There's no place like home and my Verzenio regimen

  Back home with my two best guys. 

  Dogs make everything better.

 My medication regimen is taking 150 mg Verzenio, twice daily, exactly 12 hours apart. There is a +/- 1 hour window to take the medication or I have to skip it for that dose. I have to keep a log of when it was taken and any side effects that I experienced. I have specific parameters for temperature and GI issues to call the UPenn oncologist to get further advice as a dose adjustment can be made if I am not tolerating it well. The #1 side effect?

  I was prescribed the following medications to help manage these symptoms, in order of escalation if needed:

• Imodium (Loperimide)
• Treats acute and chronic diarrhea
• Side effects of constipation, dizziness, and mild stomach discomfort (concern for addiction due to opioid)
• Mechanism of action - An opioid receptor agonist that attaches to and activates opioid receptors in your brain and body to provide pain relief, relaxation, or other effects such as reducing the movement of fluids and food through your digestive tract and helping the intestines absorb more water and salts due to diarrhea
• Diphenoxylate-Atropine (Lotomil)
• Treats severe diarrhea
• Side effects of dry mouth, headache, dizziness, drowsiness, and constipation
• Mechanism of action
• Diphenoxylate is an opioid that slows down movement in your intestines allowing your body to absorb more water and makes your stool firmer (concern for addiction without added atropine as it is an opiod)
• Atropine is an anticholinergic medicine added in very small amount which causes unpleasant symptoms if someone tries to take too much of the drug to get high (since it is an opioid)
• Dicyclomine (Bentyl)
• Treats painful abdominal cramping and spasms
• Side effects of dry mouth, blurred vision, dizziness, drowsiness, and constipation
• Mechanism of action - Blocks the chemical messenger acetylcholine in the gut slowing down gut movements and relaxing smooth muscle in the stomach and intestines
• Ondansetron HCL (Zofran) 
• Treats nausea and vomiting
• Side effects of constipation (no sleepiness) - for use in daytime
• Mechanism of action - blocks serotonin from binding to 5-HT3 receptors in your gut and brain
• Prochlorperaine (Compazine)
• Treats severe nausea and vomiting
• Side effects of sleepiness - for use at night
• Mechanism of action - blocks dopamine D2 receptors in the brain, particularly in the chemoreceptor trigger zone, which stops signals that trigger nausea and vomiting

 Flashbacks to my nausea decision tree from chemotherapy.

 Is anyone else surprised to hear that anti-diarrheals are opioid agonists?

 Here's a helpful image for my medical professional readers out there! The more you know!

 Ok, now I'm really geeking out! What came first, the knowledge that opioids cause constipation therefore using this as the mechanism of action to prevent diarrhea or the development of an anti-diarrheals? The former!!!!

From Google AI:

Yes, traditional opioids came thousands of years before targeted synthetic opioid agonist anti-diarrheals. 

History of Traditional Opioids

• Ancient use: Humans have used raw opium (derived from the opium poppy, Papaver somniferum) for over 5,000 years, with cultivation dating back to ancient Mesopotamia around 3400 BCE. 
• Early anti-diarrheal use: Historical preparations like paregoric (a camphorated tincture of opium) and laudanum were used for centuries to treat severe diarrhea and pain by slowing down the digestive tract.
• Isolation: Pure opiate compounds like morphine were first isolated from opium in 1803 by German chemist Friedrich Sertürner.

History of Opioid Agonist Anti-Diarrheals

• Targeted synthesis: Modern, specialized synthetic opioid agonist anti-diarrheals that focus primarily on the gut without significant central nervous system effects were developed much later.
• Diphenoxylate: Synthesized in 1956 by Paul Janssen at Janssen Pharmaceutica, and commonly combined with atropine as Lomotil.
• Loperamide: Better known by the brand name Imodium, it was first synthesized in 1969 and introduced for medical use in 1976.

 Due to this very game being baseline for me, I am utilizing the Medications tracking option in the Apple Health App. It even allows me to set a critical alert if I have not marked "taken" within 30 minutes of my expected time to keep me on track for the specifics of the clinical trial.