amphoterrible
dry your eyes, boy
Lauren (she/her) | 30+ | Mom of toddler by day, pharmacist by night.
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MORE THOUGHTS
Odysseus……………….handsome
I literally yelled HEPHAESTUS
it’s so funny I’ve unlocked more stuff than my husband but he has gotten further down than I have I’m a collect and immediately unlock gamer and he is a collect and hoard gamer
lmao I’m not a real gamer I am playing on god mode I have a toddler and a full time job I don’t have time for this
I’m assuming Charon has a new design that isn’t ready yet??
what does Narcissus look like I must know
lmao my husband only played Hades to the first credits???? He had to watch a catchup video because again, toddler and full time job and no time
Hades and FFXIV were my two big games I played during 2020 to help ignore The Horrors at work
mmmmmm hades 2 thoughts
they made Odysseus SO HOT ugh
Did we know the narrator was Homer in the first game??? Am I just forgetting???? Anyways I loved it
I forget how bad I am at these games but I have a ps4 controller hooked up to my desktop so we are ready to die over and over babyyyy
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mmmmmm hades 2 thoughts
they made Odysseus SO HOT ugh
Did we know the narrator was Homer in the first game??? Am I just forgetting???? Anyways I loved it
I forget how bad I am at these games but I have a ps4 controller hooked up to my desktop so we are ready to die over and over babyyyy
#hades 2#hades 2 spoilers#hades 2 early access#I finally finished rewatching House season 1#and I’m done with my masters class for the spring semester#AND I have two project shifts this on week#so basically I can get back to my house rewatch fanfic soon
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also got some Glass Animals tickets!!! In my summer concert era, as the kids say
yessssss I got Hozier tickets for next year
#this’ll be the third time I’m seeing Glass Animals#I saw them in 2012 and it was the one time I was hip and cool
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please Supergiant Games let me play the Hades II technical test
#totally okay if I don’t get access#I’m playing to buy early access anyway#since I have so much free time (sarcasm)#but I’m almost done with my class for the semester and should be able to get some more House rewatched#before I fall back into FFXIV for Dawntrail
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travel-sizes your ffxiv greatwyrm
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I hate when people use the phrase “what have I done” because then sweet jesus what have I done become a thief in the night become a dog on the run have I fallen so far and is the hour so late that nothing remains but the cry of my hate the cries in the dark that nobody hears here where I stand at the turning of the years if there’s another way to go I missed it twenty long years ago my life was a war that could never be won they gave me a number and murdered valjean when they chained me and left me for dead just for stealing a mouthful of bread yet why did I allow that man to touch my soul and teach me love he treated me like any other he gave m
#e his trust#he called me brother#my life he claims for god above#can such things be#for I have come to hate this world#this world that always hated me#take an eye for and eyeeeeeeeee#turn your heart into stoneeeeee#this is all I have lived for#this is all I have knoooooooooooooooooown
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#sigh here we go again#I worked on and got Perfection last year#so I’ll check what the Perfection Tracker says#then it’s time for a new farm!#I’m almost done with my class for my masters#then back to my House analysis
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my coworker/friend last night was like, “oh yeah there’s a patient with Wilson’s disease over here” and I said “WILSON’S DISEASE I know how to treat it’s like penicillamine or something I looked it up for my House manifesto”
#I have used company time to work on this rewatch fact checking#but the only rule for project time is it has to be related to pharmacy#and like#this is related to pharmacy lmao
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#dropout#brennan lee mulligan#ross bryant#make some noise#I love you Ross Bryant and Brennan Lee Mulligan#every time Ross is on make some noise my husband and I are like YEAAAAAA#everytime Ross is on anything on Dropout my husband and I are like YEAAA
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some background information
What am I doing? Why, I'm re-watching House, M.D. as a whole-ass pharmacist and taking meticulous notes!
I’m only going to focus on when House, M.D. gets something about medication just wildly wrong. I’m not going to be like “why are the chest compressions so slow” or “would Chase really be inserting that temporary transcutaneous pacer at the beside wouldn’t they want to do that in the EP lab” or anything else along those lines. I am but a humble pharmacist.
Hydrocodone/acetaminophen (APAP), the U.S. Food and Drug Administration (FDA), and the Drug Enforcement Administration (DEA)
This is going to be interesting because House aired from November 16, 2004 to May 21, 2012 and there are two things that come to mind for me: 1) The U.S. Food and Drug Administration (FDA) asked drug manufacturers to reduce the strength of acetaminophen in combination acetaminophen products to 325 mg in 2011(1) and 2) hydrocodone combination products were still scheduled as schedule III by the Drug Enforcement Administration (DEA).(2) Hydrocodone combination products weren’t rescheduled to schedule II until 2014. Schedule III prescriptions are a lot easier to write and fill than schedule II prescriptions. A lot of the legal nuance varies by state and I am not going to read New Jersey pharmacy statutes, thank you very MUCH I barely passed every Multistate Pharmacy Jurisprudence Examination (MPJE) I’ve ever taken. Back to the Vicodin. So how am I going to know exactly what formulation of Vicodin House was consuming?
I really don’t care about the hydrocodone component of it. There is no ceiling to an opioid, it’s whatever the patient can tolerate it. (Well technically there is too much to give but you have to look at if the patient is used to taking opioids or not don’t just slam someone with 10 mg of IV Dilaudid you know what I’m saying.) And if they don’t tolerate it give them some naloxone. And patients with chronic pain can tolerate a lot of opioids. Was Vicodin an appropriate opioid for House? No! But it was less regulated! And the threat of liver failure is dramatic! But Oxycontin would make more sense – Wilson’s an oncologist, he would be prescribing it all the time! Cancer hurts! Antineoplastics hurt! Oxycontin was the most widely abused prescription opioid in the United States in 2004(3), right when House started airing. But no, it’s Vicodin. The writers chose Vicodin for a reason. I’m going to let the art flow over me. We’re sticking with Vicodin. Or, hydrocodone/APAP because Abbott isn’t paying me to do this.
I worked in an independent retail pharmacy my first year of pharmacy school (which was 2010 before I realized I do not have a poker face to deal with the general public and immediately started working in a hospital), and I vaguely remember there being way too many formulations of hydrocodone/APAP. Hydrocodone/APAP has a few brand names: Vicodin, Norco, and Lortab. I usually say Norco because it’s the easiest. (I actually say hydrocodone/acetaminophen because I’m an asshole.) I found this email(4) sent by Abbott in October 2012 that discussed the newly reformulated Vicodin®, Vicodin ES®, and Vicodin HP®, which is handy since it lists the old formulations too:
Vicodin®
Hydrocodone 5 mg/acetaminophen 500 mg
Vicodin ES®
Hydrocodone 7.5 mg/acetaminophen 750 mg
Vicodin HP®
Hydrocodone 10 mg/acetaminophen 660 mg
Who the fuck puts 750 mg of acetaminophen in one tablet? That limits the patient to five tablets in 24 hours. We’ve known the maximum dose of acetaminophen is 4000 mg since the 1970s. What the fuck, Abbott.
(Matthew Mercer Voice) How Do You Want To Do This?
So, like, I guess I’ll just count the tablets I see House consuming and then calculate the total daily dose of acetaminophen for each Vicodin formulation? I feel like I can do total acetaminophen dosage based on episodes versus trying to keep track of the days. The timeline of this show is wonky and like once you hit the toxic dose you’re there so? Also, sometimes he takes more than one and it’s hard to hear the tablets like, clink against his teeth or whatever. Sparkle on! We’ll do our best. I was going to put this in an Excel spreadsheet but I just remembered I am a pharmacist and I cannot function in Excel.
Let’s talk about the mechanism of liver toxicity and treatment of acetaminophen overdose if we hit significant toxicity. Wouldn’t it be funny if we didn’t?? That would result in me rambling about House M.D. for pages and pages and he doesn’t even get hypothetical liver failure. Is this fanfiction? Am I writing really weird fanfiction? Anyways significant toxicity occurs if you hit 150 mg/kg of acetaminophen.(5) How much does Gregory House weigh?? Let’s give him a range: 160-180 pounds (73-82 kg). Fairly average, actually. So House’s toxic dose of acetaminophen is likely 10,950 mg to 12,300 mg. Let’s say lower range is 22 tablets of Vicodin®, 15 tablets of Vicodin ES®, 17 tablets of Vicodin HP® and the upper range is 25 tablets of Vicodin®, 17 tablets of Vicodin ES®, and 19 tablets of Vicodin HP®.
References
Department of Health and Human Services. Food and Drug Administration. Prescription drug products containing acetaminophen; actions to reduce liver injury from unintentional overdose. Federal Register. 2011;76(10):2691-2697.
Seago S, Hayek A, Pruszynski J, Newman MG. Change in prescription habits after federal rescheduling of hydrocodone combination products. Proc (Bayl Univ Med Cent). 2016; 29:268-270.
Zee AV. The promotion of marketing of OxyContin: commercial triumph, public health tragedy. Am J Public Health. 2009;99:221-227.
Abbott. Newly reformulated Vicodin® launch announcement. https://www.uspharmacist.com/email/ecf1248.html. Accessed January 8, 2024.
Hendrickson RG. Acetaminophen. In: Nelson LS, Howland M, Lewin NA, Smith SW, Goldfrank LR, Hoffman RS, eds. Goldfrank's Toxicologic Emergencies, 11e. McGraw-Hill; 2019:486-499.
#house md#hate crimes md#house rewatch 2024#I'm halfway through season 1 this is going to take A Bit#so please bear with me#but here's some background ramblings#I'll make a pinned post and have links to each season#so I am ~*~organized~*~
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I started my House re-watch, want a preview of the first three episodes of season 1???
Season One (or: I don’t remember Wilson looking like such a baby the first time I saw this how old is Robert Sean Leonard in season one? THIRTY-FIVE?? FUCK)
In “Pilot” (or “Everybody Lies” if you’re feeling frisky) there’s not much going on in Vicodin Land. Our acetaminophen dose ranges from 1500-2250 mg. Boring.
“Paternity,” again, acetaminophen 1000-1500 mg.
Oh, “Occam’s Razor.” Dosage of acetaminophen is 1500-2250 mg, but this is our first medication tangent. Colchicine toxicity! Did you know the FDA told drug companies to stop manufacturing unapproved injectable colchicine in 2008?(1) Because I didn’t! There is no antidote for colchicine toxicity, it’s all supportive treatment. When I was re-watching this episode, I actually thought they confused colchicine for digoxin which I thought was weird because I feel like digoxin is so well known. But it turns out there is experimental colchicine-specific antibodies, but they’re not commercially available.(2) How did you get them, House? How did you get them so quickly?? Literally there is one published case report where they used Fab fragments for colchicine toxicity and it was published in 1995.(3) One patient! Nine years before this episode aired!
References
The Rheumatologist. FDA enforcement against injectable colchicine. https://www.the-rheumatologist.org/article/fda-enforcement-against-injectable-colchicine/. Accessed January 8, 2024.
Schier JG. Colchicine, podophyllin and the vinca alkaloids. In: Nelson LS, Howland M, Lewin NA, Smith SW, Goldfrank LR, Hoffman RS, eds. Goldfrank’s Toxicologic Emergencies, 11e. McGraw-Hill; 2019:537-547.
Baud FJ, et al. Treatment of severe colchicine overdose with colchicine-specific fab fragments. N Engl J Med. 1995;332:642-645.
#house md#hate crimes md#this is going to take so long#I'm going to watch 5 episodes#then do research#then maybe type up some stuff#then watch 5 more episodes
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oh no I started it I started the "I'm rewatching House and documenting each episode's dose of acetaminophen House consumes" document and it's already 4 pages long
#house md#lmao I'm on season 1 episode 4 this is going to take SO LONG#but wait let me wax poetic about acetaminophen toxicity#my little 2024 project#:)
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jokes on me House MD won the rewatch battle I can’t say no to those two co-dependent assholes
I’ve warned my husband I may be watching Supernatural again…there is no hope for me…take our son…escape while you can…I am still a Deangirl…
#I want to see if I can count how many Vicodin House consumes each episode#and calculate each instance he would have gone into liver failure#but was Vicodin hydrocodone/apap 5/325 mg or 5/500 mg????#or was it 7.5/750 mg UGHHHHH I don’t remember or are they being annoying and just using Vicodin to label hydrocodone/apap#like I know why it’s Vicodin it’s because the danger of liver failure is there#and back in the early 2000s Vicodin was a CIII which is easier to get than a CII#but damn this is going to be tricky
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yeah I’ll “stay late” (work until the end of my shift and not leave 15 minutes early) because you jerks only work 70 hours a rotation and get paid for 80 and I’m used to working the full 80+ hours and doing so much more stuff!! All of the time!!! I read Hilson fanfic all night and still had plenty of time to safely do my job!!! I am mad but I am so happy I work here fuck!!
#guess who got a job at The Academic Medical Center in her city#and not the smaller one with no research grant money#haha it me#I already started a House rewatch#can’t wait to get annoyed about when they’re wrong about meds
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bro doesnt even have the jennies (certain je ne sais quois)
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The duality of Ed and Stede's whole vibe. They're toothachingly earnest like lovesick teenagers. They're deeply emotionally stunted and traumatized middle aged pirates. They do cute little soft things like thumb wars and breakfasts in bed. They literally kill for each other. They hold and kiss each other so softly and tentatively. Stede also erotically stabs ed at gunpoint and slams him up against the wall. They have a slyly complicated butch/femme dynamic. Stede is a soft man full of pent up rage and Ed is a tough man full of tenderheartedness and sorrow. Truly ship of all time.
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yessssss I got Hozier tickets for next year
#thanks for coming to the [redacted] area#appreciate that man#need to brush up on my Hozier discography
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