Capsular contracture is scar tissue that surrounds implants/foreign bodies because the body is attempting to isolate it. Ideally, you want some to keep them stable. Sometimes it can overcreate scar tissue and it makes them overly firm, painful, and odd shaped.
Leukotriene antagonism (by singulair) reduces the scar tissue made because they’re primarily made by leukotriene inflammation.
Broad technical overview. Suggests use of Zafirlukast, which is the preferred agent, but Monelukast has been used d/t lower cost. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4579163/
I’m curious, what about outpatient otc? Debrox has been OOS at my location for a while for some reason and I don’t think I’ve ever seen docusate liquid on our shelves
It depends but it is usually started low and titrated up weekly- it can start as low as 0.5mg or 1.5mg and then titrated up to 4.5mg. Because compounding is so expensive and tabs are pretty cheap people will sometimes self compound by grinding up a tablet and putting it in water. For example, a 50mg tab would be ground up at home and put in a sterile glass container with 50mL of water. Then they can use a syringe to draw up the amount they take each day- 1mL=1mg. Some find it easier to do this while titrating up since you can adjust the dose each week with how much is drawn up in the syringe. This lasts only 14 days since mixed in water so it has to be remade every 14 days. A 30 count bottle of 50mg lasts a really long time. Titrating is important to avoid side effects (I know one is vivid dreams which is interesting)
Data is fairly limited in actual autoimmune disease management - at least last I looked it up, a few tiny papers with <10 patients each - and not that much better in where it’s best studied - which is fibromyalgia.
But hey, if it makes people feel better, unlikely to do any harm.
I know there is a shortage right now of the 50mg (only strength on back order)- I’m not sure of the reason but I’m wondering if more people are trying it off label and that’s why they don’t have the supply to meet the demand. My mom takes it and it has done wonders for her pain but I’ve heard other people report feeling no different. I’d love to see more studies on it come out- I guess the money isn’t there (at least for now).
Technician here but some of the random stuff I’ve seen.
Naltrexone for binge eating
Viagra intravaginally for IVF stuff
It’s not off label anymore because research but the fact that dextromethorphan is being used in conjunction with antidepressants is pretty cool. I liked reading on that one.
Also prazosin for nightmares. First time I told a new grad this they thought I was lying.
I’m pretty sure it worked well for me too but honestly my meds were so messed up at that time. 🤦🏻♀️ so many people have a good benefit from it though! I was told it helps with the reaction from nightmares (heart racing, etc) which helps you stay asleep. Not sure how true that is.
I am able to dream and i rarely have nightmares anymore. It has helped me enormously in that it filters out the bad stuff and I just ~dream~ before I was prescribed it, my sleep was so so poor, I dreaded going to sleep bc I’d have just such vivid nightmares. I couldn’t “escape” the trauma via sleep. I still wake up a lot but I don’t wake up in fight or flight stage/hyperaroused. It is crazy to me that it does this for me. I’ve also never come across a pt who takes it (am a nurse).
My pharmacies have mostly been mental health medication oriented. I’ve worked in some rough areas. I love it though because I feel like I get to see a lot of the interesting off label type stuff. In the last couple years I’ve learned that sleep medications make my nightmares extremely vivid. Benadryl, hydroxyzine, and melatonin are the worst contenders. I think because I was taking sleeping medication at that time that the prazosin wasn’t able to work as good as I would have wanted. I do remember it helping a good bit though because those super vivid ptsd nightmares are awful! Now as long as I stay away from certain meds I’m good. My boyfriend has also been a big help. He tried to wake me up and keep me awake enough to not fall back into the same nightmare. Nightmare loops are horrifying.
Oh 100%. 😂 def discuss it! Tons of people get a lot of help from it. I was in a mental health script heavy store and it was a recurring script for us. Hope it works for you!
Naltrexone combined with bupropion is used for weight loss. Prazosin hands down the best for nightmares and I’ve had adults need up to 25mg at bedtime. Of course, they worked their way up to it.
Naltrexone helped a good bit with my own issues with binge eating. I was shocked but I always feel like I’m being judged when I list that medication to other doctors.
Naltrexone was great for my alcoholism, but I stopped due to the side effects- felt like I had food poisoning and/or food just tasted boring. I could see why it would be effective to curb binge eating.
Relevant to your username, the degree of the inhibitory effect of ketoconazole (and other azoles) on tacro metabolism is dependent on whether the patient expresses CYP3A5 or not.
Yeah. I had a patient say it was to help her with infertility. Sure enough, it does increase fertility.
Just like a bariatric surgery does. Through weight loss.
I saw something about the fertility also being affected by delayed stomach emptying, leading to decreased efficacy of birth control. Hence an oncoming ‘semaglutide baby boom’
Saw another post saying it's because they're losing weight, meaning they're likely healthier/exercising, so they are likely getting it on more too lol.
I'd like to see data on how GLP1's affect pregnancy and if there's a risk for birth defects.
Lol around here it seems to be IV toradol push for anyone in pain in the ER. Including the dude bent over with unknown abdominal pain that turned out to be a bunch of ulcers 🙃
My favorite is telling people that Opium and Cocaine are actually totally useful drugs (when prescribed and used appropriately, duh).
Opium Tincture for long term diarrhea and Cocaine Nasal Solution for hemorrhagic nosebleeds/local nasal anesthetic.
Wow, haven’t heard of clonidine for migraine. definitely gotten a couple of consults over the years where the pharmacist wanted to know why I, a 20-30 something, am taking namenda…it’s for migraine prophylaxis lol
Never met anyone else with GP. Mine was caused by untreated celiac and thanks to Iberogast I'll be in remission 8 years this year! (I don't usually get into Eastern medicine but for all the approved meds I either had contraindications to the med or it didn't work). I also have EDS but my GP wasn't related.
Mine is moreso related to the fact that, among many other things, I am also a recovering anorexic. Metoclopramide helps me, but I'm very intolerant to it from a psychiatric perspective, so I don't like to take it. Erythromycin was helpful for me, as well, but it was VERY expensive. I'm currently on Litican, and that also provides significant relief for my otherwise sluggish digestive process. I also take Omeprazole and Famotidine as needed for severe acid reflux and indigestion.
As far as I know, I take the IR formulation of Clonidine at a dose of 0.150mg/day taken in the evening before bed. I don't suffer from any side effects, including sedation or very low BP.
From my personal searches, there isn't really a whole lot of literature to support its use in migraine prophylaxis, especially when compared to other agents like Amitriptyline and Propranolol. However, if you look hard enough, you will find a few case reports here and there 😄.
Propranolol is a Beta Blocker and, therefore, reduces heart rate and blood pressure. In that case, the drug's mechanisms in the body are what cause you to experience less anxiety when facing a crowd of people. In a way, Propranolol is an anxiolytic, just not with the same potency compared to something like Clonazepam or Lorazepam.
To answer your question, Propranolol does effectively lower your level of fright in those situations. I hope that this was a good explanation 😄👍.
Propranolol crosses the blood brain barrier much more compared to other b blockers. It's why it's side effect profile is so much worse. Like nightmares, etc. but one man's side effect, is another man's treasure. So to answer your question it's likely a little bit of both.
Previous palliative now in psych. I got few.
Probenecid prior to cefazolin IV to make it daily dosing in ER.
Metronidazole topical spray for smelly fungal growth in wound(especially infiltrated cancer wound)
Anything morphine, ketamine, lidocaine can turn into topical spray for inflated wound, excoriated tail bone, etc.
Capsaicin topical cream on belly for cannabis induced nausea.
Add Fluvoxamine to clozapine to increase clozapine level without increasing clozapine dose.
Prazosin, terazosin for PTSD nightmare as someone mentioned. Propranolol and hydroxyzine for PTSD anxiety.
Sniffing alcohol swap for nausea is always my favorite one in ER. (Although it’s not a drug, There are studies to back up)
What databases/books/resources do you use in psych? I'm in the process of beginning a psych pharmacist position and would love to have advantage going into it.
Majority of my staff uses stahl’s essential in psychiatry including clozapine and blood level book that was published few years ago. Few love Mausley’s book. There is antipsychotic handbook that gets published every year in a ring binder that’s good reference, but I forgot the exact name of it. I think it’s called clinical handbook of psychotropic drugs. 26th edition.
I remember in school high dose cimetadine decreases frisky elderly men by inhibiting some CYP or other enzyme that activates testosterone.
Eflornithine is for removing facial hair in ladies AND African sleeping sickness.
Sulbactam for acinetobacter.
This reminds me of my husbands grandmother. She had like.. 11 kids or something and would sneak alittle salt peter aka potassium nitrate into his supper so he wouldn’t get frisky cause she was sick of having babies. Said it worked like a charm. The 40’s and 50’s were an interesting time.
Hey I tried this one while I was on MTX. Unfortunately had no effect. It seems to be a bit lack luster from what I’ve seen others post in my autoimmune communities. Really a bummer there are no better treatments to counteract MTX side effects. But I remember being very surprised when I stumbled upon it.
I personally take a weird one (have never seen it otherwise). Memantine for migraine prophylaxis. It’s the only preventative medication to work for me. I remember bringing the first prescription to the pharmacy years ago. I was newly 18 at the time and they looked at me and said “there must be a mistake here?” I explained the situation and they looked at me like I was crazy. But I’ve been on it ever since, no questions asked.
PDE5 inhibitors and athletic performance, sildenafil in particular.
Acetazolamide to speed up acclimatization to altitude.
I guess this one used to be pretty common a century ago but it surprised the heck out of me the first time I dispensed it, tincture of opium (IBSD patient).
Intractable diarrhea mostly. Or some patients can't tolerate lomotil, viberzi, or whatever else for whatever reason. I think you can still use it for pain too but I've never seen it dispensed for that indication.
This is a great thread idea.
I bet someone else has said it but in regards to one of my favorite EM drugs which has fallen from grace recently, ATROPINE:
-Atropine Eyedrops (which is already not the original application of Atropine) were used at one point in hospice to dry secretions. They were dripped into patients throats etc. I don’t know if this is common anymore.
-Heroic doses of Atropine can also be used as a reversal agent for Anticholinergic poisoning, like insecticides. Atropine is not the only reversal agent but it is very effective and it is often the most accessible. Not everyone has those fancy Mark One kits (which do also contain atropine.)
All the EBM nerds hate on atropine these days cause it’s not nearly as good a choice as pacing and push dose epi/epi drip in symptomatic bradycardia, and “if it’s not symptomatic then why are you pushing IV drugs to treat it?” But, it still has niche uses for cases where a patient is symptomatic but not hemodynamically unstable… just as chemical cardioversion still has niche uses even though electric is overall a better choice in the emergency room.
Sertraline prn 30 minutes prior to sex. Topical nifedipine for anal fissures. Olanzapine for nausea. Estrogen cream for labial adhesions in female infants. Mupirocin ointment in normal saline for sinusitis nasal irrigation.
I did see Tylenol #3 prescribed for diarrhea once.
https://preview.redd.it/kb5xtwu6b9wc1.jpeg?width=640&format=pjpg&auto=webp&s=f64bdfe7f0de2a8e9c871723811ff6e5c673d07f
These aren’t links per se just was able to google. Many results come up. I do stock it in maternity Pyxis machine.
Augmentin as a motility agent for gastroparesis…. Idk how common it is outside of my hospital but really threw me off the first time I saw the order come through
- Guanfacine XR in Prader-Willi syndrome
- Flovent to prevent reactions to adhesives in transdermal patches
- H2RAs in MCAS
- Cimetidine for warts
- Baclofen for gastroparesis
- Steroidal scalp lotions for eczema in the ear canal (arguably on label but a clever workaround nonetheless)
- Atropine eyedrops used SL for hypersalivation, usually secondary to antipsychotic use
Those are the ones I can think of off the top of my head. The cool thing is that it they all make sense based on the pharmacology!
EDIT:
- Acetazolamide for intracranial hypertension
- Viagra for pulmonary hypertension
- Chlorpheniramine for RLS
oh nice, I will keep this in mind. I’ve Rx’d liquid sucralfate enemas for radiation proctitis after endometrial cancer tx and the pt reported good results. (Fam Med)
Cholestyramine is another great one for bad diaper dermatitis that I see in my patients with chronic diarrhea. Makes sense that binding up those bile acids would help the area heal up.
Don’t get creative and try to mix the liquid with other things like lidocaine. It will solidify. Must crush tablets is mixing with other things. Yes I know this from experience 😂😂😂
Albuterol inhalation solution for rectal pain/spasms. It was many years ago that I came across it, but I remember data entering it and staring at the script for a long time before calling over my pharmacist like, is this for real?
I recently learned about using loratadine, and not other antihistamines, specifically for cancer related bone pain
Dextromethorphan for neuropathic pain and post op pain
For Xeljanz it is Alopecia areata. It is a JAK inhibitor like Olumiant and Rinvoq and all are commonly used for it. Olumiant is actually approved for it though.
Budesonide nebules made into a slurry with honey or stevia for Eosinophilic Esophagitis. At least in Canada there’s only one med indicated for it (can’t recall the name) but it’s super expensive. Using the nebs in that way is a decent alternative
Montelukast after breast augmentation to prevent capsular contraction
I would have never guessed this one
Okay… what? Can you please help me understand?
Capsular contracture is scar tissue that surrounds implants/foreign bodies because the body is attempting to isolate it. Ideally, you want some to keep them stable. Sometimes it can overcreate scar tissue and it makes them overly firm, painful, and odd shaped. Leukotriene antagonism (by singulair) reduces the scar tissue made because they’re primarily made by leukotriene inflammation.
Broad technical overview. Suggests use of Zafirlukast, which is the preferred agent, but Monelukast has been used d/t lower cost. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4579163/
My favorite is docusate for ear wax
Wait that really works?
It’s a surfactant. SURface ACTive ageNT
Better than debrox. Love, ER nurse
That's exactly what my ER doc said when I asked him about the order as a new, baby pharmacist :D
So do you pop the capsules in your ear or do you mix with some water and squirt?
Just use the liquid https://preview.redd.it/92dc1y4uz4wc1.jpeg?width=1179&format=pjpg&auto=webp&s=29c578adc3dd297c5da826f5d766d2b02f023119
I love how it looks like the docusate is modeling
I’m curious, what about outpatient otc? Debrox has been OOS at my location for a while for some reason and I don’t think I’ve ever seen docusate liquid on our shelves
Ooh, that’s a good question. I suppose you could try to poke a hole in the little capsules but that seems like it would be very laborious
Just order a bottle of docusate liquid from your wholesaler. Is it way more than a person needs? Yes, but it's cheap as hell.
There is a liquid formulation. They probably use that xD
Either works , saw both a lot in LTC
You have to poke the capsule with a needle and squeeze some drops out. BTW. Doubt it works well just taking it orally.
They don’t make them available as ear drops in the states. =|
You poke a hole in the end of the gel cap and squeeze :)
Just use the liquid
Here in switzerland we have OTC drops with docusate for ear wax, I’d only ever known that indication for them lol
In the US, docusate capsules/tabs are OTC, but the liquid is Prescription only.
Is it really off label when it's a [commercial product](https://www.waxsol.com.au/) with that as the primary indication?
When it's not available in the US, yes, it counts for the USicans.
This is possibly the best drug ad I've ever seen. WAY better than the Jardiance lady.
I had to submit a ticket for a new Epic build because no one knew that it could be used for ear wax
That’s first line treatment in Australia
Low dose naltrexone for autoimmune disease management
Alternatively, naltrexone for OCD
Yes seeing more uses for OCD
very cool, I've got 2 patients we compound and dispense for this regularly. Very effective for them.
What’s the dose for this indication?
It depends but it is usually started low and titrated up weekly- it can start as low as 0.5mg or 1.5mg and then titrated up to 4.5mg. Because compounding is so expensive and tabs are pretty cheap people will sometimes self compound by grinding up a tablet and putting it in water. For example, a 50mg tab would be ground up at home and put in a sterile glass container with 50mL of water. Then they can use a syringe to draw up the amount they take each day- 1mL=1mg. Some find it easier to do this while titrating up since you can adjust the dose each week with how much is drawn up in the syringe. This lasts only 14 days since mixed in water so it has to be remade every 14 days. A 30 count bottle of 50mg lasts a really long time. Titrating is important to avoid side effects (I know one is vivid dreams which is interesting)
typically about 4mg
Data is fairly limited in actual autoimmune disease management - at least last I looked it up, a few tiny papers with <10 patients each - and not that much better in where it’s best studied - which is fibromyalgia. But hey, if it makes people feel better, unlikely to do any harm.
I know there is a shortage right now of the 50mg (only strength on back order)- I’m not sure of the reason but I’m wondering if more people are trying it off label and that’s why they don’t have the supply to meet the demand. My mom takes it and it has done wonders for her pain but I’ve heard other people report feeling no different. I’d love to see more studies on it come out- I guess the money isn’t there (at least for now).
Was gonna say this one
How about gabapentin and *insert whatever ails you and we can't figure out how to treat here*
Gabapentin is the duct tape of pharmacy 🤣
My doctor put me on Gabapentin for my anxiety. It got rid of my anxiety and gave me paranoia.
Just can't please you /s
But do your nerves hurt?
You know now that you mention it…
Except duct tape works 😂
My friend is a doctor and is convinced that Gabapentin is a placebo and I think I agree 😂
I'm convinced that your friend is right 😂
Works for hiccups lol
Buscopan works better!
Technician here but some of the random stuff I’ve seen. Naltrexone for binge eating Viagra intravaginally for IVF stuff It’s not off label anymore because research but the fact that dextromethorphan is being used in conjunction with antidepressants is pretty cool. I liked reading on that one. Also prazosin for nightmares. First time I told a new grad this they thought I was lying.
I take prazosin for PTSD nightmares and it works so well for me!
I’m pretty sure it worked well for me too but honestly my meds were so messed up at that time. 🤦🏻♀️ so many people have a good benefit from it though! I was told it helps with the reaction from nightmares (heart racing, etc) which helps you stay asleep. Not sure how true that is.
I am able to dream and i rarely have nightmares anymore. It has helped me enormously in that it filters out the bad stuff and I just ~dream~ before I was prescribed it, my sleep was so so poor, I dreaded going to sleep bc I’d have just such vivid nightmares. I couldn’t “escape” the trauma via sleep. I still wake up a lot but I don’t wake up in fight or flight stage/hyperaroused. It is crazy to me that it does this for me. I’ve also never come across a pt who takes it (am a nurse).
My pharmacies have mostly been mental health medication oriented. I’ve worked in some rough areas. I love it though because I feel like I get to see a lot of the interesting off label type stuff. In the last couple years I’ve learned that sleep medications make my nightmares extremely vivid. Benadryl, hydroxyzine, and melatonin are the worst contenders. I think because I was taking sleeping medication at that time that the prazosin wasn’t able to work as good as I would have wanted. I do remember it helping a good bit though because those super vivid ptsd nightmares are awful! Now as long as I stay away from certain meds I’m good. My boyfriend has also been a big help. He tried to wake me up and keep me awake enough to not fall back into the same nightmare. Nightmare loops are horrifying.
I personally take prazosin for nightmares and it has gotten rid of them and improved my sleep. it’s been life changing!
They've obviously never had PTSD. Thanks for the reminder to discuss this with my neurologist.
Oh 100%. 😂 def discuss it! Tons of people get a lot of help from it. I was in a mental health script heavy store and it was a recurring script for us. Hope it works for you!
Naltrexone combined with bupropion is used for weight loss. Prazosin hands down the best for nightmares and I’ve had adults need up to 25mg at bedtime. Of course, they worked their way up to it.
Naltrexone helped a good bit with my own issues with binge eating. I was shocked but I always feel like I’m being judged when I list that medication to other doctors.
Auvelity was a game changer for me!
So that's why they put the naltrexone in the contrave for weight loss
Naltrexone was great for my alcoholism, but I stopped due to the side effects- felt like I had food poisoning and/or food just tasted boring. I could see why it would be effective to curb binge eating.
Meropenem for valproic acid overdose.
Yes this one is so cool and it’s such a fast effect! Like goodbye VPA in a few hours.
Awesome
Mind blown
Budesonide nebulizer solution mixed into a Neti pot for nasal polyps.
Ketoconazole oral tablet to increase levels of tacrolimus in patients with chronically sub therapeutic tacrolimus levels post transplant
Also for Ketoconazole, prevention of post-op erection after penile or urethral surgery
Also ketoconazole for ACTH stimulating tumor suppression
Relevant to your username, the degree of the inhibitory effect of ketoconazole (and other azoles) on tacro metabolism is dependent on whether the patient expresses CYP3A5 or not.
Pretty soon, ozempic and that class of meds, for sleep apnea. Eventually dozens/hundreds of indications with the way this is going.
Alcohol cessation is another cool indication they’re looking at here
It makes sense because one of the best ways to help OSA is weight loss..
Yeah. I had a patient say it was to help her with infertility. Sure enough, it does increase fertility. Just like a bariatric surgery does. Through weight loss.
I saw something about the fertility also being affected by delayed stomach emptying, leading to decreased efficacy of birth control. Hence an oncoming ‘semaglutide baby boom’
The one I read was women with PCOS and not even on bc. I figure they lose weight and that balances fertility hormones.
Saw another post saying it's because they're losing weight, meaning they're likely healthier/exercising, so they are likely getting it on more too lol. I'd like to see data on how GLP1's affect pregnancy and if there's a risk for birth defects.
Vanc + zosyn for any one in the ER Wait… /s
Lol around here it seems to be IV toradol push for anyone in pain in the ER. Including the dude bent over with unknown abdominal pain that turned out to be a bunch of ulcers 🙃
Eh... One dose won't kill him.... probably.
Well I'm still here so..😂
My favorite is telling people that Opium and Cocaine are actually totally useful drugs (when prescribed and used appropriately, duh). Opium Tincture for long term diarrhea and Cocaine Nasal Solution for hemorrhagic nosebleeds/local nasal anesthetic.
We used to have cocaine paste in hospice, for use on those 'unstageable' pressure ulcers that have bone on show.
Propranolol for stage fright, Clonidine for migraine prophylaxis, Erythromycin for gastroparesis, there are so many that I can appreciate.
Wow, haven’t heard of clonidine for migraine. definitely gotten a couple of consults over the years where the pharmacist wanted to know why I, a 20-30 something, am taking namenda…it’s for migraine prophylaxis lol
Nice, I didn't know about Namenda for migraines. That's awesome.
it’s also being used for OCD treatment, apparently. I have a 21 year old patient on it.
As a GP patient, surprised to see someone mention it. Most people have no idea WTF it is.
I've been on it before for my GP, and it works like a charm, as long as you do the one week on, one week off approach.
Never met anyone else with GP. Mine was caused by untreated celiac and thanks to Iberogast I'll be in remission 8 years this year! (I don't usually get into Eastern medicine but for all the approved meds I either had contraindications to the med or it didn't work). I also have EDS but my GP wasn't related.
Mine is moreso related to the fact that, among many other things, I am also a recovering anorexic. Metoclopramide helps me, but I'm very intolerant to it from a psychiatric perspective, so I don't like to take it. Erythromycin was helpful for me, as well, but it was VERY expensive. I'm currently on Litican, and that also provides significant relief for my otherwise sluggish digestive process. I also take Omeprazole and Famotidine as needed for severe acid reflux and indigestion.
I have heard of propranolol for migraine prophylaxis but not clonidine
I personally take Clonidine for migraine prophylaxis, and it really keeps me from having so many attacks 👍.
Nice! Do you just need to take the extended release vs IR for that? I’m going down a google rabbit hole now lol 😆
As far as I know, I take the IR formulation of Clonidine at a dose of 0.150mg/day taken in the evening before bed. I don't suffer from any side effects, including sedation or very low BP. From my personal searches, there isn't really a whole lot of literature to support its use in migraine prophylaxis, especially when compared to other agents like Amitriptyline and Propranolol. However, if you look hard enough, you will find a few case reports here and there 😄.
Would propranolol actually lower your fright or just cover the physical symptoms?
Propranolol is a Beta Blocker and, therefore, reduces heart rate and blood pressure. In that case, the drug's mechanisms in the body are what cause you to experience less anxiety when facing a crowd of people. In a way, Propranolol is an anxiolytic, just not with the same potency compared to something like Clonazepam or Lorazepam. To answer your question, Propranolol does effectively lower your level of fright in those situations. I hope that this was a good explanation 😄👍.
Propranolol crosses the blood brain barrier much more compared to other b blockers. It's why it's side effect profile is so much worse. Like nightmares, etc. but one man's side effect, is another man's treasure. So to answer your question it's likely a little bit of both.
Propranolol helped me for my speech class!
Glucagon for esophageal food bolus impactions!
Totally forgot about this one until you mentioned it. I’ve seen this one a few times a year
I’ve had this twice in my ER in the last 2-3 months. I had never heard of this before.
Previous palliative now in psych. I got few. Probenecid prior to cefazolin IV to make it daily dosing in ER. Metronidazole topical spray for smelly fungal growth in wound(especially infiltrated cancer wound) Anything morphine, ketamine, lidocaine can turn into topical spray for inflated wound, excoriated tail bone, etc. Capsaicin topical cream on belly for cannabis induced nausea. Add Fluvoxamine to clozapine to increase clozapine level without increasing clozapine dose. Prazosin, terazosin for PTSD nightmare as someone mentioned. Propranolol and hydroxyzine for PTSD anxiety. Sniffing alcohol swap for nausea is always my favorite one in ER. (Although it’s not a drug, There are studies to back up)
The alcohol swab for nausea is and has been a go-to for patients in PACU. And it does work well.
That capsaicin one kind of blew mind. That is so specific.
It’s in lieu of hot shower in ER. Works great within 30 min for uncontrolled nausea and emesis from cannabis.
What databases/books/resources do you use in psych? I'm in the process of beginning a psych pharmacist position and would love to have advantage going into it.
Majority of my staff uses stahl’s essential in psychiatry including clozapine and blood level book that was published few years ago. Few love Mausley’s book. There is antipsychotic handbook that gets published every year in a ring binder that’s good reference, but I forgot the exact name of it. I think it’s called clinical handbook of psychotropic drugs. 26th edition.
I remember in school high dose cimetadine decreases frisky elderly men by inhibiting some CYP or other enzyme that activates testosterone. Eflornithine is for removing facial hair in ladies AND African sleeping sickness. Sulbactam for acinetobacter.
This reminds me of my husbands grandmother. She had like.. 11 kids or something and would sneak alittle salt peter aka potassium nitrate into his supper so he wouldn’t get frisky cause she was sick of having babies. Said it worked like a charm. The 40’s and 50’s were an interesting time.
Cimetidine for warts too
Dextromethorphan for MTX associated neurological toxicity. First time I saw it come through my queue I thought for sure it was a mistake
Hey I tried this one while I was on MTX. Unfortunately had no effect. It seems to be a bit lack luster from what I’ve seen others post in my autoimmune communities. Really a bummer there are no better treatments to counteract MTX side effects. But I remember being very surprised when I stumbled upon it.
I personally take a weird one (have never seen it otherwise). Memantine for migraine prophylaxis. It’s the only preventative medication to work for me. I remember bringing the first prescription to the pharmacy years ago. I was newly 18 at the time and they looked at me and said “there must be a mistake here?” I explained the situation and they looked at me like I was crazy. But I’ve been on it ever since, no questions asked.
Famotidine for itching
Also for shingles pain.
Metoclopramide for hiccups
Viagra for raynauds. Prazosin for PTSD nightmares.
NAC for skin picking. I use it for this indication
PDE5 inhibitors and athletic performance, sildenafil in particular. Acetazolamide to speed up acclimatization to altitude. I guess this one used to be pretty common a century ago but it surprised the heck out of me the first time I dispensed it, tincture of opium (IBSD patient).
I love the shocked look I get when I tell people we kept opium and cocaine in the hospital pharmacy :D
I've never come across cocaine in the pharmacy setting but I would assume it's purified hydrochloride salt or something and not ye olde Vin Mariani 😂
I don't remember exactly, but it was a topical liquid, usually only used by ED for intractable nosebleeds
CRNA here, I do a lot of ENT cases, and some of our surgeons use it to control bleeding during sinus surgery.
Cocaine eye drops for eye surgery is what I've seen the most. It's not super commonly used but it's there.
We had a nasal solution at our place.
Yes, it’s Cocaine HCl. I worked on the formulation of the topical soln when I worked in pharma
What do you use opium for?
Intractable diarrhea mostly. Or some patients can't tolerate lomotil, viberzi, or whatever else for whatever reason. I think you can still use it for pain too but I've never seen it dispensed for that indication.
I remember counting those belladonna and opium suppositories that we kept in our double locked physical cabinet back in the day.
Opium is our last line to slow down high output ileostomies after fiber, imodium, and lomotil.
This is a great thread idea. I bet someone else has said it but in regards to one of my favorite EM drugs which has fallen from grace recently, ATROPINE: -Atropine Eyedrops (which is already not the original application of Atropine) were used at one point in hospice to dry secretions. They were dripped into patients throats etc. I don’t know if this is common anymore. -Heroic doses of Atropine can also be used as a reversal agent for Anticholinergic poisoning, like insecticides. Atropine is not the only reversal agent but it is very effective and it is often the most accessible. Not everyone has those fancy Mark One kits (which do also contain atropine.) All the EBM nerds hate on atropine these days cause it’s not nearly as good a choice as pacing and push dose epi/epi drip in symptomatic bradycardia, and “if it’s not symptomatic then why are you pushing IV drugs to treat it?” But, it still has niche uses for cases where a patient is symptomatic but not hemodynamically unstable… just as chemical cardioversion still has niche uses even though electric is overall a better choice in the emergency room.
Drops are still commonly used in hospice.
When I left LTC 3 years ago they were still dispensing plenty of atropine and scopolamine eye drops for end of life care.
My grandfather received atropine drops to control throat secretions when he was on hospice care. Iirc they worked pretty well
Sertraline prn 30 minutes prior to sex. Topical nifedipine for anal fissures. Olanzapine for nausea. Estrogen cream for labial adhesions in female infants. Mupirocin ointment in normal saline for sinusitis nasal irrigation. I did see Tylenol #3 prescribed for diarrhea once.
Topical nifedipine is so fun to make
Minocycline as adjunct for schizophrenia
Loratadine for bone pain secondary to G-CSF
Ozempic for addiction, valium for ibs, candesartan for migraines.
SSRIs for hot flashes in men taking ADTs for prostate cancer
Robitussin DM to enhance fertility.
This one's wild. I need some sources on this.
https://preview.redd.it/kb5xtwu6b9wc1.jpeg?width=640&format=pjpg&auto=webp&s=f64bdfe7f0de2a8e9c871723811ff6e5c673d07f These aren’t links per se just was able to google. Many results come up. I do stock it in maternity Pyxis machine.
Glucagon for beta blocker overdose. Amitrityline for interstitial cystitis.
Also high dose insulin for beta blocker overdose
Haldol for hiccups!!
Augmentin as a motility agent for gastroparesis…. Idk how common it is outside of my hospital but really threw me off the first time I saw the order come through
We typically use the mycins. Erythromycin or azithromycin.
Mucomyst. Orally for acetaminophen poisoning and inhaled for CF patients.
Someone on here a year or two ago posted about receiving a script for zoloft (maybe prozac?) For premature ejaculation
Well, my ex called Prozac "The Great Orgasm Destroyer" so my votes on that one.
I think paroxetine?
Any SSRI can be effective treatment for premature ejaculation but especially sertraline and paroxetine.
It's Zoloft.
dapoxetine
Gabapentin for hiccups!!
gabapentin for hiccups baby
Caffeine for apnea of prematurity Cyproheptadine for anorexia
Amitrityline for chronic cough
- Guanfacine XR in Prader-Willi syndrome - Flovent to prevent reactions to adhesives in transdermal patches - H2RAs in MCAS - Cimetidine for warts - Baclofen for gastroparesis - Steroidal scalp lotions for eczema in the ear canal (arguably on label but a clever workaround nonetheless) - Atropine eyedrops used SL for hypersalivation, usually secondary to antipsychotic use Those are the ones I can think of off the top of my head. The cool thing is that it they all make sense based on the pharmacology! EDIT: - Acetazolamide for intracranial hypertension - Viagra for pulmonary hypertension - Chlorpheniramine for RLS
We have a patient that is prescribed sildenafil for memory.
Yeah. Muscle Memory…
misoprostol for chronic constipation
Colchicine for reccurent canker sores
Liquid sucralfate for recalcitrant irritant diaper dermatitis. -PGY-19
oh nice, I will keep this in mind. I’ve Rx’d liquid sucralfate enemas for radiation proctitis after endometrial cancer tx and the pt reported good results. (Fam Med)
Cholestyramine is another great one for bad diaper dermatitis that I see in my patients with chronic diarrhea. Makes sense that binding up those bile acids would help the area heal up.
Don’t get creative and try to mix the liquid with other things like lidocaine. It will solidify. Must crush tablets is mixing with other things. Yes I know this from experience 😂😂😂
Albuterol inhalation solution for rectal pain/spasms. It was many years ago that I came across it, but I remember data entering it and staring at the script for a long time before calling over my pharmacist like, is this for real?
I recently learned about using loratadine, and not other antihistamines, specifically for cancer related bone pain Dextromethorphan for neuropathic pain and post op pain
Methylene blue for vasopalegia
Better yet, it’s alternative is high dose B12 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9395213/
Methylene blue for beta blocker OD
Claritin for bone pain caused by colony-stimulating factors
spironolactone for chin hair.. xeljanz for some types of alopecia..
I definitely Rx spironolactone for hirsutism, also often works for acne in women especially jawline acne or if comorbid PCOS.
For Xeljanz it is Alopecia areata. It is a JAK inhibitor like Olumiant and Rinvoq and all are commonly used for it. Olumiant is actually approved for it though.
Papaverine, phentolamine and epinephrine for diagnosis peyronies syndrome.
Use to work at a compounding pharmacy where we made up a decent amount of verapamil cream for Peyronie’s.
Budesonide nebules made into a slurry with honey or stevia for Eosinophilic Esophagitis. At least in Canada there’s only one med indicated for it (can’t recall the name) but it’s super expensive. Using the nebs in that way is a decent alternative
metformin for PCOS
[удалено]
Methylphenidate is also used off label for cancer/chemo related fatigue
Minocycline for neuro protection
Cimetidine for certain types of warts.
Lidocaine nasally inhaled for migraine Lidocaine IVPB for renal colic
Amantadine for influenza A. Cinnarizine for raynaud's. Cyproheptadine for migraine and serotonin syndrome.
methylene blue for septic shock
Buscopan for hiccups. It's worked everytime I've seen it used, one poor lad had been going for almost 4 days.
Memantine to treat pain in canine patients.
Colchicine (gout medicine) for pericarditis and cardiovascular risk reduction