Oh My Gosh

Rewind to Sunday night. Busy wrapping up pharmacology revision, rushing everything, in a panic.

Drank some chamomile tea. While still having a bad tummy. Tummy ache worsened. Only to find out later on Google that chamomile tea is a cholinoceptor agonist (pharm crap) so that it'll make my tummy worse. Oh crap. Pharm exam coming up, and I used a glaringly inappropriate drug. I'm so gonna fail.

That's the problem with pharmacology teaching in NUS. I might know the exact mechanism of drugs like proton pump inhibitors for peptic ulcers, all the half-lives and plasma concentration curves and all. But when the patient's in front of me and needs treatment, do I really know what to give the patient? Probably not.

Oh. And in the evening, JS reminded me that the exam is on Wednesday and Friday. Not Monday and Wednesday.

Oh my gosh. I'm such an idiot for not checking the exam timetable properly. Geeeeee, I really should take more responsibility for my own education! I gotta admit. I'm still having trouble coping with the university environment where everyone fends for himself. No peer pressure from close friends. Just the looming fear of failing the exams.

So now I have 2 unplanned-for days. Good in the sense that I can do even more revision. Bad in the sense that I dunno where to start now that my schedule's unplanned. And it feels like I got 2 days less of holidays. Ack.

Some musings: Back to the topic of Pharm teaching. You begin to doubt everything you learn when:

Your neighbourhood GP prescribes Piriton(chlorpheniramine) to a working lady for itching. But the problem is, it's 1/2 tablet 3 times daily. Maybe i'm ignorant about some details or etc so pardon me. But my impression is:

1. WTF! Giving a working lady sedating (side effects include drowsiness, fatigue) in the day! What is she thinking, when there are other non-sedating antihistamines that are commonly-used! (That was drilled into me at a tender age of 17 during my job shadowing at National Skin Centre. Tailoring medication regimens to the lifestyles of patients.)

2. WTF! Does she really believe that patients will take the effort to meticulously chop those tablets into half 3 times a day? Bet not.

Picture on the left shows CORRECTLY-PRESCRIBED sedating antihistamines. At night. Warn of sleepiness.

Your neighbourhood polyclinic prescribes 1/2 tablet atenolol for hypertension.

1. WTF! Halving tablets every morning for years!

2. WTF! National Institute for Health and Clinical Excellence (NICE), UK already doesn't see beta-blockers as suitable first-line treatment for hypertension, so why not use an alternative!

Morever, one very-often overlooked side effect. Often mentioned on online forums, often mentioned anecdotally, hardly documented. Beta blockers reduce one's capacity for exercise. (for fellow meddies: blockade of sympathetic stimulation of heart, heart rate can't rise enough to cope with increased oxygen demand of muscles) So patients might just go "dang, exercise is so tough, I can't even run a kilometre without feeling weak all over. Why should I even bother?"

OK. Maybe it's cheaper that way. But that's no excuse for reducing the health of the community just to save the taxpayers a few cents. (Although the BEST alternatives - angiotensin receptor blockers and calcium channel blockers - are costly, there are good and cheap alternatives such as thiazides and angiotensin converting enzyme inhibitors.)

And. Sigh. History will repeat itself when the Pharmacology department is all so interested in us memorising half-lives and cell signalling biochemistry, but not batting an eyelid at the travesty that's happenning in the field.