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Toxicologists are often consulted about 🍄foraging misadventures (wild mushroom ingestion).
Usually you don't get a clear mushroom image like this video (at best a blurry photo of some OTHER mushroom), or more often no image.
So what to do?
A 🍄🧵
#FOAMed #FoamCC #MedEd
Usually you don't get a clear mushroom image like this video (at best a blurry photo of some OTHER mushroom), or more often no image.
So what to do?
A 🍄🧵
#FOAMed #FoamCC #MedEd
If you do have a good sample or photo you can work with a mycologist (your posion center knows one) to identify the shroom. But this is not frequent.
Since we almost never have that we usually rely on history and symptoms
Key to differentiating mushroom toxicity types: time to onset of GI issues. Most mushrooms upset the tummy. The 5hr “rule” helps identify bad ones.
Key to differentiating mushroom toxicity types: time to onset of GI issues. Most mushrooms upset the tummy. The 5hr “rule” helps identify bad ones.
Here's suggestion number 7 for How to Use #ChatGPT in #Academia for #MedEd and #TwitteRx:
Sometimes getting the output you want is difficult and can take several back and forth discussions. Here's what I first sent ChatGPT to create the #Tweetorial
1/x
Sometimes getting the output you want is difficult and can take several back and forth discussions. Here's what I first sent ChatGPT to create the #Tweetorial
1/x
Not very specific, but I wanted to see where it would take it. Vague input allows #ChatGPT to drive the conversation, and is great for idea generation. I wasn't thrilled with the first response as it was quite boring and would have required me to break up the tweets. 😴
2/x
2/x
Draft #2 was MUCH closer to the goal, but had 2 big flaws. First, it recommended something it currently cannot due (access realtime data) and it was all a series of prompts.
3/x
3/x
Today’s tip is a doozy, but also very meta. Why should I tell you how to use #ChatGPT when it can create a #Tweetorial about itself. Everything below is all AI-generated with no edits starting NOW!
Tweetorial: Using #ChatGPT in #MedEd and #TwitteRx! 🧪💊
Tweetorial: Using #ChatGPT in #MedEd and #TwitteRx! 🧪💊
1/Can you ACE this #MedEd & #TwitteRx #Tweetorial on non-allergic drug-induced angioedema? 57yof w/ swelling of face, lips, and tongue w/ no urticarial rash. Meds: valsartan, sacubitril, metformin, simvastatin, sitagliptin, & risperidone. How many meds may be contributing?
2/Drug-induced angioedema (DIA) can be divided into 2 categories
1⃣ Allergic DIA: IgE-mediated release of histamine from mast cells
2⃣ Non-allergic DIA: Increased vascular permeability mostly from disruption of the kallikrein-kinin system (KKS)
1⃣ Allergic DIA: IgE-mediated release of histamine from mast cells
2⃣ Non-allergic DIA: Increased vascular permeability mostly from disruption of the kallikrein-kinin system (KKS)
3/For non-allergic mediated DIA, easiest to think about changes in bradykinin (BK) activity
🥇- 👇metabolism of BK (and substance P)
🥈- 👆BK production
🥉- 👆BK receptor activity
🥇- 👇metabolism of BK (and substance P)
🥈- 👆BK production
🥉- 👆BK receptor activity
Ok #twitteRX I think it’s time for another thread. After the public very public spat with an RPh in academia, now is a good time to talk about the role of academia and professional organizations in retail pharmacy. 1/
I’ll start by saying that most people in academia and the professional organizations have the best intentions and are likely highly accomplished and talented pharmacists and techs.
With that being said, they are not accomplishing much for us in retail. 2/
With that being said, they are not accomplishing much for us in retail. 2/
Sure they’ve tried to do a lot to expand the role of a pharmacist from immunization to MTM to pushing for provider status to prescribing roles in certain situations. And that’s great but they do little to make sure that we’re given the proper resources to do them. 3/
Had the opportunity to be part of a fascinating work. Americas Poison Center Annual report.
A comprehensive poisoning epidemiology study compiled of data from all 55 U.S. Poison Centers
Free 🔗➡️bit.ly/3wbIwWS
Pubmed🔗➡️bit.ly/3wdgeLP
A🧵on emerging trends
A comprehensive poisoning epidemiology study compiled of data from all 55 U.S. Poison Centers
Free 🔗➡️bit.ly/3wbIwWS
Pubmed🔗➡️bit.ly/3wdgeLP
A🧵on emerging trends
This year we highlighted two important trends in addition to baseline poisoning data.
Firstly, THC product exposures have been increasing since 2016, and the demographics are changing. In 2021, edible products (red line) eclipsed plant based marijuana (blue line) for products
Firstly, THC product exposures have been increasing since 2016, and the demographics are changing. In 2021, edible products (red line) eclipsed plant based marijuana (blue line) for products
The change in products also represents changing demographics. While Adults (gold) comprise the majority of exposures, pediatric<6 (green) is taking an ever increasing share of the THC exposure calls since 2016.
A few years ago I made a digital resuscitation game with a working cardiovascular system. A playground to play with pressors/resuscitation.
TODAY I REALIZED I COULD PLAY IT IN Virtual Reality
So I made a video. An 11 part 🧵for VR septic intubation!
#FOAMcc #FOAMed #MedEd
TODAY I REALIZED I COULD PLAY IT IN Virtual Reality
So I made a video. An 11 part 🧵for VR septic intubation!
#FOAMcc #FOAMed #MedEd
Part 2/11
Virtual Reality Septic Shock Resuscitation/Intubation
Video YouTube link here🔗: )
Play game ➡️: rfeldman.itch.io/the-resuscitat…
#Medtwitter #FOAMcc #FOAMed #TwitteRx #MedEd
Virtual Reality Septic Shock Resuscitation/Intubation
Video YouTube link here🔗: )
Play game ➡️: rfeldman.itch.io/the-resuscitat…
#Medtwitter #FOAMcc #FOAMed #TwitteRx #MedEd
Part 3/11
Virtual Reality Septic Shock Resuscitation/Intubation
Video YouTube link here🔗: )
Play game ➡️: rfeldman.itch.io/the-resuscitat…
#Medtwitter #FOAMcc #FOAMed #TwitteRx #MedEd
Virtual Reality Septic Shock Resuscitation/Intubation
Video YouTube link here🔗: )
Play game ➡️: rfeldman.itch.io/the-resuscitat…
#Medtwitter #FOAMcc #FOAMed #TwitteRx #MedEd
Tomorrow is NYE, there will be partying, pills, and powders. Some leading to overdose.
I work in the ER NYE/NYD & expect a few "OD's" from said pills n powders. What exactly is in them?
A 🧵from Camden, a VERY human 28 y.o male, on the illicit drug supply
#MedED #FOAMed
I work in the ER NYE/NYD & expect a few "OD's" from said pills n powders. What exactly is in them?
A 🧵from Camden, a VERY human 28 y.o male, on the illicit drug supply
#MedED #FOAMed
Cam was out with his friends celebrating NYE with some beverages when one of his friends offered him a tan powder. Cam was pretty hesitant at first but..
Eventually peer pressure won. Cam gave it a try.
A few minutes after trying the substance...
A few minutes after trying the substance...
let’s just break down the cost of midyear for a student real quick…
1) ASHP Membership: $54 #TwitteRx #ASHP22
1) ASHP Membership: $54 #TwitteRx #ASHP22
2) Registration: $340-520
3) Hotels (let’s just stay at the convention hotel cause why would they pick one of the most expensive hotels, right?!?): $278-780 a night. let’s say 3 nights… so $834-2340
Are you considering making the transition to #medMastodon and #TooteRx from #twitteRx? Then this is your thread for introductions.
2/x
choose an app to use
Mastodon is good, but Metatext is better IMHO because it similar to twitter
A detailed read if interested transponderings.blog/2022/05/21/eig…
choose an app to use
Mastodon is good, but Metatext is better IMHO because it similar to twitter
A detailed read if interested transponderings.blog/2022/05/21/eig…
3/x open the app and “sign up”. Here you will pic a server. For most #TwitteRx folks that’s med-mastodon.com. Search for it and give it time to “pop up”.
Then create your email and password.
Then create your email and password.
Maybe the biggest thing that’s concerning about retail pharmacy is that Walgreens and CVS aren’t concerned about what’s happening. Another #twitteRX 🧵 1/
Currently work conditions are horrible to the point that pharmacies, especially Walgreens are closing pharmacies on a regular basis because they can’t find enough pharmacists to work. 2/
Let’s be crystal clear, there’s no pharmacist shortage, just a shortage of pharmacists willing work in the conditions being offered. But why aren’t they doing anything to change the conditions? That’s the answer I’m afraid to find out. 3/
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…
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)
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)
1. Basic Pharmacology
2. Pharmacokinetic Data
3. Animal Data
4. Toxicity
5. Clinical Data in Humans
(3/n)
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
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.
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.
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)
📸 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
😃 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
⚠️⬇️🚨🤔🤣🔴✅📢❌▶️
Emoji use evaluated in misinformation tweets! Very interesting!!
@EckerleIsabella at #ECCMID2022 @ABsteward
Emoji use evaluated in misinformation tweets! Very interesting!!
@EckerleIsabella at #ECCMID2022 @ABsteward
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…
“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…
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 🧐🧐🧐
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 🧐🧐🧐
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!
#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/
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/
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/
-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/
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
@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/
1st-line for serious ocular candida, CNS cryptococcus, severe histo/blasto, and mucor
2nd-line for cocci & aspergillosis
pubmed.ncbi.nlm.nih.gov/11801575/
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/
pubmed.ncbi.nlm.nih.gov/11722981/
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!
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
🚨 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/
#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/
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
💡 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
✨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
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)
✨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)
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
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
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…
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…
Question 8 #IDTwitter . Rare, but a very serious infection. #IDFellowship #IDboards #MedTwitter #Infectiousdiseases #Medicine #Microbiology #Pharmacy #TwitteRx #IDMedED
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
