Category Archives: Uncategorized

Epocrates Medical App Reviewed (you won’t believe the cost…)

In today’s tech-savvy market it’s out of the ordinary if you are not using medical apps in your every day practice. So, I am sure most of you have either seen and/or used the medical/prescribing apps mentioned below. However, just in case you have not and are still grappling with which ones to actually purchase, here is a no-frills review of Epocrates:

Epocrates:

Pros:

  1. Arguably one of the most useful and universal medical apps on the market.
  2. Despite the recent update, still a pretty clean, simple user interface.
  3. New updates = New user-friendly features.
  4. Quickly check interactions right from the medication information page.
  5. Access to Guidelines for nearly all Specialties.
  6. Pill identifier, pill pictures, tables and math equations.
  7. Provides free empirically-based research articles, as well, as FDA Alerts:

Cons:

  1. Empirically-based articles are in all Specialties and currently, there is no way to narrow it down. (see above, but please correct me if I’m wrong.)
  2. Before the most recent update, the interface was a lot cleaner. Now, it seems convoluted, and a bit cluttered (see below).
  3. New Features = More expensive. Some of the more useful features have to be unlocked via purchase. We are not talking about 0.99, 1.99, 0r 2.99 like most apps. It is 174.99/year!! That said, if you are willing to shell out the $, or your company will pay for it, this could be the ONLY app you need.
  4. Guidelines are limited and not all-inclusive. (Specifically, Psychiatry only has 2 available.)
  5. Marketing advertisement pop-ups.

 

Cranial Nerves Mnemonic (Dirty)

Okay, so there are tons of Cranial Nerve Mnemonics out there. Some PG and others X rated. Memory is a funny thing because I tend to remember the dirty ones. In fact: the dirtier, the better. Make what you will from that. Either way, here is the one I use and it never fails me:

Oh (Olfactory) Oh (Optic) Oh (Oculomotor) To (Trochlear) Touch (Trigeminal) A (Abducent) Female (Facial) Vagina (Vestibularcochlear) Gives (Glossopharyngeal) Verne (Vagus) A (Accessory) Hard-on (Hypoglossal)

I know… It’s horrible!! But it’s SO horrible, I remember it every time! And it goes right along with the Nerve Function Mnemonic:

Some Say Marry Money But My Brother Says Big Breasts Matter More (S=Sensory, M=Motor, B=Both)

Thanks,

Dr. Jon Chandler

Sharing is Caring

Tricyclic Antidepressants, or TCAs

Tricyclic Antidepressants, or TCA:
Cyclic antidepressants are named tri (3), or tetra (4), depending on the # of rings in their chemical makeup.
Maprotiline is a Tetracyclic antidepressant because it has 4 rings.

All of the medications listed below are Tricyclic antidepressants:

  • Amitriptyline
    • Initial dose:
      25 to 100mg per day in 3 to 4 divided doses or 50 to 100 mg at bedtime.
    • Maintenance dose:
      25 to 150 mg per day in single or 3 to 4 divided doses.
Amitriptyline

Amitriptyline

  • Amoxapine
    • Initial dose:
      50mg 2, or 3x daily.
      Depending on tolerance, the dosage can be increased to 100mg 2, or 3x daily by the end of the 1st week. When an effective dosage is established, the drug may be given in a single dose (nor more than 300mg) at bedtime.
    • Maintenance: 200-300mg/daily. 
Amoxapine

Amoxapine

  • Desipramine (Norpramin)
    • Initial dose: 75mg/day orally given as a single dose or in divided doses.
    • Maintenance dose: 100-200mg/day.
Desipramine

Desipramine

  • Doxepin
    • For Mild Depression:
      Initial dose: 25mg/day in 1 to 3 divided doses.
      Maintenance dose: 25-50mg/day in 1 to 3 divided doses.
    • For Moderate Depression:
      Initial dose: 75mg/day in 1 to 3 divided doses.
      Maintenance dose: 75-150mg/day in 1 to 3 divided doses.
  • For Severe Depression:
    Initial dose: 150mg/day in 1 to 3 divided doses.
    Maintenance dose: 150-300mg/day in 1 to 3 divided doses.

    Doxepin carton

    Doxepin carton

  • Imipramine (Tofranil)
    • Hospitalized Patients:
      Initial dose: 100mg/day given in 3 to 4 divided doses.
      Maximum dose: 300mg/day.
    • Outpatients:
      Initial dose: 75mg/day given in 3 to 4 divided doses.
      Maximum dose: 300mg/day.
    • Intramuscular: Up to 100mg/day in divided doses.
tofranil-25mg

Tofranil 25mg

  • Nortriptyline (Pamelor)
    • 25-150 mg/day orally in divided doses or 1 dose.
Nortriptyline

Nortriptyline

  • Protriptyline (Vivactil)
    • 15 -40mg/day divided into 3 or 4 doses, up to 60mg/day, if necessary.
Protriptyline-hydrochloride

Protriptyline-hydrochloride

  • Trimipramine (Surmontil)
    • Outpatients:
      Initial: 75mg/day, orally in divided doses.
      Titration: May increase up to 150mg/day.
      Usual range: 50-150mg/day.
    • Hospitalized patients: 100mg/day, orally in divided doses.
      Titration: May increase gradually over a few days to 200mg/day.
      If there is no improvement after 2 to 3 weeks, the dose may be increased to 250 to 300 mg per day.
      Maximum Dose: 300 mg per day.
Trimipramine

Trimipramine

Common Side Effects:

  • Dry mouth
  • Blurred vision
  • Constipation
  • Urinary retention
  • Drowsiness
  • Increased appetite leading to weight gain
  • Drop in blood pressure when moving from sitting to standing, which can cause lightheadedness
  • Increased sweating

IMPORTANT: Pharmaceutical companies HAVE to list every side effect reported during clinical trails. So, just because a medication lists a certain side effect DOES NOT MEAN YOU will have it. In fact, most people experience very few side effects and with continued use (2 weeks and beyond), most of the initial side effects dissipate, or resolve completely. Additionally, the dosages listed above are FDA approved for treating Depression in an otherwise healthy Adult. For more specific information in treating your symptoms, consult your doctor. 

**Nearly all of the medications listed above have been replaced by newer antidepressants with less side effects. See my posts on SSRIs and SNRIs **

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