The tickle of curiosity. The gasp of discovery. Fingers running across the keyboard.

The tickle of curiosity. The gasp of discovery. Fingers running across a keyboard

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Sunday, May 25, 2014

Prescription Drugs and Pharmacists in Your Plot Line: Info for Writers with David Perry



Fiona - 
David Perry
Today, our guest is David Perry. David would you introduce yourself?


David- 
I'm David Perry. I have been a pharmacist for thirty years and an author for about eight years. I spent the first eleven years working in the hospital setting as a clinical pharmacist working with doctors and other clinicians on drug therapies and better medication usage. The last years, I've been a community pharmacist here in Newport News. My first novel was published in 2012, and my plot lines deal with pharmacy and my protagonists are pharmacists.

Fiona - 
I can't remember ever reading a book with a pharmacist or pharmacy in the plot line, but it seems like so much fodder for things to go very badly.


David - 

Amazon Link
Yes, absolutely. In the reading I've done over the years, I have seen very little published that deals specifically with our profession, especially with a pharmacist as the hero. 

My heroes to date--and in the future--will be pharmacists. I would like the reading public to understand more about how pharmacists and their work contribute to the community and healthcare.The Cyclops Conspiracy revolves around Jason Rodgers who is a community pharmacist who becomes ensnared in and international plot. Second Chance is about Alex Benedict, a clinical pharmacist who discovers suspicious deaths in his hospital. I weave every day pharmacy scenarios into the story lines.


Fiona - 
In my article on archery (LINK) I mentioned that the heroine could use the bow and arrow to tranquilize a Yeti to take samples. A reader asked me the reality of tranquilizers. It occurred to me that that is the most frequent use of medications
in plot lines. 

Can we take some time to talk about the particulars of knocking
someone out with drugs - especially delivery, time it takes to be
effective, what symptoms a heroine might experience.
Is there anything our heroine could do to save herself
at that point?

David - 
 
Sure, we can definitely discuss that. Depending on the delivery method for a drug (sedative, tranquilizer), the effect will vary. 

The mortar and pestle, one of the internationa...
 (Photo credit: Wikipedia)
If someone or an animal is given a sedative orally, the effect will generally take about 45 minutes to an hour to take effect.This will depend on whether or not they have anything in their stomachs. If the stomach is empty,
you might see an effect with within thirty minutes. 

If the stomach is full and depending on the food that was eaten, it might take two hours. 

If the drugs is delivered in a liquid form, the effect will be faster than in a pill form. Drugs are absorbed in the small intestine (not the stomach) so the drug must pass through the stomach to the small intestine to be absorbed. 


Stomach diagram in Inkscape.
(Photo credit: Wikipedia)

If a drug is administered via injection or as through the bow, the drug gets into the blood faster and the effect is generally quicker--thirty minutes or less. 

If you have a heroine who realizes they been drugged orally, they can prevent some absorption by inducing vomiting with ipecac if it's available. Another way to would be to induce the gag reflex by sticking their fingers down the throat. There are other ways to induce vomiting but their effectiveness is questionable. A mustard and water mixture, strong saline solution, even watching another person vomit can induce vomiting. If a drug has been administered by injection unless that drug has a specific antidote or reversal agent (like opiods) then there's not much she can do.

Fiona - 
I'm assuming the ingested foods that would slow absorption would be fatty?

David - 
Yes, the fattier or heavier the food, generally the longer it will delay absorption

Fiona - 

(229/365) Daily injection
(Photo credit: Sarah G...)
So even if they are shot with a dart or given a shot, they are not going to look down at the injection spot, roll their eyes back in their heads, and pass out. 

Can you tell me what a typical reaction to a drug that causes unconsciousness would be... in that thirty minutes of time could they speak? Would they slur? Are their thoughts cogent and linear? Do they lose balance, coordination, focus? Could they for example be in a gun fight ...

David -
As for the injection or the dart, perhaps ten or fifteen minutes would be a better estimate. When someone is injected, it goes into the muscle. From there it has to be absorbed through the muscle into the blood stream. This is generally very fast. If I were to inject you 
with say Demerol for pain, you would be coherent for ten minutes or so, then you would feel groggy and become less coordinated. You could still function for these few minutes before the drug takes effect. 

English: Close-up of 0.5mg tablets of the bran...
 Ativan. Generic name is Lorazepam. (Photo credit: Wikipedia)
Now, if you inject the drug into the vein directly (IV), the drug is immediately delivered into the blood stream, goes to the brain, and the effect is much, much quicker. Usually less than one minute. Some good drugs for tranquilizers: 
* Midazolam 
* Lorazepan (Ativan) 
* Any kind of pain killer, especially codeine, morphine. 

Then there's the old favorite, choral hydrate (not used much any more)...when taken with alcohol...it is what was referred to as a mickie... effects is very rapid. Naturally, when you combine these drugs with alcohol which may be the case in plots, the effects are sped up.

Fiona - 
What are some of the more comic/bizarre reactions that you've read about heard of from a drug reaction?

David - 
I've had several funny instances in terms of drug reactions.

viagra is a commercial produced medicine conta...
. (Photo credit: Wikipedia)
The most memorable involves a gentleman who for some reason developed priapism (which is an erection lasting more than four hours). Yes, this is what they say on the Viagra commercial. Priapism is considered a urological emergency and treatment must be immediate. It can be induced by various medications or conditions. 

In this man's case it was a drug called Trazodone which was once used for depression, but is used more for sleep these days. He went to the doctor to have the priapism treated after he showed up at my pharmacy. He limped in, bent at the waist. I asked what was wrong and he stood a little more erect (pun intended) and showed me the "pup tent" in his pants. He said it had been like that for about an hour and a half. He tried to smile (as it is quite painful) and asked if he should I call his girlfriend. I called an ambulance for him, and they took him to the ER. There, they had to insert a needle directly into his penis to drain the fluid
that was blocked in the cavernosum! Ouch!

Fiona - 
LOL I was going to ask you about the four-hour rule! So it's painful - not a pleasurable - 4 hour stint, and a helper would not in fact help?

David -
Yes, priapism is incredibly painful...or so I'm told. I never had the pleasure... or pain of experiencing it. Not a situation where you'd want to call all the women in your life!

Fiona - 
No - not all of them surely - one, maybe two...

David -
I've also had several instances with patients taking sleeping medication..getting up in the night (sleep walk) go shopping and drive around...without ever having remembered the incident. 

Then there was the well-endowed woman who had an allergic reaction to an antobiotic. She said she had a rash and didn't know what it was. I asked if she could show it to me. She promptly lifted her shirt (no bra) and showed me her rash.

Fiona - 
A rash decision, I think.

David - 
I also had a woman who complained once that she was having some problems with the suppositories she received from us several years back. She was an elderly lady. She said the supp were hurting when she used them. She brought the used 
supp in (Fiona interrupts, USED? Ugh!) and showed them to me. Using my well-honed clinical skills, I was able to determine what the problem was. I said to her, "Mrs. Jones (named changed), you have to remove the wrapper before you insert the suppository. Now when I type the labels I type, "unwrap and insert one suppository." I've been doing that for about ten years now. I've never had another problem after that.

Fiona - 
What are some ways legal and not so very legal that a villain could get hold of drugs to administer for their nefarious plans?

David - 
One way for a villain to obtain drugs is through doctor shopping. We see this a lot in pharmacy. People shop around for doctors that will prescribe the medicine they want. They take it to the pharmacy and get them filled then sell or use them on the street. 

Another way would be buying medications from a corrupt pharmacist without a prescription. 

Stealing them from friends or family members who use the drugs legitimately. 

Nurses can steal them, doctors as well. 

Amazon Link








Perhaps through a college campus if they are using stimulants.

Fiona - 
Would it be hard for someone to double or triple dip? Go to several doctors to get pain pills etc. that they were abusing? Or would this show up in a system somewhere?

David -

No it would not be hard to double or triple dip.


There is monitoring program called the Prescription Monitoring Program in which all pharmacies submit prescription data to the state. Pharmacists and doctors can access the info in it. Someone can still get pills without being detected if the pharmacy or MD do not check the website. The program does not automatically warn doctors or pharmacists; they have to take the time to go into the site. This usually happens when we become suspicious of a patient. But not everyone accesses it.
Fiona - 
Tell me abut your writing. Pharmacy and writing seem to be worlds apart.


David - 

I find writing to be an incredible outlet for creativity. It is different from pharmacy in the sense that as a pharmacist I respond to patients and doctors and prescriptions. Where as in my writing, I can really explore my creative side and use pharmacy in ways I never imagined. 

I plan on continuing my writing. I am currently at work on the sequel to The Cyclops Conspiracy which will be out in paperback in Feb 2015. readers can check out my website: www.davidperrybooks.com or find me on Facebook. And I'd love to help with any medicine or pharmacy related questions or issues.

Fiona -
David, that's incredibly generous of you. 



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9 comments:

  1. Fascinating post. I'm amazed that I got my research right, since I've used both midazolam and ativan in recent plots!

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    Replies
    1. Thank you kindly for stopping by, Debbie. Glad to know you've been verified. You're welcome to put up your book and link.

      Cheers!
      Fiona

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  2. Such an interesting idea for fiction! I'll have to check it out. Great interview <3

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  3. How precise does drugging someone have to be if you're trying to just knock them out? What is the fine line between just dazing them, overdosing and killing them or doing serious harm, and actually getting it right?

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    1. History Rebel: Depending on the medication you are talking about, the effect of "dazing" them can be a side effect or the primary effect of the drug itself and can be obtained with regular appropriate dosing of that medication. Any medication with the ability to create drowsiness or sedation can accomplish that task (a good example would be diphenhydramine which is Benadryl). As an antihistamine, diphenhydramine can be used to induce sleep. A normal adult dose would cause lethargy and somnolence. If you gave them and extra dose or two at the same time, there would not be much danger to the "patient" other than the drowsiness. Now if the the character were to attempt to drive a car that might lead to serious harm.

      The fine line you mention most often is not as fine as you think. Most medications require massive doses to do serious harm. There are exceptions to this rule however. If you are attempting to harm one of your characters there are drugs you can administer in generous doses to make this happen such as opiods (morphine, codeine etc).

      In your writing, I don't think your readers will delve deeply into the exact dosing of a medication, unless you are writing about a drug in particular. If you have questions about the specific doses of medications (both safe and dangerous doses) I'd be happy to answer more specifically.

      Also, please realize that the dosing of medications is not an exact science. Depending on the medication, you might be able to give a large dose to a two hundred and fifty pound man and not see much of an effect. But if you gave the same dose to a one hundred pound woman, the effect could be dramatically different. Some drugs are based on weight, and other drugs are not affected by how much a patient weighs. There are many factors that go into dosing which are too complicated to go into here.

      Hope this helps. Please feel free to let me know if I can provide any more info. Stay well. www.davidperrybooks.com

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    2. Thanks for the response. I actually thought weight would play a bigger part in the effectiveness of most drugs.

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  4. Unwrap before using. Brilliant! =) Great article and interview.

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  5. Good stuff. Too many people treat drug use in the same manner--with the same characteristics--as alcohol use. When the effects are often markedly different. My car-thief-turned heister is addicted to codeine which is probably the closest in effect to alcohol and still WAY different. Thanks for sharing.

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