Discover and read the best of Twitter Threads about #TwitteRx

Most recents (24)

**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
**Thread**

There has been a disturbing trend of some healthcare providers discussing how racial disparities and socioeconomic disparities have been a protective role for African Americans in order to prevent them from getting opioid therapy and getting “addicted” below documents
some of this.. Thanks @life_is_art___ for sharing this video below. This is a video by Dr. Tauben from the University of Washington School of medicine giving a lecture in 2018 regarding the opioid epidemic.. Quote listed below:
Quote:

“Like all things socioeconomic disparities abound which is good for people of color because their less likely to be exposed to opioids because we dont prescribe them opioids because we dont trust them based on the color of their skin
Read 7 tweets
Let's talk about "Trans Broken Arm Syndrome", a sadly common problem that prevents transgender people from accessing adequate care, and how as healthcare workers we can stop perpetuating it!
#TwitteRx #MedTwitter #LGBTQ #trans #pride

1/ 🧵
"Trans Broken Arm Syndrome" is the practice of assuming any health problem a transgender patient has is due to their transness, especially hormone therapy. It is also when a trans person's gender history is discussed in-depth when it has no relevance to the problem at hand.

2/🧵
Headaches? GERD? Injury? Clearly it is your hormone therapy, which you should stop. This can prevent trans people from getting adequate care for their issues, and even outside of healthcare, has people assuming our transness is the reason for our sickness and death.

3/🧵
Read 9 tweets
Alert 🎙Pharmacy Grand Rounds Thread Ahead! 🚨

Last week I had one of my final presentations of the year! With a catchy title😉

Urine for an Update! Updates in the management of metastatic urothelial cancer

Hold your bladders, this is an extensive update! 😂
#oncopharm Image
Bladder cancer can be divided into two ✌️subtypes:
1) Non-muscle invasive: encompasses in-situ and localized disease➡️5-yr OS >70%

2) Muscle invasive: encompasses regional or metastatic disease➡️5-yr OS dismal especially for metastatic disease 😔 Image
Cisplatin=SOC
50% of pts w are ineligible due to older age👵🏻, poor PS, ⬇️ renal function, ⬇️hearing, neuropathy, heart failure 🫀& other comorbities that ⬆️ risk of ⚠️

Carboplatin yields inferior responses➡️NOT 🙅🏻‍♀️ an equal alternative due to ⬇️ OS😢➡️pt left w/minimal tx options Image
Read 12 tweets
Interesting article from pharmacy times.. Once again i think it greatly misses the mark.. Their answer to slowing the opioid crisis is to reduce opioid prescribing in the hospital.. Once again this obsession with focusing on Rx opioids is misguided

pharmacytimes.com/view/slowing-t…
For almost the past 10 years this crisis has been dominated by illicit fentanyl, and polysubstance abuse.. Stimulants are also on the rise, and some experts are saying we could see a 4th wave involving stimulants.. This crisis is being dominated by an adulterated supply
The way to solve this is to have safe consumption sites, drug testing strips, expanding MAT, etc.. If we know what drugs are causing overdose deaths we can understand how to solve this problem.. Truth is rx opioid deaths alone have been decreasing for some time now as well as
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1/ Forget COVID for a sec! Come read about 🌟𝘱𝘭𝘢𝘤𝘦𝘣𝘰𝘴🌟 instead.

Is placebo effect as powerful as some suggest?
Not really.
But it's surprisingly consistent, & that has important implications in medicine.

I dug up an old student presentation on them.
Let’s dive in🧵 Quote from Emile Coue "...
2/ The term was 1st used in medicine in the 1800s: Treatment "adapted more to please than to benefit".

Even then, the importance of suggestion/placebos/bedside manner/whatever you call it was known to be tremendously important.
3/ A famous early Placebo-controlled trial (i.e. comparing the "treatment" to an identical sham) used wooden rods in place of Perkins Tractors, which were metal rods made of supposedly "special alloys".
It showed they were no more effective in managing the advertised disorders Front cover of early study ...
Read 16 tweets
What medications 💊 are should be avoided 🛑 or used with caution ⚠️ in patients with Myasthenia Gravis? 🤔

See 👀 the thread 🧵below⤵️ that summarizes an amazing grand rounds presentation by @UKPharmRes PGY1 @AliW_PharmD on key 🔑 medication considerations in MG
1️⃣Antibiotics to avoid or use w/caution🦠 💊

🛑FQs = FDA BBW for ⤴️ risk of MG crisis ➡️ avoid use if possible
⚠️ Macrolides ⤴️ rate of MG crisis (case reports)
⚠️ AG linked to ⤴️ ICU acquired weakness & exacerbate ‼️ MG crisis
📝Risk⬆️ w/neomycin vs. tobramycin & amikacin
Antibiotics considered to be SAFE alternatives to the above include

✅Beta-lactams
✅Tetracyclines
✅Linezolid
✅Bactrim

Ex. In an MG patient who presents 🏥 w/CAP 🫁 ➡️ choose ceftriaxone + doxycycline✅ OVER ceftriaxone + azithromycin🛑
Read 7 tweets
(1/10) 71 yo F with HTN and ESRD on HD presents to the ED w/ fever 🌡 + back pain, 🧫 BCx + Clostridium septicum. Which test should be considered? 🧐
(2/10) Clostridium septicum [motile, gram +, anaerobic, spore-forming rod] is rare in the GI tract. In colorectal tumor: anaerobic glycolysis = acidic and hypoxic environment ↑ C. septicum spore germination + tumors break down mucosal barrier and ↑ C. septicum blood entry
(3/10) Infxn mortality rates are high (60-79%)

Early diagnosis🩸and aggressive treatment💊of C. septicum are essential.

Colonoscopy is recommended to evaluate for malignancy. What is another gram + organism associated with colon CA?

pubmed.ncbi.nlm.nih.gov/11736823/
Read 11 tweets
Kolodny frequently states that just because Rx opioids have declined around the same time as increases in overdose deaths climbed up doesn’t mean A caused B.. It’s ironic in his lecture below he states that around the same time opioid sales went up as well as opioid death and
addiction and one caused the other. These all happened around the same time but does that mean one caused the other? Correlation doesn’t equate to causation right? it’s interesting he says that regarding decrease in Rx opioids and increase in ODs, but doesn’t apply the same logic
in his lecture above.. Why is that? It’s because his worldview is so focused on Rx opioids being the cause of everything in this crisis that he doesn’t stay consistent in his reasoning.

#TwitteRx
Read 4 tweets
***Thread***

Are medications like oxycodone and hydrocodone essentially heroin pills??

Kolodny recently did a townhall discussion last year on the opioid crisis and COVID... and he made some interesting assertions regarding the semi synthetic medications like oxycodone
He stated when you make molecules like oxycodone, hydrocodone you’re essentially making drugs that cross the BBB easier and are more lipophilic. He continued in the video clip above and stated that they are like heroin in creating a rewarding effect due to it crossing the BBB
His assertion that semi synthetic pain medications such as hydrocodone, and oxycodone are essentially “heroin pills” I think is somewhat hyperbolic and I will try to explain why below...

Molecules like heroin, hydromorphone, oxycodone, etc even though they are made to target
Read 10 tweets
Interesting study done last year looking at the toxicology OD data in British Columbia, Canada.. “They identified by the BC Coroners Service in 2015–2017, were linked to the prescription drug histories of individuals as recorded in BC’s PharmaNet database”
What I like about this descriptive analysis is that they disaggregated the OD data in order to see what drugs were involved in Overdose deaths.. Usually a lot of times you see reported in the media this number so and so died of drug overdose, but what you don’t see reported is
The data disaggregated in order to figure out what drugs were involved.. The chart below shows that from the sample only about 2% of deaths involved prescribed opioids alone in the absence of non-prescribed opioids. The majority of OD deaths involved non prescribed stimulants, Image
Read 6 tweets
***Thread***

Dependence vs Addiction

I have been seeing this flyer around social media and i wanted to do a quick thread on the difference between the 2.. I think alot of times we tend to mesh these two concepts together or often conflate these terms which can
Cause issues as well.. To start off this flyer states "If you get prescribed opioids, you may end up wishing you hadn't. That's because anyone could become dependent on painkillers like hydrocodone, oxycodone, and fentanyl which can ruin your relationships, health and career"
So this flyer states that dependence can happen when taking opioids Which can cause you to ruin your relationships, career, etc.. So what is dependence? It is considered when you have physical or physiological dependence it is indicated by tolerance and withdrawal symptoms.
Read 8 tweets
Its interesting even during the time of the mid 90s and the whole Purdue Pharma fiasco that it was mainly fueled by shady, and illicit activity (whether it was shady Pharma practices, pill mills, non medical use, etc) Patients who use pain medications medically based on the
data don't tend to OD.. Throughout the whole history of this opioid crisis its always been fueled by illicit activity.. Having a legal safe supply regulated market can prevent black market activity.. Imagine if we had sensible drug policy i believe we could have
avoided alot of the OD deaths that we have seen throughout the history of the opioid crisis.. We have a chance to implement sensible drug policy. What will the next 10 years look like regarding OD deaths?? Who knows, but i know if we continue on the trajectory were on now
Read 4 tweets
I'm surprised he hasn't blocked me yet.. 😂😂 But I'm gunna continue to push back on his narrative.. #TwitteRx
@ChadDKollas laying down some facts!! Convo for those who are blocked lol...
Read 4 tweets
Another one of my colleagues took a nice, cushy MSL job and I just met a new staff pharmacist at my 🏥 who is PGY2 CC-trained and doesn’t WANT to do clinical anymore. At 36, I’m now the “old” one amongst our clinical pharmacist. It’s led me to reflect on why that is. A 🧵: (1/)
Starting out, so many of my residents’ 5-year goals read like this: “I want to work at an academic center where I can teach, precept & do research”. Then after 5 years, they jump ship. What happens? (2/)
For starters, it’s really hard to be on service constantly. Our physician colleagues often get time off-service, but it’s rare in clinical pharmacist positions. It’s hard to balance (and excel!) at non-stop patient care, admin tasks, teaching, research, etc. long term. (3/)
Read 10 tweets
Well didn’t take too long until he posted this smh 🤦‍♂️ lol.. His worldview is so focused on prescription opioids being the main catalyst for addiction that he will admit that our record lows of rx opioid prescribing is not low enough smh.. He really can’t connect the dots Image
with Rx opioid prescribing down at record lows and OD deaths still climbing.. It never occurred to him to analyze what drugs are actually causing the overdose deaths.. He then argues that deaths were also soaring when people were using heroin etc when rx prescribing was also high
What he fails to realize is that we have had data describing increase in overdose deaths decades before the mid 90s high prescribing and the fiasco with Purdue Pharma and OxyContin... Once again to only focus on prescription opioids is to miss so many other variables at play
Read 7 tweets
After listening to NPRs new podcast episode with kolodny and others on How to fight the opioid epidemic I came across many things that were problematic but the two issues that stuck out to me I will highlight below...
The 1st issue I had was kolodny’s narrow view of addiction.. Throughout the episode we heard tragic stories of people succumbing to addiction and dying of overdose.. In these stories we heard how they suffered with substance abuse issues, psychiatric issues, also people with
Socioeconomic issues as well.. Instead of discussing all these factors and how they can attribute to why someone can succumb to addiction kolodny wanted to focus on 1 thing being the main catalyst: Prescription opioids.. Dr. Carl Hart who is a neuroscientist has been doing some
Read 12 tweets
PGY1 Resident @NatalieHaddadRx will be presenting an exciting Grand Rounds topic today. Join us with live tweets starting at 11 am CST as she discusses the role of midodrine for vasopressor discontinuation!
Use of #midodrine has increased nearly 50% from 2011 through 2016, and its use has likely increased further in recent years. What is its role in vasopressor discontinuation?
Midodrine is a prodrug with its active metabolite desglymidodrine acting as an alpha-1 agonist. Its peak effect on blood pressure occurs in 1-2 hours with a half life of 3-4 hours. ⌛️
Read 15 tweets
6yo 👦 presents to your ED with multiple deep lacs after being attacked by the neighbor's 🐕... He's screaming/crying in pain but wont let the RN get near him for an IV, looking at the 💉 makes him 😭 even harder.

How do you treat the pain?

(Josh)
1/...
Consider picking 👃!

How does intranasal drug delivery work?
✅ Capillary rich respiratory mucosa allows 💊 to directly enter the 🩸(systemic circulation)

✅ Olfactory mucosal absorption leads to rapid therapeutic levels in the CSF.

Source:[27397490]
2/ Image
A few nerdy PK pearls below:

💎 Quick onset of action
💎 Lipophilic drugs = better absorbed
💎 Unionized drugs 🔀 BBB more readily than ionized forms
💎 IN delivery bypasses GI & first past metabolism, BUT nasal mucosa contains lots of CYP450 enzymes!

PMID:[30449731]
3/
Read 9 tweets
I had no clue what a pharmacist did before I started at @UK_COP. Like most people, I thought I knew. But I didn't. Not really. Here’s what I’ve learned in 4 years. ⬇️ 🧵 ⬇️
The other day, I randomly came across another picture of Dr. Steven Stack holding up a @UK_COP mask at a press briefing and thought: THAT is what a pharmacist does. They save lives every day, get us masks, offer vaccines, and never ask us to notice.
They’re the type of people at our college who want to send out 8,500 masks because it’s the right thing to do to keep people safe. Pharmacists protect us when we don’t even know we need it. And holy sh*t do they work hard at it. 3/x
Read 27 tweets
Tip for new pharmacists; learn as MUCH as you can about diagnostic procedures as some play an important role in pharmacotherapy💊

1/
Ex: Lumbar puncture➡️procedure to collect CSF➡️assess for CNS🧠diseases (i.e meningitis, CNS leukemia)

‼️imperative to ✅ for timing ⏰ of LP
B/c anticoagulants/antiplatelets must be discontinued🛑prior to an LP or else there is a risk of spinal hematoma🤯or intracranial hemorrhages🩸

🛑Apixaban/Riva 24-48 hrs before
🛑LMWH PPX 12 hrs and Tx dose 24 hours before
🛑Dabigatran 48 hrs before
🛑Warfarin until INR<1.4 Image
Recommendations and infographic from in this awesome article below 👇🏻👇🏻

#oncopharm #pharmICU #TwitteRx #meded #MedTwitter

pn.bmj.com/content/practn…
Read 3 tweets
👋👋 A quick poll to start off this week's TIL
[❔]: Does your institution have droperidol on formulary?

1/
#TwitteRx #MedTwitter #FOAMed #emergencymedicine #NurseTwitter
Droperidol ➡️ butyrophenone, D2 receptor antagonist, similar to haloperidol with
✅ faster onset (3-10m IV/IM)
✅ shorter-acting
✅ more sedating

Dosing = 0.625 - 10 mg
Indications: Agitation, N/V, HA/migraine, vertigo, adjunct analgesic

ADEs = EPS, hypoTN, QTp
Preg = C

2/
[1961]: Developed
[1960s - 2000]: Frequently used in ED

[2001]: FDA ⬛️ Warning d/t QT prolongation & TdP + coincides w/ drug shortage of 💉 products ⏩ ultimately withdrawn from market 🪦

[2019]: American Regent™️ announces droperidol is back 👀... so is it worth the risk?

3/
Read 9 tweets
#OTILT #IDtwitter #oncopharm

What factors do you have to consider while treating a cancer pt with a malignant pleural effusion and concurrent infection? 🤔

1/
🚨Cancer pts are at risk for MPE➡️consequence of metastatic involvement of the primary tumor in the pleura💨
💡Lung, breast, and lymphoma are the most common causes💡

Query of the pleural fluid with the use of the Lights criteria will help to determine the etiology (transudative or exudative)

Exudative=malignant OR infection

One of the criteria is a serum protein ratio >0.5
Since both MPE & infectious effusions🦠contain↗️↗️protein

🛑Avoid highly protein bound abx (Ex: daptomycin, ceftriaxone, ertapenem)➡️can get sequestered in the pleural fluid& have↘️systemic distribution & ↘️the ability to treat a bacteremia if present 😳🤯
Read 4 tweets
This weekend I learned what an intra-cardiac epinephrine is. Wish I could say it was from a 📔 or topic discussion... 😂 Nope, it was John Doe, 🎁 w/ cc of traumatic arrest s/p lots and lots of 🔪 wounds 🙃... so what is intra-cardiac EPI❔❔❔

1/...

#MedTwitter #TwitteRx
Just as it sounds 🤦‍♂️... EPI 💘 directly into the myocardium. Generally only used in ATLS after performing an ED thoracotomy in conjunction w/ manual cardiac compression

So here are a few clinical pearls I learned from John Doe

2/...
💎
[Dosing & Freq] = same as ACLS ➡️ 1 mg Q 3-5min.
✅ There are pre-filled 💉 products specific for intra-cardiac use, but ISMP says ⛔️ d/t risk for errors.

Also, there isn't great evidence on what volume to use... what does ur institution use?

3/...
Read 5 tweets

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