{"id":29822,"date":"2015-01-25T02:00:31","date_gmt":"2015-01-25T07:00:31","guid":{"rendered":"http:\/\/quotulatiousness.ca\/blog\/?p=29822"},"modified":"2015-01-22T23:31:36","modified_gmt":"2015-01-23T04:31:36","slug":"prescribing-modern-drugs-for-richard-iii","status":"publish","type":"post","link":"https:\/\/quotulatiousness.ca\/blog\/2015\/01\/25\/prescribing-modern-drugs-for-richard-iii\/","title":{"rendered":"Prescribing modern drugs for Richard III"},"content":{"rendered":"<p>In <a href=\"http:\/\/blogs.bmj.com\/bmj\/2015\/01\/19\/richard-lehmans-journal-review-19-january-2015\/\" target=\"_blank\">Richard Lehman&#8217;s BMJ journal review<\/a>, there was an amusing bit of interest to Ricardians:<\/p>\n<blockquote><p>King Richard III of England was 32 when he died at Bosworth and then famously suffered the indignity of being buried in a Leicester car park. I think I probably drew your attention to <a href=\"http:\/\/www.thelancet.com\/journals\/lancet\/article\/PIIS0140-6736(14)60804-7\/abstract\" target=\"_blank\">this account of his post-mortem examination when it appeared online last September<\/a>. Had Richard III been spared avoidable mortality in the form of a bashed-in skull and a spear through his spine, he would probably have needed a walking frame by the age of 70. He was never in the best shape:<\/p>\n<p><em>I, that am curtail\u2019d of this faire Proportion,<br \/>\nCheated of Feature by dissembling Nature,<br \/>\nDeform\u2019d, unfinish\u2019d, sent before my time<br \/>\nInto this breathing World, scarse halfe made up,<br \/>\nAnd that so lamely and unfashionable,<br \/>\nThat dogges bark at me, as I halt by them.<\/em><br \/>\n(from <strong>The Tragedy of Richard the Third: with the Landing of Earle Richmond , and the Battell of Bo\u0283worth Field<\/strong> by Wm Shakespeare c.1592, First Folio text 1623)<\/p>\n<p>With his nasty scoliosis and his habit of moving around castles with smoky rooms and no hand rails on the stairs, Richard III would have needed an OT assessment and a dosset box containing all the drugs which are now compulsory for elderly people in the UK:<\/p>\n<p>simvastatin 40mg to add 2 days to life and cause muscle aches<br \/>\ntramadol 50mg to fail to ease pain &#038; cause dependency, falls, confusion<br \/>\nnaproxen 500mg to cause GI bleeds and fluid retention<br \/>\nfurosemide 20mg to reduce fluid retention due to naproxen<br \/>\nomeprazole 20mg to prevent GI bleeds, encourage C diff<br \/>\nsenna 7.5mg to counter tramadol constipation<br \/>\ncitalopram 20mg to cause serotonin syndrome with tramadol<br \/>\ntrazodone 50mg for agitation due to serotonin, to worsen it &#038; cause falls<br \/>\ngababentin MR 800mg to see if it will help pain<br \/>\nparacetamol 500mg because it hasn\u2019t helped the pain<br \/>\ntamsulosin 400mcg for nocturia due to age and furosemide<br \/>\nlisinopril 5mg for \u201cgrade 2 CKD\u201d due to furosemide &#038; naproxen<br \/>\nSeretide inhaler for low FEV1 due to scoliosis<br \/>\netc.<\/p>\n<p>My kingdom for a bit of horse-sense.<\/p><\/blockquote>\n","protected":false},"excerpt":{"rendered":"<p>In Richard Lehman&#8217;s BMJ journal review, there was an amusing bit of interest to Ricardians: King Richard III of England was 32 when he died at Bosworth and then famously suffered the indignity of being buried in a Leicester car park. I think I probably drew your attention to this account of his post-mortem examination [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[4,66,7,16],"tags":[598,243,771,162],"class_list":["post-29822","post","type-post","status-publish","format-standard","hentry","category-britain","category-health-science","category-history","category-science","tag-aging","tag-medicine","tag-richardiii","tag-socializedmedicine"],"jetpack_featured_media_url":"","jetpack_shortlink":"https:\/\/wp.me\/p2hpV6-7L0","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/quotulatiousness.ca\/blog\/wp-json\/wp\/v2\/posts\/29822","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/quotulatiousness.ca\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/quotulatiousness.ca\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/quotulatiousness.ca\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/quotulatiousness.ca\/blog\/wp-json\/wp\/v2\/comments?post=29822"}],"version-history":[{"count":1,"href":"https:\/\/quotulatiousness.ca\/blog\/wp-json\/wp\/v2\/posts\/29822\/revisions"}],"predecessor-version":[{"id":29823,"href":"https:\/\/quotulatiousness.ca\/blog\/wp-json\/wp\/v2\/posts\/29822\/revisions\/29823"}],"wp:attachment":[{"href":"https:\/\/quotulatiousness.ca\/blog\/wp-json\/wp\/v2\/media?parent=29822"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/quotulatiousness.ca\/blog\/wp-json\/wp\/v2\/categories?post=29822"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/quotulatiousness.ca\/blog\/wp-json\/wp\/v2\/tags?post=29822"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}