Post-Apocalyptic Formulary: a Georgetown University IRB-approved Survey

[Sahana Chakravartti]

Imagine you're the healthcare provider for survivors in a post-apocalyptic world. If you could have a lifetime supply of 20 essential medications to take with you, which drugs would you choose?

Georgetown University Medical Center’s PharmedOut is conducting a survey on prescribing choices in a hypothetical scenario, and would greatly appreciate your participation. And please spread the word to your peers and colleagues!

Find the survey here: https://bit.ly/Top20Drugs.

Georgetown University Medical Center’s PharmedOut advances evidence-based prescribing and educates healthcare professionals and students about pharmaceutical and medical device marketing practices. Learn more here: www.pharmedout.org.

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[annoyedpsychiatrist]

This is a pretty broad question, being super analytical here are you saying a supply that never ran out? Treating chronic conditions wouldnt matter if you eventually ran out of the medication, so the shift would be more on medications helped in the acute setting like antibiotics.

 

[Sushirolls]

In a post apocalyptic world I would be focused on the essentials. Clean air, clean water, Food, and shelter. Followed up by defense, working rifles and handguns with sufficient munitions. Practicing psychiatry is the last thing I'd be doing.

Do do you mean if Democrats and socialists take over America and we're on a restricted formulary and force a universal healthcare upon everyone? That is more feasible, and probably a better way to ask this question. But then again, if this hellscape were to emerge, practicing Psychiatry is probably the last thing I'd be doing, too.

Or less politically polarizing way to approach this, say you are on Elon Musk's colonization space ship to some random earth like planet, and are the only Psychiatrist on ship reporting to the chief medical officer. (you know, cause Mars already got colonized) Which 20 meds will you choose to service the very large crew for this multiyear expedition?

 

[WisNeuro]

In a post apocalyptic world I would be focused on the essentials. Clean air, clean water, Food, and shelter. Followed up by defense, working rifles and handguns with sufficient munitions. Practicing psychiatry is the last thing I'd be doing.

Do do you mean if Democrats and socialists take over America and we're on a restricted formulary and force a universal healthcare upon everyone? That is more feasible, and probably a better way to ask this question. But then again, if this hellscape were to emerge, practicing Psychiatry is probably the last thing I'd be doing, too.

Or less politically polarizing way to approach this, say you are on Elon Musk's colonization space ship to some random earth like planet, and are the only Psychiatrist on ship reporting to the chief medical officer. (you know, cause Mars already got colonized) Which 20 meds will you choose to service the very large crew for this multiyear expedition?

Do you try to be a caricature, or doe sit come naturally?

 

[Sushirolls]

Do you try to be a caricature, or doe sit come naturally?

I try not to doe sit, but buck walk.

 

[comp1]

Here is the actual question for those who didn't want to click the link:

SCENARIO:

You have been chosen as the healthcare provider for a diverse group of families who have volunteered to colonize areas that were wiped out by a record-breaking natural disaster many years ago.

You receive a grant that will allow you to purchase a lifetime supply of up to 20 essential medications to take with you.

What are they?

I'm not sure psych drugs would make the top 20 in this situation. I'd rather have an internist or ED doctor manage this question. I wouldn't send floridly psychotic patients out to be colonizers...

 

[Sushirolls]

antibiotics

birth control

anesthetics for surgery
*lidocaine for sure (dentistry too)
*Propofol

pain meds
*Ibuprofen
*tylenol
*morphine
*vicodin

If any room for psych... Effexor (or sertraline) & Haldol

Perhaps a combo approach... Haldol for nausea in a pinch and Psych?
Ketamine for surgery and Depression?
Try to find as many dual meds as possible for broadest reach.

 

[Merovinge]

antibiotics

birth control

anesthetics for surgery
*lidocaine for sure (dentistry too)
*Propofol

pain meds
*Ibuprofen
*tylenol
*morphine
*vicodin

If any room for psych... Effexor (or sertraline) & Haldol

Perhaps a combo approach... Haldol for nausea in a pinch and Psych?
Ketamine for surgery and Depression?
Try to find as many dual meds as possible for broadest reach.

In a post-apocolyptic world I would expect rates of depression and anxiety to be markedly less than current 1st world countries. Psychosis likely still present at a base-rate, maybe heightened by the state of things. I think it would be reasonable to consider Haldol for nausea, psychosis, and chemically sedating "the opposition". Definitely would save the other 19 for the IM/EM team to figure out.

 

[Desired Member]

That was fun. For psych meds, I mentioned olanzapine, lithium, escitalopram

 

[annoyedpsychiatrist]

Well people would really love klonopin during an apocalypses. Vyvanse may be useful too, lol. I think LAIs may be more useful since I imagine people are less compliant in an apocalypses. Also a huge amount of humira, which people havent mentioned yet since autoimmune coniditions will still be a big deal and it treats everything. Also corticosteroids because if all else fails, go for steroids.

 

[smalltownpsych]

antibiotics

birth control

anesthetics for surgery
*lidocaine for sure (dentistry too)
*Propofol

pain meds
*Ibuprofen
*tylenol
*morphine
*vicodin

If any room for psych... Effexor (or sertraline) & Haldol

Perhaps a combo approach... Haldol for nausea in a pinch and Psych?
Ketamine for surgery and Depression?
Try to find as many dual meds as possible for broadest reach.

Good list, but probably don’t need the NSAIDs as long as there are willows growing around. 😁 Morphine, lidocaine, and an antibiotic or two would top my list. My son who has diabetes would vote for insulin, but maybe we screen that out for the colony. Not sure if we need birth control post-apocalypse, but pretty hard to imagine not having the ability to time pregnancies these days. I see several votes for haldol, wonder why this as opposed to olanzapine?

 

[mistafab]

For psych meds, I would vote haldol and lithium. Or possibly olanzapine and lithium. I think on sushirolls list I would remove all the pain meds and just keep morphine. Antibiotics would likely boil down to 3 meds.

 

[allantois]

In a post apocalyptic world I would be focused on the essentials. Clean air, clean water, Food, and shelter. Followed up by defense, working rifles and handguns with sufficient munitions. Practicing psychiatry is the last thing I'd be doing.

Do do you mean if Democrats and socialists take over America and we're on a restricted formulary and force a universal healthcare upon everyone? That is more feasible, and probably a better way to ask this question. But then again, if this hellscape were to emerge, practicing Psychiatry is probably the last thing I'd be doing, too.

Or less politically polarizing way to approach this, say you are on Elon Musk's colonization space ship to some random earth like planet, and are the only Psychiatrist on ship reporting to the chief medical officer. (you know, cause Mars already got colonized) Which 20 meds will you choose to service the very large crew for this multiyear expedition?

Except we are on a restricted formulary cause, you know, patients are uninsured and cannot afford anything that came out in the past 20 years

 

[clozareal]

antibiotics

birth control

anesthetics for surgery
*lidocaine for sure (dentistry too)
*Propofol

pain meds
*Ibuprofen
*tylenol
*morphine
*vicodin

If any room for psych... Effexor (or sertraline) & Haldol

Perhaps a combo approach... Haldol for nausea in a pinch and Psych?
Ketamine for surgery and Depression?
Try to find as many dual meds as possible for broadest reach.

I would not include birth control. If you're trying to recolonize and repopulate, I would want babies coming out like hotcakes.

 

[allantois]

That was fun. For psych meds, I mentioned olanzapine, lithium, escitalopram

This is fun; is Lithium really a med tho?

 

[allantois]

How about Depakote? Kill 2 birds with 1 stone

 

[clozareal]

From what I see in the community, all you need are two meds: Adderall and Lamotrigine.

 

[Merovinge]

From what I see in the community, all you need are two meds: Adderall and Lamotrigine.

How lucky to work somewhere that isn't XanniesRUS incorporated.

 

[BigRedBeta]

super interesting question.

As a pediatric intensivist, tried to think what I could use in multiple scenarios, especially for critical illness but also in a more routine setting.

If you get cancer, sorry.


Morphine
rocuronium
ketamine
(I can get you through almost any surgical procedure with these meds)

acetaminophen

ceftriaxone
amoxicillin
meropenem
vancomycin

epinephrine (as a pressor, for croup/asthma, anaphylaxis)
albuterol

hydrocortisone (can essentially use for any steroid need from rheumatologic, to endocrinopathies, and also croup/asthma)

insulin (self explanatory)

lorazepam
levetiracetem
(seizures are bad, can also use ketamine for seizures)

furosemide
amlodipine

fluoxitine (depressed people tend to be less productive than their potential)

Oxygen



It wouldn't be easy, for sure, but I think I could manage a great many number of ailments with these medications.

 

[HemeOncHopeful19]

super interesting question.

As a pediatric intensivist, tried to think what I could use in multiple scenarios, especially for critical illness but also in a more routine setting.

If you get cancer, sorry.

I dunno I mean we could probably do a lot with cancer using 5 out of 20… I feel like there’s at least an argument to be made over Keppra or Prozac.

But you’d need a good support system and imaging/surgery which this post apocalyptic world may not have?