5/13/2019

Lichen of the Day: Cladonia amaurocraea 

Found across the US, this lichen doesn't have a lot of papers publish unlike the others in this species, but hope to find some really cool facts about this in the future.  The nickname for this lichen is known as the reindeer moss.

Fungi of the Day: Agaricus bisporus

Type of fungi: Basidiomycete
This is one of the few edible mushrooms that we could get at the grocery store! Notes about this mushrooms and noted publications is that there are some beneficial compounds that have antioxidant and immunomodulating properties.

Drug of the Day: Venlafaxine

• Brand name: Effexor (XR formulation)
• Formulation: tablet, capsules
• Mechanism of Action: "believed to be associated with its potentiation of neurotransmitter activity in the CNS. Preclinical studies have shown that venlafaxine and its active metabolite, O-desmethylvenlafaxine (ODV), are potent inhibitors of neuronal serotonin and norepinephrine reuptake and weak inhibitors of dopamine reuptake. Venlafaxine and ODV have no significant affinity for muscarinic, histaminergic, or α-1 adrenergic receptors in vitro. Pharmacologic activity at these receptors is hypothesized to be associated with the various anticholinergic, sedative, and cardiovascular effects seen with other psychotropic drugs. Venlafaxine and ODV do not possess monoamine oxidase (MAO) inhibitory activity." (1.)
• Uses: Antidepressant, Major depressive disorder
• Dosages: " The recommended starting dose for Effexor is 75 mg/day, administered in two or three divided doses, taken with food. Depending on tolerability and the need for further clinical effect, the dose may be increased to 150 mg/day. If needed, the dose should be further increased up to 225 mg/day. When increasing the dose, increments of up to 75 mg/day should be made at intervals of no less than 4 days. In outpatient settings there was no evidence of usefulness of doses greater than 225 mg/day for moderately depressed patients, but more severely depressed inpatients responded to a mean dose of 350 mg/day. Certain patients, including more severely depressed patients, may therefore respond more to higher doses, up to a maximum of 375 mg/day, generally in three divided doses " (1)
• Side effects: Serotonin syndrome, sustained hypertension, Mydriasis
• Contraindications: hypersensitivity, concomitant use with MAOi (have a 14 day washout period before starting Effexor and wait 7 days after last Effexor dose before starting MAOi)
• Drug interactions: Alcohol, Cimetidine, Diazepam, Haloperidol, Lithium, Highly plasma protein bound drugs, Drugs interfering with hemostasis, CYP2D6 inhibitors, CYP3A4 inhibitors, Imipramine, Metoprolol, Risperidone, Indinavir, CNS active drugs, Serotonergic drugs, Triptans

OTC/Herb of the Day: Vitamin A

Once I typed up vitamin A in PubMed, there was 53,230 results that pulled up (review paper needs to made? Questions I have).  This vitamin is essentially used to help with vision health.  This is a fat soluble vitamin, so do keep in mind of drugs that do take away fat soluble vitamins.  There's probably going to be a huge update on this once I'm able to go through all the articles.

Trial of the Day: Prism Trial (A Randomized Trial of Progesterone in Women with Bleeding in Early Pregnancy)(2.)

• Type of trial: multicenter, randomized, double-blind, placebo-controlled trial
• Treatment: 400 mg of progesterone or placebo twice daily 
• Outcomes: birth of a live-born baby after at least 34 weeks of gestation
• Study size: 4153 women
• Location: United Kingdom
• Conclusion: did not see significant higher incidence of birth than placebo

Word of the Day: JOMO: noun (slang): a feeling of contentment with one’s own pursuits and activities, without worrying over the possibility of missing out on what others may be doing. (5.)

Resources
1. Venlafaxine package insert: https://www.accessdata.fda.gov/drugsatfda_docs/label/2008/020151s051lbl.pdf
2. PRISM trial: https://www.nejm.org/doi/full/10.1056/NEJMoa1813730?query=featured_home
3. Agaricus bisporus metabolite: https://www.ncbi.nlm.nih.gov/pubmed/29119493
4. Cladonia amaurocraea: http://lichenportal.org/portal/taxa/index.php?taxon=53366
5. JOMO. https://www.dictionary.com/e/word-of-the-day

Comfrey

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Empath Cleaning

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New Year's Resolution+patient case review

Hi everyone and welcome to 2019!

2018 was huge for me cause a lot of things went on, it was like being on a constant hike in a mountain to where you have your highs but then you have your lows.  I started at the beginning of last year starting to look at grad school and seeing what all I needed to start applying.  I finally finished all my didactic courses for my PharmD degree and started on my rotations.  There was the Rite Aid buyout by Walgreens that I helped out heavily on (most of my off block went to that).  Also, I can say that I've helped out a lot during the Fred's buyout also.  

With my rotations, I felt like I started to learn more about myself (and how much work I can put on myself without my body resisting).  Started to learn that I love to write things that I'm passionate on (which is big cause English is not my thing!), hopefully with this next year, I'll have more content put out to show for it.  Also, my research started exploding like crazy.  I've met a lot of people over this past year that it's been insane, but I loved all of it cause I've been able to learn something from that individual.

What to hope from 2019?

• more blog posts
• more articles
• PharmD degree (finally) and pass my boards
• getting into grad school
• another publication (one is in the making)

So, to start out 2019, thought to start on a review of a patient case that I saw.  It's going to be my little project to read more patient cases and see what I can get out of it (let me know what kind of post you guys want and if you want this article, let me know, and if you find a good article, I'll review it too!)

Fulminant Liver Failure Due to Usnic Acid for Weight Loss  by Durazo et. all

Published in 2004

First and foremost, patients need to be educated about healthy ways to lose weight (diet and exercise and not through dietary supplements).  The Fit Pharmacist (@thefitpharmacist on Instagram, Facebook, and he has his own podcast!) stresses the importance of good dieting and as a healthcare provider in training, I feel as it is important to pass these along so that way patient would not have to have liver transplant like this patient did.

This patient was a 28 year old lady who came in with flu-like symptoms, myalgias, arthralgias, and vomiting.  A few days later she saw symptoms of jaundice and clay-colored stool.  Labs presented with liver test abnormalities (serum alanine aminotransferace of 449 U/L (normal 5-50), serum aspartate aminotransferace of 1016 U/L (normal 15-50), serum total bilirubin of 28 mg/dl (normal 0.2-1.5 mg/dl)).  Hepatits serologies, HIV, nuclear,and smooth muscle antibodies came back negative.

This patient ended up having to get a liver transplant.  

The only thing noted was that patient was starting to take Pure Usnic Acid 500 mg/day to lose weight.

structure of usnic acid

My review

So far, I've only read articles in which they talked about is LipoKinetix (which contains sodium usniate).  This is the first article I've read that talked strictly on usnic acid itself.  I would personally like to see the correlation with this article and the toxicity profile on this compound cause I think that this drug is probably narrowly therapeutic if it was to be used for something else.  Also, I wonder if the patient was taking any other OTC products (like acetaminophen) that could have created a synergistic effect. Although it's a good case report to have, I still have some questions from it.

What was interesting to see that there's usnic acid in kombucha and that's a recently popular drink that people are drinking. I think that's something I'll have to look into and see if there's any reports of toxicities in there.

Here's what NIH has to say on it: https://livertox.nih.gov/UsnicAcid.htm

So thoughts?  Would love to heart what you guys think!

Eyebright infograph

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Myrrh Infograph

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Comfrey infograph

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