Grid Down Hospital Part V: The Pharmacy

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Another in the series from FlightERdoc:

Grid Down Hospital Pharmacy

Any meds normally taken, plus the following – listed in order of schedule. Quantities are as many as you can, and as with all perishable medical supplies, the smaller the factory container, the better – it’s better to keep them sealed in their original containers.

Storage of medications should normally be in a cool, dark, dry location – but not freezing, especially for liquids or ointments. They may separate during freezing and not recombine correctly. One drug that can be frozen is epinephrine. An Epi-pen can be frozen and then thawed completely in five minutes or so by placing it in an armpit.

Drug

Purpose

Rx / OTC

Acetominophen 500mg 100’s NSAID

OTC

Aspirin 325mg tabs, bottle 24’s NSAID for pain, fever, inflamation, cardiac

OTC

Betadine Sol 4 oz bottle topical antiseptic

OTC

Bisacodyl (Dulcolax) 5mg PO Laxative

OTC

Caffeine tablets (No doze) 12s’ caffeine headache, stay-awake

OTC

Chap Stick hot weather in ziplock lip balm

OTC

Clotrimazole oint 1% (Lotrimine) 1/2oz Fungal skin infections

OTC

Clotrimazole sol (Lotrimine) 10ml Fungal skin infections

OTC

Diphenhydramine (Benedryl) 25mg 24’s antihistimine

OTC

Eye drops (Visine or equal) 15ml btl minor eye irritation

OTC

Famotidine tab 10 mg Pepcid-AC blister pack Gastric reflux / heartburn

OTC

Ibuprofen (Motrin) 200 mg 100’s NSAID for pain, fever, inflamation

OTC

Instant Glucose 25gm tube hypoglycemia tx

OTC

Loperamide (Immodium) 2mg 12’s diarrhea

OTC

Loratidine 5mg (Claritin) 12’s allergies

OTC

Meclazine chewable (Bonine) 16’s motion sickness, diziness

OTC

Oxymetazoline (Afrin) Nasal Spray 0.5oz btl nasal congestion, non sedating

OTC

Potassium Iodide tabs 14’s

OTC

Robitussin DM 4ozl btl cough

OTC

Robitussin lozenge indiv wrapped 25’s cough

OTC

Sting-eze btl 15ml sting relief

OTC

Sudafed 30 mg tab 24’s allergic rhinitis, congestion

OTC

Triple-Antibiotic oint 15ml tube antibiotic oint

OTC

Acetazolamide (Diamox) 500mg tab For edema

Rx

Amoxicillin Clavulinate (Augmentin) 875mg tabs Penicillin, animal bites

Rx

Azithromycin 250mg 6 tab Z-pack Macrolide Antibiotic

Rx

Ceftriaxone (Rocephin) inj 1 gm kit 3rd Gen Cephalosporin Antibiotic

Rx

Cephalexin (Keflex) 500mg tab 30’s 1st Gen Cephalosporin

Rx

Ciprofloxacin 500mg 60 First gen fluoroquinolon

Rx

Cyclopentolate opth sol 2 ml 1% Cyclogel Corneal abrasion or snowblindness

Rx

Dexamethasone (Decadron) 4mg/ml 25 ml vial For cerebral edema

Rx

Dextrose 50% 25gm pre-fill diabetic hypoglycemia

Rx

Diazepam (Valium) 10mg tablets 30’s Benzodiazepam, sedation / muscle relaxation

Rx

Diazepam (Valium) inj 5mg / ml 10 ml vial Benzodiazepam, sedation / muscle relaxation

Rx

Diphenhydramine (Benadryl) preload 50mg /1ml allergy – longer action than epi

Rx

Droperedol 2.5mg/ml 2ml vial Sedation / nausea

Rx

Epinephrine 1:1000 30ml amp Alergy

Rx

Epi-Pen twinject autoinjector 0.3ml For anaphylactic shock

Rx

Erythromycin oint opth eye infection

Rx

Etomidate inj 2mg/ml 10ml vial anesthesia induction

Rx

Fluocinolone acetonide cream 0.025% (Synalar) 15 gm tube topical rash

Rx

Furosemide (Lasix) 10mg/ml Diuretic

Rx

Levofloxacine 500 mg tabs 30’s 4th Gen Fluoroquinolone

Rx

Lidocaine 1% 50 ml vial local anesthetic

Rx

Lidocaine 1% with Epi 50 ml vial local anesthetic

Rx

Meloxicam 15mg 30’s NSAID pillpack pain reliever

Rx

Metronidazole (Flagyl) 500mg tab 30’s Intra-abdominal infection, Giardia, UTI

Rx

Moxifloxacin (Avelox) 400mg quinolone Abx

Rx

Naloxone (Narcan) 2mg/ml Opiate antagonist for accidental OD

Rx

Nifedipine (Procardia) 10mg tab 100’s HAPE, Ca++ Channel blocker, HTN

Rx

Nitroglycerine spray 0.4ml dose Angina

Rx

Phenytoin (Dilantin) inj 50mg/ml 1gm vial anti-convulsant

Rx

Piperacillin/tazobactam (Zosyn) IV Penicillin

Rx

Pralidoxime 1gm vial dry organophosphate poison

Rx

Prednisone 20mg tab 100’s Corticosteroid, inflamation

Rx

Promethazine (Phenergan) 25mg/ml 10ml vial nausea

Rx

Provigil 200mg 30’s awake-aid

Rx

Silver Sulfadiazine Cream 1% 50 gm jar Topical Burn treatment

Rx

Sodium bicarb inj 8.4% Alkalanize, 50 ml vial

Rx

Tetracaine Opth sol 0.5% 1ml dropper tube Eye injury – painful exams

Rx

Thiamine HCl Inj 100 mg/ml 2 ml amp for refeeding after starvation

Rx

Trimethoprim (160mg) / Sulfamethaxazole (800mg) (Septra DS) 30’s Sulfonamide

Rx

Vancomycin 1gm dose IV vial

Rx

Vecuronium sedation (rapid) paralyitic

Rx

Water sterile 20ml vial

Rx

Sonata (zalepelon) 10mg 30’s sleep aid

Rx

Morphine Sulfate inj 10 mg/ml 1 ml amp Pain relief, serious

Rx Sched II

Hydrocodone 10mg / Acetaminophen 500mg (Vicodin) tabs 30’s Pain relief

Rx Sched III

Ketamine 50mg/ml 10ml vial procedural sedation

Rx Sched III date rape

Loreazepam (Ativan) inj 2mg/ml anianxiolytic

Rx Sched IV

Loreazepam (Ativan) tablets 1mg 30 anianxiolytic

Rx Sched IV

Versed inj 5mg/ml 10ml vial sedation (rapid)

Rx Sched IV

Old School Remedies (that actually work) that you can make at home:

Dakin’s solution (sodium hypochlorite) skin and wound disinfectant. Must be made fresh for each use, lasts about 6 hours.

http://www.virginia.edu/uvaprint/HSC/pdf/09024.pdf Accessed June 23, 2015

Burow’s solution (aluminum acetate)

http://reference.medscape.com/drug/domeboro-astringent-solution-powder-packets-burows-solution-aluminum-acetate-solution-999353 Accessed June 23, 2015

Lugol’s solution (iodine) – Lugol’s is a skin disinfectant, and is good for fungal infections as well. It’s hard to find the iodine these days since it’s listed as a precursor to illicit drugs.

http://www.fda.gov/Food/FoodScienceResearch/LaboratoryMethods/ucm062245.htm Accessed June 23, 2015

General purpose cleaner – Mix dish soap and white vinegar, 50/50, put in a spray bottle. Give it a shake before use. This works so well it’s become our go-to cleaner at home for the bathroom, kitchen, degreasing the grill, etc.

Surface disinfectant – White vinegar (acetic acid 5%) and water 50/50 in a spray bottle.

16 responses to “Grid Down Hospital Part V: The Pharmacy

  1. One would do well to become familiar with the medicinal plants that grow in one’s AO. All the above-mentioned drugs are well and good but they will run out … and then what? Nature provides. Learn.

  2. Great Med Info!
    However this comment is for the wrsa blog editor. You use to link to blog posts by SilverDeth over at the dethguild.com. He’s been dark since Jan 2016. Not trying to get in his business in anyway, just curious if anyone has heard from him? The guy had a pulitzer prize winning way with blog posting and phrasing. He owes our world zero in that regard, but considering the complete abortion this election is, his posts would have been inciteful.

  3. Just FYI-
    In Ohio Narcan can be purchased OTC, local -(N.E. Ohio)-Walgreens and Wal-Mart sell small bottles of iodine.
    Can’t buy Sudafed w/o ID and signing for it in Ohio, if more than 1 person st same address needs Sudafed they’re screwed-amount is limited to I think 30 per month.
    I figure I’m screwed w/o access to antibiotics/ meds due to recurring upper respiratory infections. Last one took 7 days of 500mg Axithromycin along with prednisolone (sp) and Combivent inhaler followed by 10 days Levofloxacin to clear up.

  4. Question: If a woman is prone to urinary tract infections, is she basically scrod once the antibiotics run out, or are there natural remedies that are actually effective?

    • DWEEZIL THE WEASEL

      dkd: Try AZO. It’s OTC at Fred Meyer.

    • Stealth Spaniel

      Why isn’t your lady taking Cranberry Concentrate Capsules or drinking cranberry juice? Any infection needs cleared up, but cranberries make the bacteria in the bladder unable to multiply and grow. The pills are available OTC and are quite cheap.

  5. Some of the meds on that list are not correct in their application. Vecuronium has no sedative properties and is a paralytic. If you give it to someone, you better be prepared to ventilate them with a BMV or ventilator for about 1 hour. Some of the others are not currently available in the U.S.

  6. Also, one anesthetic that is not listed is ketamine. In appropriate dosages, it is probably one of the safer anesthetics to use in the absence of extensive monitoring capablity. If given with a benzodiazepine (valium) some of the side effects (delirium and hallucinations) can be reduced.

  7. The Valium is also a Schedule IV controlled narcotic. If you can get a prescription for any of the Schedule narcs at all, treasure that doctor, because the FDA crackdown on same is epic.

    You’ll also encounter a good bit of difficulty getting hands on the paralytic Vecuronium, or the Etomidate sedative.
    In any event, get hands on of as much of the above as you can. That’s probably about 90% of everything I’ve given in 20 years in the ED, other than cardiac arrest-specific code drugs and stroke anticoagulants.

    Also, most insect sting venoms, IIRC correctly, are proteins. Adolph’s Meat tenderizer, and generic versions, contain papayin, which is a derivative of papayas that breaks down proteins. Like in stings. As an added bonus, it also makes tough meat easier to chew.

    And even if you stick with the OTCs, along with any previously suggested medical pharmacology text, get your hands on any good nursing drug reference (my personal preference is Mosby’s Nursing Drug Handbook). It gives you the same information as the PDR, by in a much more accessible manner, and boiled down to the hows of administration, the normal effects and side affects, and the layman-simple contraindications and potential problems with everything above.
    You could also print out that info from online, and make your own short version, for only the meds listed here, plus any personal Rx meds you or your tribe members take already.

    Most of the antibiotics can be had as fish formulations, and are generally made by the same manufacturers in the same plants as the human doses.

    The oral meds take care of themselves, but you will obviously need a supply of syringes and needles for a number of these meds to administer them intramuscularly, intravenously, or subcutaneously. And you’ll need to know how to do those procedures, and where, etc.
    Which is covered in any general nursing textbook from Amazon or at the local J.C. bookstore, and doubtless, on numerous YouTube videos, or on nursing procedure DVDs.

    • If you have a friend in Russia, they maybe able to source product we can’t get here. There formularies are not as restrictive and there are more than enough willing Docs to write the script. The trick is delivery.

  8. FlightERdoc,

    Any recommendations for those patients that have allergic reactions to the ‘-cillins?

    Thx.

  9. For scheduled drugs, if you don’t have either an understanding doctor or friends in low places, you can order just about anything from Chinese or Indian pharmacies online, or via various marketplaces on Tor. There are a lot of grey market functional analogues (“research chemicals”) of scheduled drugs as well; i.e. diclazepam could be used as a replacement for diazepam, etc.