Your world with Dr. Beatrice Hyppolite
Hello,
I am Dr. Marie Beatrice Hyppolite. I hold a doctorate in Health Science with emphasis on Global Health and master’s degree in social work. I have over 14 years of experience in the field of health and human services.
This podcast is primarily focused on mental health and the quality-of-life elements that affect it such as divorce, death, domestic violence, trauma, toxic relationships, and single parenthood to name a few. It is no secret that mental health challenges continue to profoundly impact modern society although not enough discussion is given due to stigma. Research has shown an increase of 25 % in mental health crises after COVID-19. It is important to have honest, uncomfortable conversations about mental health while being supportive. Although we are interdependent, change begins with the individual, hence “your world.”
I welcome you to join me on my journey and look forward to your responses.
Your world with Dr. Beatrice Hyppolite
Pharmacology and Drug Efficacy in Modern Medicine
Ever wondered why a medication that works wonders for one person might not have the same effect on another? Esteemed pharmacologist Dr. Mario Gustave returns to unpack the complexities of pharmacology in modern medicine. Prepare to challenge your understanding of drug efficacy as we explore factors such as age, ethnicity, and genetics that play a vital role in how medications work. Discover the startling reality behind the 100,000 drug-related injuries that occur annually and the urgent need for preventive measures, particularly in communities with limited resources.
Join us as we navigate the fascinating world of drug absorption and distribution in the human body. From the impact of body fat and proteins on medication storage to the importance of lifestyle changes over pharmaceuticals, our conversation highlights the significance of preventive healthcare. Hear compelling stories of individuals managing health conditions through non-medication approaches and learn how countries like Canada, Cuba, and the United States approach the balance of healthcare differently.
In the final segments, we delve into the critical nature of understanding medication side effects and adherence. Dr. Gustave shares invaluable insights on prescribing antipsychotic medications, focusing on the importance of patient education and starting with minimal doses to avoid unwanted side effects. With a focus on communication with healthcare providers and staying informed about the latest research, this episode equips both patients and providers with the knowledge needed for effective and safe treatment. Don’t miss this enlightening discussion that promises to elevate your understanding of pharmacology and its role in your health journey.
Hello everyone. I'm Dr Beatrice Ippolit, and this is your World. Today we have the privilege to have back on the show Dr Mario Gustav. Last time Dr Gustav was with us, we spoke about neurological disorder, and today he's here to talk about pharmacology. Welcome back.
Speaker 2:Thank you, it's really my pleasure to be here. Thanks for the invitation, because I have a good interest in education, rehabilitation. I think the preventive measure in medicine will help a lot, especially in the community with not enough means to address your problem. So I just want to start by a few statements of people we need to know. There's maybe 100,000 injuries every single year in this country due to drug administration, to drug addiction. So I think it's too many. We can help by decreasing those injuries. They involve death. Actually, around 60 years of age, people in average get maybe seven medications High blood pressure, diabetes, arthritis, a lot of medications and then it's important to know good versions of those medications, those medications. But unfortunately sometimes you have problems with culture, with bad habit, and that's that's another problem, you see, because medication should be individualized and your neighbor did well with ex-medication mean you're going to do well with the same medication for the same problem. It's important that people understand that part. I'm going to tell you why.
Speaker 1:So basically you're telling me so if you're taking a medication for high blood pressure and even myself suffering with high blood pressure I cannot decide to take your medication just because I cannot find my or I'm wanting out of medication.
Speaker 2:That's exactly what I'm saying and, like I said once again, the choice of medication depends on so many factors your age that will play a big role your ethnicity. Let me give you an example so you can understand. Like we're talking about blood pressure, we have two medications that work better in the Caucasian, like the ACE inhibitor, the beta blocker, work better for them, whereas black people we got the calcium channel blocker, the diuretic. It's just based on the ethnicity that can make a difference. What about gender? If you're male, if you maybe can resist to alcohol twice compared to a female because your level of metabolism is a little stronger, if I can use that word? It's not the right word, I'm sorry, but let's put it like that. I'm going to give you another example of what happened. That was in 2008, when America had 17 studies. They said if you give a group of medication called antipsychotic in the elderly with dementia, you increase death. They got 17 studies. Canada has 13 studies saying the same thing. 13 studies saying the same thing. Therefore, fda said you know what? We should not prescribe antipsychotics in the elderly with dementia unless we don't have another choice. I cannot believe.
Speaker 2:In Korea, the finding is the opposite. They find antipsychotics protect people, the elderly, with dementia. How come? It doesn't make sense If you don't understand what I'm trying to tell you. Medication got to be individualized. Your neighbor take that medication doesn't mean it's going to work for you. Your mother suffer of high blood pressure. You suffer of high blood pressure. You more likely do have good results with your mother's medication compared to your neighbor's medication because you have the same genetic predisposition in some aspect. So we got some bad habits.
Speaker 2:Like I said again, sometimes people use the medication for the side effect, not so much it got good indication. I'm telling you, like the elderly, usually they use Tylenol 3 to sleep. Tylenol 3 is not to sleep, is for pain, but one of the side effect is to make people sleepy, so they use it for sleep. I think that's a little dangerous. If you ask me, the topic is so important. I'm just going to try to use a way people can understand what I'm saying. To me, pharmacology is a date between a foreigner and a local. Let me explain what I mean. Your body got one objective. The drug you're taking got another objective. Body got only 100. I need to get that thing out.
Speaker 1:I need to do any deportation I need to you need to get better.
Speaker 2:You need to improve no, I'm talking about between your body and the drug you're taking. I said it's like a date, two people's right. Your body doesn't like foreign substance. I'm going to make everything possible to get that migrant out To reject that foreign object.
Speaker 2:Oh yeah, and the drug said I'm going to try my best to change that aspect of you, to change that aspect of you. So if you talk about medicine, what your body is doing, they call it pharmacokinetics. But for us, for today, let me tell you what your body is doing. It tries to get rid of that substance. Let's put it that way. Forget about pharmacokinetics, right? And what about the drug? What the drug is doing, whatever the drug is doing, they call it pharmacodynamics. Forget about pharmacodynamics. What the drug is doing is to try to make change, to modify things. I hope people can understand. Your body won't get really want to get rid of the drug. The drug want to change your body. We'll put it that way. So all is going to get rid of the drugs. It's going to use a lot of strategies Absorb the drug, distribute the drug, metabolize the drug, elize the drug, eliminate the drug. Four things, If I can repeat again absorption, distribution, metabolize, elimination, absorption.
Speaker 2:All people absorb drugs. There's many ways people can absorb drugs. The most common one is by mouth. That's the one mostly we use, but sometimes you can use also by your rib-tongues. Sometimes we can use also sublingual. You put the jug under the tongue and I'm gonna tell you why. Sometimes there is the different aspect to treat people. Sometimes it can be buccal. They put it in your mouth, sometimes it could be parenteral. What does that mean? They're not going to use your mouth or your rectum. They're going to use, maybe another way.
Speaker 2:It could be intramuscular. They give it in your muscle. It could be intradermis, because your skin got a lot of layers. It could be just over your skin, some cream you're going to and then just put it on your skin. It could be intravenous. Put it on your skin, it could be intravenous. All of those stuff, all of those modalities, they got the good thing and the bad things. When you take that drug by mouth, the drug got to go to the bloodstream, but before that it's gonna go to the liver. The liver has a problem if, if you come here, you're going to pay tax. If I take 100 mg of drugs. When you get to the liver, the liver is going to take some, so you won't have 100 mg.
Speaker 1:So basically it's a must when, whatever medication that you take, he has to go through the liver first through the liver first, depending on how I use that medication.
Speaker 2:If I use it intravenous, the liver is out. If I use it intramuscular, the liver is out. Some lingual the liver is out because he could. It's the pain, it's the pain of the way For some people. I need to choose the best way to administer the drugs. If you have a liver problem, I'm trying to stay away from the liver. I'm trying to give you a drug that will not go to the liver. You got surgery. If they remove your stomach, right, I need to find a way for that drug to get to the bloodstream without using your stomach, because it's very important. To absorb the drug is very important you have the secretion of acid that help in the process. If you don't have that, that will make them so difficult.
Speaker 1:If you hold, there's a little problem the acidity of your say if you're old, what age would you?
Speaker 2:consider Usually after 60. So the acidity is different. So your absorption compared to the younger population will be different. The movement of your intestine will be different. It's slower compared to the young population. So when I'm gonna give you drug, if you're 25, you're 60, I cannot give the drug the same way or the same dosage most of the time because we're different. We're gonna process, access the drug differently. So all those factors need to be taken into consideration when I'm giving medication. Like I said again, people work at Kings County, not even doing some support service, but there are doctors in the block. If the neighbor got problem they will go to them and things that we need to prevent that. That can be very dangerous for why I just explained. So we're talking about absorption. Absorption will be different depending on your age, depending on your condition. If you have liver problem, if you have a stomach cancer, if you have, it's gonna be different. It's not the same thing.
Speaker 1:Okay If I were to ask this question. I understand people take medication because there is a medical condition going on, and that's why it is important for people to take medication. But what will happen, you know, if I were to be prescribed, you know, to take this or that specific medication and I will not follow the requirement as it was indicated?
Speaker 2:Alright, you remember at the beginning we said there's 100,000 injuries in this country every year due to drug administration. That's part of it. We got a lot of people who discharge and will come back to the hospital. What's the reason? Exactly what you said. They don't follow the recommendation. And I'm going to give you an example. It wasn't even there, but I have to do it right now.
Speaker 2:Let's say, we got some people with psychosis and they have a hard time to treat them and they end up to give them medication the last resort medication called Clozoril and unfortunately that patient is a smoker. When you discharge your patient, the first thing he's gonna do is to buy cigarettes right when he's gonna smoke that cigarette. What's gonna happen? There's something called an inducer. The cigarette will be an inducer for the enzymatic system in your body. It's going to make the system work more rapidly. You think your patient got closure at 10, or because of the smoking, maybe it's at 2 or 3. That patient will come back to you right away because of that interaction between the cigarette smoking and the medication.
Speaker 1:What about if it was a different drugs, let's say weed, alcohol or what have you so what? You know what we're?
Speaker 2:gonna. That's part of the presentation we're gonna talk about that. We're about drug drug interaction. Okay, that's a very important concept. Drug drug interactions can be very dangerous, very, very dangerous. You're not gonna believe it. The most popular one I can tell you is you're gonna give somebody lithium with an NSAID. That's a big problem. You can lose that patient. So that interactions will create a lot of problem. We're going to discuss uh, so, so we're done with absorption. Absorption, like I said, is take the drug and get it to your bloodstream. That's what we call absorption. But the drug is not for the bloodstream. Maybe it's going to go to a tissue, a tissue that is the repair, right. So they will be going to distribution, right? How are you going to distribute that drug? Once again, that depends. That depends on your age, that depends on your weight, that depends on your gender, that depends on your ethnicity.
Speaker 1:Your heart has what.
Speaker 2:Weight More than high.
Speaker 1:Does your high have a wall?
Speaker 2:Why are you talking about high? You want to. I'm short already, so so I was saying that that will depend on your weight. Wait, what I'm saying is that many of the those drug are lipofueling. That means they will go to the fat tissue, right? You take the drug the first day nothing happened. Second day, nothing happened. One week, nothing happened. That medication is not working.
Speaker 2:If you're not aware of that concept, they're gonna increase the medication, all right, but the medication is there. The only thing, the medication that work is the free medication, not the one in your fat tissue combined to proteins such as albumin, right? And when the fat tissue is saturated, what's going to happen? It's going to reach back like drug to the blood stream and right there, that's intoxication, because you got more drug available right now for action than before. So people need to take that in consideration. Let's say those drugs also are different. Some of them they are absorbed from the stomach, some of them from the colon. You need to know that what drug is going to go, where going to be absorbed, where the distribution, so on, and again will depend on your nutrition.
Speaker 1:That what drug is gonna go where gonna be absorbed, where the distribution, so on, again will depend of your nutrition but, dr Gustav, when you go to the doctors for whatever medical condition that you may, go to that doctor and medication was prescribed. They normally don't educate you or inform you. They just give you medication. So how people going to know about all of that you just mentioned?
Speaker 2:That will be a different topic to discuss, because I have to tell you we really don't want to discuss that one. There's a lot of politics involved. In some countries like Canada, they will do more prevention than proactive medicine. They will try to prevent you to get sick. Cuba they will try to prevent you to get sick In America. You're going to the doctor. In Cuba, the doctor is coming to you. That's a different thing, different result.
Speaker 1:They don't have money, they don't have the resources that we have, but the prevention pays so much, is cheaper and is more effective exactly because if I know that if you drink two cup of coffee, that can increase your blood pressure, so I will, instead of letting you drink two cup of coffee, I'll help you at least have one cup or half of a cup, just to prevent you from getting in that condition exactly.
Speaker 2:You don't need that condition. I don't need to wait until you get high blood pressure to treat you with medication for high blood pressure. What about if I tell you you know what? Maybe you should decrease your coffee? I'm telling you that even you don't have blood pressure. But I'm doing prevention telling. Oh, maybe a little exercise will help. I'm not. You don't have a brother. I'm trying to prevent that. Yeah, it's more. It's really cheaper compared to those medication drugs. Once again, it's a law politics. I don't want to do that.
Speaker 1:It's like before I let you go. So I remember one time I took a friend of mine who was pregnant at that time, to the doctor and she was prescribed a bunch of medication and for whatever reason, she decided you know how many that she was going to and so for her alone, to my surprise, when she went back to the doctor after the second, the seven days time bracket that was giving to her to take the entire battle, and she told the doctor I only took this amount and the doctor was like okay, okay.
Speaker 2:There's a lot of anecdotes, things like that. I got a good friend of mine with high cholesterol. He was prescribed medication for high cholesterol. He said not me, let me go exercise. But the guy is good, he knows what he's doing, 45 minutes a day, he will do it no matter what. Went to the doctor, the cholesterol was good. That said continue to take the meds, that's good, but I never take the meds.
Speaker 1:he was exercising 45 minutes yeah so he knows that you know, by exercising or cutting down on whatever like data, like dairy, if you suffer cholesterol, there are a lot of food, like greasy food that you know that you have to stay away from. By staying away from those greasy food or dairy food, plus exercising 45 minutes a day, so that's even way much better than taking medication.
Speaker 2:Yeah, because those medication don't get me wrong. I'm not saying I'm not against medication, not at all. All I'm saying we can do prevention. We can do a lot of non-medication approach. When they fail, when we don't have any other option as a last resort, at that time I will take medication. It can't be your first step. That's the way I've seen it.
Speaker 1:But oftentimes, you know, as a patient, I may not know, because I just go to your office and I explain what my conditions are and you decide, hey, you may suffer from this, so you may send me, you know, to the lab to have some blood test one and what have you and sooner or later, so medication may be prescribed I have no problem with that.
Speaker 2:But, like I said again, sometimes we have to try the non-medication approach I will have been best, of course.
Speaker 2:Anyway, no more politics. So I was a. I said the distribution of the medication depends on a lot of factors your weight, medication, fat tissue. Fat tissue gets saturated, release the medication plus the one you're taking, so you get intoxicated Because of that. You don't take consideration of your weight. If you malnourish, you don't have protein, you don't have enough protein. So most of the medications sometimes is combined to albumin, which is a protein in your blood. Guess what happened? If you don't have enough albumin to combine with your medication, you're gonna have more medication available for action in your blood, right? That's another problem also. So even your nutrition is part of the parameters you're going to use to medicate.
Speaker 2:And then about metabolism, what your body is doing to judge. Like I said, all you're trying to do is get rid of the medication. When the medication gets to your body, the liver is going to use a lot of strategies like oxidation reduction to make the medication more soluble, more water soluble, so it can eliminate that medication. But in the liver also there's a system enzymatic that help with the metabolism. That's what I'm saying when you take more than one medication. Sometimes one medication can act on that system, make the system more active. We call it an inducer because he make that system more active.
Speaker 2:You take medication a that I can resist and make it more active and take medication be. The system is gonna meet or metabolize a medication be rapidly. You something. You're not getting the treatment. I don't know if I'm clear enough. There's a system enzymatic on your liver that help metabolize the drugs, but some drugs unfortunately enter a cavity with that system and can make the system work more rapidly and then it's gonna neutralize medication very rapidly. You think you're taking the medication. The medication is not effective because of what I said. Those are inducers, right, but you got medication also. They are inhibitors. You know what they do. They slow down the system. You take medication A. Medication A slows down the system. You take medication B when you take medication a medication a slow down the system. You take medication b. When you take medication b is still in this is still in the system longer than you think. You get intoxicated because the medication stay longer in your system and we got very dangerous medication where we have that problem, like medication like warfarin.
Speaker 1:So when a situation like that occurs, will, as the patient or the person taking the medication, will I have an understanding of what's going on?
Speaker 2:Not at all.
Speaker 1:That's a worse part of it, you're taking the medication, your problem remains.
Speaker 2:You're not gonna say, oh, that's because my cytochrome before 50 is not working. No, nobody's gonna take about that.
Speaker 1:So it's like you know, if the medication is not working now, I go back to the doctor increase the medication instead of considering or looking at the reason why the medication is not working I'm pretty sure that the doctor probably know. But instead of considering, you know, to look at the problem, they will just increase the medication.
Speaker 2:I don't know what they're going to do. All I know, sometimes those medications interact with each other. I can give you a list of them that interact with each other. I give you lithium and instead you cannot give those two together. That's a problem. Valproate oh man, you cannot give valproate with a few medication. There's a lot of them like that, uh, phosphine phento, in those medication.
Speaker 2:When you give them, you better make sure you know what other medication the patient is taking, not know what other medication the patient is taking. Not only what other medication the patient is taking. You have to ask do you buy any medication over the counter? Because some patients use their own things, maybe culture from their culture, from the things? Because, uh, there's a few of them. I know, have you ever heard of saint john or something? No, all right, anyway, we don't all.
Speaker 2:I'm saying medication, canada with medication, and I'm gonna tell you the number again 100,000 injuries every single year in this country because of drug-drug interaction. So people should be careful about it. So we're talking about the metabolism and then after that the excretion of the medication. Usually it's by the kidney. What the liver is doing. The liver makes the medication water-soluble. Water-soluble, the excretion can be easy, you send the patient out. Sometimes the liver uses another strategy called conjugation. It adds another molecule, another radical, to the molecules and can excrete it in your cell, things like that. So that's like I was saying again when you get to 60 years of age, taking maybe seven, eight medications, if you're not, at least at least your blood pressure, your diabetes, your cholesterol, it's going to be all done.
Speaker 1:If you reach that age, you are not taking that amount of medication. You should consider yourself as being low-key.
Speaker 2:Oh my God, that would be rare. I think that would be very rare. I always what happens with medication, the way they act. They use something called nomitters.
Speaker 1:Dr Gustav, while you mention that, you say when someone reaches the age of 60, some medical conditions will come with age.
Speaker 2:Of course Some are age-dependent. If you live long enough, there's a few organs you're going to have some deficits, some weakness. It's like you have a car. Sometimes you need to change the starter. Unfortunately, we cannot go to change the starter. Unfortunately we cannot go and change part of your body like that. They don't function the same way they used to. We have to admit that. Like I said, you remember at a younger age you can go to the supermarket and buy your thing. Now I won't take that chance. If I go to the supermarket, I have to write what I'm going to buy. There's nothing wrong with that. He's age-dependent. He's not working the same way he used to work.
Speaker 1:You have to admit that You're afraid that you may go back home and forget to buy.
Speaker 2:Of course you're going to forget Of that, of course.
Speaker 1:You need it to buy Okay.
Speaker 2:And another thing also I'm a male. Our brain has got some issues also.
Speaker 1:Compared to female.
Speaker 2:Compared to female. I'm sorry it's not scientific what I'm going to say. Please do not quote me. Nobody should quote me, but we don't pay attention to details. I don't think male will take it. The female, they are better on that. I'm sorry it's not scientific, all right. Male, we take the female, they are better on that. I'm sorry it's not scientific, all right. Uh, so I was saying medication sometimes use what we call neurotransmitters.
Speaker 2:Right, the neurotransmitters it to make me do what I want to do. And then those neurotransmitters they got so many steps they can mess up. I just want to take one so people can understand. Instead of taking a drug medication, talk about it. I'm taking a neurotransmitter that use many medication and then people can understand what I'm saying. Let's talk about. Sometimes we there's a neurotransmitter called acetylcholine. Acetylcholine is a combination of a molecule produced by something called mitochondria in the cells, acetyl-coa, and in my diet I got something called choline. The combination with an enzyme gives me acetylcholine called choline. The combination with an enzyme give me acetylcholine. All I'm gonna ask people to remember. Acetylcholine play a very important role in memory, in learning, in concentration, in analgesia. That's all I'm gonna ask people to remember learning, memory, concentration and anesthesia. What I'm saying? I'm saying if the process, if acetylcholine has some deficit or problem in the process, you may impair those four things.
Speaker 1:I just tell you, not the four of them at the same time.
Speaker 2:It doesn't have to.
Speaker 1:Okay.
Speaker 2:Memory, learning, concentration and anesthesiaia and that happened. That will lead to diseases, right, like we know now. If you are don't have enough acetylcholine we know what happened with your memory. You know that can lead to alzheimer's right. But it's not the only one. We have dopamine, also another neurotransmit't know what to say. I'm not going to discuss dopamine, I'm just saying Dopamine. If you don't have enough dopamine, you may have Parkinson's, because it's important in the movement, in the execution of the movement. It's so important I cannot describe how important is dopamine. That's the one that reinforce the movement you want to do and that don't stop the movement you don't want. Think about, if you have a problem in the release of dopamine, what will happen. But we're not gonna discuss that one. This is a different topic, like I said, is the physiopathology of parkinson's disease. We don't need to discuss that.
Speaker 2:Let's talk about acetylcholine. He said that's very, very important. I told you those neurotransmitters. They help the organ to function the way. But acetylcholine cannot do the thing by itself. In order for acetylcholine to work, it needs to react with something called a receptor. I'm going to ask people one again to understand. There's many types of receptors acetylcholine can work with. We got two big groups. We got the nicotinic one, we got the muscarinic one. All I'm saying is that acetylcholine, when released, is going to stimulate some receptor and then act on the organ. Let me give you an example. If you release acetylcholine, it's going to interact with your heart. It's going to slow down your heart. At the same time, on your lungs it's going to const down your heart. At the same time, on your lungs it's going to constrict the bronchioles.
Speaker 1:It's going to increase secretions in your lungs. So what factors do you normally consider when you prescribe medication to patients?
Speaker 2:Make corrections of those deficits. If somebody got too much acetylcholine, I need to do something and that happened. That happened and unfortunately the army, those people, the people who were doing war, they know that too. They use a substance called ecotropat. The ecotropat will make you release a lot of acetylcholine. You remember I just told you acetylcholine make you increase secretions in your lungs. That's exactly what happened. They will die because it's like drawn in your own liquid.
Speaker 2:I was saying that neurotransmitter gonna interact with some receptors and create some effect, like on your heart, on your lungs, almost everywhere, everywhere. I think people should know what increases that substance and what decreases that substance. You know the best way. I'm going to ask people just to remember, please. Too much acid to call in, remember it's water everywhere, meaning what? Increased salivation, diarrhea, increased diarrhea and urination everywhere you're gonna have increase of secretions, nothing of acetylcholine. Dryness everywhere, meaning constipation everywhere, dry mouth. Those are things you can see. Those are things that can affect people in not a very good way, that people need to address. But I prefer that to be addressed by your doctor most of the time because, as you can see, those maneuvers they are non-innocent maneuvers.
Speaker 1:Bad thing can happen if you don't know how to do those things you know, by listening to you talking, dr Gustav, an idea just pop up. I believe that everybody should have the capability to, basically, when they are prescribed with medication, to do research about the side effects, to do research about you know the impact that can cause to the bodies.
Speaker 2:That could be a good thing, but everything got good and bad thing at the same time, because every medication they will give you will have a paper with Many of the things I'm saying. But who's going to read them? I know, not me. So what I'm saying?
Speaker 1:is, and that's where we probably do the most harm to ourselves. Yeah, because the instruction is there for a reason.
Speaker 2:Yes, but because of politics, because of legal issues, the instruction, even the instruction. You know what they're going to do. They're going to do, they're going to put everything in that paper, even something that happened one on a million. They're going to put it on the paper because they don't want to get sued. So sometimes you got people coming I'm not going to take that medication because it's doing that. That happened early and we got ways to address the problem. I'm not going to take that medication. When I take the medication, I jewel. I'll give you an example Closure will make you jewel a lot. No, but we got a way to address the problem.
Speaker 1:You know why you mentioned that the patient come and say that I'm not taking that medication. I remember once I had a similar reaction. I had a bad cold. After a few weeks I realized the cold will not go anywhere. I decided to go to the doctor and I was prescribed with some medication and when I read the instructions there were two few side effects, but two of them were like stroke and heart attack.
Speaker 2:Who's going to take that medication?
Speaker 1:And I'm like, oh, just for a simple cold, you know. So it's like and I'm like, but I did take it one time. That one time I had such a headache and I'm like you know what, before that headache turned into something, I just waste the bottle somewhere. So sometimes, you know, I understand the side effects of the medication can really scare people what they forget to tell you.
Speaker 2:that happened maybe 50 years ago in one patient. That's what they will tell you. That thing because they don't want to take any chance, they don't want to get sued. I told you look at that. Usually it's a very fine, small character, but I think people should get educated about the medication. The most common reason people will stop taking their meds is because of side effects. They are not educated about the side effects of the meds. If I tell you you know what? When you take that medication it's possible you're going to go home, you're going to drool a lot when you drool, I think it's better if the doctor forgets to tell you that and he says what happened, I thought look what happened to me. When you take that medication you may have a little cramps. So just I think that's better.
Speaker 1:You'll be better off to know it's a possibility you have that side effect than not knowing anything yeah, because you know you already got a heads up of what's gonna happen after you take that medication so, once again, if people need to remember about that presentation, they need to remember there is 100 000 injuries in this country because of drug interaction, drug drug interactions, so people should be careful.
Speaker 2:And then medication got to be individualized. You work for your neighbor doesn't mean it's gonna to work for you. And then about the side effect we discussed. Please discuss that with your doctor.
Speaker 1:And I have one question. So can you describe your approach to manage medication side effect?
Speaker 2:Yes, education.
Speaker 1:Okay.
Speaker 2:That's about education. I'm going to tell you what's possible and what to do. The first thing to do is to call me.
Speaker 1:Okay, I understand I can call you if I experience any side effects, but while you're prescribing me that medication, you don't think that that would be the best time to educate me, at least for two minutes, two minutes or five minutes, of course, that's what I'm saying so, I'm gonna try to discover the possible side effect, the most common one, and ask you to call.
Speaker 2:Don't try to address it by yourself. That's another thing. Please don't do it. Some of them are easily. Let me tell you about the dissonant reaction. That's something you get when you get an antipsychotic. It's a scary thing. You got a contraction of a reaction. That's something you get when you get an antipsychotic. It's a scary thing. You got a contraction of a good muscle. That thing can be treated in five minutes. A little Benadryl, a little Congentine. After five minutes you're okay. But if you don't know that, if you don't discuss that with your doctor, if you don't call your doctor to tell you what to do, that's a problem because, like I said, it's a little scary. If you say it it's a little scary.
Speaker 1:My next question can you discuss the role of antipsychotics in treating bipolar disorder?
Speaker 2:All right. The problem with antipsychotics what they are doing? They try to modulate the dopamine. So when you take they block one type of dopamine, that's dopamine d2. That dopamine is going on five different track. You got one track that's an agostrata. Look at the tubular and fungibular. We got five, one that you can block. That's why you got side effect, because actually if you can have one selective one that can block the one that gives you trouble, that will be better. But it will block all the track, right, all the five track. So that's where the side effect comes most of the time okay like you block the tubeo and fungibre track.
Speaker 2:You know what's happen. We got people who got actoria, meaning milk in the breast, things like that Male or female right. So we don't need that. Is that the reason we give it? If we can find a way to give it and prevent the antipsychotic to block that tract, that would be nice.
Speaker 1:That would be okay. Anti-psychotic to block that track? That would be nice, okay. So my next question how do you monitor and adjust medication regimen to optimize treatment?
Speaker 2:outcome you start with the lowest level of medication. You start low, you go slow break that down down.
Speaker 1:You know more for me to understand.
Speaker 2:There's no reason to go and start with the maximum dose of medication. It doesn't even make sense because you don't know what was those the patient. Your patient will respond. Like I told you, medication got to be individualized. Some people respond to one milligram of Whispadol, example. Some people need maybe four milligram of risperdal, for example. Some people need maybe four milligrams. That's happened, so I'm not going to start with the maximum dose. And the maximum dose is the one that usually comes with the side effects. That's the one that comes with the side effects, Especially at the beginning. There's no reason, there's no watch to coincide with a high dose of medication.
Speaker 1:When you say especially at the beginning, it's probably because it's a foreign object so it's like your body is new to it.
Speaker 2:Not only that, it's foreign to your body. It's going to do whatever it can. Too many of them, let's react. It's a wall. It's like a wall, okay.
Speaker 1:Would you consider that it's like taking drugs you know for the first time?
Speaker 2:Of course, that's exactly what it is. That's exactly it.
Speaker 1:Okay, so how do you stay current with that new development and research in that area?
Speaker 2:You have to go to those conferences when you got to continue to read the new papers, things like that, so that's the best way to do it conference. Uh, you know and we do and follow the whatever that?
Speaker 1:uh, we sent research that was available in that regard definitely, but no, that's very important about research.
Speaker 2:You need to know exactly what you're gonna read. I'm sorry you come up with it. I have to explain it because that very important. If you google any type of topic right now in medicine, you're gonna see maybe 1,000, 20, 20,000 papers. We're going to see a lot of papers on that topic. Do you have to read all of them? No, not at all. Not all of them are very good papers. So you need to know how to choose a good paper. Let me continue to make sure.
Speaker 2:Some studies. There's different type of studies. There's studies like a case report. I'm going to take an example. A case report. I'm gonna take an example.
Speaker 2:A case report is something you see in one patient, right, and you say, oh, I never seen that. Usually when I give antipsychotic, I have seen that. Let me write a paper about it. It's a very weak study because this is just one patient. You don't even know if what you're saying is because of what you did. That's just a case report. Can we take that in consideration? Yes, yes, for what reason? To have further, better study to find out if what you saw was something valid or something? So I'm not going to read your case report. I don't have time to read your case report.
Speaker 2:What about your case series? A case service is more than one case. Is it a good study? Is it a weak study? And that can create a lot of trouble. I'm going to give you a case in 79. There's five men in three Los Angeles hospitals. They developed PCP. They are losing weight. They are homosexual. They are people. They didn't know what was going on at that time. They were accusing community. Oh, those are those communities. They are the ones responsible. I'm talking about the beginning of HIV. They were so wrong in those case studies. They were wrong. They were wrong. They come with four ages, if you remember. That's so inappropriate, so mean to take a case series instead of doing further studies. Like I said, just think, publish that and make decisions on that To come up with a conclusion.
Speaker 1:No, that's wrong. That could further down arm other people.
Speaker 2:They have other type of study, like a cross-sectional study. This is like a picture between an exposure and an outcome. It's another week study. I don't read them why? Because in order for me to say event exposure A cause, event B, I have to prove that exposure A free death, outcome B. If I got a picture cross-sectional, I cannot do that.
Speaker 1:And sometimes some studies. They tend to repeat them, but before they even come out with the result, they will repeat them more than twice to see if they're going to come with the same result.
Speaker 2:That's what they have to do. That's exactly what they have to do, because that's how you're going to come with the same result.
Speaker 1:That's what they have to do. That's exactly what they have to do, because that's how you're going to prove the validity of the research.
Speaker 2:That's exactly what I have to do. That's what I'm talking about. So a good study is not that common. A good study got requirement. It got to be a good clinical trial. When I got an exposure right, I got an exposure right. I got some an exposure and I follow a population with that exposure and I'm gonna see the outcome. For a different group that will be a good. But even that one can be a one wrong too.
Speaker 1:I need to have the right sample size yeah, the right sample size, the right sample size, the right sample size Sometimes play a major role. I have to have the right Because you know, if you conduct a research, you know and your sample size was like only 10 people or 20 people.
Speaker 2:It's not a good one.
Speaker 1:So it's not. You know that was a weak sample size.
Speaker 2:And my wind-up got to be my sampling got to be wind-up. I cannot take my family to put down the study. I need to pick people randomly to represent the community. So once again you're going to see a lot of studies, but it doesn't mean all are good studies.
Speaker 1:I respect your opinion. You know I respect your opinion. Before I go to my last question, there was something you mentioned about drugs and drugs Drug-drug interaction.
Speaker 2:Yes, yeah, because that's what I explained. Some drugs can inhibit the system, the enzymatic system in the liver. You take another drug because that drug inhibits that system. It makes the other drug more available and can cause toxicity. Some other drug increase the rapidity of the metabolism, therefore make the other drug sub-therapeutic.
Speaker 1:You know, I know. I know few patients or clients. I know few patients or clients who are taking psych medication at the same time use marijuana. What that can cause.
Speaker 2:There is no good study. There is no good study between marijuana and psychotropic and psychotropic medication. It doesn't mean you're going to study. Of course you're going to study. All I'm saying there's no good clinical trial with a good sample size to test. What you said. That's what I'm saying. We know once again, they have studies, but we need a good clinical trial.
Speaker 1:Is there any specific drugs that was tested?
Speaker 2:Cigarettes. I just said.
Speaker 1:Oh, only cigarettes.
Speaker 2:No, not only cigarettes. I have cigarettes, I have alcohol, I got a few drugs.
Speaker 1:Oh, okay, let's address our last question. Oh, okay, let's address our last question. I don't know if you can walk us through any thought process when you're treating a patient with a complex medication regimen.
Speaker 2:Like I said, two good treatments start with very good therapeutic alliance. We're doing it together. I cannot do it by myself. You cannot do it by yourself. Let's try to do it together. That cannot do it by myself. You cannot do it by yourself. Let's try to do it together. That's the first thing. The complexity is going to be addressed by both of us. That you know what. I cannot take that medication in the morning. It makes me sleepy. I can't go to work.
Speaker 2:Okay let's move it maybe at nighttime. Okay, let's move it maybe at night time. He needs to. Like I said, it has to be something both of us invest good interest, energy. It can't be just the doctor or just the patient. I've seen that he should know, better to take that medication. No, he doesn't know better. That's why he's here. So we have to work with our patients to make them understand the importance of complying with a complex medication.
Speaker 1:So it should be kind of like your role as a care provider to help the client understand the importance of taking medication and taking medication as prescribed. Exactly, and if there is any change, like you said, the patient may feel like, oh, when I take the medication in the morning, it makes me feel this way.
Speaker 2:So you know, as a care provider, you're like, hey, let's address like you just mentioned let's try it at night time, but I'm not going to keep prescribing on the morning and you're not gonna take it, and then I don't even know what time you think will be better. What do you think about 8 pm? Let's have that choice together.
Speaker 1:let's do it together but there are some medications that are required to be taken at night.
Speaker 2:Because if that medication makes you drowsy, I think you better take it at night. You don't want to be drowsy during the day. That will make sense, but it's not an absolute rule. Those are things we can address, we can discuss.
Speaker 1:Okay, that is pretty interesting. Anything else you want to add to that before we wrap up?
Speaker 2:One again remember there's a lot of injuries with medications. Start again. Don't take your neighbor's medication. It may not work for you, even though if it works for the neighbor. And then once again talk to your doctor. Doctor, try to have a very good team.
Speaker 1:That will be a team to address your issue, not individual things people should not try to mix their medication you know with other people medication basically that's bad, you know. And so if you were to be prescribed to take a medication for a speed you medication for a specific amount of time, you cannot exceed that time.
Speaker 2:Not at all.
Speaker 1:Okay, all of those are very important for people to know. Or what about if, for any reason so, you prescribed me some medication to take for a duration of seven days or nine days I travel? Unfortunately, I didn't take that medication with me, but I already took that medication three times. Should I contact you to inform you? That's it, yeah, okay, definitely okay, because I'm like you know basically. So it's like for the four days that you know. So it's like. My thing is like should I continue or should I?
Speaker 2:No, let's talk about it.
Speaker 1:Let's talk about it. So you hear what Dr Gustav said. So everything, have a way to address them. So if you were to be prescribed, you know, to take your medication for seven days or nine days, or you miss two or three days don't say you know what. So it's okay, I'll just add the other four days another time. No, have a conversation with your care provider because at the end of the days, we have our ways of doing things, but we have to consider the best way that's it it was a pleasure to have you, dr gustav.
Speaker 1:Thank you for your time, you know, I know today is it's a windy day for you to make it to the show, so it's uh well appreciated. Thank you so much no problem, thank you okay, so, of that said, I'm gonna let you go. So it was a pleasure, you know, having you watching or listening. Please don't forget to subscribe, leave a a comment. I'll see you next time. It was with you, dr Beatrice Ippolit, with your world.