Sleep Med Preference

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splik said:
although i am sure that some people have used it in this way it is certainly not a commonly used one. the availability of GHB in many countries is actually quite limited so even people who think they are using GHB often are using something like GHL. Also GHB has a particular taste such that unless you were already really wasted you would notice that something is off and this is not a particularly good date rape drug. if you've ever tasted GHB you will know that it could not be imperceptibly added to a drink. alcohol itself is of course the most common date rape drug. and at the level of drunkenness where someone wouldn't realize that there was something weird about the way their drink tasted you wouldn't need to drug them with anything else.
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This guy did not need zyrem. That's all Im sayin.
 
splik said:
although i am sure that some people have used it in this way it is certainly not a commonly used one. the availability of GHB in many countries is actually quite limited so even people who think they are using GHB often are using something like GHL. Also GHB has a particular taste such that unless you were already really wasted you would notice that something is off and this is not a particularly good date rape drug. if you've ever tasted GHB you will know that it could not be imperceptibly added to a drink. alcohol itself is of course the most common date rape drug. and at the level of drunkenness where someone wouldn't realize that there was something weird about the way their drink tasted you wouldn't need to drug them with anything else.
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It isn't called SODIUM oxybate for nothing.
 
GroverPsychMD said:
In your peer review at the VA as an np, didn't your collaborating physicians give you ideas on what other interventions to try?
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I'm the sole prescriber for an embedded BH team for the Army, not the VA. I have plenty of ideas; just wanted to get others opinions. I've got people here whose hands would shake if they had order a stimulant, benzo, or any med with any potential for abuse.
 
Zenman1 said:
I'm the sole prescriber for an embedded BH team for the Army, not the VA. I have plenty of ideas; just wanted to get others opinions. I've got people here whose hands would shake if they had order a stimulant, benzo, or any med with any potential for abuse.
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Makes sense. Don't want to create unnecessary problems.
 
Shikima said:
Not an accurate description. For one, orexin neuron have died off or are no longer functioning. Since it's a disorder of wakefulness, using this medication wouldn't be 'inducing' anything remotely close to narcolepsy despite the colloquialism you've created. It triggers the on/off switch for enter into sleep.
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That's why I said "mimic" rather than "induce." But based on your explanation, I guess it's probably oversimplified to the point of being inaccurate...
 
GroverPsychMD said:
Pt said the medicine is not working and too expensive. 11 dollars a pill!
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Yeah, I have tried to prescribe it a few times, but the insurance coverage was usually limited, so I've only had one patient whose insurance was good enough so that she could actually get it.
 
She found that it was intermittently either wonderful or ineffective. As time went on, there were fewer wonderful nights and more ineffective nights. But she is a bad TRD patient (improved significantly with MAOI + TCA + ECT, but still somewhat depressed), so it's hard to think that her case is generalizable.
 
My patient wants a barbiturate trulia that is not made in the US anymore. Only in England. And she needs and FDA waiver to get in to the US.
wth
 
I find myself prescribing a lot of Zillow.

Seriously though, the same thing happened to me once. And I just said, "Ha! No."


Sent from my iPad using Tapatalk
 
GroverPsychMD said:
My patient wants a barbiturate trulia that is not made in the US anymore. Only in England. And she needs and FDA waiver to get in to the US.
wth
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Chloral hyrdate is still made in liquid form and it used to come in a liquid filled type of capsule if you wanted to go that route.
 
Last I heard chloral was not being made anymore and pharmacies either didn't have it or dispensed it rarely, only when needed. But I agree, it's amazing at putting manic patients to sleep!
 
PistolPete said:
Last I heard chloral was not being made anymore and pharmacies either didn't have it or dispensed it rarely, only when needed. But I agree, it's amazing at putting manic patients to sleep!
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Makes me feel so old, but after my intern year we could no longer access it at my program. It didn't completely knock out the manic patient I gave it to, but did help him sleep for a few hours...
 
In slang, a Mickey Finn — or simply a Mickey — is a drink laced with a psychoactive drug or incapacitating agent (especially chloral hydrate) given to someone without their knowledge with intent to incapacitate them. Serving someone a Mickey is most commonly referred to as slipping someone a mickey, but it is sometimes spelled "mickie".[1]

The Mickey Finn is most likely named for the manager and bartender of a Chicago establishment, the Lone Star Saloon and Palm Garden Restaurant, which operated from 1896 to 1903 in the city's South Loop neighborhood on South State Street. In December 1903, several Chicago newspapers document that a Michael "Mickey" Finn managed the Lone Star Saloon and was accused of using knockout drops to incapacitate and rob some of his customers. Moreover, the first known written example (according to the Oxford English Dictionary) of the use of the term Mickey Finn is in 1915, twelve years after his trial, lending credence to this theory of the origination of the phrase.

Maybe the next generation will call Chloral hydrate a "Bill Cosby". 🙄
 
it was so old it was never FDA approved for any indication so was effectively off licence. it was particularly popular for kids and apparently dentists used it for pediatric patients too. it was toxic and overdose and there were various idiosyncratic reactions. it was also a controlled drug. that combined with declining use meant it was too risky and not financially viable enough.
 
GroverPsychMD said:
now she wants seconal. Sigh..
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Sounds like she's from another time or had a prior psychiatrist from another time.

The pharmaceutical industry has developed two successive classes of addictive tranquilizers since barbiturates: benzodiazepines and the creatively titled non-benzodiazepines, which ironically are so similar to benzodiazepines I'm not sure if they really are deserving of next-generation classification.
 
splik said:
it was so old it was never FDA approved for any indication so was effectively off licence. it was particularly popular for kids and apparently dentists used it for pediatric patients too. it was toxic and overdose and there were various idiosyncratic reactions. it was also a controlled drug. that combined with declining use meant it was too risky and not financially viable enough.
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Interesting factoid: You can still get laudanum legally in the US. It was grandfathered in because it predated FDA regulation.
 
PistolPete said:
Interesting! I've never heard of laudanum... Wiki says it's just tincture of opium!
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I think it used to be mixed with other things. I only know of it because I attend a university Thomas Jefferson attended (hmm . . . not being terribly discreet) so I've read into his history quite a bit. He was addicted to laudanum. And being someone who loves the sound of words, I love the sound of the word laudanum. It goes so well with other words I like saying in a Southern accent like mint julep and chifforobe.

Edit: I can't say with certainty he was addicted. But he used it constantly toward the end of his life until he died, which I don't think was terribly uncommon from what I remember about laudanum. It seems like it was quite readily available.
 
splik said:
yes laudanum is opium in alcohol
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Well not always - like most premodern pharmaceuticals there was wide variance in composition. A popular concoction involved tincture of opium with saffron and some other aromatic herbs but was still called laudanum. Still, I am guessing the version with booze was most clamored for back in Jefferson's day...
 
I have a friend in Latin America who was given a prescription for Plidan, which the doctor told her was an all natural anti-anxiety medication. She asked me if I knew about it.

I looked it up and the version she was given contained a muscle relaxant along with quite a few herbs that are supposed to cause relaxation. But I then saw that in some countries it contained Valium. In some of those countries the fact that it contained Valium was advertised, in others it was advertised as all natural in spite of containing Valium.

It's a common name for a drug throughout Latin America but with varying natural and pharmaceutical ingredients--and through official channels.

I wonder if this is similar to the concept of laudanum, where there were multiple preparations.
 
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