Monthly Archives: October 2011

All typical antipsychotics are considered to be equally effective if given in equipotent doses.

best thing i read today. it’s like equal things will be equal. tautology is a tautology.

some drugs like digoxin relieve patients’ symptoms of heart failure and keep patients’ out of hospitals, but they don’t improve morbidity and mortality. statistical analysis that ends up this way kind of annoys me. depending on what outcomes you choose, you can get completely different results. so how am i supposed to interpret this? if we don’t give a patient digoxin, they won’t get worse, but they don’t get better. so why bother? does that mean the symptoms are not indicative of patients’ almost-dying status? does it mean that hospitals don’t improve morbidity and mortality? there’s so many links. and the links are all linked to each other.

last night i watched “50/50” in the movie theater. big surprise, actually going to the theater. anyway, it’s a good movie. i kept hearing commercials for it on the radio, but it never actually mentioned what the movie was about. all i kept hearing is “if you were a casino game, you’d have the best odds” or something along those lines. apparently it’s about a guy who gets cancer, and his probability of survival (according to the webmd.com in the movie) is 50%. (i also looked up his cancer on webmd, and there is no mention of survival probability). he has neurofibrosarcoma and schwannoma, which are two different tumors, but i guess he had both in the movie or something. they give him chemo first, then they do surgery. which is wrong. if cancer isn’t metastasized yet, should start surgery first. the one scene of a chemo bag they showed was cytarabine, which is usually used for leukemia and lymphoma. but maybe there is an unlabeled use for this rare cancer. i don’t know. and all the signs and symptoms were not consistent with his disease. he only had stomach pain or something. oh well. the movie is nice that is shows what might go through a person’s mind when they realize they are dying (at least in a hollywood style). and there’s some pretty funny scenes. like when he and the other chemo patients are eating marijuana brownies. and the scene at the modern art gallery. so good. exactly my feelings toward modern art.

last night i watched “shall we dance?” it is an old japanese movie from 1996 or something. i first watched it in japanese class in high school, but i don’t really remember it. but now i watch it and it’s like wow, what a great movie. an accountant is bored with life and work. and is pretty depressed. he is curious about and starts ballroom dancing. then he really enjoys it and it makes him a much happier person. unfortunately ballroom dancing isn’t really manly in japanese society (and most places, i think). so he keeps it a secret. and his wife thinks he’s having an affair and lots happen. it’s great that someone can find something they truly enjoy to take their minds off of life. i wonder what hobby i can find. hopefully i won’t need to do it so secretively though.

i was watching “the rock” in the pharmacy breakroom today during lunch. last time i watched it was in like early high school or maybe even late middle school. but this time i noticed when they said the gas was an “anticholinesterase inhibitor”. the two other pharmacists in the room were like “oh. is that really that deadly?” i said, “hm, doesn’t that just make you cholinergic?” one asked, “which does what? increases what?” nothing came to my mind except “secretions”. hm. well, i looked up the movie now, and apparently it was VX gas in the movie. which is an anticholinesterase inhibitor. and it is quite deadly, but only one person has died from it in real life. the movie also has intracardiac injection, which is the only thing i really remember from the movie when i watched it years ago. i didn’t get that far this time, but i guess it is atropine. pharmacy school really changes the way i watch movies now. bioterrorism from a different perspective.

the american heart association’s heart failure guidelines state:

The combination of hydralazine and nitrates is recommended to improve outcomes for patients self-described as African-Americans, with moderate-severe symptoms on optimal therapy with ACEIs, beta blockers, and diuretics.

the combination of hydralazine and nitrate is this new drug “bidil”. they found bidil worked well in african americans so guidelines recommend it. when we were discussing yesterday, a classmate asked “what about a jamaican guy that comes to america?” presenter said “i guess that’s why the guideline specifically states ‘self-described'”. then another classmate made another good point “what about people that are from african, but don’t come to america?” i guess bidil doesn’t work well for anyone out of america. statistics is such a problem. if they did the studies on “black” people, but only did it in hospitals, does that mean they can extrapolate the data to all black people? but they specifically wrote “self-described african americans” in their paper, so i guess that’s limiting. how narrow do you want to go?

heart failure guidelines are based off the most ridiculous clinical trials ever. instead of basing the outcomes on goals from the person’s physiological status (such as blood pressure, heart rate, other heart-related stuff), it’s based off of drug doses. so the patients were started on a beta blocker and ace-inhibitor and titrated to some really high target dose. and then the outcomes from the study are based off those doses, not whether their blood pressure, heart rate, etc was in a good safe range. it’s like they made the trials so that you can only conclude that you need to be on drugs. i guess you can’t really have a physiological surrogate for showing the decrease in the sympathetic nervous system and renin-angiontensin-aldosterone system activation stuff, but still, very shady.