Tuesday, January 1, 2019

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.
See the source image
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!

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