Michael Jackson death from drug interaction?

Started by JamesL1585
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If the reports from the scene were true - dude takes Demerol, has shallow, slow breathing, cardiac arrest...I'd wager it's probably just because he took too much of an opiate. I doubt it was anything more elaborate than that.

But what do I know. I'm certainly not a physician from the TV box.
 
WVUPharm2007 said:
If the reports from the scene were true - dude takes Demerol, has shallow, slow breathing, cardiac arrest...I'd wager it's probably just because he took too much of an opiate. I doubt it was anything more elaborate than that.

But what do I know. I'm certainly not a physician from the TV box.
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Disseminated intravascular coagulation secondary to Serotonin syndrom. He was Probably on SSRIs w/ Demerol , drank Jesus juice , took benzos and some cough meds? idk?
 
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BanBidil said:
Disseminated intravascular coagulation secondary to Serotonin syndrom. He was Probably on SSRIs w/ Demerol , drank Jesus juice , took benzos and some cough meds? idk?
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on a snowy fourth of july in haiti when lightning struck and scared the emu into a stampede
 
metrarx said:
What the hell is serotonin syndrome??
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It's a toxidrome that can result from taking multiple types of serotonergic drugs at the same time. MAOI and SSRI combinations are the big offenders, but pretty much any combination of drugs acting on the serotonin system can cause it. Part of the reason they limit medical residents to 80 hours a week now is because of a well-publicized death due to an overworked intern prescribing meperedine and tranylcypromine at the same time (Libby Zion, back in the early '80s).

As far as the DIC secondary to serotonin syndrome causing death, I highly doubt it. Serotonin syndrome is rare as it is, and DIC is an even rarer complication. It's also highly unlikely that it would have caused a cardiac arrest with no warning signs at all (twitching, fever, etc.)

Probably just a bad combination of benzos and opiates.
 
DIC would have showed up on the autopsy.

There's going to be the people grabbing some cheap publicity by stating how they think Mike died. That article only scratches the surface with respect to potential causes.
 
does Narcan completely reverse Demerol? I'm brainfarting on that one.

Paramedics have access to plenty of it.
 
i bet they make this into a 'House' episode. i love that show!! but of course House will figure it out before he dies.
 
njac said:
does Narcan completely reverse Demerol? I'm brainfarting on that one.

Paramedics have access to plenty of it.
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Well...it competes for receptors. It's not like it really "reverses it" from a receptor-xenobiotic perspective. And it would cause the opiate effect to rapidly decline. However, if a person loses electrical conduction without a defib device there, I'd wager the narcan would be like expecting to be able to refurbish a burnt down house after simply pouring water on the thing after its been burning for 12 hours and is nothing more than a smoldering pile of rubble.
 
metrarx said:
serotonin syndrome is a real condition that many pharm school professors suffer from. It causes incoherent ramblings about a weird drug interaction. Unfortunately, this **** is contagious and causes many students to repeat said interaction over and over, especially on message boards.

I think I'm immune to it.
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I've not come across it in practice (my lengthy 6 week career thus far) - but I have been quizzed on it by not one but two pharmacists and a CCU physician.

What practice setting are you in.?. Don't say retail - or it negates the witty nature of your response thus far.
 
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aboveliquidice said:
I've not come across it in practice (my lengthy 6 week career thus far) - but I have been quizzed on it by not one but two pharmacists and a CCU physician.

What practice setting are you in.?. Don't say retail - or it negates the witty nature of your response thus far.
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We had a case last year at my hospital, but I'm a little fuzzy on the details. The guy had been taking Prozac for a while and inadvertently confused his wife's amitryptyline with one of his meds. He developed a low-grade fever and his eyes started twitching pretty hard. We thought it was meningitis at first, but all his cultures came back negative. Eventually his wife brought in the pillbox he was using and they figured it out from there.

It was a pretty mild case, basically fluids and monitoring and he was good as new in a few days.
 
el hospital. es muy guappo con el burro y los ninos.

I have no idea what I just typed. I just know they are spanish words...and that I work at a hospital...and I am watching a soccer game over the internet at work broadcast in spanish.
 
metrarx said:
Thanks but I was really hoping BanBidil would answer, he or she sounds very smart.
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http://www.medscape.com/viewarticle/582862

Ramblings... Ok cowboy calm down. I don't think I am smart, in fact I barely know anything, they don't teach you anything in school anyway. I figured with all the MJ jokes out there (which are bad) i'd have a pharmacy one. Laugh its good for you.

And by the way:

"Hell no, Me be working in hospital" :claps:
wow,clap clap, very smart, you are soooo great and so much better than us "retail folks"....have fun working on a contract which won't increase in pay when you boss tells u to p*ss off when you want a raise after you have given your soul to the hospital. Where is the upward mobility? How is it any better than Retail?

"Oh but my job is guaranteed where as yours isn't":
Yeah if you have no people skills and can't help with care and explain things to the general public....did that feel good? Because that's how you sound like an *ss. I could go on but I have good friends in hospital pharm who don't have a superiority complex like you.
 
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he OD'ed on digoxin like in the james bond movie, someone slipped it into his drink and bam... just too bad he didn't have a aston martin stocked with digibind like good old james did.
 
metrarx said:
Yes, thanks for the link. Thanks for showing me the light. I forgot about that article I read 3 months ago.

Wait wait, let me guess......you probably authored the thing didn't you? You're just so smart and so great! 👍

But why are you so quick to admit that you're not smart? Hell, maybe you did mean your previous post as a joke. I don't know. It just didn't sound funny to me. I actually thought you were being serious with that attempt. Sorry padre.

Oh ok, i'm sorry I didm't make YOU specifically laugh. I will try harder next time. Also, I know that I know every little because I am a student, and have not started rotations that is why I admit I don't know everything.



C'mon BiDil, you can't deny big-chain retail blows nowadays. Sure, we can thank them for the salary increases, but look at what that ended up doing to retail pharmacy.

The hell with the chains. I hope to run my own place one day, it's my dream (don't know if it will happen with all the AMP cuts) and today with TPNs growing MTM possibilities, Oprah endorsing compounding , there are ways to make money. Alternatively, I could go the Nuke pharm route as I secured a rotation there 🙂 and have always been interested in that. If all else fails, I would just do pharmaco econ, get and MBA and tell you what drugs you can and can't use 😀


"Where's the upward mobility" Well, let's see, I have one more option than you do in the retail setting. I can get an MBA and work my way up to directorship OR I can get a BCPS certification and work my way up the clinical ladder. But don't you worry about my job.

I can get an MBA too and join the evil CVS/Caremark type mega empire and do evil PBM work or move up the corporate latter if I chose to work for a chain, bonuses increase higher up the chain. So, really, you don't have one more option.


And why the hell are you quoting this? How would you like it if I started quoting stuff you didn't say?

Preemptive response.


I think I have excellent people skills. I do pick up shifts at an independent and people have no problems with me whatsoever. In fact I've gotten numerous compliments from people. But not because of my superiority complex, of course. It's because I take the time to counsel almost everyone on new meds (it's a slow store) and I go out in the isles to counsel pts on OTCs. Also, I frequently call providers to change meds that are much more affordable for patients (trust me, your average, 700-script-a-day-chain won't do that for you). Another failed attempt, eh banbidil?
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Good job working for an independent, we should own our profession. On the same page here and have been with NCPA and attended conferences since day 1.


and WVU Pharm:
I do not bag chips, I bag candy. Like those brown sugar coated skittles like Pyridium pills that go with Clinda or Cipro/Levaquin candy. By the way, do you think WVU can win the big east next year? I'm hoping Cal finally takes the PAC-10 this year.

Also, so long as we are on Cardiac drugs, has anyone used adenosine in the hospital yet? i'm curious.
 
Serotonin syndrome may be some imaginary thing but I don't want to be the pharmacist that filled a triptan for a patient loaded up on SSRI/TCA/Ultram. You know its a guaranteed lawsuit when it happens even if the odds are 1/1 billions
 
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VancTheTank said:
Another excellent intervention point for a pharmacist-anesthetist.

On topic (sort of), we used to call on all new orders for linezolid when pt was already on a ssri. Our HIS still flags it with a red "DANGER" pop-up. Most of the ID docs felt as though the interaction was overblown and clinically insignificant. Good pharmacy trivia, though.
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I wouldn't discount it entirely; after all, case reports have to come from somewhere. I think the problem comes from the fact that there are often no other reasonable options (especially in the outpatient realm).

I don't think it would be unreasonable to D/C the SSRI or at least monitor more closely.
 
VancTheTank said:
True, true, and maybe.

Case reports do come from somewhere, but the information is not easily generalized to the population as a whole.

Problems come in at the "So, what do we do?" stage. If you need linezolid, your infection is probably a more pressing matter than your depression. However most ssris have longish half-lives, so DC'ing the drug won't allow you to completely avoid the combination.
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Agreed. There really isn't all that much you can do other than monitor and hope for the best.
 
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