Field Medicine

[TommyGun]

I would like to tap into the vast wealth of knowledge form the 18D's and up on what type of medication you prefer to deploy with or attain in theatre.

1. Antibiotics

2. Pain MGMT

I would like to get away from the normal stuff , like Cipro and Toradol. I am looking for what you never leave home without type stuff.

TG

I did search first but if this has been discussed before, first I apologize, second I would appreciate an azimuth correction.
:)

[Red Flag 1]

if it was worth saying, it would have been quoted.

RF 1

[TommyGun]

thanks...I guess I was looking for medics favorites kind of thing. I should caviat that I am a paramedic, I was just wondering if there were some meds out there that they just could not live without. Either theatre would be fine...Iraq or Afg. Just picking brains. Thank you for the azimuth.

Tommy

[Eagle5US]

I am going to dispense with the obvious answers regarding mission dependence, AO, duration of anticipated patient care vs MEDEVAC capability and pt population....and back up to some even MORE basic information.

Your first constraint will be your level of training. What you are "allowed" to both bring and dispense IAW your formal training and level of credentialing. I see nothing in your profile that would indicate your ability to provide prescription medications (though your profile is not specific regarding your qualification level).

Outside of that, understand that your EMT-P skill set and your mil skill set are two different animals and controlled by two completely separate entities. As Combat Lifesavers and Medics cannot start IV fluids on the civilian population, unless you are cleared from some higher medical authority regarding local EMS protocols on military members, your EMT-P skills are wasted on the mil population.

There is always...yes ALWAYS... a person or office that is signing off on what you can and cannot give - from Aspirin to Zantac and everything in between. Even as an ER Trained PA I have someone who says "you are authorized to give this, not authorized to give that". So does my physician boss.

Even OTC Meds...it is very VERY different is someone buys their own tylenol and takes it, vs YOU giving them the same tylenol. Why? because YOU and whoever is over you is now responsible.

Realize also...EXPOSURE to a medication in a training environment DOES NOT EQUATE to authorization to PRESCRIBE the medication.

Perhaps you want to re-think your question and / or provide some additional information regarding your level of training.

One last thing - if stuff works, like Cipro and Toradol...why get away from it? Just because it is exotic or expensive doesn't mean it is any more effective. And yes, even PCN is still prescribed. Why, because it works.

Eagle

[TommyGun]

Roger Sir,
I appreciate the response. I will rethink my question and provide more details. I am a state certified EMT-P and a Combat Medic who has given prescription Medicine in both envorioments, I did not mean to demean the current usage of medication, I was just looking to see what was the preferred meds out there. I apologize for my lack of writing skills.

TG

When I saw that you had responded, my first thought was...UH-OH :D

[Eagle5US]

Roger Sir,
I appreciate the response. I will rethink my question and provide more details. I am a state certified EMT-P and a Combat Medic who has given prescription Medicine in both envorioments, I did not mean to demean the current usage of medication, I was just looking to see what was the preferred meds out there. I apologize for my lack of writing skills.

TG

When I saw that you had responded, my first thought was...UH-OH :D

Not at all...
but you should know as a CBT Medic....you can't give prescription nothin without a memo on file from your immediate medical authority.

Nicely done on obtaining your EMT-P....but again....you are only authorized to use those skills (and meds) within the limits of your State EMS regulatory entity and in the capacity that there is SOMEONE who is covering your actions to the level of your training.

Of course, I know I am only stating what you already know...

Eagle

[TommyGun]

Roger Sir I copy all the way,

I will try another stab at this.

As a 18D is there or are there certain meds you always make sure you have in your bag, such the obvious "Ranger candy"-Motrin? Maybe even go so far as do you have a standard vs favorite antibiotic for GSW?

Another note when I was in Iraq the Doc (with C CO 25th INF) I ran all my procedures through informed me that they had performed a study there in Kirkuk in regards to the dosage of Cipro for "Saddam's revenge", the study results showed that a one time dosage of 1000 mg vs the 500 mg BID for 5-7days. The one time dosage seemed to knock it out...

I was just wanting to see if the 18D's had a certain go to war pack they favored.

Again I appreciate any and education I get from you guys.

TG

p.s. I will update my profile to include more details.
:munchin

[Eagle5US]

Better stated.
Aid Bag does have some good information regarding your question.
Good luck

Eagle

[swatsurgeon]

Be careful of the term "favorite".... bad choice of words. A lot of education, use, research, literature goes into choosing, not because it is a "favorite", it is deemed most appropriate.
Critical thinking is involved with choices for meds that involves safety, efficacy, cost (?), transport stability, environmental degradation, side effects, route of administration, chain of command approval, your scope of practice, etc, etc all go into the thought process of what to equip one's self with.
Agree with Eagle....

ss

[wet dog]

I've got an elderly father who takes .175 mg qd Thyroid/Synthroid. My question is, is there any field expedient, homipathic remedies, recipes that can be used in the event of a Haiti, Katrina or Obama?

[wet dog]

See post below.

[swatsurgeon]

WD,
you posed a rather difficult question for a lot of reasons....the majority of people taking any prescription medicine have at their disposal less than a 30 day supply due to the ironic/stupid/ignorant decisions made by insurance companies, pharmacies and other unknown entities to have patients continue to make "co-pays" and keep the money coming in. It was a recent phenomenon to be able to get a 90 day supply but after 2 1/2 months, your stock is down to 15 pills and you are too low in inventory for an emergency situation for a potentially life saving medication. People are generally not "allowed" to refill too soon (arbitrary!!) so no long term meds available typically.
To answer specifically, a few herbals that are weak replacements but nothing that would sustain hypothyroidism for too long...you do need synthroid. My best advice is always get 90 day supplies and shave off 10 pills each time, rotate stock to keep it 'fresh' which brings me to another point of "expiration"...few meds deteriorate that quickly. by the way it takes 2 weeks or so to deplete your thyroid hormone effect stores so if he skipped everyother day he might feel alittle tired and slower but would be okay for a prolonged period of time.
Moral of the story, it is up to each patient to figure out a way to keep 30 days around at all times..more if possible for just such an emergency. Most meds can be obtained within 30 days for sure, 2 weeks maybe, 3 days rarely.

ss

[PedOncoDoc]

PM inbound, WD.

Good thoughts from SwatSurgeon - an alternative would be to alternate days of taking 1 pilll with days taking 1/2 pill - you'd save 10 pills every 30 days that could be rotated out to have an emergency stock and may be better tolerated. I believe the 175mcg pill is scored.

Alternatively, many large national pharmacies have cheap rates for common drugs and Synthroid is almost assured to be on that list. I checked Wal-Mart - it has Synthroid - all standard doses - at a price of $4 for 30 day and $10 for 90-day supplies. Shop around and find a local pharmacy that has a deal like this. I'm not sure if these programs qork with your drug prescription coverage or independent of it. A quick phone call to the doctor could get you a fresh prescription called in for a 90-day supply with several refills. It would be easy to get this filled and keep on hand for an emergency/disaster.

Regardless, make sure to swap out the saved pills for new pills every 2-3 months so as to not worry about the drug's shelf-life.

[wet dog]

Little is said about Hypothroidism in patients who for whatever reason are forced to quit, either for lack of access or natural disaster. I remember as a younger person, in rural communities, there was always that one or two older person with an inflamed thyroid.

My father had his removed, (burned out, radioactive iodine drink), when he was in his early 40's. His heart rate before treatment at the rest was 140 bpm. After treatment and suppliment, a tender 56 bpm.

I believe my plan in the near future is to locate other sources of medication, aside from Wal Mart, Walgreens or the doc's office.

I have been studing the efficacy of many household meds, after 1 year, (stored in dry cool places), most retain a reliable strength of 85%, can I assume that is correct?

WD

[shr7]

I have been studing the efficacy of many household meds, after 1 year, (stored in dry cool places), most retain a reliable strength of 85%, can I assume that is correct?
WD

The FDA defines an expiration date as “the date placed on the container/labels of a drug product designating the time during which a batch of the product is expected to remain within the approved shelf life specifications if stored under defined conditions, and after which it may not be used.”

I seem to remember hearing the 85% in school referring to how most products must remain at AT LEAST 85% potency at the end of the expiration dating in order to market the product with that specific shelf life. For example, if my 81mg aspirin is dated 6/2010, then it must have at least 68.85mg active product in it by the end of June 2010. However, each product has different potency limits on it that are set by the United States Pharmacopeia (USP). Looking into it now, it would seem most products have a tighter lower potency limit of 90%.

However, just because this is the minimum potency level does not mean that the product must be at 90% potency by the expiration dating. In fact most medications are stable far longer than the dating would imply. The DOD/FDA runs a program called the Shelf Life Extension Program (SLEP) and they found that "84% of 1122 lots of 96 different drug products stored in military facilities in their unopened original containers would be expected to remain stable for an average of 57 months after their original expiration date". Some antivirals stayed stable for 25 years post expiration date.

http://www.medicalletter.org/freedocs/expdrugs.pdf

However expiration dating is different than "beyond use" dating. "Beyond use" dating is what pharmacists use when filling prescriptions from the sealed manufacturer approved bottle into the pharmacy's vials. USP guidelines dictate that beyond use dating be either 1 year or the manufacturer's listed expiration date, whichever is sooner. There is very little data on extending the beyond use dating on drugs due to the differences in how medications are dispensed. For this reason, I would feel much safer using expired medications in a bottle sealed by the manufacturer than I would in one packaged by the pharmacy.

Levothyroxine (Synthroid) used to have limits of 90%-110% by the end of expiration dating before 2009. However due to the following data collected by the FDA:
http://www.fda.gov/ohrms/dockets/AC/06/slides/2006-4228S1-01-04-Eric%20Duffy%20slides.pdf

It amended it limits to 95%-105%:
http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProvi ders/ucm161257.htm

The USP issued the new monograph after the 2 year transition period required by the FDA:
http://www.usp.org/USPNF/notices/iraLevothyroxine.html

The take home point for me is that levothyroxine (Synthroid and others) has proven stability issues that prompted the FDA to take this action and I would not count on much of an extended shelf life beyond expiration dating for this particular medication. Especially given the relatively narrow therapeutic index.


To comment on the fine MDs comments on how to extend your stock, I would personally choose the easiest path and get your physician to write for a 30 or 90 day supply and use one of the pharmacies with the $4/$10 prescription program. This would be outside of insurance, your insurance would come back "refill too soon" and the pharmacy would not fill it. Just tell them you will pay cash, and it will only be $4 or $10. The pharmacy may be hesitant to fill it if you are using the same pharmacy that you normally receive the medication at, but I would just explain it is for an emergency stock and you plan on rotating out expired meds. If they still give you trouble, find another pharmacy. Also, check to see if you can get it in the original packaging. You may get an extended expiration date than you would if the pharmacy filled it due to "expiration date" vs "beyond use date". You could ask the pharmacy to fill it with their longest dated supply as well. Most pharmacies use up their "short dated" product first in order to not waste it.

Good luck
SR

[wet dog]

Good info, thanks everyone.

WD

[Gypsy]

To comment on the fine MDs comments on how to extend your stock, I would personally choose the easiest path and get your physician to write for a 30 or 90 day supply and use one of the pharmacies with the $4/$10 prescription program. This would be outside of insurance, your insurance would come back "refill too soon" and the pharmacy would not fill it. Just tell them you will pay cash, and it will only be $4 or $10.



I have done this with no problems or questions at a large national chain that fills prescriptions. I won't say which chain in the open but if you want to know...PM me.