Pick 5 meds...

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tac57
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Pick 5 meds...

Post by tac57 » Mon Jul 29, 2013 10:42 pm

I remember a similar topic on another forum and I thought it would be interesting to discuss it here. 

So: If you had to pick only 5 meds to stock a drug bag for use in an austere environment what would they be and WHY?

Be specific. For example, don't say antibiotic, say what specific drug you would take and your rationale.

I will give you a freebie: since i live in Canada where it is not considered a drug, 0.9% Nacl will not be considered a drug  for the purposes of this topic (but other fluids will be). Multiple dosage forms of the same drug also count as that same drug-oral and injectable forms of the same drug only use up one choice.

Also feel free to mention what administration equipment you would like to have along with you (no restrictions here).

So what would be YOUR top 5 medications to take with you?


I'll start it off: 

1. Epi 1:1000 - can use to tx anaphylaxis or asthma exacerbation refractory to salbutamol.

2. Either naproxen or ibuprofen. Not sure which one i'd take. For minor injuries.

3. Gravol (dimenhydrinate) injection - it is an antihistamine (salt of diphenhydramine). In theory you might be able to use it for allergies as well as n/v if there was no other option.

4. Ketamine - can be used for analgesia, sedation or general anesthesia depending on dose. Pts keep their airway reflexes intact.

5. A broad spectrum ABx for PO and IV/IM use, likely a fluroquinilone such as levofloxacin or ciprofloxacin. A cephalosporin such as cephalexin would be useful for Abx. prophylaxis for wounds.

I'm not sure what would be more critical - the cipro will provide coverage for most types of common RTI, UTI and bacterial gastroenteritis issues whereas keflex could save your ass from a wound ifxn as long as you didn't need anaerobic coverage.

I would also add a few litres of saline and iv start gear. Again, in canada, crystalloid iv solutions are otc and not legally considered drugs.

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Re: Pick 5 meds...

Post by CrossCut » Tue Jul 30, 2013 7:18 am

This ought to be good.

I'll restrict my choices to those I could obtain legally, I don't have a source that will provide scheduled drugs. Also those appropriate for my locale (woods of the upper midwestern US), for my expected group (aged 6-72, + a couple canines), and in a longer term situation (over two weeks).

- Aspirin - Analgesia, anti-inflammatory, antipyretic, and blood thinner.

- Augmentin - Respiratory infections and good wound coverage, including bites / closed fist injuries.

- Flagyl - Anerobes/Protozoa, and good synergy with augmentin for treating something like appendicitis or septis.

- Benadryl - Antihistimine, antiemetic, mild sedative.

- Lidocaine HCL (powder) - Mix and melt in NS for inj. local anesthesia for wound debridement/closure, tooth extractions, or nerve blocks for more extensive procedures.

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Re: Pick 5 meds...

Post by Kelvar » Tue Jul 30, 2013 7:29 am

I'd be curious to see if you guys could also suggest five essential meds that are available without a prescription that would be important for those of us who don't have extensive medical backgrounds. The reason I ask is totally selfish, because this is something I'd personally like to know.
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Re: Pick 5 meds...

Post by iron_angel » Tue Jul 30, 2013 9:04 am

I am not a nurse, but as far as completely OTC meds (available OTC in the USA, anyway), the ones I'd have are these:

1) Aspirin - yeah, it's harder on the GI tract than ibuprofen and doesn't last as long as naproxen, but it can be a lifesaver for heart attacks in addition to the obvious analgesic and antipyretic uses.

2) Diphenhydramine - Anihistamine, antiemetic, mild sedative, for some people it has anxiolytic effects.

3) Loperamide - diarrhea can be bad news, this is probably the best thing you can get for it OTC.

4) Acetominophen - seems redundant with the aspirin, but since it's not an NSAID as such, it can be used when there are allergy problems, and can, in theory, be stacked with aspirin (like what Excedrin does).

5) Famotidine - good cure for acid indigestion, and since it's an H2 histamine inhibitor, it can have good synergy with diphenhydramine in allergy cases. Clearly won't replace an epi-pen, but if you don't have one (say, because you don't normally need one, but you find yourself traveling with someone who might), it's better than nothing. Also has some efficacy against nausea - I used to use it along with meclizine for seasickness.

I might have a few topical drugs too - hydrocortisone, diphenhydramine, lidocaine or benzocaine, neomycin/polymyxin and probably either clotrimazole or butenafine (for those exceedingly uncomfortable fungal afflictions).
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Re: Pick 5 meds...

Post by alpha_texas1969 » Tue Jul 30, 2013 9:34 am

Kelvar wrote:I'd be curious to see if you guys could also sugget five essential meds that are available without a prescription that would be important for those of us who don't have extensive medical backgrounds. The reason I ask is totally selfish, because this is something I'd personally like to know.
There really isn't anything very useful available for serious stuff that does not require a script, unless you want aquatic ABx. 5 OTC meds I would suggest are

1 Naproxen

2. benadryl

3. Loperamide

4. Aspirin

5. antihistamine
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Re: Pick 5 meds...

Post by Browning 35 » Tue Jul 30, 2013 9:45 am

-cephalexin
-amoxicillin
-hydrocondone
-phenergan
-ibuprofen

By the way, you don't need an extensive medical background to buy some meds online without a prescription. Just a credit card.
http://ourmeds.org/products/antibiotics ... axa-button

You'd probably have a hard time finding pain meds simply because they're more restricted (I also think that it's illegal to sell narcotics online without a script). To store that next time you go to the dentist just tough it out and take ibuprofen.

For the rest of them though you can get many meds online. Especially the antibiotics. That's legal.
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Re: Pick 5 meds...

Post by BigDaddyTX » Tue Jul 30, 2013 12:55 pm

1. Omeprazole Magnesium
I have chronic stomach problems, without it life is annoying.

2. Ibuprofen

3. Hydrocodone
Bad discs, easy for me to get

4. Pepto

5. Doxycycline
My Dad is allergic to penicillin, and this seems to cover the largest amount of "common" things I could hope for I guess. Someone feel free to please educate me since all I've done is a tiny bit of googling for this.
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Re: Pick 5 meds...

Post by dallas » Tue Jul 30, 2013 3:58 pm

iron_angel wrote:
3) Loperamide - diarrhea can be bad news, this is probably the best thing you can get for it OTC.
I would rather have an oral re hydration mix. Loperamide can get real nasty if you take it for a bacterial GI infection without antibiotics. It is better to stay hydrate, take an antibiotic and let nature take its course.

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Re: Pick 5 meds...

Post by dtwn92 » Wed Jul 31, 2013 4:11 am

Asprin - pain relief and good for MI's/blood thinner.

Benadryl/Diephydromine - Goes with out saying, great for seasonal allergies and allergic reactions.

Lopramide - works the best for me.

Motrin - Mild pain, easier on the stomach than aspirin and kids can take it.

Zofran - antiemetic.

If I could get access to anything I'd replace Motrin with codeine and Zofran with Epi 1:1000 probably.
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Re: Pick 5 meds...

Post by ironraven » Wed Jul 31, 2013 11:18 pm

Ibuprofen- analgesic, anti-inflamitory
Lopramide
Tums Dual Action- you learn to listen to the ulcer the first time you cough up blood, it's never far away
Sudafed - allergies, colds, and Benydril puts me out fast
B-complex mega dose - I can put two dozen in a vial the same size as 5 hour energy and get the same effect for less cost.

if I could add a sixth, acetomenophin. I normally swap between it and Ibuprofen for even and odd days if I've got something going on for multiple days, and after quite a bit of dental work, I've found there are times where a half dose of each works better than a full dose of either.
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Re: Pick 5 meds...

Post by We'reWolf » Thu Aug 01, 2013 1:04 am

i think my pharmacist friend said you shouldn't stack pepto besmol and ibprofan but i can check i'm not 100% i mean if this is common info or what ever than someone edit this out
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Re: Pick 5 meds...

Post by BigDaddyTX » Fri Aug 02, 2013 2:10 am

We'reWolf wrote:i think my pharmacist friend said you shouldn't stack pepto besmol and ibprofan but i can check i'm not 100% i mean if this is common info or what ever than someone edit this out
:/

The problem with both pepto and ibuprofen is that they aren't good for little kids.
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Re: Pick 5 meds...

Post by okiebill » Fri Aug 02, 2013 2:29 pm

OTC:

#1 Diphenhydramine (Benadryl): Antihistamine / sleep aid

#2 Ibuprofen (Motrin): Anti inflammatory / painkiller / Fever reducer

#3 Aceteteminophen (Tylenol): Painkiller / Fever reducer

#4 Loperamide (Imodium): Anti-diarrhea

#5 Famotidine ( Pepcid): Anti Nausea / Anti Ulcer / Heartburn


Rx:

#1 Ciprofloxacin: Broad Spectrum Antibiotic

#2 Metronidazole (Flagyl): Parasitic Infections Giardia and Dysentery

#3 Azithromycin: Bacterial Infections and STD Treatment

#4 Cefdinir : Third Generation Broad Spectrum Antibiotic

#5 Amoxicillin : Moderate Spectrum Antibiotic OK for Kids


If I could only take 5 of these I would take any combination of the top two or three in each category. Schedule II Painkillers while being nice to have are not the priority, infection control in an austere environment is the real challenge.

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Re: Pick 5 meds...

Post by Nickthezombiehunter » Fri Aug 02, 2013 10:48 pm

Hate to be the Debbie downer, but its entertaining to watch this thread bc many don't know shit about meds.
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Re: Pick 5 meds...

Post by okiebill » Fri Aug 02, 2013 11:06 pm

Nickthezombiehunter wrote:Hate to be the Debbie downer, but its entertaining to watch this thread bc many don't know shit about meds.
Dazzle us with your Brilliance Nick, I'm sure all of us could use your expertise or did you jump in to insult / troll folks as opposed to actually contributing something positive to the discussion... :roll:

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Re: Pick 5 meds...

Post by BigDaddyTX » Sat Aug 03, 2013 1:13 am

okiebill wrote:
Nickthezombiehunter wrote:Hate to be the Debbie downer, but its entertaining to watch this thread bc many don't know shit about meds.
Dazzle us with your Brilliance Nick, I'm sure all of us could use your expertise or did you jump in to insult / troll folks as opposed to actually contributing something positive to the discussion... :roll:
Yup, I certainly asked for someone to brain me with their knowledge and, well, this helped. Thanks!
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Re: Pick 5 meds...

Post by Keith B » Sat Aug 03, 2013 1:43 am

I learned the benefits of ranitidine from a courteous ER doc many years ago. The five drugs I carry in my backwoods kit are:

1)Ibuprofen-I'm not a big fan of naproxen, this takes away the aches and pains of the trail.

2)Imodium-cause no bowel movement is better than too many bowel movements

3)Benadryl-Alpha blocker for allergic reactions

4)ranitidine- Beta blocker for allergic reactions, also good for heartburn and acid reflux after the buffalo chicken MRE.

5)Zyrtec-for those seasonal allergies that Benadryl is too much for.
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Re: Pick 5 meds...

Post by mough » Sat Aug 03, 2013 4:42 am

Excedrin. NSAID + analgesic + antipyretic = win

Doxycycline, as antibiotic, and can be used low dose to treat periodontal disease. I'm thinking that dental hygene will be poor and dentists will be rare in PAW

Loperamide hydrochloride because the hershey squirts can kill

oral ketoconazole is the mother of all anti fungals. Athletes foot, ringworm, and other various types of crotch rot.. solved.

Abilify, there are allot of crazies out there.

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Re: Pick 5 meds...

Post by iron_angel » Sat Aug 03, 2013 7:12 am

mough wrote:Excedrin. NSAID + analgesic + antipyretic = win

Doxycycline, as antibiotic, and can be used low dose to treat periodontal disease. I'm thinking that dental hygene will be poor and dentists will be rare in PAW

Loperamide hydrochloride because the hershey squirts can kill

oral ketoconazole is the mother of all anti fungals. Athletes foot, ringworm, and other various types of crotch rot.. solved.

Abilify, there are allot of crazies out there.
Out of curiosity, why ketoconazole and not itraconazole or voriconazole? Both are less hepatotoxic and also effective against a few other nasty possibilities (Valley Fever, if you're somewhere where it's endemic).
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Re: Pick 5 meds...

Post by DrJack » Sat Aug 03, 2013 12:04 pm

Keith B wrote:I learned the benefits of ranitidine from a courteous ER doc many years ago. The five drugs I carry in my backwoods kit are:

1)Ibuprofen-I'm not a big fan of naproxen, this takes away the aches and pains of the trail.

2)Imodium-cause no bowel movement is better than too many bowel movements

3)Benadryl-Alpha blocker for allergic reactions

4)ranitidine- Beta blocker for allergic reactions, also good for heartburn and acid reflux after the buffalo chicken MRE.

5)Zyrtec-for those seasonal allergies that Benadryl is too much for.

I like this list.
I'd probably swap 4 & 5 for an antiemetic and cough suppressant. And I AM a fan of naproxen, but Vitamin I is just a little more broad based I feel.
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Re: Pick 5 meds...

Post by Medic Mentor » Sat Aug 03, 2013 2:41 pm

Great question that I once posed to many Navy Physicians:

The five A's....some if not all are RX though.

A zithromycin
A mbien
A risticort
A cyclovir
A NSAID of your choice.

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Re: Pick 5 meds...

Post by TacAir » Sat Aug 03, 2013 5:41 pm

For OTC (no Rx required)

Percogesic (Acetaminophen and Phenyltoloxamine) does well as a general analgesic and reasonable antipyretic properties. May cause drowsiness as it contains an antihistamine.

Many here have picked loperamide, while it does have a place, I prefer Bacid (Lactobacillus acidophilus) tabs to go with clear fluids. Since Kaopectate is no longer made from kaolinite and pectin, it's not a choice for us. The use of probiotics is still an open question for many.

Aspirin. Good general analgesic, reasonable antipyretic, anti inflammatory properties. Might as well carry something like Anacin for the extra caffeine.

TUMS - because they work for heartburn.

Ocutricin brand ophthalmic solution (bacitracin, neomycin, and polymyxin B ophthalmic) good for eyes and ears + is triple antibiotic, so good for boo-boos that might get infected. Buffered for use as an ophthalmic solution so the cost is higher, offset by multiple uses possible.


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Re: Pick 5 meds...

Post by medic photog » Sat Aug 03, 2013 7:29 pm

Here's my choices, and I keep em in tiny Nalgine bottles too;
Aleve liquid gels,
Vicodin
Soma
Prilosec
Immodium
Now, why? Because I use them damn near on a daily basis.

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Re: Pick 5 meds...

Post by dallas » Sat Aug 03, 2013 9:34 pm

okiebill wrote:
Nickthezombiehunter wrote:Hate to be the Debbie downer, but its entertaining to watch this thread bc many don't know shit about meds.
Dazzle us with your Brilliance Nick, I'm sure all of us could use your expertise or did you jump in to insult / troll folks as opposed to actually contributing something positive to the discussion... :roll:
I posted that it is a bad idea to take Imodium for a diarrhea from an infectious etiology; however, everyone keeps ignoring that and putting on there list. Some times people do not listen to advice.

I am in third world countries all the time. I just met with some people tonight to plan a trip to Ecuador. I live the primitive conditions you plan for.

"IMODIUM (loperamide hcl) should not be used as the primary therapy:

- in patients with acute dysentery, which is characterized by blood in stools and high fever,

- in patients with acute ulcerative colitis,

- in patients with bacterial enterocolitis caused by invasive organisms including Salmonella, Shigella, and Campylobacter,"
http://www.rxlist.com/imodium-drug/over ... ations.htm" onclick="window.open(this.href);return false;

You have to you an antibiotic along with it in cases of bacterial enterocolitis.

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