Gripe/Plaquenil ADR prevalence

[prryjones]

Regards,
I was amazed that the thread concerning Plaqenil sort of spiraled out of control. I am as much to blame for starting the conflict as anyone as I could have been a little less sarcastic with sweden in my response to his challenge to me.
Anyway, Red, of course there are numerical guestimates for the ADR prevalence of all dugs. These may not be available to the layman, but of course the info. can be found in the pharmacy specific literature that pharmacists/researchers use. Tools of the trade, so to speak, not normally available to all (who would want it, except, as in this case, a clinician?)
Anyway,I've been a part of this group since the Yahoo days. I never told anyone that I was completing a PharmD Degree, unless I was asked. No one can say I've tried to toot my horn or brag or "talk down" to anyone.
My screen name isn't "PrryjonesPharmD"
The only thing thats ever bothered me is when folks get rude without cause. Then yes, I can get a little condescending at times because you know what? If one is going to rudely criticize or challenge me, as Bradley and sweden have done, then yes...I'm going to call them on it...because concerning the subject matter, as I have been studying this stuff for the last 5 years (program is 6 yrs in length), then I do consider myself an expert, relative to the them. Arrogant as that sounds, you guys would prob. feel the same way if you were completing your 6th and final year of school and a layman basically told you that you we full of sh1t.
Since Kelli posted on the last thread, I will use her as an example: I seem to recall that Kelli is a designer. Ok...well then she is an expert in design relative to me. So, for me to arrogantly and rudely challenge her on some design principle that I know nothing about, this would prob. insult her and she would naturally want to know why I feel like I do. She would basically respond with, "Ok...you think I'm full of crap..so then show me what you've got". I can judge her proficiency as a designer no more than Bradley can arrogantly evaluate my proficiency as a 4th year pharmacy student (by the way, Kelli, I don't remember arguing with you).
Now, on the other hand, If sweden would have said, "Perry, tell my why you feel that Plaquenil is safe for the avg person to take". Hey...I love it. I would appreciate his confidence in me in asking the question, and I would do my damnest to find the answer. If I couldn't locate the answer, then I would ask someone (prof) for help, or simply say, "Hey, sorry, I don't know." And this is how, IMO, its supposed to work, and I think that if folks just exercised a little more respect and restraint on these forums, then there would be more harmony and less discord. The End.

Answer: according LEXI-COMP's Drug Information Handbook, 12th ED., 2004 (www.lexi.com) the prevalence of ADR's of Plaquenil are listed as "Frequency not defined". This means that the side effects are so rare (could have happened only once) as to be not quantifiable. All side effects of the drugs are quantifiable above 1 percent. Of couse, I called AU's drug information specialist and she said that FND could mean anywhere from 1/1000 to 1/1000000. So, there you go.
LEXI-COMP is but one of the drug information resorces we use, but is considered by most to be the one of the most comprehensive, in depth drug monograph resources available. In taking drug interactions exams, this resource is one of the most popular resources and rotations students love Lexi bc you get daily updates on your PDA.

Note: Concerning the stats (or lack of) of Plaquenil, it's important to note that most of the ADR info. on drugs comes during phase 2 and 3 of clinical trials, but...also much can be learned from the "postmarket" studies (phase 4) of drugs (the MD's prescribing the drugs report to the manufacturer ADRs, esp, unusual ADR's). My point is that in most areas of the world where the anti-malarials are still used for that reason -- the third world countries (eg the Congo, Indonesia, etc), -- then the reporting of these side effects is not as complete, as say, here in the US, so the prevalence may be higher.
Sweden, to answer your question, I am taking Plaquenil now. My dad took some anti-malarial drug during his two tours of duty in Vietnam, and it just so happens that one of the profs. who taught us the basics of drug ADR's also spoke of the anti-malarials during his tour in Vietnam. Otherwise, I know next to nothing about them. Had to look the info. up.

ps If anyone doesn't agree with the above info. concerning Plaquenil, then don't gripe to me. Call the manufacturer. Email LexiComp. Call your local pharmacy school. Write the FDA. Bitch to your dococtor or pharmacist.
I am not going to argue about this anymore.

[Kelli]

Hey Perry,

It's funny you brought up my profession. I was actually going to use the same analogy, but in a slightly different context. I was going to say that simply because some would consider me a design expert, I have to make sure that I understand that I am wide open to critiques, and questions. I have snapped a few times and said, "Because I said so, and I'm the expert!"

I honestly didn't go through and read every last post in that thread, because it bored me. I tend to ignore a lot of what Sweden posts, because frankly, I can't understand it. The English is so broken.

Yes, we argued about Dr. Nase. You've taken a few passing shots at me, or so I've taken them. And, honestly, even before I knew you were a Pharm student, I thought you were a bit cocky. Probably like you thought I was a bit of a bitch. Tone is really hard to take on these boards, which I think has gotten many of us into trouble at one time or another. I tend to be very sarcastic. I can't tell if that's you or not.

Anyway - thought I'd respond. Good luck with your final year!

[Bradley]

I can judge her proficiency as a designer no more than Bradley can arrogantly evaluate my proficiency as a 4th year pharmacy student

I wasn't being arrogant when I said 'I hope your chosen speciality isn't accutane since advising people to split open isotretinoin capsules and literally 'drink' the contents raw isn't exactly my idea of a well-trained pharmacist.' That is your advice and I provided my view on that advice. How can I say that is a sign of a good pharmacist when your direction is contraindicated in accutane's instructions?

[prryjones]

Bradley,
First of all, my chosen specialty isn't Accutane. It's pharmacy (the "A" in Accutane should be in caps, by the way).
Second, I don't recall ever recommending to anyone to take Accutane in this way. May have, but I don't think so. I think I was simply explaining how "I" took Accutane. You can go back and find the post.
Third, your use of the word "contraindicated" is incorrect. If you want to debate with me, then please learn the vocabulary, ok?

Fourth: Drug monograph, Isotretinion, LEXI-COMP, 12th ED, 2004, p. 807.

Administration:
"Administer with food. Capsules can be swallowed, or chewed and swallowed. The capsule may be opened with a large needle and the contents placed on applesauce or ice cream for patients unable to swallow the capsule. Whole capsules can be swallowed with a full glass of liquid."

Great, huh???
Ok, pull the foot from the mouth and keep reading...we're not finished yet....

Maybe I can also clear your confusion on this: There are a lot of things in drug monographs that are there just to rule out any undue or POSSIBLE risk(s). Does not mean this has happened in the past, or that there is a good possibility of it happening in the future. Bradley, do you think that folks were fed "raw" isotretinoin to gauge the possible irritation that may develop? Hmmm...I doubt it...and anyway, since the medicine has the viscosity of thick oil, do why do yo think its put in a gelcap? To keep from burning holes in throats? You see, viscous drugs are alway surrounded in gelcap. Why, you ask? because this way, you carry the capsule to work with you, for instance, and therefore don't have to carry the drug in a cup and spoon it to yourself! Ingenious! I mean, does this make sense to you?
By the way, I am reading the Roche Accutane monograph now, and I see no warning of "esophageal irritation" (I assume thats what youre referring to?). The monograph is current, I thought you'd like to know.

Also, and I would have thought you would have figured this out...that Roche (maker of Accutane) is not going to advise anyone to tamper with their med. Why should they? To split a 40mg cap into 10 doses would not be profitable for them. The above monograph simply showed that it is SAFE to take raw Accutane, but I doubt that Roche wants everyone to be dividing up their own doses....Does this make sense to you? Not due to danger, but bc they lose money.
This is sort of analogous (this means "similiar") to the argument that Dr. Nase made to me when I told him I was mixing my Accutane with flax oil (before I got lazy and now just lick the capsule and chase with milk --by the way, shame on you Bradley...you didn't mention that I "chased with milk").
Dr. Nase said that Roche reps told him the drug, upon exposure to air, would oxidize (look this up) too fast and be rendered useless. Well...that is ridiculous. If something were oxidized that fast, it would likely cause a flame! Anyway, I can tell you from my own experience that it works, even though exposed to air for a few minutes. Geez....Bradly...another example is the "spoil date" on foods...The FDA requires these, always shorter than the actual spoil time. Bradley, does your milk really go bad when it reaches the spoil date? No fair leaving it outside....
I can tell you this: If isotretinion were so caustic as you think (put some on your hand and see for yourself--better have a fire extinguisher handy)
then you damn sure would see more in the literature about it (by the way, you can also show me the studies which showed possible throat irritation). Thanks in advance.
Also may interest you to know that for whatever its worth, my method of taking isotetinion (for me, not anyone else) was thought to be a great idea by a couple of the pharmacologists at AU, and believe it or not, they know almost as much about Accutane as you do.
Is there anything else I can help you with to clear any confusion you may have? Can I be your pharmacist now???
ps If you don't believe the drug monograph above, call your local pharmacist and tell him to check his Lexi-Comp.
ps2 You know, I know I am being a total ass here, but you picked this argument and kept on. I tried to overlook you...you see...contrary to what you may think...you have no qualifications that would warrant me having to justify myself to you. NONE. I am angry bc this whole post is a complete waste of my time. I have devoted time to writing this drivel when I could have been doing something productive. Also, instead of worrying about how proficient a student I am, how about working on your communication skills.

[Bob Bear]

I tend to be very sarcastic.

Really?






Sorry, me too

Ok, I get the whisk stick for this thread. I'll go sit in the corner...

BB

[marecki]

bob you are a true gentelmen

...... I was a bit of a bitch......

i on the other hand was looking for a understatment and upeee found one

Kelli , sorry i just coudn't help my self , please take that as a joke i'm just another idiot #-o

man i hope you don't respond like a texas toronado [-o<

[sweden]

It's funny im being criticized for my ability of speaking/writing english..by Americans! Most Americans (not hispanic maybe) can't speak another language than their own. Most Europeans probably know what im talking about (have you heard an American try to speak french or german!? horrible pronunciation!). Their knowledge about the rest of the world is often laughable. A majority of them can't even point out the country they're in a war with on a map! Maybe you should think twice before saying my English is "broken", considering your own linguistic abilities in other languages then your own. I guess I'll have to pay more attention to the leader of your country, maybe I can improve my English syntax then..lol

[redhotoz]

Please note: This Forum is not a place for pointless arguing. It just wastes everybody's time, sometimes it is better to agree to disagree.

Please no personal attacks - move personal debates to email.

Please avoid profanity.

Respect other posters. Contributors come from many different countries and cultures, and have widely different views. Treating others with respect is key to collaborating effectively in building a community.

[Bradley]

I am angry bc this whole post is a complete waste of my time.

It's actually spelt 'because' but we're not testing each other's grammar here since it's a rosacea forum. I'll leave the rest of your post for you to spell check since you seem to enjoy doing this.

Moreover, my use of the word "contraindicated" is entirely correct:

contraindicate

• verb Medicine (of a condition or circumstance) suggest or indicate that (a particular technique or drug) should not be used.

— DERIVATIVES contraindication noun.

[OXFORD DICTIONARY]

Your technique of squeezing isotretinoin into the mouth raw is indicated against in accutane's instructions.

In conclusion, it would probably be better if you were able to over-come your inferiority complexion and strange attitude prior to criticising others of their spelling and grammar.

[prryjones]

Bradley,

Instead of writing a long, sarcastic, REALLY condescending reply, I have decided that this is not worth my time.

I have no inferiority complex. Trust me. Esp not concerning you.
Simply, I am not going to continue to berate you here on this public forum. I am starting to feel like a damn sadomasachist (sp?) here, and so it's time for me to stop.

FYI: The meaning of the word "contraindication" is narrowed in pharmacy terminology to mean:

The prefix "contra" gen. means "opposed to" or "against". "Indicated" in pharmacy lingo means that a drug is suitable for a particular purpose -- eg a particular disease state. So..."not suitable for".
For example, certain beta blockers eg. propanolol will relieve blood pressure, but also may constrict the bronchioles (of lungs). So non-specific beta blockers (propanolol) may be contraindicated (not suitable for) certain cases of hypertension (eg if the person is has athsma).
To use the word, for example, in the sentence, "oil and water are 'contraindicated' with each other" may be correct according to which definition you use (I don't know)...but certainly isn't consistent with how the word is used in the medical profession, esp. concerning drug therapy.

You chose a non-medical dictionary. Check a medical dictionary- eg Steadmans - and I think you may find the above, more specific meaning.

Perry Jones
ps I realize I incorrectly spell words all the time. The reason I chose to highlight your "accutane" is bc I felt that if you were going to counsel me on its proper use, then you should know how to correctly display it (with caps).
ps2 Thanks to Redhotoz for informing me that I had my definition of "contraindication" all screwed up...whew...all this arguing is getting to me....