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Comments

Re: Medical!anon?

[writingcyan]

I'm not a psychiatrist, but I think I can answer this one...

Bucky's medication post-CA:TWS would depend on 1) his diagnosis, 2) his metabolism.

Generally, people tend to headcanon Bucky with PTSD post-CA:TWS. Standard medical treatment for PTSD is SSRI antidepressants; a class effect is presumed, meaning any SSRI would probably have some effect, but evidence supports using paroxetine (Paxil), sertraline (Zoloft), or fluoxetine (Prozac - used in Europe but not approved by the FDA for PTSD treatment in the US as far as I know).

However, if Bucky's version of the supersoldier-serum has the same effect on his metabolism as Steve's, medicating him presents a serious challenge. The reason why Steve can't get drunk is presumably because the alcohol dehydrogenase enzyme in his liver which converts ethanol to non-intoxicating chemical compounds is either produced in much larger quantities or is much more efficient than usual. SSRIs are similarly metabolised by enzymes in the liver, which means a steady-state condition would be nearly impossible for supersoldiers to achieve as they'd metabolise and eliminate the drug instantly.

However, if you want to handwave a way to medicate Bucky for fanfic plot purposes, it's worth noting that while paroxetine is converted to inactive metabolites and sertraline to only minutely active metabolites (meaning Bucky would have no effect of FDA-approved SSRIs), fluoxetine is hepatically converted to norfluoxetine, which exhibits the same pharmacological activity as the precursor substance. This means that even if Bucky's liver instantly metabolised fluoxetine, he'd still have a potent SSRI in his blood. (Of course, since both fluoxetine and norfluoxetine are eliminated by hepatic metabolisation in a second step, he'd then proceed to break down the norfluoxetine as well, but that's where the handwaving comes in and we pretend he instead excretes more than 2% of it unaltered through his kidneys). So Prozac would be the best least-bad option for Bucky (and Steve).

As for hypnotica, that is, medication prescribed for insomnia, the go-to drugs are either benzodiazepines/benzodiazepine-like substances or antihistamines such as diphenhydramine. For Bucky, the first choice would be diphenhydramine, but unfortunately it is also metabolised by liver enzymes. Some benzodiazepines and similar substances do not undergo hepatic elimination, but they have a whole range of other problems including the risk of addiction and anterograde amnesia (there's no way Bucky would think this is a good idea), and most of them preclude patients from operating heavy machinery, which in Bucky's case would mean himself. All in all, I think cognitive therapy would probably be the best option for Bucky's insomnia.

Now! To answer your actual question: yes. The serum-concentration of most drugs can be measured in blood tests. It's not a routine test, though; when I prescribe standard lab tests in the ER, I won't know which drugs are in my patients' blood unless I ask the medical technicians to test for them specifically (and then only over-the-counter/prescription drugs; hospital lab equipment isn't set up to measure most recreational drugs, so in that case you'd need a forensic chemist). Also, I can't ask the med techs to check for medication in general; I need to specifically ask for the serum-concentration of X substance, and if X isn't present in the blood but Y is, Y won't show up in the lab results. If Bucky turned up at the ER, the doctors wouldn't look for medication in his blood unless they suspected he'd overdosed on it. But his psychiatrist would routinely check the serum-concentration of his prescribed medication to make sure the dosage is effective. If Bucky didn't take his medication as prescribed, his psychiatrist would find out and be cross with him (doctors don't like non-compliance, it makes us cranky when our patients don't do what we tell them to).

A neat detail is that since most medical labs use the Vacutainer system for blood samples (http://en.wikipedia.org/wiki/Vacutainer) and the meaning of different colours are standardised, it's possible to guess what the med techs are testing for even if they don't tell you. Medication/ethanol serum-concentration tests are as good as always collected in 5 mL tubes with a red top, whereas recreational drugs are usually collected in 10 mL tubes with a grey top (mind that these tubes are used for other tests as well, such as antibodies, so don't freak out if you see them the next time you go in to have a blood sample taken). There's a good chance Bucky would know if/when someone checks his medication.

Re: Medical!anon?

[(Anonymous)]

You are brilliant, that's a lot of extremely useful knowledge. Thank you so much for taking the time to sum that up!

I was asking because I'm writing one of the 'Bucky thinks the Avengers are his new handlers'-fics, and I'm contemplating various issues he could be facing.

For example, in this 'verse I imagine him seizing his first chance not to take his meds. He'd suspect the Avengers/his doctors/Steve of dosing him as another means of keeping him under control, so he'd try to boycott them. He'd worry, obviously, that they'd find out, and I was wondering if that was an actual possibility. So yes, good to know.

[more rambling below, tw suicide mention]

I guess not taking his antidepressants would make his doctors frown, but it probably wouldn't raise red flags like if they suspected he was saving up sleeping pills? Then again, from what I understand, in the US you don't need a prescription for (certain?) hypnoticas anyway. You're right though, no one would think anything that could induce anterograde amnesia would be a good idea for Bucky to take. Besides, unlike SSRIs, people don't necessarily take sleeping pills every day, so if they knew he didn't take them they'd probably just assume he didn't have trouble sleeping.

Anyway, a confession: I usually handwave my way through medical issues (and Steve getting drunk) by assuming that supersoldiers just need a much larger dosage of everything. ;p

(Also, don't know if I can use that in the fic or not, but next time I'm having a blood test, I'll definitely think of you and check out the color of the tubes, heh.)