Episode 183: Examining Drug Interactions

spk_0:   0:00
Hello, everybody.

spk_1:   0:01
Hello, everybody. And welcome to the show The big show. Most important in clear, clean podcast, blah, blah, blah wearing our car, we airhead and boards an event today we're going to be covering. And, uh, welcome to the show. We got a mystery. We gotta reverse mystery episode today because I do not know what the subject of the episode is today, But she does, because she wrote an article for three B y for you last night and this morning, and I have no idea what it's about, she probably told me, but that would, you know, that would mean I would have to be listening to her, and that's probably, well. Chances are not strange things. Let's not have unrealistic expectations here, so take it away.

spk_0:   0:47
It's about drug reactions because a lot of people have taken to using. I have an allergy as a catchall term, for I don't react well to that substance for summer. Sometimes it's because they people will do it at restaurants because they don't want a eaten. So they tell people they're allergic to gluten, or sometimes they'll really think they're allergic to a drug. Because they took the antibiotic and they got diarrhea from it. So they think they're allergic to imagine that happens a lot with antibiotics. So I was reading Alton's antibiotics and infectious disease. But

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by Dr Bones and Amy

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Doom and Gloom, who are actual physicians? I'm not one. He's an actual

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condition. Dr Alton and Amy. Oh,

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she is a nurse, so they're both actual treating medical people, and I am not. But I read a lot of the medical literature, and he he said something that that spoke to me and I thought needed to be shared more widely. And it was about knowing whether the reaction you reactions, you have to drugs the adverse reactions, knowing if their allergies or if they're just some other kind of adverse reaction, like a side effect or a drug interaction. And the reason it's important is because allergies can kill you. So taking a drug you are actually allergic to if it's the kind of allergy that causes an anaphylactic shock, can just kill you dead. And in that case, the cure is definitely worse than the knees, and you are. I at least wouldn't absolutely not want to take that drug if if I'd had anaphylactic type allergic reaction to it. Even if it was a mild and galactic type reaction, I wouldn't be going near that drug again, at least without a whole bunch of medical sport behind me, even if the situation was dire. But if you're in a low medical access situation, you might not have a whole ton of choices for what you take. And if you need medical treatment and the only one available is something you've had a bad reaction to, you might need to know whether it was a really allergy or whether it was something else, because that affect the calculus of whether or not it's a good bet to take that drug again.

spk_1:   3:10
I'm just a lay person, but here's one thing I know from working for many years in the field that I work in, and all of the fields that I work in isolating the problem is often both difficult and the only real way you figure out if the if what you suspect the problem is is actually the problem. For example, um, I'll just use ah computer terms. Well, it won't turn off. The computer won't turn on Well, what you have to, dio is you start down basically a set checklist of this justice justice to make sure that, you know, you start checking the problems off the list. And then once you find the suspected problem, if it doesn't just magically fixing your they're like, for example, it's plugged in. You plug it in, it works. Okay? You're not. What you could do is you could work around to make sure that you have isolated What the problem. Waas. You could replace that part with the different park it comes on. You put the part back in just to make sure that it was a bad part. It fails again. Okay, you have isolated the problem. I would assume that isolating the problem with allergies is a really kind of paying in the sort of thing. Sometimes,

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yeah, because, ah, lot of adverse drug reactions. They can look kind of similar of whether there are a side effect or an allergy in some cases. But it's important to know which one's which, because you treat them completely differently. Avoidance is the only real answer we have for allergies other than the regular allergy shots that desensitize you to it, and that's not really something. That's a very grid down answer. So avoidance ends up being the best answer if it is of a dangerous.

spk_1:   4:59
But one of the good things is if you have, for example, an allergy to penicillin or penicillin derivatives, you know this. If you know this I'm saying, then you don't stock penicillin type drugs he produced pulling over here. Wonder why those flashing lights were on with this siren at fault. You're part of a warehouse. Probably somebody that police officer. That one's got really flashy lights. I think I am. See how close that guy's got here is to pull over and let him get past a point off her.

spk_0:   5:48
Now, if you know you're alert two syllables than you stock more of other things that are not so. And you also hit the literature before you do your stocking to see who else in penicillins family because most of it had the name still in in, um but not all of them, especially not all the Jared trade name.

spk_1:   6:05
Right now. One thing to keep in mind is you want to stock things for you. If you were there allergic person but it's okay to stock things that are solutions for other people who are not allergic. But just realize that this is I need to have something else for me that may possibly work. Of course, this we're getting way in beyond the scope of

spk_0:   6:29
Yeah, I'm gonna do more on antibiotics choices later, after I've studied more on the subject.

spk_1:   6:35
Another thing, too. This is a kind of aside, if you know you are allergic to something or have bad reaction may not be allergic, but you may have bad reactions. Make sure you know what they were. Isolate them, For example. I've had surgery put too many times now, and one of things I know is that the anesthesia that they typically give me and since it's in my radical records and they know I don't have allergies to it is to use the same one over and over again. But it does cause may, um, nausea, nausea, But we know this. So I make sure that I always tell the anesthesiologist all the thousands of times that I get to talk to them, that I have really bad nausea with that, and I see the other that it works perfectly, and it makes them not happy. But you never making any all just happy but anyway.

spk_0:   7:30
And you can stack the anti nausea drug when you get an aesthetic

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and then a point.

spk_0:   7:35
Yeah, so maybe, but fine. Knowing what the real problem is is important knowing that the real drug is is important and sewing. So does knowing what kind of reaction it is because you got the allergies and you really don't have an allergy unless you've been exposed to that molecule or molecule very much like it before. Nobody dies of an allergy the first time they get exposed to something. You because here's an analogy. I use a lot because I think it works very well. You see a mosquito land on the head of a child, and you do not wish the mosquito to be on the head of a child. That's not a good place for a mosquito, so you smash it with a hammer that is an allergy. Your immune system is supposed to defend you from things that aren't you, things that are not you but are not terribly harmful. It's still supposed to remove, but it's not supposed to get super aggressive about it. When it does get super aggressive about it, the museum itself causes you more problem than the non self thing did. And you have an allergy.

spk_1:   8:34
Pro tip Never hit the head of a child with a hammer.

spk_0:   8:39
Let the mosquito bite it first. If if that's gonna be the thing, you know this is this is thought executing a

spk_1:   8:44
mosquito with a hammer if you could do it. Not a problem that's not on a child at the time. Do not hit Children with hammers ever, ever for moral protein.

spk_0:   8:55
Okay, so you have to get exposed to something to teach your immune system what it looks like and give your immune system time to work up a whole bunch of cells that totally despise that particular molecule. Before you can have this super aggressive, dangerous reaction, potentially dangerous reaction we call an allergy. And there are different sorts of allergies, and some sorts don't get worse than the stuffy nose, a little bit of stomach upset variety and some sorts. The anaphylactic sword can flat out kill you in a few minutes. So which sort of allergy you're having is also a useful? No. But there are other kinds of drug reactions that often get mistaken for allergies. One is side effects. Every drug that I've ever heard of has side effects. If you take aspirin for a headache, it tends to make you bleed more. And that's a side effect. If you take aspirin every day to help discourage clotting so you don't have a heart attack, you're less likely to get ahead. Get a headache. And that, too, is a side effect. That whole question about. How does the drug no, where to go where it hurts. It doesn't. It's a stupid little molecule. It goes all over the place in the bloodstream. And wherever it's particular biochemical reactions are happening. It does whatever it does with that set of reactions. Sometimes that's the effect you wanted. And sometimes it's something else. If it's something else, it's a side effect. Not all of them are bad, but mostly

spk_1:   10:20
but some of them are very effective and good side effects. And just beyond the pale of what we're talking about today. But you know, you used for years of drug because of its side effect, but it was it was

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off label use because it was meant to stop seizures. But it was noticed when they were given it to pull to stop seizures that it also had the effect of stopping. Okay. Hot flashes and ah, chemotherapy treatment can give women ah, super sized monster hot flashes that destroyed your ability to sleep without thinking or in a burning building, so some side effects are good. But if you're having a good side effect, you don't have a problem. Just roll with it and you're fine.

spk_1:   11:05
That's right. Now here's here's one thing I wish I wish we had available to us a physiologist await It's by somebody who had it explained in a brief, short amount of time to those who may not know exactly what it is, what exactly that does not include me. I know what I have heard this many times, but what if I wasn't? What exactly is un allergic reaction? What actually iss. I wish we had a physiologist around who could explain.

spk_0:   11:45
That's when the non self molecules do we. I think he knows he's seen me over here like a Labrador retriever that's been invited to go for a walk. Oh, I could do. That

spk_1:   11:56
thing is more like I got your ball good for your tennis ball into that lake over there. Are you ready?

spk_0:   12:04
This your human would lose so many tennis balls. If I were not here to rescue him,

spk_1:   12:09
Go ahead.

spk_0:   12:10
So, yeah, you get exposed to the molecule the first time you happen to have a few white blood cells randomly produced to defend against it because you've got a few white blood cells randomly produced to defend against pretty much every dang thing come across. That's not you. So it's not a very dangerous thing. But for some reason, something goes wrong with your control systems and your immune system reacts like it is a really dangerous thing. It produces a whole bunch of really aggressive cells, and you get rid of that molecule for awhile, and those cells live a long time. So at some later point you get exposed to the same molecule again and the reaction you set in place the first time kicks into high gear in a very short period of time, and it in the process of vigorously destroying that molecule, it causes a lot of reactions that are somewhat harmful to the host. Now the immune system is a general rule is supremely unconcerned about collateral damage. It damages your tissues all the time in the process of getting rid of invaders. And it doesn't care. Not a bit. That's a cost of doing business. As far as that's concerned, it's gonna cause some damage to you. But long as it gets rid of the invader, it's happened. Yeah, I see a small Jacob care. Yeah, the immune system's not care like about collateral damage. And when you've got an allergy, basically all of the damages collateral damage from the that non self molecule wasn't really be any harm, but your immune system thought it was. And it got so aggressive about it. It'll tear you up and potentially

spk_1:   13:52
you You're out here. You are the weakest link. Goodbye. That show. Yeah, I do. You know, we don't watch much TV, but everywhere like that. Well, you are the weakest link. Goodbye, bank.

spk_0:   14:06
But I don't remember anything else about show. But that's OK. I'm probably not missing

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much. All right. Press a gremlin.

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So those are allergic reactions. What else

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did you see? The firing, The fire thing of that bank fire thing, not. Oh, well, you know, they had fire on little bank sign. Oh,

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I know. The rule Fire department here is having a volunteer charity money collection event.

spk_1:   14:31
I wonder if that has anything to do with allergies. It probably doesn't. Oh, so

spk_0:   14:37
to get back on topic, you have side effects, which are unintended consequences of the drugs. But side effects do not reliably show up for every drug. Old time, every drug has potential to cause some. In many cases, the same drug will cause the side effect in some people, but not others. It will cause reactions at some doses, but not lower doses. It may cause adverse reactions when you've taken it for a long time, but not when you take it for a short time. So it's not completely predictable what side effects you're gonna get. But there's always a relation between which drug it is and which side effects show up with it. And that's known information. You can read about that drug now. Well, Google is at your fingertips and figure out what side effects may accompany that drug. And if those show up and they don't look like an allergic reaction. Then you're having a side effect and not an allergic reaction. Side effects are generally much less dangerous and much easier to get rid of. I stop in the drug than allergic reactions are. So if it's a side effect, maybe you could get rid of it just by cutting the dose down. Maybe you can live with it. Maybe you could manage it, but it's not necessarily a It would be really stupid to take this drug ever again situation. And then there's drug interactions were the only reason you had a bad reaction when you took this thing is because you were also taken this other thing at the same time, and the two did not work and play well together.

spk_1:   16:08
And there's not only drug interaction there are. There are drug and supplement interactions. We just posted on articles that she did on when vitamins and drugs don't play well together and antibiotics, sometimes they don't play well together, and sometimes they do. So you know what? It could look like an allergy, but it's really just a bad interaction between a vitamin and a antibiotic. But just be clear. If in doubt skip the vitamins. Take the antibiotics.

spk_0:   16:44
Yeah, if and

spk_1:   16:46
if in doubt,

spk_0:   16:47
there are few situations where taking a vitamin is a short term necessity, very few situation and the same is not true for some time. I gotta admit what he says. Perfectly correct. But in my mind there's not a difference there, because when I hear supplement, I hear drug that is not a known concentration and regulated by the FDA because there's

spk_1:   17:09
nothing to school drug.

spk_0:   17:11
True, some of those supplements, like ST John's wort. It's a valuable

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is that it's a draw. And, yeah, that's the drugs a job.

spk_0:   17:19
It's a drug, but it doesn't have to be sold as a drug because the FDA is really weird for that. Basically,

spk_1:   17:25
see John's weren't it's one of those things. Esten article.

spk_0:   17:29
Yes, it would have. Do actually have one while ST John's work. Enough vodka. Yeah, and it's been a while.

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We may revisit state general, but anyway, pressing right along,

spk_0:   17:40
so it may be an interaction, question and interaction questions, or our problems are usually the easiest to solve because it's often possible to just stop one or the other of the two things that are interacting, so that may be the thing, and there are other kinds of drug reactions. But those are the three most common types of the side effects the interactions and the allergies. And only one of those is a pretty firm avoidance strategy is the best way to go. So if you know which of those things you're looking at, you have a better idea of how to proceed. If you don't have a lot of choices over what drug to take when you really need a drug, one last thing I probably ought to mention, How do you know when it in allergic reaction? It could be hard to tell precisely. But there are some things you look out for, particularly I'm gonna mention the ones associated with the most dangerous of the Arctic reactions. The anaphylactic reactions E You can get fish face if you eat it because it makes your lips swell up and your tongue swell up and everything starts getting kind of tingly, Bernie, because your nerves are being generically activated in your brain, doesn't know what to make of it,

spk_1:   18:54
and your throat swells. You look like an eel. Yeah, I was kind of start to look

spk_0:   19:00
like a purple eel because your throat closes up enough, it can suffocate you. Oh, your airways squeeze. Shut

spk_1:   19:06
this sticking a pin in somebody's throat. Don't do that.

spk_0:   19:11
Yeah, that's a Hollywood. That's

spk_1:   19:13
a Hollywood. Don't do that.

spk_0:   19:15
If you know how to do to do it. Tracheostomy, then you know how to do a tracheostomy. Don't try and get the information from a movie with

spk_1:   19:24
a big pen. If you don't know how to do it, don't do one. Yeah, because they might survive. That moves from from helping somebody out to attempted murder. So yeah, really? Don't do that.

spk_0:   19:38
A manslaughter. I would say you were trying to say

spk_1:   19:41
attempted manslaughter or manslaughter actually killed over. Don't do that.

spk_0:   19:46
Yeah, we'll figure that out when you

spk_1:   19:49
really know.

spk_0:   19:50
No, I don't need thio. Don't need to go into that explanation. So anaphylactic reactions Those swell e tingly reactions might be anaphylactic reactions. Airways constrict. So you feel like you're laboring to pull every breath in, and it whistles like you're trying to suck air through a thin little coffee stirring straw because your airways have narrowed and you're basically trying to suck your air in through this early thin heart rate gets really fast. Blood pressure drops. You can have these really dramatic color changes because when it first happens, you get this flush because blood vessels getting wider open is part of the allergic reaction. So you can see somebody flush this really bright red color when the allergic reaction first comes on and then their blood pressure does this terrible nose dive because all the blood vessels have opened up. You've got a lot more pipes. Not any more blood to put him in. The pressure goes way down, and that blood pressure drop is actually life threatening. You're blood pressure control system notices. The blood pressure is dropping in the tank tries to bring it back up by causing this really strong stress reaction. So you might get surfaced basal constriction again, where everything that was bright red suddenly turns white. Is all the surface vessels constrict? The pulse gets really rapid because the stress reaction is doing that you have what has been described as a feeling of imminent doom. It tends to cause panic attacks. I personally think a feeling of imminent doom when you're in the middle of anaphylactic reaction is not inappropriate, but it's not terribly, terribly helpful, either. To be honest with you, person may faint because they're not getting enough blood flow to their head. So the difficulties with breathing, the blood pressure dropping really low, the faintness, the post getting really rapid. They'll break a cold sweat because that's part of the stress reaction their pupils dilate because that's part of the stress reaction up feeling of anxiousness. All of those guys are a sign of anaphylactic reactions, and if I had any hint of those when I was exposed to a molecule, I would be avoiding that molecule in the future. But that's just me. I don't give good advice. So that's basically what I had. How to tell which kind of adverse reaction you're having and decide what to do based on the kind of adverse reaction, instead of just assuming everything's an allergy, because a lot of times they're not. If you ask people if what they're allergic to and then test them to see what they're actually allergic to, people are really allergic to about 1/3 of the things they because they're having other kinds of adverse reactions for their read something in the Internet and talked themselves into the fact that their fatigue and lack of energy is somehow an allergy to some food they ate. Probably ism.

spk_1:   22:43
Coop. I think we're gonna have a a creature feature ending for this podcast. Rooting for it.

spk_0:   22:52
Born ready

spk_1:   22:52
when the monster dies, roll the credits. So So I think the critter just died. Credible. The credits. Thank you for listening. We appreciate it. If you like what you hear, share it. Please give us a rating on iTunes or stitcher or whatever conglomerate er that you listen to podcasts fuel into it on our website. Please give us a thumbs up on the on the like button and we'll catch the next time. Thanks a lot. Oh, yes. And if you like what you hear, we like what you subscribe to the podcast and you can subscribe to the Web site by going up to the, uh,

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Right. And on the upper right hand corner up there, you said subscribe to the Web site. You can actually get all of our stuff, all of our articles, Anyway, that we publish you could get him via email.

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It's written in plain English.

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You could sign up for you set up for our newsletter. I don't really lose under very often wanted to wanted to a month. Basically, it's just this is what we've been doing. But I highly recommend it E and I think they'll catch it. So for now, thank you for looking and bye bye.