- what can you generally tell me about what medications are used against multi-drug resistant infections of the lungs? As someone who’s dealt with MRSA I’m very oddly curious about MDR infections and plan to incorporate that in a thing I’m writing.

Whelp, I managed to find a wonderful article on MDR ventilator-associated pneumonia. There are many different approaches on how to treat it, I would suggest you approach an actual hospital for first hand experience (as this is coming from research only)

ONE METHOD is starting out with one of these bad boys:

Piperacillin-tazobactam CefepimeCeftazidime Imipenem Meropenem Aztreonam

PLUS adding a [ONE] polymyxin for the highly resistant P. aeruginosa:

Colistin

Polymyxin B (2.5 to 3 mg/kg IV per day divided in two daily doses)

Aztreonam

PLUS one of the following:

Linezolid

Vancomycin

Telavancin

Very aggressive therapy regime, as you can see. Hope this helps!

SOURCE

[scriptpharmacist-blog]

Hey!! I have a character who has to perform (dance) and he is very nervous about it. He has a doctor friend. What medication could the doc suggest that could ease nervousness/trembling without side effect to motor skills or attentiveness ? Cheers! :3

Well, looking at a lot of medications, most of them cause sedation which is not what you want. One which does not is propranolol.

Propranolol is a nonselective beta blocker which can be used for stage fright. It is prescription only. It should be taken with caution if your character has breathing problems, as it can cause bronchoconstriction.

[I was taught in class to never give beta blocker to a patient, but all the upper classmen are like no, go right on ahead]

Beta blockers can also have issues with other disease states, and many other medications.

Since beta blockers also lower the heart rate, I would be a bit worried about light headedness... but hopefully your character will be able to be alright.

If any of my followers have anything they want to add, please do so!

[scriptpharmacist-blog]

So things like cinnamon are like natural pain relief for at least slight things like cramps but how manny over the counter pain relievers or natural pain relievers word someone have too take for something like a field amputation right above the knee

Hi there!

Unfortunately, I don’t believe that there is an OTC medication that is strong enough to deal with the pain of amputation without causing toxicity. I am also not very knowledgeable on natural pain relievers.

Sorry I couldn’t help you!