A perfect circle

Today is the last day (sniff) I promised myself I would not cry (sniff), but I just can't help it (weeping uncontrollably).

But, seriously it will be somewhat weird to not have to be working on something for www.rateadrug.com, at least as far as the internship is concerned. I have my final paper basically written, I just need to put in some more supporting information from my survey results, and I should be done. That will be weird, I have worked on this thing practically nonstop since I got the raw data. Although, it will be nice to focus only on school, this is intended to be my last semester seeking a degree and thus I don't have the option of taking things again if I don't do well. Plus, I want to take a glassblowing class and that will take up more time.

When I began this blog I started out by talking about the medical treatments for Hydrocephalus. It seems only fitting that I finish with talking about that subject. It makes the whole thing tie up in one neat knot, I think.
We have talked about Acetazolamide and Furosemide and illustrated the mechanisms by which they work. In the case of both of these medications they are essentially used to decrease the amount of CSF that is retained in the body - commonly known as loop diuretics (for further info on those two drugs check out the links to previous posts). And, according to http://emedicine.medscape.com/article/1135286-treatment both Acetazolamide and Furosemide work well for infants. Basically any medical treatment for Hydrocephalus must cover only the acute as long term use of either Acetazolamide or Furosemide can cause damge to the body. Chronic Hydrocephalus must be treated surgically.

I have, however, found a new medication I was previously unaware of: Isosorbide.
I will talk about Isosorbide, and if I can, I want to find a video of the shunt insertion surgery, I can't guarantee that I will, but I think I can at least link it.
The use of medication to treat Hydrocephalus is a controversial topic. It is believed that the best way to provide a 'normal' life for anyone who has Hydrocephalus is to perform a surgical procedure and either shunt - punt in a valve that dumps off excess pressure - or to perform a interventriculostomy - basically a hole is drilled between the ventricles of the brain to allow for absorption of CSF and to relieve pressure by spreading it out across the brain.

Isosorbide Mononitrate looks like this to a chemist:

Unfortunately, I am taking biochem this semester, so I can't talk about what this thing does in your body exactly, but I do have some good resources at my fingertips.

Isosorbide mononitrate is in a class of drugs called nitrates. Isosorbide mononitrate dilates (widens or relaxes) blood vessels (arteries and veins). When blood vessels are dilated, it is easier for the heart to pump. Also, more blood, which is rich in oxygen, can flow to the heart.
(http://www.drugs.com/isosorbide_mononitrate.html)

And, of course, www.rateadrug.com has some interesting resources for anyone who is taking Isosorbide, or wants to know more about it. According to
Dlmeyers1970:

When I first started taking the medication it gave my significant headaches, dizziness and a stomach ache, but after one week the side effects stopped. I am so glad for this medication because it has stopped my coranary artery from spasming and the chest pain is finally gone. I used to have chest pain, in varying strengths, all day long, and now I am chest pain free.
(http://www.rateadrug.com/Isosorbide-Mononitrate-side-effects.aspx)

Of course, that person is talking about taking the medication for angina and other heart-related troubles, but it can be used for short term treatment of Hydrocephalics as well.



I have managed to get some videos of the procedures I have been talking about. The first will be a short animation about insertion of a VP shunt - the VP shunt is the most common shunt that I see opst-operatively. Basically with the VP shunt the end of the catheter is placed in the periotoneal cavity so the body can re-absorb the extra CSF.
The second is from a thing I found on youtube.com where a neurosurgeon is giving a basic definition of Hydrocephalus.



Lastly, there will be a link to a video of an actual surgical procedure. I can't, and won't, post that on here due to it's code and it's gory content, but the link is well worth watching. The video should be about an hour long.
http://www.or-live.com/distributors/NLM-Flash/nep_2553/rnh.cfm?id=838

Sorry, it took me so long to figure out how to post video, but I did at the end! Best for last!

That concludes our internship, and our internship blog. Thanks for staying tuned. I have really appreciated tdoing this work. Thanks also to www.rateadrug.com for giving me a shot at working with them in this internship.
Bye, and stay classy internet.

Decisions....decisions....

Well, here we are. Finally at the end. The paper is due this coming Saturday, and I don't think anyone has done any additional surveys for about 2 weeks now. I have been working nearly non-stop over the last several days on the final write-up. I think I have a final subject figured out and it is nearly complete. Just need to add some more data from my surveys. I won't explain everything that it is about because it will be published on the www.rateadrug.com site and I want you to take a look at there. For a teaser, though, I will say that my final article covers ground that apparently relatively few studies have covered before. It should prove to be a good read. After all of the work I have put in, I think that it will be a good paper, but that remains to be seen. Typically when I put in the same amount of work on other things, I get grades in the A ranges, so we will see.

Today I don't have a drug feature, I just wanted to talk about the paper and the end briefly, but later this week I will post my last and final feature. That is part of why I am not going to do one today, I don't want the one that I am going to finish off with to seem less by comparison. It might be possible, I don't want to get your hopes up, but it might be possible to have a video posted. Can't guarantee anything, but sure gonna try.
That is about all for right now, things are winding down well, and I have kept busy with this final write-up.
I would also like to give public credit to my editor, without whose help I would not be so good at this thing.

So, until later I will to get everything done so that I can have a really cool final feature. See you all later, I have some homework I have been neglecting!

Here I go again on my own

Time keeps on ticking, ticking, ticking...into the future.
I am no nearer reaching a conclusion on what to write about for my final write-up. In an older post I discussed what had been the most troubling thing for me; that is most likely what I will end up writing about. Although, that seems more like a study in society than it does a study in medications and pharmaceuticals, although I guess it still qualifies if I use my Pharm data as supporting evidence for my claims.
(Sorry if my sentences don't make much sense, I worked last night and then slept until 3 today, that kind of messes with your head. Also, anyone interested in industrial music should check out this band that I found on youtube.com the other day. I am listening to it right now, good stuff!)
So, that is where I am at on that account. IRB approval is grinding along slowly. Maybe the woman I talked to about the finance review is on vacation or something. Doesn' really matter because I am done collecting surveys, now it is all about writing the paper.

Today, however, I am going to do a brief discussion of a medication that I have seen used, and it seems, abused. On my unit we often talk about patients that are 'frequent flyers' meaning that they are in and out rather often. Actually, come to think of it, it has been about 6 months since the last time I saw the 2 most famous. One of those most famous, however, has been accused by some of the staff of being addicted to a med that is often used as a painkiller. That med is known as Dilantin, and last night I witnessed it's use again - not on this 'frequent flyer' patient mind you - and that got my brain a-thinkin'.

So, today we are going to talk about Dilantin:

Here, like always, is the organic molecule. I should do a feature of something like Lithium - used as a mood stabilizer - because the molecule would look cool, and it is not organic. I will think about that...
Anyway, Dilantin works by:

In chemical structure, Dilantin (phenytoin) is related to the barbiturates.

The mechanism of action is not definitely known, but extensive research strongly suggests that its main mechanism is to block frequency-, use- and voltage-dependent neuronal sodium channels, and therefore limit repetitive firing of action potentials.

At usual levels, there is little or no change in normal patterns of firing. At high or toxic levels, however, phenytoin can impair the function of healthy neurons.(http://professionals.epilepsy.com/medications/p_dilantin_mechanism.html)

It is interesting how many drugs they are not sure on the exact mechanism of action with. According to this information though, it sounds like Dilantin can be used for anti-epileptic activity. That is interesting. If you have been a follower of my blogs then you understand at least in part, how sodium channels in the body and the neuronal pathways work.

The preceding graphic illustrates, basically, how the sodium channel operates in the human cell. Each cell has a door that will open only for certain materials; usually only ions can pass into or out of cells, by so doing the cell maintains an electrical potential that it uses to carry out chemical reactions essential to it's survival. By adding a med like Dilantin the cells potential is altered in a certain direction which then alters the flow of Na2+ ions and alters how that cell will react. When carried out over a chain of cells and, in this case, neuronal transmitters the ultimate effect is to reduce the repeated firing of that neuronal transmitter and thus reduce epileptic activity or pain.
Any questions?

This has been interesting information for me to gather. I am glad I did Dilantin today, now I know more about it, and I know more about how it works. This fall I have a Bio-Chem course that I am nervous about, but also excited because we will be talking all about this sort of stuff. I still remember the day I read the back of the shampoo bottle and I knew what the chemicals were, and what they did... That was a good day...
But, enough about chemical memory lane, thank you for learning about Dilantin with me.

I probably won't post until next week sometime, and then it will be a fond farewell, (sniff). Oh, I am no good at goodbyes..

Pride cometh before the fall...

While the end may be nigh, I find myself with a plethora of medicines and pharmaceuticals that I can talk about. I would like to at least keep this blog going until the end, which is August 29th as far as I am currently aware. Plus, I have some weeks that I need to make up for; like when I was on vacation etc.

Recently at work I have thought myself quite the expert on the medications. This, of course, has been a consequence of my being in this internship and keeping this blog. As I have done research on medications that I have come across at work I have learned things about how they are administered, and what they are used for. It has been rather enlightening. So, I have considered my knowledge great and have volunteered this knowledge like a 5 year old kid who just learned to spell. Often I am wrong, which is what leads us to the feature for today. I would say the feature for this week, but I am trying to squeeze in some extra time on the blog, so it will be a daily feature for today.
My last post was about Klonopin, and since that time I have volunteered my knowledge on the subject to anyone that would listen; however I have begun to mistake Clonidine for Klonopin. It seems like an amateur mistake, but I am an amateur at pharmaceuticals and medicine, so there you go. With this in mind the feature for today will be Clonidine. I want to know what it is and what it does so that I won't have to make the silly mistake again. You can all come with me as I blog along!

Here is the organic molecule:
This is an interesting molecule. Rather simple if you know much about organic chemistry, but there are definitely some areas that can interact.
Here is what it looks like in the box:
In most previous blogs I have known things solely by their brand names, but it seems that this time Clonidine is the generic name and Catapres is the brand name.

Clonidine is most often prescribed for the treatment of hypertension. It has also been used to manage the symptoms of narcotic withdrawal, nicotine withdrawal, diabetes-associated diarrhea, diabetic neuropathy, hot flashes associated with menopause, and as an adjunct to manage severe cancer-related pain. (http://www.pharmaenergy.com/CLONIDIN-AWN-75-Kaps-x100-pr-824.html)

The above webiste is also where I found the picture of Clonidine in the box - it seems that they sell it on this website, although they are out of stock right now DANG!
However, it seems that it is entirely possible to acquire Clonidine without a prescription. I found that rather surprising - it is possible that it is a dosage based thing. A simple google search told me that if I want it I can get it, which is true of most things on the internet, but I didn't have to pass a bunch of firewalls and passcodes to get there, so I suspect it is legit.

Anyway, the largest use of Clonidine is for hypertension or high blood pressure. It seems that it is also very useful for all kinds of other things. This quote is a bit redundnat, but interesting nonetheless:

Clonidine lowers blood pressure by decreasing the levels of certain chemicals in your blood. This allows your blood vessels to relax and your heart to beat more slowly and easily.

Clonidine is used to treat hypertension (high blood pressure). It is sometimes used together with other blood pressure medications.

Although not approved by the FDA for these purposes, clonidine has also been used to relieve alcohol withdrawal, as an aid in methadone and opiate detoxification, as an aid in quitting smoking, to treat diabetic diarrhea, to treat Tourette's Syndrome. Clonidine has also been used to reduce menopausal flushing, to treat postherpetic neuralgia, to treat ulcerative colitis, and to diagnose pheochromocytoma. (http://www.drugs.com/clonidine.html)

I find that rather interesting. How does Clonidine do that you ask? Well, let's find out; shall we?

Clonidine is a centrally-acting alpha-2 agonist. It selectively stimulates receptors in the brain that monitor catecholamine levels in the blood. These receptors close a feedback loop that begins with descending sympathetic nerves from the brain that control the production of catecholamines (epinephrine, also known as adrenaline, and norepinephrine) in the adrenal medulla. By fooling the brain into believing that catecholamine levels are higher than they really are, clonidine causes the brain to reduce its signals to the adrenal medulla, which in turn lowers catecholamine production and blood levels. The result is a lowered heart rate and blood pressure, with side effects of dry mouth and fatigue.

An analogy would be the lowering the temperature of a house by holding a lit match under the thermostat connected to the furnace.

(http://www.experiencefestival.com/a/Clonidine_-_Mechanism_of_action/id/1237669)

That is a rather succinct definition. I have also found information that concludes that the channels are opened via Ca2+ ions. Essentially that means that the neuron channels open to allow Calcium ions to enter thus initiating the whole process. The graphics illustrate the basic process. And this other graph shows how Ca2+ ions increase as a consequence of having Clonidine on board






















This stuff is all rather fascinating to a nerd like me. After this semester - my last seeking a degree - I will have taken BioChem and will understand all of these principles that much better. I have to say that although I rather suck at it, I think Chemistry is just fascniating.
It also make sense that Clonidine would be administered in the setting that I work in because a lot of our kids have hypertension issues after trauma or because of Hydrochephalus, Seizures etc.
Thanks for figuring out Clonidine with me. Stay tuned as I try to work out what to write for my final report. I have some ideas swishing around my head, and some other stuff I wrote about months ago that I might ressurect to come to a conclusion.
See you in a few short hours!

The Final Countdown

Hello one and all. It seems that it is finally time to be finishing up the internship. I have my raw data in hand and need to spend most of my time working on the final report. I will, however, try to get a few more neurological meds posted before the end. I need to make up some weeks that I missed so I will try to post a few more things over the course of this week and next.
School starts again next week, which should be interesting. Especially considering that this is supposed to be my last semester seeking a degree from the University of Utah. I am sort of freaking out. It is really hard to think that I won't be going to school in the spring. School has been such an integral part of my existence for so long.
Also, it is weird to think that the internship is about over. I have worked on this for such a long time as well. It has been about 6 months since I first signed up with www.rateadrug.com - and now it is almost over. Some of the other interns have really put up some good numbers too, it makes my initial efforts look rather pathetic. I was once #1 in the entire program and now I am down to #5. I sort of feel like Andre Agassi after he married Brooke Shields - if you don't know what I am talking about you are too young and need to google that particular incident.
Anyway, this is just intended to be a brief description of where things are. I will try to post a neuro med either later today, or tomorrow.
Tomorrow being the most likely.
Be good my faithful followers.

King Klonopin

Ah, finally back to the swing of things. I apologize for making you all sit through my photos, but I needed to show SOMEONE how awesome Japan was. That is nowhere near the amount of photos we took either.

Anyway, back to business as usual. Things are going well with the internship. I have slipped to second place as of this week, but I have an ace or two up my sleeve. Part of me wonders if I was passed because of my advice, although the other interns probably have way better ideas anyway.

So, we are back with the 'Drug of the Week' feature. This week I decided to take a look at some of the resources that are found on www.rateadrug.com (the link there is for Klonopin itself). It has been nice being able to refer to that stuff when I need to. After looking on that list for about 2 secs I found a medication that I have seen used many times in my work at the hospital. That med is Klonopin. I have seen it used, but like so many of the other 'DotW' features I have no idea how it works.
You have certainly already guessed that this weeks feature shall be: Klonopin.

Old tricks are usuall the best, so here goes the organic molecule (actually I forgot this and had to come back, can you believe it? How many of these drugs posts have I done now, and I forgot? Silly).
Ah, that is better.
I thought this was kind of cool too, these are the pills themselves. Each tablet is 5mg, this is obviously the brand name version because the big K's and the fact that the pills say Roche, or the pharmaceutical company that makes Klonopin, on them.
Klonopin is part of a class of drugs known as benzodiazepines. Some of the drugs that belong to this class that I might also be featuring in the next little while are Ativan - another relaxant or anti-seizure medication - and one that most people are familiar with Valium.
(http://www.drugs.com/klonopin.html)

Clonazepam is a potent AED [Anti-Epileptic Drug] and the drug of choice for myoclonic seizures and subcortical myoclonus. It also is effective in generalized convulsions and, to a lesser extent, in partial epilepsies. It rarely is used as adjunctive treatment of refractory epilepsy because of its sedative effect and tolerance, which are similar to those of other benzodiazepines. It is very effective in the emergency treatment of status epilepticus, like diazepam, and can be given IV or rectally. Withdrawal from clonazepam may induce status epilepticus or exacerbation of seizures.
(http://emedicine.medscape.com/article/1187334-overview)

A seizure reflects an imbalance between excitatory and inhibitory activity in the brain, with an increment of excitation over inhibition. The most important inhibitory neurotransmitter in the brain is GABA....GABA has 2 types of receptors, GABA-A and GABA-B. When GABA-A receptor is stimulated, chloride channels open to allow the influx of negative ions (ie, chloride) into the neuron and cause hyperpolarization, moving the membrane potential further from the cell-firing threshold. The GABA-B receptor is linked to a potassium channel....The GABA-A receptors have multiple binding sites for benzodiazepines...
(http://emedicine.medscape.com/article/1187334-overview)

Essentially, Klonopin works, like all other benzodiazepines, by interacting with GABA-A and altering the sodium channel in the neuron, making in negatively charged so it moves farther away from the 'cell-firing threshold' and decreases the activity of the seizure.

This is a simplified mechanism of how the alteration of GABA-A and GABA-B affect seizure activity.

Klonopin is also known as Clonazepam, which I did not know. I have seen various movies and television programs where people are taking Clonazepam. Usually the characters are taking it to help them 'relax'. Sometimes in a clinical sense, and sometimes in a recreational sense.

It also seems that any form of barbituate will have a negative effect with Klonopin. On the www.rateadrug.com page that shows the comments made about Klonopin someone stated that they had problems with alcohol abuse and Klonopin really threw them for a loop. That makes sense, if Klonopin is a moderate to high-end relaxant or anti-anxiety drug then a barbituate like alcohol would really cause some problems.

The other list of counter-indications or medications that might cause problems with Klonopin is as follows (http://www.drugs.com/klonopin.html):

• propantheline (Pro-Banthine);

• an antifungal medication such as fluconazole (Diflucan), itraconazole (Sporanox), ketoconazole (Nizoral), or voriconazole (Vfend);

• an antidepressant such as amitriptyline (Elavil, Etrafon), doxepin (Sinequan), imipramine (Janimine, Tofranil), nortriptyline (Pamelor), and others;

• a barbiturate such as amobarbital (Amytal), butabarbital (Butisol), mephobarbital (Mebaral), secobarbital (Seconal), or phenobarbital (Luminal, Solfoton);

• an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate); or

• medicines to treat psychiatric disorders, such as chlorpromazine (Thorazine), haloperidol (Haldol), mesoridazine (Serentil), pimozide (Orap), or thioridazine (Mellaril).

And, this is a list of common and not so common side-effects
(http://www.drugs.com/klonopin.html):

• confusion, hallucinations, unusual thoughts or behavior;

• hyperactivity, agitation, hostility;

• unusual or involuntary eye movements;

• weak or shallow breathing;

• depressed mood, thoughts of suicide or hurting yourself;

• chest tightness, fast or pounding heartbeats;

• painful or difficult urination, urinating more or less than usual;

• pale skin, easy bruising or bleeding; or

• new or worsening seizures.

Less serious Klonopin side effects may include:

• drowsiness, dizziness, spinning sensation;

• memory problems;

• tired feeling, muscle weakness, lack of balance or coordination;

• slurred speech;

• drooling or dry mouth, sore gums;

• runny or stuffy nose;

• loss of appetite, nausea, diarrhea, constipation;

• blurred vision;

• headache;

• nervousness, sleep problems (insomnia);

• skin rash; or

• weight changes.

Personally, I have seen Klonopin administered after a patient has had a prolonged seizure. It certainly seems to be effective. It is interesting the more I learn about various medications, the more I am interested in Pharmacology. I can't wait to move on with my education!
Thanks for staying tuned in, look forward to another discussion next week!

Worth a thousand words...

Finally, we come to the last post that I will make regarding my trip to Japan. I know I am dragging this out rather long, but we took A LOT of pictures. It is also my hope that someone who is also going to undertake a trip to Japan will come across this blog - or at least the 3 posts that concern Japan - and find information or ask questions about it. That way my knowledge can become someone elses.

As far as things relating to the internship all is going well. I have completed paper surveys for anti-bacterial medications which have already helped me. I got about another 15 surveys over the last weekend by taking some paper surveys with me. Just yesterday I submitted the last thing I needed for IRB approval and spoke with the woman in charge of billing and she said we should be good to go. Now I just wait, but soon I should have access to the patients at 3 major hospitals in the valley. That should work out just fine...

Anyway, let's get on with the photos, I also have some video to post for which I am excited. So far I have not had an opportunity to post any videos.

So, at this point in our journey we are in northern Honshu Japan.
All over the place people had really neat and well maintained gardens.

This was taken from a cemetery cloes to where we were staying. I can't be sure, but I think that the ashes of the deceased are in the tomb. People will also bring personal belongings and favorite foods or drinks of the deceased person as offerings for their spirit. Most people are married in Shinto ceremonies, but buried in Buddhist cemetaries.

Here is a shot of me standing at the Tori gate of a Shinto shrine just down the street from the cemetery in the last photo.

This is a package of Octopus that we saw in the fish market in Hachinohe
Also from the fish market. You can't tell, but the crabs in this box are still alive and crawling around.

These are tentacles from a Giant Octopus. Even though they had been cut of from the main body of the Octopus they were fresh enough that they would dilate and react to touch. My hand is there to give an idea of the size of these things.

These are squid guts that I ate at the fish market. They were about as good as they sound, but it was rude to refuse if someone offered you something. I tried to be a good ambassador of my country by keeping it down; felt kind of ill the rest of the day though.

This was from a mall in Hachinohe. The floats that they build for festivals put any and all of our floats to shame.

While we were in Misawa - the place that we stayed for the remaining 2 weeks we were gone - we went to the Aomori Show Restaurant. It was a bit pricey, but so worth it. This is a picture of the apetizer a big plate of all kinds of sushi.
Japanese food is not for the feint of heart.
This is the rest of the meal from the Show Restaurant. Each level is a different course.

This is in a place called Oirasse Gorge. It is hard to over-state the beauty of Japanese landscapes.

Also in Oirasse Gorge. There is a legend about this spot, that a beautiful woman once lived under that rock and seduced travels so that she might murder them and steal their things.
This is me and my wife in front of a waterfall also in Oirasse Gorge.

This is a badger that we happened upon while visiting the area.

This is from 'Shipwreck Beach'. The name fits the place rather well, as you can tell.

(Unfortunately after trying for several hours I won't be able to post video after all. I am messing with file converters, but so far I have not come up with anything that works. I will have to post video later when I can get the thing working.)

This is the 100 yen sushi store. All of the dishes come across on a conveyor belt and you pull off the things that you want to eat. I am not sure of all the stuff we ate because it was all in Kanji.

This is the seagull shrine. Not sure of the real name, that is just what we called it because of all of the seagulls. I wish I could get the video to work, the noise is just deafening. If you have ever seen Alfred Hitchcock's movie, 'The Birds' it was A LOT like that.

This is Tanasashi Seaside Park. It is where we ate lunch, just a pretty place to look at.

And finally, we got to see some Snow Monkeys. They are so called because they live in the northern part of Japan where there is heavy snow. These monkeys survive by hanging out around hot pools during the cold winter months. This part was pretty cool, I had never seen monkeys before!



That concludes my photo adventures through northern portion of Honshu Japan. I really enjoyed this trip. I think anyone that can should go, I am definetly going to try to get back. Thank you for looking at all of my pictures, I know there have been a ton. Starting next week the features will be back and life will continue as normal, at least for this blog and for my internship.