Discover and read the best of Twitter Threads about #TwitterRx

Most recents (9)

Dad bleed to death 5 years ago today.
I usually prefer to remember his life, but ever since I got the letter from @CVSHealth PBM Caremark saying I couldn't continue on the anticoagulant with the lowest risk of major bleeding, Dad's final moments have been heavy on my mind. 🧵
I got the call around 4am from my parent’s neighbor saying there was blood everywhere in Dad’s bedroom. Mom was hysterical. EMS were on the scene. 2/
Dad was stabilized at their small rural hospital before being transported an hour to a large academic hospital. He had a major bleed in his lungs. Despite best efforts over the next 48 hours, he had one final traumatic bleed out which could not be stopped.3/
Read 22 tweets
Non-medical drug switching--born not of clinical reasons but out of the revenue-maximizing contract negotiations between pharma & PBMs--has tangible human impact. I am one of those impacted. #CardioTwitter #StopTheSwitch #MedTwitter #TwitterRx…
2) Shared decision making necessitates that no one stand between a patient & clinician making decisions based upon the clinical evidence.
Non-medical drug switching= the insurance PBM knows better than patient & doctor.
#MedTwitter #CardioTwitter #TwitterRx #StopTheSwitch
3) If clinical evidence cannot be acted upon at the point of care at the dictates of a profit-motivated third party, can clinicians really be said to be practicing evidenced-based medicine?
🚨Clinical decisions MUST be between a patient & physician only.#MedTwitter #CardioTwitter
Read 5 tweets
Please help.

PBM CVS Caremark cold called me 2x because of my TWEETS about their Eliquis drop & resulting patient harms. A 🧵

Please RT & tag your elected leaders, media, ANYONE who can help protect patients.
#TwitterRx #MedTwitter #CardioTwitter
2) For those new to the Eliquis CVS Caremark coverage issue, take a moment to read my patient story & the issue explainer I published in @RPTHjournal :…
3) I never gave CVS social media my phone number, subscriber number or permission to access my medical records or contact my insurance plan manager. They did ALL this before cold calling me about a TWEET I made re this @FOX13Memphisnews @FOX13Mandy story…
Read 25 tweets
Duration of Antibiotic Therapy
Deciding on the duration of antimicrobial therapy for an infection is neither straightforward nor simple. 👇
#MedTwitter #MedEd #USMLE #FOAMed #hospitalist #mbbs #medicine #doctor
#medschool #MedStudentTwitter #medstudent #TwitterRx

Most ID guidelines are based- either expert opinions or evidence-based medicine. Historically, duration of ABX Rx were based on arbitrary extension of days(magic numbers like 7, 10 & 14 days) rather than on reliable evidence with the main aim to ⬇️ failures & avoid underRx.

There is growing evidence to support for shorter courses. It is important for prescribers to be up to date with best practices. Duration of therapy plays a pivotal role in antimicrobial stewardship programme within the global effort to optimize antibiotic use &⬇️resistance.

Read 26 tweets
THREAD: #ExercisePrescriptions

1/5 The TI’s Dr. Josh Levin asks:

Clinicians, can you help your patients be more active? 🏃🏾‍♀️🏊🏾‍♂️ 🚶🏾‍♂️

👉🏾Watch Dr. Levin’s recent presentation: 👨🏾‍💻

#Exercise #prescribing #twitterRx
2/5 #ExercisePrescriptions: How much activity should people get? It depends on their age.

👉🏾See the Canadian Society for Exercise Physiology activity guidelines for different age groups: 🏊🏾‍♂️🏃🏾‍♀️🚶🏾

#Exercise #prescribing #twitterRx #BetterHealth
3/5 Below is an example of an #ExercisePrescription 🏊🏾‍♂️🏃🏾‍♀️🚶🏾‍♂️

#Exercise #prescribing #twitterRx #BetterPrescribing
Read 6 tweets

Let’s talk vancomycin and the kidney.🧪

A 65 y/o woman on week 4 of IV vancomycin for ankle osteomyelitis presents with AKI (Cr 6.32mg/dL) and elevated vancomycin level (136 mg/dL).

What’s to blame?
#tweetorial #MedTwitter #Nephtwitter #FOAMed #TwitterRx @TheSkeletonKG

Vancomycin nephrotoxicity is a challenging diagnosis because elevated vanc levels may be the cause and/or the effect of acute kidney injury.

Vanc nephrotoxicity is a diagnosis of exclusion based on:
◼️Elevated vanc level
◼️No more likely explanation

The original vancomycin formulation earned the nickname Mississippi Mud (‘Sippi Mud for the locals) due to its muddy color and many nephrotoxins 🐷🐷🐷

The modern vancomycin formulation is 95% pure, but is associated with 2.45 relative risk of AKI
Read 18 tweets


I recently encountered a patient with a history of severe angioedema. I was familiar with its association with ACE inhibitors...

However, I realized that I didn’t know that much about it. Here are the cliff notes 🤓

Angioedema is localized swelling of the skin or mucosal tissues. It is divided into two main types, histamine-mediated and bradykinin-mediated.

It’s important to identify the type, as the treatment strategy is completely different.

Histamine-mediated angioedema develops quickly (minutes), involves pruritis/urticaria, and is associated with an allergic reaction.

Look for exposure to foods, drugs, insect stings, and other allergens.
Read 10 tweets
Ever wonder how the BCG (Bacillus Calmette–Guérin) vaccine works against bladder cancer?🤔

BCG vaccine➡️approved for the tx of bladder cancer in 1990⌛️
✅Main intravesical agent shown to⬇️risk of progression of non-muscle invasive to muscle-invasive disease (>platinum chemo!)🤯
So, how does a vaccine for MYCOBACTERIUM work for bladder cancer!?🤨(dont worry, I was making the same confused face you are! Let me explain it to you!)

BCG=attenuated live strain of Mycobacterium🦠 bovis (which interestingly is related to the bacteria that causes tuberculosis) Image
It is administered by DIRECT instillation into the bladder and the mycobacterium outer membrane binds to a substance (Fibronectin) that is ALSO found within the urothelium. Image
Read 5 tweets
Pharmacy education post***

Why are the benzodiazepines Lorazapem, Oxazepam, and Temazepam recommended in the elderly?

Benzodiazepines are metabolized either through Phase 1 or Phase 2 metabolism
Phase 1 metabolism includes for example oxidation or reduction and turns the parent molecule into a more polar compound and eventual inactivation of the drug. Phase 1 metabolism involves the enzymes CYP2C19 and CYP3A4 and are responsible for benzos that undergo Phase 1..
Phase 2 metabolism involves conjugation of charged compounds and makes it more water soluble facilitating it into the bile or urine. So Phase 1 metabolism tends to decrease in the elderly and Phase 2 metabolism is for the most part preserved..
Read 5 tweets

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