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InvisibleSimplepowa
In Pursuit of Knowledge


Registered: 03/06/09
Posts: 4,310
One Drug, Two Names, Many Problems
    #19210635 - 11/30/13 11:34 PM (10 years, 1 month ago)

Bedside November 30, 2013, 2:50 pm
One Drug, Two Names, Many Problems
By THERESA BROWN

My patient was shaking uncontrollably. People say such shaking feels unbelievably bad, but rigoring, as the medical profession calls it, is treatable with the narcotic Demerol. I hurried to the computer to order some from the pharmacy, thinking “rigors = Demerol.”

But the computer listed drugs by their generic names only, and Demerol is a brand name. In the heat of the moment my mind went blank; I couldn’t get the medicine my patient needed. An embarrassed call to the pharmacy yielded the correct name — meperidine — and my patient got relief. Still, it was a reminder of how needlessly dangerous our drug-labeling system is.

In the context of what’s at stake in health care, the practice of giving drugs two names, a brand name and a generic name, makes no sense. Is there any other industry in which thousands of component parts are insistently given two dissimilar names, even though people can suffer, be hurt, possibly even die, if a mistake in names is made? Every drug with two names — and that means practically every drug in use — is a medication error waiting to happen.
Johnny Selman

Worldwide, almost all medications have a brand name that remains patent protected for 20 years, meaning the patent holder is the sole manufacturer and distributor. That allows the holder to charge more for it. When drugs go generic (for example, Tylenol to acetaminophen), anyone can make them and the price tends to drop, meaning company profits drop, too. But the companies keep the brand names, and insist they be used wherever they can, because they know people tend to trust brand names more, even when there is no difference from the generic.

Others can argue whether drug companies’ profit margins actually serve the public interest or enrich their shareholders, but that’s not my quarrel here. The patent protections can stay in place. The dual-name regime shouldn’t.

To make things even more confusing, we have recently seen a proliferation of look-alike, sound-alike meds. For example: Zantac is used to treat heartburn, while Xanax is an anti-anxiety medication. A list of these sound-alikes fills a full eight pages on the Institute of Safe Medication Practices website.

Data on medication errors is not collected systematically in the United States, so it is impossible to say accurately how many errors result from such confusion. Whatever the number, and the attendant misery the most serious mistakes generate, it seems undeniable that the potential for error is increased by the dual naming of all drugs.

Though we in the health professions learn to be disciplined in a crisis, the human mind, especially in stress, can remember only so much. In a 2009 survey a group of Australian nurse-anesthetists accurately identified only 29 percent of the trade names for common drugs. And I am hardly alone among my colleagues in momentarily forgetting a generic’s name in the heat of the moment.

And whether or not a nurse or doctor can flawlessly recall the dual names of every drug ever learned, those two names take up mental space that none of us in health care can spare. A hospital is not a place for single-track minds: Nurses are interrupted on average every six minutes, and sometimes much more often. Doctors face constant distraction from pages and cellphones. Throw the completely unnecessary complication of drugs’ having two names into the mix and we all move inexorably closer to error.

Fortunately, the solution is obvious and easy. All drugs now being sold could use either their brand name or the generic name. That name, and the manufacture of that medication, would be patent-protected for 20 years. Thereafter, any other producer of that drug would append it with a “-G,” indicating that it is a generic formulation. Acetaminophen sold as a generic would become Acetaminophen-G, and Plavix, a brand name blood thinner, would be sold as Plavix-G in its generic form. Combination drugs like the brand name inhaler Duoneb might have to use generic names (albuterol and ipratropium) to avoid confusion.

The Russian names in Tolstoy’s “War and Peace” drove my high school debate coach crazy. A character’s first name, patronymic, family name, diminutive name and shortened patronymic might all be used at different times. In the last section of the novel Tolstoy introduced some new characters, all with their several names. My debate coach, fed up, slammed the book shut and never finished it.

Mentally pulling up drug names in the hospital can make me feel stuck in the pharmaceutical version of a Russian novel: cyclophosphamide is Cytoxan. Velcade is the brand name for bortezomib. Percocet is oxycodone and acetaminophen, but Vicodin is acetaminophen and hydrocodone. Multiply that short list of drugs by 500, and it’s clear what nurses and doctors are up against.

It makes no real difference if a determined reader stops before the end of a great book. But a patient’s being hurt because we insist on giving drugs two distinct names is a different matter.

Theresa Brown is an oncology nurse and the author of “Critical Care: A New Nurse Faces Death, Life, and Everything in Between.”
A version of this article appears in print on 12/01/2013, on page SR5 of the NewYork edition with the headline: One Drug, Two Names, Many Problems.

http://opinionator.blogs.nytimes.com/2013/11/30/one-drug-two-names-many-problems/?emc=edit_tnt_20131130&tntemail0=y&_r=1&


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Carl Sagan - "Who are we? We find that we live on an insignificant planet of a humdrum star lost in a galaxy tucked away in some forgotten corner of a universe in which there are far more galaxies than people."

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Robert Pirsig - "When one person suffers from a delusion it is called insanity. When many people suffer from a delusion it is called religion."

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Brian Cox - "[One] problem with today’s world is that everyone believes they have the right to express their opinion AND have others listen to it. The correct statement of individual rights is that everyone has the right to an opinion, but crucially, that opinion can be roundly ignored and even made fun of, particularly if it is demonstrably nonsense."


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OfflineCaddilac
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Registered: 11/19/13
Posts: 469
Loc: WY. Flag
Last seen: 5 years, 7 months
Re: One Drug, Two Names, Many Problems [Re: Simplepowa]
    #19211159 - 12/01/13 03:42 AM (10 years, 1 month ago)

That's where you doctor must know chemical names and everyone can have a brand name!! Wait is that good? It's just the beginning of modern times well new modern times and all the time that will change. Illegal drugs have it correct. Nobody gets confused when Lsd is said tto be lysergic acid diethymide 25 that was marked under many names from many sources pharma or not. correct anything if I'm wrong. I dont know much bout drugs much but i can make aspirin and make it. proprietary blend "patent" material. The system will square. like Memory. does.


Edited by Caddilac (12/01/13 03:53 AM)


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Offlineniteman

Registered: 06/29/11
Posts: 1,050
Last seen: 2 years, 6 months
Re: One Drug, Two Names, Many Problems [Re: Caddilac]
    #19211509 - 12/01/13 08:29 AM (10 years, 1 month ago)

Doctors should be the ones that know these things. The author of the article needs to take some classes or something if (s)he doesn't know drug names from brand names. I'm sorry but if I know more ahout the drugs I'm taking than my doctor, I'm going to be pissed.

Nevermind I see she is a nurse but still its not that difficult if you can memorize things well.


Edited by niteman (12/01/13 08:31 AM)


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Offlinedownlowfunk
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Registered: 09/25/04
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Re: One Drug, Two Names, Many Problems [Re: niteman]
    #19211549 - 12/01/13 08:43 AM (10 years, 1 month ago)

ObamaCare says this is good. 90% of the worlds population must be exterminated.


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OfflineImmortal Jellyfish
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Registered: 03/23/13
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Loc: Colorado Flag
Last seen: 3 months, 21 days
Re: One Drug, Two Names, Many Problems *DELETED* [Re: downlowfunk]
    #19212469 - 12/01/13 12:31 PM (10 years, 1 month ago)

Post deleted by Immortal Jellyfish

Reason for deletion: Unnecessary post



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OfflinePsYcHoDoUgHbOy
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Registered: 08/11/08
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Re: One Drug, Two Names, Many Problems [Re: Immortal Jellyfish]
    #19212801 - 12/01/13 01:44 PM (10 years, 1 month ago)

Quote:

Immortal Jellyfish said:
I can only imagine how rushed doctors and nurses become sometimes, but i highly doubt adding "-G" to genetic medication names will be the end-all fix of this. Make genetic medications sound almost exactly like the brand names, right? Such as...Tylenol, and Tyclenol as the generic would be acceptable in my opinion.




That wouldn't be logical. Acetaminophen is the chemical name of the compound (N-acetyl-p-aminophenol). It is named that due to the chemical composition. Tylenol has nothing to do with the chemical composition.

Adding a -G to the legitimate name would most definitely work.


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Offlineegodeathflux
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Registered: 02/02/10
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Re: One Drug, Two Names, Many Problems [Re: Simplepowa]
    #19216226 - 12/02/13 07:43 AM (10 years, 1 month ago)

I thought Demerol was actually 'Pethidine', quick wiki search shows that Pethidine and Meperidine hydrochloride are both used, dependent on country/region.

:themoreyouknow:


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"Atrophic interludes weave through my life far too often, for me to fight the biggest enemies"




"Standing on the corner of 5th and Vermouth"



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Offlines240779
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Registered: 12/07/10
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Re: One Drug, Two Names, Many Problems [Re: Simplepowa] * 1
    #19216652 - 12/02/13 10:44 AM (10 years, 1 month ago)

Big fuckin' deal.


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InvisibleCidneyIndole
www.shroomery.OG
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Registered: 05/16/05
Posts: 4,761
Loc: Love's Secret Domain
Re: One Drug, Two Names, Many Problems [Re: niteman]
    #19216845 - 12/02/13 11:40 AM (10 years, 1 month ago)

Quote:

niteman said:
Doctors should be the ones that know these things. The author of the article needs to take some classes or something if (s)he doesn't know drug names from brand names. I'm sorry but if I know more ahout the drugs I'm taking than my doctor, I'm going to be pissed.

Nevermind I see she is a nurse but still its not that difficult if you can memorize things well.







I get it. That was my initial reaction as well. But let's face it-- you and I are doing this at an amateur and highly selective level.


For example, I can give you the brand name and corresponding generic for a decent list of opiate drugs. Change "opiate" to "antibiotic" and the list becomes much, much smaller.


How many ani-psychotics can you name in both generic and brand form? Beta blockers? Anti-emetics? Steroids? Etc etc etc...


Doctors don't need to remember a few meds, or just one or two classes of meds, but tons of meds, in many different classes. Hell, even with the shorter list of meds I have (somewhat) thorough knowledge of, I make mix-ups. Just the other night I was trying to recall if my grandfather had been taking Demerol (aka Meperidine aka Pethidine) or Dilaudid (aka hydromorphone) just prior to his death. 



Mistakes happen. Lapses in memory happen. It would seem logical to say that the more items one has to keep track of, the greater the likelihood that one of them could be temporarily forgotten, tip-of-the-tongue style, or mixed up.


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I am me. We are You.


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Offlinehuffinglue
tryin to stay sober
Male

Registered: 09/26/08
Posts: 450
Loc: Texas
Last seen: 9 years, 5 months
Re: One Drug, Two Names, Many Problems [Re: CidneyIndole]
    #19222404 - 12/03/13 02:05 PM (10 years, 1 month ago)

Wtf. Was this nurse watching untold stories of the ER while her patient was having a seizure? Why did she have to call a pharmacy? Why didn't she ask a doc? Or do they block google on there computers or something?


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I fucking hate grammer nazis! Yes, I can't spell. Yes, I don't have perfect grammer. I post from my phone and dont give a shit about people whose lifes are so boring they get off on putting people down for not having perfect fucking grammer, even though they know excactly what there saying.. Fuck You. It's just a ride mang...


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