Tuesday, March 10, 2015

Not so Big Pharma

I don't know how whippersnapperRN's  keep abreast of the constant barrage of  drugs. Just listening to all those direct to consumer ads on TV is headspinning.  The pharmaceutical industry truly has some remarkable offerings, but this progress has come with  problems I could have never imagined.

We had a very limited number of drug classifications and they really did work for their application. Drugs like: penicillin, digoxin, gelfoam, and Lasix did not need drug reps to sell them-they sold themselves.

Gelfoam was one of the most extensively used pharmacologic products.  This animal gelatin hemostatic substance came in a powder, sheets (about 4X5 in), and even in zig-zag strips for packing. It was a conditioned response-anywhere there was bleeding, think gelfoam. We even tried to force a slurry of the powder down NG tubes for GI bleeding. It was a remarkable hemostatic agent and I vividly recall that comforting rectangular Upjohn logo on the container.

The only limitation was that Gelfoam did not work well with arterial bleeding. It was like attempting to patch a firehose with chewing gum. The pressure would dislodge the gelfoam.

For pain control, Demerol was used for 3-4 days post-op. The patient was usually kept in the hospital until pain free. Upon discharge, they went home with some APC's (aspirin, phenactin, and caffeine)  tabs We used to call them All, Purpose Cures.  There was no drug seeking issues with this analgesia regimen and nobody ever claimed to misplace or lose APCs.

Antibiotic wise there was penicillin for gram+ infections and sulfa or gentamycin for gram- infections. When there was a question as to sensitivity, Keflin always seemed to work. The microbiology course I took made no mention whatsoever of viral illness. The concept of drug resistance was unknown and the limited number of antibiotics available did seem to be effective.

Digoxin was used extensively for compromised cardiac issues as well as nitroglycerine SL for angina. We also used a nitroglycerine paste that was applied to the chest wall. There were no beta blockers or calcium channel blockers. As a pressor agent, ephedrine capsules were used. Maybe it was a blessing that we lacked IV pressor agents. There would be no way to accurately dose without IV pumps or controllers.

Diabetics had the choice of beef or pork insulin. When antibodies to beef were developed, switch to pork. This came in two confusing strengths U40 and U80.

Huge categories of drugs we take for granted today were lacking. Things like statins, SSRIs, atypical antipsychotics, beta blockers, anti-neoplastic drugs, and oral hypoglycemics all missing

No unit dose. All drugs were dispensed from stock on the ward. This led to some whacky drug dosage calculation test questions such as you have a stock bottle of a 1:50 solution. How would you dilute this to a 1:250 with only 10 cc of diluent

Patients today have much greater expectations and I think the pharmaceutical companies promote this by overhyping their products. Nurses today have it so much more difficult today than I ever did.  I never had to face anyone demanding more opiates because they lost their prescription


  1. I enjoy your blog so much! I too am a dinosaur and relate so well to your stories. While reading this post I really had a blast from the past. I had totally forgotten about U40 and U80 insulin for instance. What WAS that all about anyway?, Sometimes I wonder exactly what nurses today have to use their math skills for anymore. Thanks for the memory va-ca!

  2. The U40 and U80 insulins pre-dated the genetically engineered U100 human insulin of today. They were either beef or pork derived and I remember switching from one kind (beef or pork) if it was thought someone was developing antibodies to one kind. The U40 was easier and more accurate to draw up because the markings on the syringe barrel were fewer and further apart. I'm guessing the U80 was available to keep the volume of the dose to 1cc or less when higher doses were required. They were color coded-U40 was red and I think U80 was green. The big problem was getting the syringes mixed up and the antibody issue due to the foreign beef and pork protein.

    When my dog needed insulin, I was surprised that U40 was still available, but of course the antibody issue was still present because there were no canine engineered insulins. He did do well though. I appreciate your comment.