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someone in my family just went through what could be the most potentially lethal mistake he’s ever made. he owes it all to polypharmacy.
this person is on several different types of medications for varying conditions. to one, he is very tolerant and really is due to take a break from it. most of the others are fairly benign, however he also occasionally takes a drug with anticholinergic (among other) properties.
i hope you see the storm brewing- because when he called me the next day asking for an explanation, and told the initial part of this story, i was getting nervous.
in a state of confusion, he took the anticholinergic drug, thinking it was the drug he was tolerant to. so he took a lot of them, as he found the usual number to be less and less effective. as i learned, his total intake of this drug was probably near the lethal dose that i found in some clinical pharmacology references. he did not know exactly how many he took, because he woke up in a stupor and took more of them because he was not experiencing the anticipated effect.
fortunately for him, he was taking the delayed-release formulation and there was a chunk of time in there where he was asleep and metabolizing drug before he took the second set of pills and slept the rest of the night. he woke up feeling awful, experiencing some pretty classic anticholinergic symptoms (classic sign that he had taken far too much of this drug). at this point, he knew something was seriously wrong and checked on his medications.
he is fine now, though it did take 3 days for his eyesight to return to normal. here’s where i will end the storytelling and dig into a little pharmacokinetics. rather than address PK at a highly academic level, i’m going to work at discussing this at a layperson level since that’s what we should be doing to communicate with the public about the importance of proper use of drugs. also, not everyone is fortunate enough to have training in this field 
pharmacokinetics, then, is how the drug is released into the body and how the body works to get rid of the drug. every time you take a drug, it has to be absorbed into your bloodstream and travel to its intended site of action. your liver is generally responsible for breaking down these drugs and eventually you excrete them some way. these processes are slightly different for all drugs.
what kept my family member out of trouble, is that the pill he took was theoretically meant to dissolve slowly and be absorbed into the bloodstream at a slower rate. the intention with this kind of preparation is to keep the concentration of drug in your bloodstream stable for a longer time period. (i will mention, but not in depth, that this doesn’t always work for as long as they’d like you to think.) the important thing is, that all of the pills in his stomach did not dissolve rapidly and release that very high dose of drug into his body all at once. the dose is always a factor in toxicity, and a part of that is just how much is really in the bloodstream to cause harm.
also on his side was the fact that the body is continually working to get rid of the drug, from the moment drug is available to get rid of. this process is called metabolism, and drug is inactivated and broken down in various ways to eliminate the effect. we can thank the cytochrome P450 enzymes in our livers for this action. there are other things to consider here, things like metabolites that remain active and are further broken down, but overall the body is furiously working to get rid of everything we dump into it.
the half-life of a drug is an experimentally determined time period, which defines how long the body takes to get rid of exactly half the drug that is in the bloodstream. the half life of the drug in question is 14 hours. my family member guesses that he slept for about 6 hours before taking the second dose, so he was able to get rid of maybe 25% of the drug that was already in his system before taking more. (i don’t know the rate order of kinetics for this particular drug, so i can only guess.) couple that with the fact that the drug was not immediately entering his bloodstream, and he was okay.
this is about how i explained it to the layperson on the other end of the phone. he seemed to understand pretty well what points i was trying to make. he was just relieved to know that he hadn’t killed himself, and vowed to change his habits and take that drug holiday. i asked him to please do that.
now for my exercise in academic discussion… as more drugs become available to treat our various ailments, and because of the ailment-specificity of many drugs, at some point or another we will all be on some combination of drugs for treatment of something. an injury, perhaps, or after a surgery, or recovering from some infection or another- life offers us many opportunities for insult to our bodies. as the medical community sends more prescriptions home with patients, what kind of problems are we going to encounter?
the cdc is already concerned about this issue- in 2004, over 20,000 deaths in the united states were accidental overdose. these statistics do include street drugs. however, prescription opioids alone made up about 7500 of those- more than heroin and cocaine. the rest, i feel it is safe to assume then, were other prescription and over the counter drugs. this is a growing problem that somehow needs addressing. as a non-medical person, i don’t call the shots on who gets what prescription. i also am not in the trenches dealing daily with real, heart-wrenching human suffering. somehow, a balance needs to be struck between alleviating pain and allowing a patient to get into serious trouble by making an honest mistake. discussion is welcome.
feels like i’ve been in perpetual motion for about a week. i’ve been cranking through secondary antibody concentration tweaking and finishing up this IF project with countless hours on the fluorescence scope, with the intent being to present the final data at my committee meeting on friday.
i wrote furiously until boss and i agreed on the content of the progress report, and it went over quite favorably with the most picky member of my committee. this is good news. i’m putting the finishing touches on the powerpoint right now, and my mind has really not deviated from the goal of a successful committee meeting for several days.
top this all off with my husband finishing his summer finals this week, needing to register him at TWO colleges on the other end of the state and arrange financial aid and payment. nevermind getting books and getting him moved over there in the first place. i feel i might go crazy at this rate, but fortunately the 15 things i’m juggling will go back to the usual 3-5 at the end of the week.
oh, we’re also spending the day at the hospital for a procedure for husband tomorrow, and i have to find some time to get the rest of my 10x mag images and have a half-hour meeting with the collaborators in there somewhere too.
so unfortunately, as the lifeless graduate student i proclaim to be, i have to call “too busy” for the time being. i have come up with my first pharmacology related post topic (as opposed to grad school topics i’ve been discussing lately, simply because my brain refuses to deviate) so i will discuss that after the committee meeting and after planning out what will hopefully be the LAST of my experiments in august-october.
i am apparently not in the blogging habit just yet! though i have certainly spent enough time writing lately, putting together a progress report for my committee meeting next week and piecing together what i think is a pretty good presentation to go along with it.
our PI is presently out of town, and the lab looks like a ghost town. we have 2 recent grads ready to leave at the end of the month, and two first-years who have yet to figure out how things work around here. i am the only one who’s stuck in some kind of rut- at least the rut is productive. for the most part.
in response to the rash of crazies running around college campuses in recent years, the university recently installed alert towers- think of the tornado sirens so common in the midwest- all over campus. unfortunately for us, one is directly across the street from our building. said building has very thin walls, and the damn thing chimes on the hour every hour. i think i am going to start a complaint campaign once people are actually here again. everyone else will be as annoyed at that noise as i am, i can guarantee that.
besides, when i’m working late i don’t care to be reminded of each passing hour. it makes me more grumpy.
it’s not often i get to work before the sun rises, before other people get here. before the vast expanse of parking lot becomes a busy, sunny place full of shining cars and people carrying bags that were free gifts from a variety of scientific meetings. (we all seem to be very proud of those, though i can’t figure out why.)
the university seems so quiet and regal, and my footsteps seem almost intrusive. and yet i trudge on, determined to get some time on the microscope to diagnose my fluorescence issue. the result was bad secondary antibody after all, so i have ordered new supplies and will resume that this weekend.
i had an interesting series of conversations with one of the two new graduate students in the lab. she is seeking a more reliable car, and had no idea where to start. her family was pushing her to buy new, and as a personal fianance stickler (hey, i support 2 of us- one very medically needy- on one grad stipend, i have to be) i was opposed to the idea of a graduate student buying a new car. especially one who is just starting out. and it got me to thinking about graduate student personal finance. how we manage our money today teaches us how to spend wisely in the future, and how we splurge today will just be taking money away from us in the future- probably with interest to top it off.
i see lots of good decisions and lots of foolish decisions being made here, and thought i would discuss a few. most of us are getting by without taking out student loans. this is great, since our department supports us at 100%. we also receive a stipend that is enough to get by on, though not much. that said, here are the things i would like to discuss.
a lot of us are sacrificing- people have room mates, live fairly near to campus. generally folks don’t live in the $1500/month lofts across the street from campus, but pretty close for cheaper. we drive older cars or at least reasonable newer cars that are pretty reliable types of vehicles. we have dinner nights in, and socialization occurs on certain nights gathered around the tv. we play board games and gather for potlucks. we help each other move to new apartments and buy pizzas instead of hiring help. we go to the campus gym together. these are great ways to live cheaply and still get your social on while not spending a lot of money.
then there are the more foolish things people here like to do. like the guy who bought a brand new luxury car, financed it, and took out student loans to make the payments. or the girl who uses student loans to make house payments. or the people who got sucked into the adjustable rate mortgages, because we as a group don’t typically have much in terms of credit history. you can’t count on graduating in a certain time frame- if i’ve learned anything here it’s that. there are folks who choose to live in a fairly nearby, more pleasant but far more expensive town. gas prices are really hurting them right now.
all of our decisions can help or hurt us. and while student loans are available for something urgent, they’re not cheap and they’re not necessary in most cases. we used some to pay off medical bills, but have chosen not to take out student loans when we lost our second income. if we didn’t need it, and couldn’t afford it, we got rid of it. it was that simple, and i still feel quite fulfilled with what life outside grad school i can possibly consider myself to have.
i can take the comments about how we have been married for 4 years and don’t own our own house. or how my husband’s car is the oldest, ugliest beast of a car. that car runs on alt fuels, and with gas prices as they are, that makes it the most attractive car to me. and it’s paid for, what more can i ask? i don’t judge my self-worth on my possessions, but i do judge my friends on how they judge me.
sure, the likely outcome is that we will all graduate one day and find jobs that pay fairly well as new phds. but setting yourself up to be behind before you get started isn’t usually the best idea. true for graduate school, true for experiments, true for real life.
i’ve been spending a fair amount of time doing immunofluorescence in free-floating brain sections. very cool stuff but tedious is not a good enough word to fit the work. couple that with the typical antibody issues/complications and we have ourselves a fun little project!
saturday i spent the better part of the day on our local interdepartmental fluorescence microscope imaging a series of sections. i learned that my background on a few of the samples was not up to my usual standards, so today began the routing out of my problem. it began with a section from each brain being incubated in secondary only, though i had already run this control in my practice samples before getting my real samples going. i really hate to think that my perfusions weren’t up to par, but i will admit it’s possible. and i would really prefer to stain some more of the sections i already have, than sacrifice even more animals for a sideline project.
all ideal microscopy hours are booked, i guess i’m showing up at the crack of dawn tomorrow. so much for catching up on my sleep!
here it is, a blog about my scientific life and other related things. my hope for this whole adventure is to commune with other science people and convey the day-to-day of the lovely lifestyle they call grad school.
i sit here today contemplating the last 4 years of my life and how i haven’t even been able to keep track of the time as grad school flew by at breakneck speed. now i begin year 5 and what i hope to be the final study in my dissertation research. i cross my fingers that my committee will be satisfied by this proposal…
i came into this whole thing knowing, but not really comprehending, what a tremendous task grad school would be. i don’t think you can really understand it until you’ve been through the wringer, and the department and university i chose just happen be very effective at putting us through it slowly and painfully. now that i am by several years the senior graduate student in my lab, it becomes my job to informally guide the younger students through the realization that grad school is a marathon that only ends far after you have become ready for it to end.
myself, i am mentally ready to move on. i am ready to go home, to be closer to my family who i left half a country away and can only afford to visit annually. i am ready to leave this climate behind and return to a place where my activity patterns more closely match one’s ability to be outdoors. but i have a ways to go yet, and so i continue on in my pursuit of something nobody in my family has ever dreamed of doing.
the following will be bits and pieces of my day to day experience. it might take me a while to get into a regular pattern, but i will be trying between running IF staining on my free-floating sections and writing documents.
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