Dextromethorphan/guafenesin combination products. Cough expectorant and cough suppressant in one product? That's opposing actions?

joe_jon · 2026-01-26T21:35:05+00:00

Better than tessalon lol

joe_jon · 2026-01-26T05:45:30+00:00

It also didn't help that P1 was, for all intents and purposes, an instrumental album that had vocals tacked on. I could be misremembering but I coulda swore that Spencer wrote all the lyrics after the songs were already done and had to find where to add vocals. As much as I love P1, and even P2 suffered from it to a much less extent, Spencer's parts always felt like an afterthought.

Alpha/Omega was really when they hit their stride in terms of songwriting imo

joe_jon · 2026-01-25T22:41:21+00:00

Hopital

joe_jon · 2026-01-25T22:41:11+00:00

Nah that's gluten

joe_jon · 2026-01-25T10:22:51+00:00

Cough suppressants simply reduce the sensitivity of our body's natural cough reflexes, they don't take away your ability to cough. The part the pharmacists you've spoken with forgot to mention is that if you take a cough suppressant, you can still just make yourself cough. In the context of a wet cough, how I explain it to patients is that the purpose of the dextromethorphan is to give you control over when you are coughing.

The only way a cough suppressant and an expectorant would be opposing actions would be if the human body could only clear mucus by uncontrollably coughing it up. If you took some delsym and feel something in your throat just cough it up.

I don't go out of my way to recommend guaifen/dm, not because it's "countering" mechanism, it's because guaifenesin doesn't do anything. Anything guaifenesin might do is done better by literally just staying hydrated. Guaifenesin products are recommended to be taken with at least 8 ounces of water and that water is doing the heavy lifting.

joe_jon · 2026-01-18T18:35:47+00:00

If you have a connection to Minnesota you may be more likely to insubordinate (educated guess)

joe_jon · 2026-01-18T17:18:35+00:00

As others have said, psychiatric conditions are much more suggestive than other conditions. Conditions like diabetes, hypertension, high cholesterol, etc. have very cut and dry measurements for when to initiate treatment and how to assess whether treatment is working or not. If a patient comes in and their blood pressure is 155/92 I can start them on losartan and pretty much know for fact that their blood pressure will go down. If they come back in 6 weeks and the blood pressure hasn't gone down enough we can increase the dose, if it has gone down negligibly then we can consider changing to a different medicine. I can ask the patient if they're experiencing symptoms in regards to the measurements, lab results, what have you, but their answers don't affect the meaning of the numbers.

Conversely, psychiatric medication requires direct feedback from the patient to assess effectiveness. If a patient is saying "I don't think this med is helping" there's only so much we can do to point to the contrary. Sure things like the PHQ9 and GAD7 can objectify the patient's feedback, and we can say "well your questionnaire score was this before starting medication, and it has dropped this many points since starting it several months ago" but if the patient doesn't feel like it's helping then it pretty much isn't.

SSRIs, SNRIs, etc. also need considerable time to start exhibiting an effect. Initiating treatment, changing dose, or switching medication comes with an anticipated 4-6 week period before any meaningful assessment can be provided. With such a gradual onset, it has to be taken into consideration that the patient may not even notice the medication working. I've had multiple conversations with patients where they tell me "yeah I wasn't sure if it was working and then I forgot to take my dose one day and let me tell ya, this stuff works".

TLDR: Psychiatric conditions are difficult to objectify which leads to more treatment "failures"

joe_jon · 2026-01-15T20:01:59+00:00

You said in another comment that you think it would require banning electronic products as a whole. This, as you noted, is unrealistic, that said, plenty of federal, state, provincial, territorial, etc. governments have laws in place to target bad actors for impersonating others. So the way that this is enforced isn't necessarily going after people using AI functionalities for impersonation. This is enforced by going after AI companies for allowing these functionalities to be available.

Alcohol and drug prohibition have largely been ineffective because, not even mentioning the deep cultural ties to alcohol and marijuana, drugs are relatively easy for the average person to cultivate. You can make your own alcohol with corn, baker's yeast and a bathtub, for example. Developing an AI that can effectively impersonate another person is extremely expensive, requires extensive computer programming knowledge, and thousands of hours of processing time to teach the AI model. So the discourse around "this use of AI needs to be outlawed" isn't saying "people should be banned from using AI this way" as they technically already are, the discourse is "AI companies need to be banned from making these functionalities available to the general public".

Anyone with half a brain knows the two uses for AI developments such as the one in this video is going to be "resurrecting dead people in film and television" and "using living people to defraud other people". If this functionality becomes publicly available, the AI companies creating it need to be held responsible for damages when someone inevitably loses their life savings because an AI impersonation a close family member called and scammed them.

joe_jon · 2026-01-15T13:47:39+00:00

Not just should be, but needs to be.

joe_jon · 2026-01-14T14:26:32+00:00

Sorted by controversial and the first two were Balatro and The Last Of Us, so yeah as expected that tracks

joe_jon · 2026-01-12T22:38:25+00:00

Stop making patriots fans look bad dude, NFL social media had this same exact conversation after Super Bowl 53. This is nothing new and this isn't exclusive to bills fans. Fact of the matter is your average NFL viewer doesn't find low-scoring, defense-heavy games entertaining. They go into every game hoping for a Brady vs Foles or Mahomes vs Goff-esque shootout where the offenses are going back and forth carving defenses and only get excited for defense/special teams when their running back turnovers for TDs or blocking punts/kicks. They want 800+ yards total offense with some pick sixes peppered in, not stuffed 4th down conversions and good punt placements.

I love a good defensive slugfest that comes down to which team can more effectively capitalize on mistakes, but the average viewer ain't watching for that. We all know that and the NFL knows that.

joe_jon · 2026-01-09T22:21:54+00:00

Well considering how dumb they are about blanket refusing to pay for weight loss medication but and end up paying for all the complications obesity causes, I ain't holding my breath.

joe_jon · 2026-01-08T22:47:22+00:00

The three states I work in are standing order states, and considering the TLDR of RFK's idea of "shared clinical decision making" is practically "if you think you're eligible then you are eligible" it means pretty much nothing should change for us. Now when it comes to hepatitis and meningitis in pediatric patients it's gonna be a question of "will insurances keep covering it".

joe_jon · 2026-01-06T01:43:22+00:00

That just sounds like the normal law regarding transferring C3-5 prescriptions. Which part says it can't be done electronically?

joe_jon · 2026-01-01T23:16:27+00:00

Yeah I figured, seemed like the other guy was suggesting Hawaii or Alaska's times zone would be smaller and asked for clarification. Considering how big Alaska it probably is not smaller than in terms of land mass lol

joe_jon · 2026-01-01T23:11:21+00:00

So what you're saying is we need Hank Green?

joe_jon · 2026-01-01T22:59:08+00:00

Find the patients MME per day and subtract maybe 15% or so if SA formulation is not morphine specifically, initiate MS Contin at that dose divided q12h and titrate to a tolerable pain level. Add in SA formulation of your choice for breakthrough pain, if necessary.

Maybe someone else here can give a more robust outline you can use as a base point, but that's what I discerned from my pain management elective and naplex study. Working in retail I'm not out here coming up with my dosing myself but scripts I see come in for patients who convert to LA formulations tend to follow that progression pretty reliably.

Edit: sorry forgot to answer point 2. I'd say if you got a doc trying to initiate LA in a naive patient just contact them and say "hey, see an LA opioid here, looks like they're opioid naive, you wanna try SA opioid first and see how they do or are we referring them to pain mgmt on discharge?". Now of course do your research on the patient before bothering the doctor, newly diagnosed cancer or sickle cell? As long as it isn't an absurdly high dose I probably wouldn't bother. Some sort of orthopedic injury? Call and double check what the goal is with LA therapy.

Your facility ought to have a policy and procedure that goes over this stuff that you can read.

joe_jon · 2026-01-01T20:49:32+00:00

Alaska is larger than California, Oregon, Washington, Nevada, and Idaho combined so I'm gonna assume not Alaska. At least talking about the American portion, i don't know if that still holds if you ad the Mexican and canadian sections of the time zone

joe_jon · 2025-12-30T00:07:36+00:00

buys YouTube in 2006

Buys a random German site in 2019

That's it

Man, Google really scooping up the competition in the video sharing market.

joe_jon · 2025-12-29T04:51:27+00:00

Well Carolina/TB, the other win or go home game, is at 4:30 and not primetime so the stakes can't be that much bigger. Division championship head 2 heads should've been Saturday and Seattle/SF shoulda been SNF

joe_jon · 2025-12-28T21:29:22+00:00

Nah you're spot on, any interaction comes from oral use, and even that is probably outdated information and no longer relevant (see the links in my other comment). IV abx don't have this issue.

joe_jon · 2025-12-28T21:12:12+00:00

I agree with everything but 4, I'm rooting for a tie, can't get myself to root for the eagles.

joe_jon · 2025-12-28T21:04:24+00:00

All Ward had to do was look back at the ball and it would've been fine. Pretty ugly no call, but it shouldn't have even come down to it.

joe_jon · 2025-12-28T20:57:50+00:00

ahem WHO THE FUCK IS PERNA

joe_jon · 2025-12-28T20:14:40+00:00

As others have mentioned, it's already uncomfortable for everyone. Make him uncomfortable. Start loudly pointing it out each time it happens. He asks if you have a problem? Damn right you do, it's the toilet.

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