Can anyone American tell me anything about Vicodin?
I am getting confused about its role in House.
/one track mind
I understand it's a combination product of opiod and acetaminophin?
I have no idea what a vicodin is!
XD
That's okay! Thanks for letting me know!
You're right, it's acetaminophen + hydrocodone. It's one of the most commonly prescribed forms of opioids out there since the
opioid content is fairly low (as you probably know), and is also is a popular and fairly easy-to-obtain street drug because of that
But House frequently bypasses the MDD for acetaminophen and his friends often freak out about him, but no-one ever mentions his liver.
littledots
is
it a subtherapeutic dose of acetaminophen or something?
(It's really hard to type acetaminophen.)
yeah, it's only 325 mg
Ahhhh.
That makes no sense at all.
...is it really only there to discourage OD?
Because that is shitty pharmaceuticals.
I think it makes people feel good about taking an opioid?
It's subtherapeutic!
/flail
...hmm.
Oh god, no. most people have no concept of what doses of acetaminophen work, and most people don't even know it's dangerous
my guess? Is that it is to comfort the lay person who is leery of taking an opioid and so the existence of tylenol in it makes them
think it's a more "legitimate" drug
Wow, that sucks.
Hang on, one more question.
I know patients who will refuse opioids at any dose and so suck down tylenol and ibuprofen
When you buy a product containing paracetamol in America, does it come with a big shiny label saying DO NOT EXCEED EIGHT TABLETS IN ONE DAY?
(is tylenol acetaminophen?)
Yeah, tylenol is acetaminophen. I use the trade name often because it's shorter to type XD
Yeah, but it doesn't communicate so well cross-country.
Although for paracetaminophen, neither does the drug name. :/
So, warning labels?
There is a warning label, but I don't think it's that huge. It might not matter even if it was a big warning... so many things
have warning labels in the US, it's kind of something people just don't even notice anymore
Wow.
:/
I've admitted enough patients with tylenol overdose where it wasn't even a suicide attempt that I just know that the education level
herongale
is
not there.
So at 325mg paracetaminophen, it would take... 27 tablets to exceed MDD.
That is.. awful.
Of course, House would not be like that. I find HIS choice of Vicodin interesting for that reason.
Go on.
(please do go on. I have to do washing, but I would love to read your thoughts on my return.)
I think that he chooses it because he feels that the acetaminophen is a built-in restraint to how many he will use, because
I don't think he'd exceed the daily dose for the tylenol, but... as you can see, you can take quite a few Vicodin before getting to the
limit, and all forms of Vicodin, no matter how much hydrocodone they contain, have the same small dose of
acetaminophen. So there's a lot of room for personal control over pain dosing and to me it suggests that he's an addict who has set
some personal limit that he doesn't want to cross when it comes to the opioids.
I think it's about maintaining optimal functionality for him. He wants to maintain his mental alertness and so won't cross
over to pure opioids even though they would be technically a lot safer for him, just because he probably thinks that with the lack of
liver toxicity to worry about, he'd just keep going up and up on the dosing as he becomes habituated.
I sort of suspect there is a pride and maybe even a sort of personal ethics thing there, too.
Me, I do everything I can to avoid taking any opioids altogether. I would rather have pain (and I do have pain) than be a doctor who
Yeah, that does make a lot of sense. I'd assumed it was just for ease of access, because they weren't DDs.
takes opioids regular, since it's incredibly stigmatized in the medical profession
Oh, sure. I don't think he's supposed to be a good example. He's just attractively broken.
Well, to me what I like is that even though he's broken, he obvious follows some sort of personal code
I would agree with that more strongly if not for his frequent combinations with alcohol.
He could get oxycodone just as easily, I think. But doesn't.
And his forays into other... agents.
Wait, really? You can get straight oral oxy on a general Rx in America??
Hmm. I didn't know he used other things.
Oh man, how many unused bottles of oxy do I have around here...
oxycontin is a controlled substance but any doctor can prescribe it, and a lot do
On rare occasion, yeah.
(watching this very educated plurk with awe)
And it is also one of the things that is not hard to get on the streed
er, street
Man, I can never remember the difference between controlled and restricted.
Which one is a DD?
DD? Eariler when you said MDD I took that as Maximum Daily Dose, but I don't know what you mean with just DD
(Sorry, Kori, it didn't occur to me that anyone else would read this. Let me know if I am being obscure.)
DD here is Dangerous Drug. An S8? I don't know what scheme Americans use.
(Don't mind me. I'm just observing. It's sexy when people talk about things they know a lot about!)
(You are adorable. XD )
Oh. We don't use that terminology! We just have controlled versus non-controlled. But within the realm of "controlled,"
there are various schedules ("schedule" being a government word for "class"
and the schedule level
and the schedule level
...good point. I keep assuming you have the same prescribing laws. Which you probably don't.
determines who, if anyone, can prescribe certain substances
(also, now that I can math again, it only takes 12 Vicodin to max out daily paracetaminophen.)
So is oxycodone under stricter Rx guidelines than, say, a statin?
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shares
Yes. Definitely.
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So, basically, in the US, medical licenses are generally handled by the state you live in.
:/ This is sad for Wilson.
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Each state provides you the license that says you can practice medicine, and this allows you to prescribe the lowest/safest "schedule" meds
I assumed it was just like our codiene-combinations. 
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But to prescribe opioids of any level, you need a DEA license, which comes at the national/federal level
Codeieiene?
All opioids are in the same class?
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No, they vary based on strength and (I think) form of administration
Yeah, that's similar to ours.
I guess this means that Wilson is an even better friend than I realised.
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Because he's the one providing House with his prescriptions?
Yup.
On demand.
Well, in a way, by taking only Vicodin, House might be protecting Wilson a little, too.
He is so full of love and issues.
Until that fails and he keeps doing it, sure.
Since that is one of the medicines that would be the least questionable to prescribe to a practicing doctor
Yeah.
Wait, I think I misunderstood that. House is protecting Wilson?
I mean, obviously plenty of doctors practice despite having medical conditions of their own, so the problem really that he's taking
Vicodin, or even that he's taking a lot of it... it's more that he doesn't disclose the extent of his use to the hospital where he works
(I'm assuming he doesn't disclose, anyway)
Um, about that.
It's not really right for Wilson to be providing House with any type of narcotics, precisely because they are friends
House should have an actual doctor who he goes to see.
He is super stealthy at popping four at a time in front of the Dean. And then saying "oops".
Yeah, I figured. That's why I love all Wilson's issues.
otoh, House is House. And when on Vicodin, he saves lives.
Which is obviously Wilson's reasoning.
Wilson's reasoning is fucked, because the world does not require House IN PARTICULAR to save lives, but of course that is
just an aspect of his love. XD
Yes!
Also, have you seen the episode including, uh, a bachelor party?
I am pretty sure you would remember it if you had.
I have only seen like the first five episodes. I had to stop because the way medicine was practiced infuriated me too much!
I can totally understand that. The medicine is ridiculous.
I really liked the diagnostic mysteries aspect of it but some of it is just... painful. It reminds me a lot of CSI, a criminal police
procedural, where one specialist can actually do any procedure ever
House is dual-specialized, right?
Infectious Disease and something else? Nephrology, I want to say?
He seems pretty firmly planted in diagnostics, but when it comes to the crunch, he does anything.
I don't remember him specifically being in ID...
I thought he was! I might be wrong!
/runs to google
/can't run to google for anything about House.
ANYWAY. The bachelor party episode totally has Wilson with no pants. Which was my point.
I approve of Wilson with no pants.
Although I am annoyed that I am still waiting on Wilson with no shirt.
Yep, I was right! Infecious disease and nephrology XD
Lol XDDDDD
I approve of that too!
HE IS FLAWLESS.
I AM UNREASONABLY UPSET THAT HE IS FICTIONAL.
I'll just tell you my brief objection to House's abilities. Mostly, every infectious disease doctor I have ever known does not do ANY
procedures. The most they do are pap smears and wound cultures.
They are brain doctors, meaning they do all their work in their head.
And nephrologists, well, the only procedures I've ever seen them do are putting in quinton catheters for hemodialysis.
I mean, as a HOD, I can understand him not doing a lot of footwork. But as a doctor, when he hasn't got his team around, he proves himself.
ngh, catheter.
It's just that in most hospitals, he just wouldn't be allowed to do all the procedures he does. They'd just consult whatever service
to do the procedures for them.
ID doctors ARE famously bossy and smart, however!
Yeah, but we do have canon evidence that Cuddy knows she is treating him special.
ID pharmacists are like that too. XD
Omg yes! I've met a few ID pharmacists and they AWE me with all the shit they know.
ikr? Mine is so freaking amazing.
She is totally making me want to specialise
We have a pretty strong ID group at my hospital since we treat a lot of patients with HIV who are not on HAART
How do you treat?
Oh, I just mean they don't go to see ID doctors or don't take their medicines and are generally non-compliant
I mean, I was under the impression that there was HAART and then there was palliative.
Ooh, right.
a lot of times because they just can't... we treat a lot of homeless patients or people with no insurance
We also treat a lot of IV drug users and they need specialized ID care, too!
But anyway my point was that when I did ID as a med student and as a resident, an ID pharmacist rounded with our team
and they always were so brilliant and had all these dosing graphs and just knew SO MUCH about all of the drugs
and all of the interactions of the drugs
Oh, man, did they carry their dosing graphs on their lanyards?
The ID doctors and the pharmacists seemed to have a really good relationship, always
There is totally a thing at this hospital about lanyards. You can tell an experienced pharmacist by the thickness of her pile of cards.
they had piles of cards but I don't know about having them on lanyards! They just held them in their hands or something
Fair enough. XD
Well, maybe they had lanyards but took the cards off the lanyards while rounding!
I don't really know, it's been a while
Do your pharmacists round with your doctors?
For certain specialties, yes. ID for sure. Oncology too.
Damn, that would be so handy.
Otherwise they mostly are just on call.
When I'm doing my hospital work I can call a pharmacist at any time to ask them questions.
Our ward pharmacists round separately and then have to fight the doctor team for charts when they cross paths. :/
Yeah, calling is more effective.
We got rid of paper charts at our hospital within the last two years. There are still binders where a few notes go but all doctor and
I am unbelievably jealous of you right now.
pharmacist notes are on the computer now.
it's SO convenient!
We still have to learn to read doctor-handwriting. :/
You know, when I order a drug on the computer, I get a warning screen before I can sign if there are any potential dangerous interactions
or if the patient is NPO and I am prescribing insulin or something. It's a nice little "are you sure you want to do this?"
Yeah, those things are great.
We've had all sorts of issues this week with them glitching, though.
We had a patient with anaphylaxis after ibuprofen, and the computer didn't even question us trying to dispense indomethacin.
We were lucky to catch it.
Do you have it where you dose certain drugs so the doctors don't have to? I always order pharmacist dosing on anticoagulants
and certain antibiotics. It's SO convenient!
We can recommend, but that's about all.
What anticoagulants to you have varying doses for?
*do you
heparin, low-molecular weight heparins, coumadin...
also those drugs where I can never remember the names but which you prescribe in HIT
Huh. Here they all have set schedules before and after the first INR.
You know, I have no idea what you give for HIT.
Well, we might have schedules too but it's the pharmacists who do that. You know, the pharmacists do all the ordering for PT/INR too
once you ask them to dose the meds!
Ooh, right.
Yeah, I guess we do that, but only according to what's written.
lemme look it up in Up To Date real fast
It's not complicated.
You have UTD as well?? Nnngh, so jealous.
lepirudin
well, I have UTD for free at the hospital, but I also pay for my own account
Hmm, okay.
Urgh, time keeps happening. I am going to have to shower and do stuff for the day. :/
But hopefully we can come back to this later!
I am enjoying talking to you aboud hospitaly things. <3
You know, I can give you a one-time 30 day complimentary pass to UTD if you want one! Like, for whatever project you are doing!
Lemme know. I just need to put in your email address and they'll send you the rest.
Really? That would be amazing!
Okay if I get back to you on that?
No problem!
Thankyou! <3
This is a super interesting conversation, though I know nothing about pharmaceuticals. 
yeah! I did not understand much of this, but it was super neat to read!