Discover and read the best of Twitter Threads about #TwitteRx

Most recents (24)

Happy to share our review of antiviral treatment of #monkeypox, co-authored with the amazing @EmilySiegrist4 and just published in @CIDJournal! @OUHealth @IDSAInfo @SIDPharm @PaulSaxMD #IDTwitter #TxID #TwitteRx #MedTwitter #OpenAccess

Short 🧵 (1/n)

academic.oup.com/cid/advance-ar…
In this paper, we review three antiviral agents with activity against #monkeypox:
1. Cidofovir
2. Brincidofovir
3. Tecovirimat
(2/n)
For each agent we discuss:
1. Basic Pharmacology
2. Pharmacokinetic Data
3. Animal Data
4. Toxicity
5. Clinical Data in Humans
(3/n)
Read 5 tweets
Increasing pharmacist workload was associated with increased ICU length of stay, reduced quantity of interventions, and reduced intensity of interventions.

pubmed.ncbi.nlm.nih.gov/35678204/

@CritCareMed @SCCM @SCCM_CPP
#TwitteRx #PharmICU
Increasing MRC-ICU score was associated with
1. Higher mortality
2. Longer LOS
3. More medication interventions
4. Increased intensity of medication interventions

^A compelling argument for DEDICATED pharmacotherapeutic expertise on the multiprofessional rounding team.
The @SCCM @ASHP_Official @ACCP Joint Position Statement (pubmed.ncbi.nlm.nih.gov/32826496/) calls pharmacists “essential members of the multiprofessional critical care team,” but we have no standards for pharmacist workload ratios.
Read 11 tweets
Jason definitely struck a nerve for many of the #PharmEd & #TwitteRx folks. This is something we’ve discussed quite a bit in Maryland, but it sounds like a larger @ASHPOfficial / @ACCP task force is needed. A few thoughts… (🧵1/10)
1st: I am very proud to be a #pharmacist & love mentoring pharmacy students & residents on research projects every year…but…the large majority of PharmD grads *do not* have the knowledge/skills to *lead* a research project. We have to acknowledge that. (2/10)
2nd: (Trigger Warning ⚠️) A decent number of faculty members & clinicians are not strong research mentors. Even a faculty member with a PhD can struggle mentoring residents, because mentoring is a skill that needs development - but we just expect it as a given. (3/10)
Read 10 tweets
📸 Now watching @EckerleIsabella about to talk here virtually at #ECCMID2022 @ESCMID

😃 Have been looking forward to this!

💬💬💬 Lots of comments at SM talks on how @Twitter is the primary platform for scientists

#IDtwitter #EpiTwitter #MedTwitter #TwitteRx ImageImageImageImage
Infodemics themselves are like pathogen epidemics

@EckerleIsabella at #ECCMID2022
⚠️⬇️🚨🤔🤣🔴✅📢❌▶️

Emoji use evaluated in misinformation tweets! Very interesting!!

@EckerleIsabella at #ECCMID2022 @ABsteward ImageImage
Read 5 tweets
NEW ARTICLE!

“Misinterpretation of the “Overdose Crisis” continues to fuel misunderstanding of the role of prescription opioids”

Written with @GhanaboyPharmd @JeffreyFudin @headdock

#TwitteRx #MedTwitter

A brief 🧵to highlight the FACTS:

dovepress.com/misinterpretat…
This editorial looks to address ongoing #false narratives regarding opioid prescribing and its current role in the #overdosecrisis

In it, we use several excerpts from a recently published news release by PROP, given the distorted reality it represents

supportprop.org/opioid-news/pr…
1️⃣:

We challenge the view that continued reductions in prescription opioids will be the “key to ending this [overdose] epidemic”…

As if cutting prescriptions in half throughout the US the past decade has resulted in reduced overdose deaths 🧐🧐🧐 Image
Read 6 tweets
This DEA case against a pharmacist lists three “red flags” that are laughable. Ready #TwitteRx? Let’s go!!
1. As Bev notes - DEA claims pharmacist should have seen a patient’s naloxone Rx as a red flag. Naloxone is the standard of care for most patients who receive and use opioids. In many, many states, it is now mandated to be co-prescribed with opioids.
2. DEA complaint identifies use of “immediate release opioids” as a red flag. Sure. Ok. They’re also explicitly preferred in the only part of the abominable 2016 CDC Opioid Guidelines that reference dosage formulations. Weird!
Read 5 tweets
#Remdesivir new trial just published

Here are the clinical implications:
Canadian trial (CATCO) in hospitalized patients with #COVID19 bit.ly/33uktIf
Compared to ACTT-1 trial bit.ly/3msi1In in patients on supplemental O2 as recommended by guidelines
🧵1/
ACTT-1 Highly Significant Mortality Reduction in Patients on Supplemental Oxygen:
bit.ly/3msi1In
2/
Both CATCO and ACTT-1 trials showed
-No liver or renal toxicity with remdesivir, and
-No safety differences between remdesivir and controls in over 2300 patients

Thus, both trials show that remdesivir is safe, prevents intubation, and reduces mortality
3/
Read 9 tweets
Hey #IDTwitter… what are your thoughts on intermittent (e.g. TIW frequency) liposomal amphotericin B (L-AmB) dosing for OPAT?

@MayoPharmRes @MsSmallsO @johnsontannerm @Stevens_AK @SIDPharm #opat #TwitteRx
Let’s look at the evidence… For starters, amphotericin B (AmB) = broad spectrum anti-fungal that binds to ergosterol

1st-line for serious ocular candida, CNS cryptococcus, severe histo/blasto, and mucor

2nd-line for cocci & aspergillosis

pubmed.ncbi.nlm.nih.gov/11801575/ Image
There are 4 formulations of AmB, but the liposomal form (L-AmB) is typically dosed at 3-5 mg/kg/day = ⬇️ nephrotoxicity (vs. deoxycholate) and ⬇️ infusion reactions (vs. ABLC) + liposome allows for ⬆️ tissue conc and a prolonged t1/2.

pubmed.ncbi.nlm.nih.gov/11722981/ Image
Read 10 tweets
So #twitterx doesn't throw me in Twitter jail, here are 10 #ASH21 abstracts...as HARRY POTTER characters.

I couldn't decide if I should rank based on "impactful" or "practice changing", so these are some that I think everyone should *read carefully*, and I tried to make it fun!
1. POLARIX = Severus Snape ash.confex.com/ash/2021/webpr… Why? Because of how controversial this is, and also this is a well done study. Should we change practice based on a drug without an OS or QOL benefit? I argue no. Nagini, kill. #lymsm
2. GRAAPH-2014 Study = Dudley Dursley ash.confex.com/ash/2021/webpr… Removing HiDAC from chemo in Ph+ ALL worsened outcomes. A cautionary tale that we can’t get greedy and we need RCT data like this as we “de-intensify” regimens in ALL with novel therapies like blin, TKIs, etc. #leusm
Read 12 tweets
🚨 I'm getting reports from pharmacists across #Texas -they are being directed to not fill prescriptions for misoprostol, mifepristone, or methotrexate until they verify that the meds are not for induced #abortion.
#SB4 is harmful to ALL of us, even w/ #SB8 still in effect 1/
🚨 This is a classic solution in search of a problem. *NO ONE* prescribes meds for #abortion in #Texas. We dispense or administer all meds directly to the patient. THE ONLY people that need these drugs in a pharmacy either have a miscarriage, cancer, or autoimmune disease 2/
🚨 Let that sink in. Anti-abortion laws harm *all of us*. I'm urging local and national journalists to start interrogating pharmacies in #Texas about this practice. It's not only ethically bankrupt and discriminatory - it literally serves no purpose. 3/
Read 7 tweets
Thread 🧵

I was reading a discussion here on twitter and they claimed that 25% of those who start Rx opioids go on to become addicted.. In my mind i was wondering where they got that stat from.. The person linked a study so i decided to look at it.. The study is below
This particular study was looking at the proportion of a geographically defined population who receive new opioid prescriptions progresses to episodic or long-term patterns of opioid prescribing
The study results stated this below.. It wasnt 25% it was 21%.. And they stated 21% went on to progress to episodic prescribing pattern.. Is this addiction?? Lets see how the study defined episodic prescribing pattern
Read 7 tweets
🚨Recently the other day @jaketapper with on @TheLeadCNN had a segment on the opioid crisis and stated that the majority of deaths ending in the month of April 2021 were from Pharmaceutical Opioids. So lets actually look at what the data says.. Sources will be linked at the end🚨
So lets look at the numbers ending in month of April 2021

The total Drug overdose deaths(including all drugs) ending in April 2021- 100,306

Total Drug deaths involving opioids is- 75,673
Out of the deaths involving opioids (75,673) deaths from natural and semisynthetic (oxy, hydrocodone etc)- 14,037

Deaths involving synthetic opioids other than methadone- 64,178
Read 9 tweets
A #MedTwitter🧵on the frequently obtained, but ever mysterious🕵️‍♀️ Procalcitonin (PCT) 🦠

💡 What is it?
💡 Where does it come from?
💡 What factors/comorbid conditions may impact PCT?

#IDTwitter #TwitteRx
1/n First, let’s discuss the normal, physiologic role of PCT 🧬

✨116 chain amino acid
✨Neuroendocrine hormone
✨Produced by thyroid C-cells
✨Enzymatically cleaved to calcitonin
✨ Regulate Ca+2 & PO4- homeostasis

DOI 10.1093/ajhp/zxaa089

@AJHPOfficial @SESmithPharmD Image
2/n Why/How does PCT ⤴️ in bacterial infections?

✨Nonendocrine tissues (adipocytes, spleen, pancreas, etc) produce PCT but LACK 🛑 enzymes to cleave to calcitonin

✨Stimulus for non-thyroid PCT production include
1️⃣LPS/bacterial toxins ⚠️
2️⃣Cytokines (IL6, TNFa, ILb) Image
Read 9 tweets
🚨🚨Thread 🚨🚨

Just finished listening to this webinar hosted by Students for Opioid Saftey in Dentistry which featured Dr. Marriott (PROP), Dr. Harold Tu, among others etc.. Image
I was smh throughout the whole thing.. It really is sad that these speakers were feeding lies to these students.. Dr. Tu perpetuated many falsehoods throughout his portion of the talk which I've debunked over and over again.. ImageImage
Dr. Tu also told these students "When we give pain pills we are giving heroin pills" 🤔🤔 i wonder where we have heard that before lol
Read 10 tweets
As promised, a 🧵 on GoodRx.

Starting off with the basics…

What is it?
GoodRx is a prescription drug price tracking and discount company. It’s essentially another middle man in the messy landscape that is #drugpricing in the US.

But it’s more complicated than that… #TwitteRx
GoodRx is best known for their coupons. They track prescription drug prices and offer patients a discounted price, which varies a bit based on which pharmacy you select.

Here’s an example of what a search for enalapril looks like…
2/17
GoodRx coupons CANNOT be combined with insurance. ❌

Now, this *might* be helpful for a patient who is completely uninsured, or someone on relatively few inexpensive meds who never hits their deductible anyway, but even then, if you ask your pharmacist for a cash price instead…
Read 17 tweets
What is the best treatment for this patient ? 🤔
Hello, #IDtwitter !!! For this patient with mild tularemia, the first line of treatment is ciprofloxacin! Thank you for participating in our weekly trivia. #IDFellowship #IDboards #MedTwitter #InfectiousDiseases #Medicine #Microbiology #Pharmacy #TwitteRx #IDMedED Image
Read 3 tweets
🚮 tweet alert! Let’s talk why. #TwitteRx #MedTwitter
Pharmacists are highly trained HCPs who are the subject matter experts in medications and treatment. *However* because of really effective MD lobbying, many of us are unable to practice independently, particularly re: decision making on therapeutics 2/
Because of that, when pharmacists practice - especially in the community - they’re doing so under INCREDIBLY strict protocols and standing orders. Literally not allowed to make decisions outside of those - even if those decisions are correct, medically 3/
Read 9 tweets
#IDtwitter #TwitteRx #obgyntwitter

What is your preferred corticosteroid💊 for #pregnant patients🤰🏽 with severe #COVID19?🤔

🧵below 1/n
🧵2/n
Background
RECOVERY ➡️Dex ⬇️mortality in severe #COVID19
Pregnant patients🤰🏽 INCLUDED 👏🏽👏🏽🙂
Enrolment low n=4, 0.06% of participants 😶
Prednisolone or hydrocortisone used instead of dex Why? 🤔
🧵3/n
Choice of steroid in #pregnancy🤰🏽 usually depends on if treatment for mum or fetus

Hydrocortisone, methypred, prednisone ➡️metabolized to inactive metabolites by placental enzymes
Fetal uptake ~10% maternal exposure
So these steroids are preferred for maternal conditions
Read 9 tweets
In hospitalized patient with osteomyelitis, what's your preferred approach if you have a bone culture :
KP ESBL R to all Abx except carbapenems and tigecycline & Enterococcus faecalis S to Ampc & tig &VAN #IDTwitter #medtwitter #TwitteRx
Would love to hear @BradSpellberg and @DrToddLee thoughts
@Cortes_Penfield would love to hear your thoughts!
Read 3 tweets
Healthcare patient primer
How to have a good experience and help the staff
Healthcare workers are under staffed and struggling under the extra burdens of Covid-19
- realize we are struggling and be helpful not a hindrance
- don't expect exceptional customer service,we don't have
the staff right now
- be direct and to the point with what you need,we are overwhelmed and unable to have an extended conversation
Example:
Hi,I need a refill (staff will guide you through the rest)
- if you have a question about vaccinations,testing,making appointments go to
the company website first, all the information is there trust me
- use automation/technology/App most simple things can be accomplished without talking to a staff member
In the store:
- be proactive and have your insurance card, drivers license, covid card, credit card out and
Read 6 tweets
My tech who contracted Covid passed away unexpectedly. He was not vaccinated. We are shocked, saddened and numb. This was way before his time. This is a wake up call for all of us, both personally and professionally. Vaccinations are important..What we are doing is so important.
We are saving lives. This work is difficult, it's stressful, it's overwhelming and it's a workload burden...BUT what we are doing is making a difference in others lives. Every vaccine is possibly saving someone's son, daughter,grandma or aunt. I'm struggling right now because I
didn't push my friend harder to get vaccinated. I never thought this would lead to his death. The moral of the story is that Covid is real, it's not a joke, and vaccination prevents serious illness. Whatever your hang up over the vaccine, put that aside, don't be selfish because
Read 4 tweets
I wasn't aware U.S. had liberalized drug laws Michael 🤦🏾‍♂️🤦🏾‍♂️ lol
Once again he is mischaracterizing Portugal's drug policy as if their main objective is to criminalize and send people to jail..
Here is what Dr João Goulão actually said in his speech he gave.. Yes they do still have fines and penalties and jail, but that is not their main objective..
Read 6 tweets
Fentanyl alongside other medications are on the WHO list of essential medications... It’s important to remember that when discussing this overdose crisis. The fentanyl that has been implicated in ODs are not made in a pharmaceutical lab.. Fentanyl has been used safely for decades
It’s also important to note that the illicit synthesis of these fentanyl analogues are usually from completely novel sources not from the pharmaceutical Janssen products as noted below
It’s important to make this distinction because many patients utilize pharmaceutical fentanyl products safely and for a myriad of different reasons.. We need to be careful and specific regarding the drugs we are discussing in the overdose crisis..
Read 4 tweets
**Thread **🧵

I don’t know if PROP is intentionally trying to be misleading but at this point there is no way they can be this willfully blind to the data.. This new article written today by their organization is highly misleading. I want to go through some of the things they
mention in their article.. So below they mention deaths from prescription opioids continue to contribute to drug overdose deaths.. 1st problem is that is not entirely accurate, 2nd is they don’t define what a prescription opioid death means.. This statement needs to be qualified.
What is the source, what drugs are involved. The data does not parse this out.. Many of the Rx opioid deaths involves drugs that were diverted, also combined with other drugs as well (psychostimulants, benzos, antidepressants, barbiturates etc) Rx deaths alone is most likely alot
Read 7 tweets

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