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So my director passes on word that the OR will be trying Entereg on a trial basis to see if it would "really" decrease patient days.
We got the whole free lunch from Panera while the drug rep rambled on and we pretended to listen thing.
And usually that's what I do...
But...you see...I have a problem with the idea.
And the problem is that I work in a ghetto-ass little rundown Rust Belt problem with an incredible drug abuse problem.
And I already know what's going to happen. See...you aren't allowed to have scheduled straight opiates for 72h prior to beginning Entereg. And this makes sense. It would basically make your GI tract go into withdrawal...giving you the most violent diarrhea and nausea imaginable...which will probably increase patient days like crazy.
So I asked the drug rep if she had any data on the receptor affinity and dissolution rates of the drug (bear with me...). Like a deer in headlights, she offered me AUC data and started talking about how delicious Panera bread is (I'm not making this up.) After bumbling around for a few seconds, she handed me a card with the fancy drug company science-dude hotline. Oh God...like they'll be honest. 🙄
So I called...the fancy science dudes didn't have any "in house data" on the subject. I think it was almost quitting time because they had me off the phone in like 3 minutes. The whole company is useless.
So I went to Pubmed for help. I found a study from 2005 that had the info I wanted. It wasn't encouraging. The only drug that might be able to break Entereg might be my new favorite pharmacological wonder, Buprenex. But I'm not even sure it can break it's GI mu-receptor spell. (I understand that's the entire point of the drug and all...but f it...) And even at that, there wasn't a wide array of opiates in said study.
But anyway...to what I'm getting at...
...like I said, there are SO MANY f'ing drug addicts and abusers in the area per capita that it's like Mainland China circa The Boxer Revolution. The economy here was strong back when they actually made steel...then it went away...as did all the other jobs...and now I work at a hospital that is >85% medicare/medicaid patients...the real Rust Belt...nothing but despair and crippling depression...which has led rather nicely into drug abuse...
And as such...I can just see now from 56,000 miles away exactly what's going to happen.
Some dude is going to get this pre-op questionnaire. He doesn't want to tell people that he's been scoring Vicodin off of some hilljack that is on worker's comp for a fake knee injury...and then just sells the Vicodin...and he's been on that hilljack's Vicodin for months...and he needs a bowel resection sx...and you know what that questionnaire is going to say? "No, sir, I do NOT use illicit drugs." And then what's going to happen? This dude will be given Entereg...and his gut will go haywire...
Which leaves me to wonder...what exactly, if anything, can I do for this hypothetical idgit that will have fluid coming out of their ass like water out of the Amazon...
And now we come back to Buprenex...my cuddly little answer for everything...do any of you out there have much experience with Entereg...and if so...have any of you tried to use any sort of drug to reverse its action on the gut if, say, some drug addict comes by and is starting to release poo soup all over your sx recovery ward? Can anything bump Mr. Entereg off of his mu-receptor perch? Because right now...I want to give them Buprenex JUST TO SEE WHAT HAPPENS...though if someone already knows the answer...I'd like to know it so I can skip my anticipated pharmacological experiment...even if the answers is "Well, Mike...that dude is just hosed, sorry..." but whatever the answer...I'd like to know it...
We got the whole free lunch from Panera while the drug rep rambled on and we pretended to listen thing.
And usually that's what I do...
But...you see...I have a problem with the idea.
And the problem is that I work in a ghetto-ass little rundown Rust Belt problem with an incredible drug abuse problem.
And I already know what's going to happen. See...you aren't allowed to have scheduled straight opiates for 72h prior to beginning Entereg. And this makes sense. It would basically make your GI tract go into withdrawal...giving you the most violent diarrhea and nausea imaginable...which will probably increase patient days like crazy.
So I asked the drug rep if she had any data on the receptor affinity and dissolution rates of the drug (bear with me...). Like a deer in headlights, she offered me AUC data and started talking about how delicious Panera bread is (I'm not making this up.) After bumbling around for a few seconds, she handed me a card with the fancy drug company science-dude hotline. Oh God...like they'll be honest. 🙄
So I called...the fancy science dudes didn't have any "in house data" on the subject. I think it was almost quitting time because they had me off the phone in like 3 minutes. The whole company is useless.
So I went to Pubmed for help. I found a study from 2005 that had the info I wanted. It wasn't encouraging. The only drug that might be able to break Entereg might be my new favorite pharmacological wonder, Buprenex. But I'm not even sure it can break it's GI mu-receptor spell. (I understand that's the entire point of the drug and all...but f it...) And even at that, there wasn't a wide array of opiates in said study.
But anyway...to what I'm getting at...
...like I said, there are SO MANY f'ing drug addicts and abusers in the area per capita that it's like Mainland China circa The Boxer Revolution. The economy here was strong back when they actually made steel...then it went away...as did all the other jobs...and now I work at a hospital that is >85% medicare/medicaid patients...the real Rust Belt...nothing but despair and crippling depression...which has led rather nicely into drug abuse...
And as such...I can just see now from 56,000 miles away exactly what's going to happen.
Some dude is going to get this pre-op questionnaire. He doesn't want to tell people that he's been scoring Vicodin off of some hilljack that is on worker's comp for a fake knee injury...and then just sells the Vicodin...and he's been on that hilljack's Vicodin for months...and he needs a bowel resection sx...and you know what that questionnaire is going to say? "No, sir, I do NOT use illicit drugs." And then what's going to happen? This dude will be given Entereg...and his gut will go haywire...
Which leaves me to wonder...what exactly, if anything, can I do for this hypothetical idgit that will have fluid coming out of their ass like water out of the Amazon...
And now we come back to Buprenex...my cuddly little answer for everything...do any of you out there have much experience with Entereg...and if so...have any of you tried to use any sort of drug to reverse its action on the gut if, say, some drug addict comes by and is starting to release poo soup all over your sx recovery ward? Can anything bump Mr. Entereg off of his mu-receptor perch? Because right now...I want to give them Buprenex JUST TO SEE WHAT HAPPENS...though if someone already knows the answer...I'd like to know it so I can skip my anticipated pharmacological experiment...even if the answers is "Well, Mike...that dude is just hosed, sorry..." but whatever the answer...I'd like to know it...
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