Latest Likes For MunoRN

Latest Likes For MunoRN

MunoRN 25,309 Views

Joined Nov 18, '10. Posts: 7,226 (68% Liked) Likes: 17,065

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  • 8:26 am

    Quote from Ndy-RN
    Lorazepam (Advan) is an anti-anxiety medication and could also be used to treat seizures. Many people (mire than you know) do take that...in some cases including nurses. No one will penalize you for taking Lorazepam! It is not their business to go into your confidential medical history to see if you have a prescription or not. You are worried for nothing! Stay Calm and get ready to start tour BScN program. [emoji4]
    That's really bad avice. One of the main thing that pre-employment or nursing school drug tests are looking for is use of a controlled substance without a prescription, and they usually take that very seriously. Even with a prescription, nurses can be prohibited from taking benzos by their employer and yes they can legally test for any prohibited substances, prescription or not.

  • 8:21 am

    Quote from BostonFNP
    I am not exactly sure what you mean by this. The psychoactive component of marijuana is delta-9-tetrahydrocannabinol which itself is lipophilic and thus stored in the body readily and is extremely potent, measured in nanograms. If it is extracted or leeched from fat cells, both it and its psychoactive metabolite 11-OH-THC, result in long-term potential impairment. Alcohol is almost immediately psychoactive but quickly clears the body. It's metabolite, acetaldehyde, is also found in marijuana smoke...
    11-OH-THC is an intermediate metabolite and is typically further metabolized prior to lipid absorption. I wonder if you're confusing 11-OH-THC for THC-COOH which is the metabolite commonly found long term in fat stores and is what urine drug screens look for, THC-COOH has no psychoactive or other impairing properties. 11-OH-THC is absorbed in fat tissue as well, but the levels it's absorbed at and then reintroduced into circulation are far less than the plasma concentrations we know cause measurable impairment.

    There's certainly some alteration of cognition and functioning beyond just the acute phase or "high", although it's not clear it's significantly different than other causes of less-than-perfect functioning. Alcohol's metabolite that is impairing and has been shown to remain in circulation for as long as two weeks, yet it would be a bit silly to say that nurses shouldn't be allowed to have a beer on their day off. I have three kids, which is a pretty clear risk for impairment since it causes me to work more fatigued and distracted than if I had no kids, should nurses be forbidden from having kids?

    Quote from BostonFNP
    There is also no doubt that nurses (or any HCP) should care for patients under the influence of alcohol, so the same should be true for marijuana, and acute impairment has been demonstrated at significantly longer intervals than alcohol.

    I don't think chronic alcohol abuse is any more benign than marijuana use, but it is legal, for better or worse.
    Acute impairment (being "high" or "drunk") are actually about the same for both marijuana and alcohol, typically 2-3 hours for smoked marijuana and typically 4-6 hours for digested marijuana.

    Unless the federal government decides to establish justification for federal jurisdiction of marijuana laws, which they don't appear interested in, the legality of marijuana falls to the states, and a number of states has made it legal.

  • 7:32 am

    My kid was watching yo-gabba-gabba when I was picking a name, Muno is this guy: Yo Gabba Gabba! Muno Action Figure | Tv's Toy Box

    At the time, I found it funny that he looks like a mascot for some sort of STD awareness campaign.

  • 7:13 am

    Quote from BostonFNP
    I am not exactly sure what you mean by this. The psychoactive component of marijuana is delta-9-tetrahydrocannabinol which itself is lipophilic and thus stored in the body readily and is extremely potent, measured in nanograms. If it is extracted or leeched from fat cells, both it and its psychoactive metabolite 11-OH-THC, result in long-term potential impairment. Alcohol is almost immediately psychoactive but quickly clears the body. It's metabolite, acetaldehyde, is also found in marijuana smoke...
    11-OH-THC is an intermediate metabolite and is typically further metabolized prior to lipid absorption. I wonder if you're confusing 11-OH-THC for THC-COOH which is the metabolite commonly found long term in fat stores and is what urine drug screens look for, THC-COOH has no psychoactive or other impairing properties. 11-OH-THC is absorbed in fat tissue as well, but the levels it's absorbed at and then reintroduced into circulation are far less than the plasma concentrations we know cause measurable impairment.

    There's certainly some alteration of cognition and functioning beyond just the acute phase or "high", although it's not clear it's significantly different than other causes of less-than-perfect functioning. Alcohol's metabolite that is impairing and has been shown to remain in circulation for as long as two weeks, yet it would be a bit silly to say that nurses shouldn't be allowed to have a beer on their day off. I have three kids, which is a pretty clear risk for impairment since it causes me to work more fatigued and distracted than if I had no kids, should nurses be forbidden from having kids?

    Quote from BostonFNP
    There is also no doubt that nurses (or any HCP) should care for patients under the influence of alcohol, so the same should be true for marijuana, and acute impairment has been demonstrated at significantly longer intervals than alcohol.

    I don't think chronic alcohol abuse is any more benign than marijuana use, but it is legal, for better or worse.
    Acute impairment (being "high" or "drunk") are actually about the same for both marijuana and alcohol, typically 2-3 hours for smoked marijuana and typically 4-6 hours for digested marijuana.

    Unless the federal government decides to establish justification for federal jurisdiction of marijuana laws, which they don't appear interested in, the legality of marijuana falls to the states, and a number of states has made it legal.

  • 7:11 am

    Quote from BostonFNP
    There is a difference, alcohol is federally legal and marijuana is not. Alcohol also does not accumulate in the body and impair function several weeks out from a single use, there could be an argument that chronic alcohol abuse does have lasting cognitive effects, but again, the law is the law regardless.
    That may have come out differently than you intended, since what accumulates in your body are non-psycho active metabolites, not active components of the drug. Both alcohol and marijuana have acute impairment and longer term impairment phases, both are dose dependent and the evidence for each is similar. The way our laws work is that federal laws only apply to what state's have not addressed, which is why in states where the two conflict it's residents are held to the state law.

    Quote from BostonFNP
    Li, M. C., Brady, J. E., DiMaggio, C. J., Lusardi, A. R., Tzong, K. Y., & Li, G. (2012). Marijuana use and motor vehicle crashes. Epidemiologic reviews,34(1), 65-72.

    Salomonsen-Sautel, S., Min, S. J., Sakai, J. T., Thurstone, C., & Hopfer, C. (2014). Trends in fatal motor vehicle crashes before and after marijuana commercialization in Colorado. Drug and alcohol dependence, 140, 137-144.
    Blood testing for active THC levels was not all that common a decade ago, in Colorado it's now widely available and is as common as blood testing for alcohol blood levels, which is why there has been a predictable increase in the number of people who test positive. There's no doubt it's unsafe to drive under the influence of either marijuana or alcohol, but there's no evidence there has been sudden increase in the number of marijuana-caused accidents.

  • 7:11 am

    Quote from canigraduate
    When I lived in Denver, it was legal on the state level, yes, but employers still screened you and refused to employ anyone who tested positive for marijuana. It's still illegal federally. Most employers screen for nicotine, now, too, and refuse to employ those who use it, even though it is not illegal at all.

    The employers in CO are actually more stringent with drug screens because they believe that the pothead culture will cause employees to slip up more. (How do I know? I asked a few.)

    As far as there being no repercussions from overdose, that is not true. Here is a link: Medscape: Medscape Access

    Here is a quote if you don't want to read the whole thing:

    "Acute cannabis toxicity results in difficulty with coordination, decreased muscle strength, decreased hand steadiness, postural hypotension, lethargy, decreased concentration, slowed reaction time, slurred speech, and conjunctival injection. Large doses of THC may produce confusion, amnesia, delusions, hallucinations, anxiety, and agitation, but most episodes remit rapidly. Chronic users may experience paranoia, panic disorder, fear, or dysphoria."

    Frankly, I don't want you handling my care if you are suffering from amnesia, delusions, hallucinations, etc. I really don't want you coming at me with needles if your hands are unsteady and your coordination is off.

    You may use the argument that cannabis is better than alcohol, spaghetti, or whatever, but it doesn't matter. It is still dangerous in and of itself.

    I have seen people put forth the argument that driving drunk is worse than driving high. Again, it doesn't matter. Driving high is still dangerous in and of itself. Slowed reaction times and decrease in coordination are not qualities I admire in drivers, especially when I watch them weaving while they're trying to roll a joint. (Oh, Denver...) If you're so stupid that you don't know to pull over, you're too stupid to drive.

    If you use MJ medically and responsibly, good for you! That's awesome. I have no beef with you. I actually applaud you for trying to find something that works for you. Just don't expect to do that and be a nurse.
    That's at least a little misleading. Marijuana "overdose" currently only exists in theory. A lethal overdose has never been known to occur. The general consensus on the amount required to cause acute harm is roughly equivalent to smoking/ingesting an amount equivalent to what a hay barn could hold in a single sitting. Even if you cherry pick and use a loose definition of harm, the low-end amount that could cause harm is thought to be around 90mg/kg worth of peak serum levels, which would require smoking about 250,000 joints in one sitting, or about 2,000 joints per minute.

    There's no arguing that marijuana is impairing and carries risks, just like alcohol and many prescribed drugs do, and nobody should drive while impaired by any of them, but to imply that the relative safety of marijuana compared to other drugs/substances used for recreational and therapeutic purposes is similar is pretty ridiculous. Drug safety is usually described in terms of therapeutic index and LD50. There no established LD50 for marijuana since the amount required to kill someone is physically impossible to ingest, and even the therapeutic index is largely theoretical. The amount of alcohol typically used for recreational purposes, or opiates or benzos used for therapeutic purposes is fairly close to the amount that causes harm, and that ratio clearly is far different than that of marijuana.

  • 1:25 am

    Quote from canigraduate
    When I lived in Denver, it was legal on the state level, yes, but employers still screened you and refused to employ anyone who tested positive for marijuana. It's still illegal federally. Most employers screen for nicotine, now, too, and refuse to employ those who use it, even though it is not illegal at all.

    The employers in CO are actually more stringent with drug screens because they believe that the pothead culture will cause employees to slip up more. (How do I know? I asked a few.)

    As far as there being no repercussions from overdose, that is not true. Here is a link: Medscape: Medscape Access

    Here is a quote if you don't want to read the whole thing:

    "Acute cannabis toxicity results in difficulty with coordination, decreased muscle strength, decreased hand steadiness, postural hypotension, lethargy, decreased concentration, slowed reaction time, slurred speech, and conjunctival injection. Large doses of THC may produce confusion, amnesia, delusions, hallucinations, anxiety, and agitation, but most episodes remit rapidly. Chronic users may experience paranoia, panic disorder, fear, or dysphoria."

    Frankly, I don't want you handling my care if you are suffering from amnesia, delusions, hallucinations, etc. I really don't want you coming at me with needles if your hands are unsteady and your coordination is off.

    You may use the argument that cannabis is better than alcohol, spaghetti, or whatever, but it doesn't matter. It is still dangerous in and of itself.

    I have seen people put forth the argument that driving drunk is worse than driving high. Again, it doesn't matter. Driving high is still dangerous in and of itself. Slowed reaction times and decrease in coordination are not qualities I admire in drivers, especially when I watch them weaving while they're trying to roll a joint. (Oh, Denver...) If you're so stupid that you don't know to pull over, you're too stupid to drive.

    If you use MJ medically and responsibly, good for you! That's awesome. I have no beef with you. I actually applaud you for trying to find something that works for you. Just don't expect to do that and be a nurse.
    That's at least a little misleading. Marijuana "overdose" currently only exists in theory. A lethal overdose has never been known to occur. The general consensus on the amount required to cause acute harm is roughly equivalent to smoking/ingesting an amount equivalent to what a hay barn could hold in a single sitting. Even if you cherry pick and use a loose definition of harm, the low-end amount that could cause harm is thought to be around 90mg/kg worth of peak serum levels, which would require smoking about 250,000 joints in one sitting, or about 2,000 joints per minute.

    There's no arguing that marijuana is impairing and carries risks, just like alcohol and many prescribed drugs do, and nobody should drive while impaired by any of them, but to imply that the relative safety of marijuana compared to other drugs/substances used for recreational and therapeutic purposes is similar is pretty ridiculous. Drug safety is usually described in terms of therapeutic index and LD50. There no established LD50 for marijuana since the amount required to kill someone is physically impossible to ingest, and even the therapeutic index is largely theoretical. The amount of alcohol typically used for recreational purposes, or opiates or benzos used for therapeutic purposes is fairly close to the amount that causes harm, and that ratio clearly is far different than that of marijuana.

  • Apr 28

    Quote from Dany102
    Wow... I just realized I've been reading your user name as "Munro" all this time... Silly me.

    D.
    Everybody does, it's ok, it's the "R" right after "Muno". I also see it that way frequently.

  • Apr 28

    Obviously there's a bit more to it, but generally when the next of kin decides the patient would no longer stop CPR we stop CPR. Are there places where you just say "too bad" and keep going?

  • Apr 28

    My kid was watching yo-gabba-gabba when I was picking a name, Muno is this guy: Yo Gabba Gabba! Muno Action Figure | Tv's Toy Box

    At the time, I found it funny that he looks like a mascot for some sort of STD awareness campaign.

  • Apr 28

    There's not actually any reason to prohibit fans in general from an infection prevention standpoint, I'm a little surprised your IP director was that badly informed. There are relatively limited situations where fans could be unsafe or should not be used, such as where it would interfere with the flow of a laminar flow air hood (used for mixing meds or in the lab), or where it may direct air from an area under maintenance to an active patient care area, or where it would interfere with the negative airflow of a airborne isolation room. Out of laziness, some organizations just prefer to ban them all together to avoid having to define these rare limitations, which is unfortunate since they can be very valuable in patient care.

    Infection control considerations for box fans | OSHA Healthcare Advisor

  • Apr 28

    Quote from Ndy-RN
    Lorazepam (Advan) is an anti-anxiety medication and could also be used to treat seizures. Many people (mire than you know) do take that...in some cases including nurses. No one will penalize you for taking Lorazepam! It is not their business to go into your confidential medical history to see if you have a prescription or not. You are worried for nothing! Stay Calm and get ready to start tour BScN program. [emoji4]
    That's really bad avice. One of the main thing that pre-employment or nursing school drug tests are looking for is use of a controlled substance without a prescription, and they usually take that very seriously. Even with a prescription, nurses can be prohibited from taking benzos by their employer and yes they can legally test for any prohibited substances, prescription or not.

  • Apr 28

    Quote from canigraduate
    When I lived in Denver, it was legal on the state level, yes, but employers still screened you and refused to employ anyone who tested positive for marijuana. It's still illegal federally. Most employers screen for nicotine, now, too, and refuse to employ those who use it, even though it is not illegal at all.

    The employers in CO are actually more stringent with drug screens because they believe that the pothead culture will cause employees to slip up more. (How do I know? I asked a few.)

    As far as there being no repercussions from overdose, that is not true. Here is a link: Medscape: Medscape Access

    Here is a quote if you don't want to read the whole thing:

    "Acute cannabis toxicity results in difficulty with coordination, decreased muscle strength, decreased hand steadiness, postural hypotension, lethargy, decreased concentration, slowed reaction time, slurred speech, and conjunctival injection. Large doses of THC may produce confusion, amnesia, delusions, hallucinations, anxiety, and agitation, but most episodes remit rapidly. Chronic users may experience paranoia, panic disorder, fear, or dysphoria."

    Frankly, I don't want you handling my care if you are suffering from amnesia, delusions, hallucinations, etc. I really don't want you coming at me with needles if your hands are unsteady and your coordination is off.

    You may use the argument that cannabis is better than alcohol, spaghetti, or whatever, but it doesn't matter. It is still dangerous in and of itself.

    I have seen people put forth the argument that driving drunk is worse than driving high. Again, it doesn't matter. Driving high is still dangerous in and of itself. Slowed reaction times and decrease in coordination are not qualities I admire in drivers, especially when I watch them weaving while they're trying to roll a joint. (Oh, Denver...) If you're so stupid that you don't know to pull over, you're too stupid to drive.

    If you use MJ medically and responsibly, good for you! That's awesome. I have no beef with you. I actually applaud you for trying to find something that works for you. Just don't expect to do that and be a nurse.
    That's at least a little misleading. Marijuana "overdose" currently only exists in theory. A lethal overdose has never been known to occur. The general consensus on the amount required to cause acute harm is roughly equivalent to smoking/ingesting an amount equivalent to what a hay barn could hold in a single sitting. Even if you cherry pick and use a loose definition of harm, the low-end amount that could cause harm is thought to be around 90mg/kg worth of peak serum levels, which would require smoking about 250,000 joints in one sitting, or about 2,000 joints per minute.

    There's no arguing that marijuana is impairing and carries risks, just like alcohol and many prescribed drugs do, and nobody should drive while impaired by any of them, but to imply that the relative safety of marijuana compared to other drugs/substances used for recreational and therapeutic purposes is similar is pretty ridiculous. Drug safety is usually described in terms of therapeutic index and LD50. There no established LD50 for marijuana since the amount required to kill someone is physically impossible to ingest, and even the therapeutic index is largely theoretical. The amount of alcohol typically used for recreational purposes, or opiates or benzos used for therapeutic purposes is fairly close to the amount that causes harm, and that ratio clearly is far different than that of marijuana.

  • Apr 28

    Quote from BostonFNP
    There is a difference, alcohol is federally legal and marijuana is not. Alcohol also does not accumulate in the body and impair function several weeks out from a single use, there could be an argument that chronic alcohol abuse does have lasting cognitive effects, but again, the law is the law regardless.
    That may have come out differently than you intended, since what accumulates in your body are non-psycho active metabolites, not active components of the drug. Both alcohol and marijuana have acute impairment and longer term impairment phases, both are dose dependent and the evidence for each is similar. The way our laws work is that federal laws only apply to what state's have not addressed, which is why in states where the two conflict it's residents are held to the state law.

    Quote from BostonFNP
    Li, M. C., Brady, J. E., DiMaggio, C. J., Lusardi, A. R., Tzong, K. Y., & Li, G. (2012). Marijuana use and motor vehicle crashes. Epidemiologic reviews,34(1), 65-72.

    Salomonsen-Sautel, S., Min, S. J., Sakai, J. T., Thurstone, C., & Hopfer, C. (2014). Trends in fatal motor vehicle crashes before and after marijuana commercialization in Colorado. Drug and alcohol dependence, 140, 137-144.
    Blood testing for active THC levels was not all that common a decade ago, in Colorado it's now widely available and is as common as blood testing for alcohol blood levels, which is why there has been a predictable increase in the number of people who test positive. There's no doubt it's unsafe to drive under the influence of either marijuana or alcohol, but there's no evidence there has been sudden increase in the number of marijuana-caused accidents.

  • Apr 28

    Quote from Ndy-RN
    Lorazepam (Advan) is an anti-anxiety medication and could also be used to treat seizures. Many people (mire than you know) do take that...in some cases including nurses. No one will penalize you for taking Lorazepam! It is not their business to go into your confidential medical history to see if you have a prescription or not. You are worried for nothing! Stay Calm and get ready to start tour BScN program. [emoji4]
    That's really bad avice. One of the main thing that pre-employment or nursing school drug tests are looking for is use of a controlled substance without a prescription, and they usually take that very seriously. Even with a prescription, nurses can be prohibited from taking benzos by their employer and yes they can legally test for any prohibited substances, prescription or not.


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