vicodin

1: 2's going crazy with the drinking. did u notice?

me: 20 beers that one night. then again the next day. crazy.

1: and he's on that medicine...

me: yeah well at least the hospital's close by

1: ha but what if something happens and neither of us are here?

me: oh yeah huh. maybe i should talk to him...


with 2's super binge drinking combined with the fact that we just went over opioids at school, the timing is great to find out why he shouldnt drink while on vicodin.

ok so it's pretty simple...

Vicodin = hydrocodone + acetaminophen

1. etoh is hepatotoxic and a cns depressant
2. acetaminophen is hepatoxic. acetaminophen + etoh >> additive hepatoxoxicity
3. hydrocodone is a cns depressant. hydrocodone + etoh >> additive cns depression

the last time i asked him if he knew what might happen, he said his liver would bleed. that's a start. i suppose i could find out whether he understands how bad life would suck if he wrecks his liver.

clinical 7/6/10

change in c.i.
-just when i was warming up to the other, we get a new c.i. let's see how it goes...

aox2
-i think if you have any doubt, you should just go ahead and ask the questions. i was surprised at what year he thought it was.

a-fib
-rapid, irregularly irregular atrial rhythm; atria dont contract, av system bombarded with many electrical stimuli, causing insonsistent irregularly irregular ventricular rate, usu tachycardic; atrial thrombi often form >> risk of embolic stroke; one of most common arrhythmias; affects men and whites more; affects 10% of people 80+ yo; sometimes precipitates HF (bc CO decr w/o atrial contraction); the longer AF present, the less likely is spontaneous conversion, or cardioversion by any means
-most common causes: htn, cardiomyopathy, mitral valve DOs (left AV valve), hyperthyroidism, binge drinking
-sx: irregularly irregular pulse, often otherwise asymptomatic
-dx by ekg: wavy baseline, lacks discernible P waves (atria), irregular QRSs
tx: drugs to control hr, anticoagulation drugs, cardioversion

tamsulosin (Flomax)
-tx s/s bph
-moa: a1-blocker relaxes bladder sm >> urine flow improved >> decr s/s bph
-adv fx: hypotension

ezetimibe (Zetia)
-tx hypercholesterolemia
-reduces plasma cholesterol by blocking absorption of it in the small intestine