Discover and read the best of Twitter Threads about #medsafety
Most recents (12)
🧵 How well do you know your dopamine antagonists? 💊💊
1/ Using these drugs safely requires that clinicians & patients appreciate their important #AdverseEffects, which are not always well understood
👉🏽ti.ubc.ca/letter139
#MedEd #prescribing #deprescribing #medsafety
1/ Using these drugs safely requires that clinicians & patients appreciate their important #AdverseEffects, which are not always well understood
👉🏽ti.ubc.ca/letter139
#MedEd #prescribing #deprescribing #medsafety
2/ #AdverseEffects may include:
⚠️ Drug-induced #Parkinsonism
-↘️ or slowed movements, rigidity/tremor/unsteadiness, facial expression loss
⚠️ #Akathisia
-intense internal restlessness or desire to move (which may be mistaken for anxiety)
👉🏽Pt videos: ti.ubc.ca/letter139
⚠️ Drug-induced #Parkinsonism
-↘️ or slowed movements, rigidity/tremor/unsteadiness, facial expression loss
⚠️ #Akathisia
-intense internal restlessness or desire to move (which may be mistaken for anxiety)
👉🏽Pt videos: ti.ubc.ca/letter139
3/ #AdverseEffects may include:
⚠️Acute dystonic reaction
-sudden, involuntary, often painful muscle spasm
⚠️Dyskinesia
-repetitive, involuntary movements...can be associated with cognitive decline
👉🏽Pt experience videos: ti.ubc.ca/letter139
#MedEd #ptsafety #drugsafety
⚠️Acute dystonic reaction
-sudden, involuntary, often painful muscle spasm
⚠️Dyskinesia
-repetitive, involuntary movements...can be associated with cognitive decline
👉🏽Pt experience videos: ti.ubc.ca/letter139
#MedEd #ptsafety #drugsafety
🧵 Reducing #PrescribingCascades ⬇️
1/ What are #Prescribing Cascades?
1⃣ A drug is prescribed 💊
2⃣ #AdverseEvent occurs but is misinterpreted as a new medical condition ⚠️
3⃣Another drug is prescribed for the drug-induced adverse event 💊💊
ti.ubc.ca/letter138 #MedEd
1/ What are #Prescribing Cascades?
1⃣ A drug is prescribed 💊
2⃣ #AdverseEvent occurs but is misinterpreted as a new medical condition ⚠️
3⃣Another drug is prescribed for the drug-induced adverse event 💊💊
ti.ubc.ca/letter138 #MedEd
2/ Anticholinergics ➡️ cognitive dysfunction ➡️ drugs for #dementia
#Anticholinergic 💊 block acetylcholinergic neurotransmission in the brain, impairing cognition & memory
Can lead to new Rx or ↗️ acetylcholinesterase inhibitor doses
ti.ubc.ca/letter138 #MedEd #FOAMed
#Anticholinergic 💊 block acetylcholinergic neurotransmission in the brain, impairing cognition & memory
Can lead to new Rx or ↗️ acetylcholinesterase inhibitor doses
ti.ubc.ca/letter138 #MedEd #FOAMed
3/ Drugs for #dementia ➡️ incontinence ➡️ anticholinergics
Conversely, AChE-I can cause urinary or fecal incontinence, that may "cascade" to prescription of an #anticholinergic
👉🏽 full Letter here: ti.ubc.ca/letter138
#MedEd #PrescribingCascades #MedTwitter
Conversely, AChE-I can cause urinary or fecal incontinence, that may "cascade" to prescription of an #anticholinergic
👉🏽 full Letter here: ti.ubc.ca/letter138
#MedEd #PrescribingCascades #MedTwitter
THREAD: Bring it down safely! ↘️💊
1/6 6⃣tweets about our new TI Therapeutics Letter 134: Finding the lowest effective dose for non-opioid #analgesics
👉🏾 Full Letter: ti.ubc.ca/letter134
#MedEd #medsafety #prescribing #BetterPrescribing
1/6 6⃣tweets about our new TI Therapeutics Letter 134: Finding the lowest effective dose for non-opioid #analgesics
👉🏾 Full Letter: ti.ubc.ca/letter134
#MedEd #medsafety #prescribing #BetterPrescribing
2/6 Consistent evidence that minority of pts get clinically meaningful pain relief from any dose of:
✅#Cyclobenzaprine (at best 1/4)
✅#Duloxetine (at best 1/6)
✅#Gabapentin / #Pregabalin (at best 1/6)
👉🏾ti.ubc.ca/letter134
#MedEd #ptsafety #BetterPrescribing #prescribing
✅#Cyclobenzaprine (at best 1/4)
✅#Duloxetine (at best 1/6)
✅#Gabapentin / #Pregabalin (at best 1/6)
👉🏾ti.ubc.ca/letter134
#MedEd #ptsafety #BetterPrescribing #prescribing
3/6 Gabapentin, pregabalin, duloxetine:
A 2021 Canadian systematic review found NNT (numbers needed to treat) of 6-7 for "clinically meaningful benefit" (defined as ≥30% reduction in pain or pain & function)
👉🏾ti.ubc.ca/letter134
#MedEd #BetterPrescribing #deprescribing
A 2021 Canadian systematic review found NNT (numbers needed to treat) of 6-7 for "clinically meaningful benefit" (defined as ≥30% reduction in pain or pain & function)
👉🏾ti.ubc.ca/letter134
#MedEd #BetterPrescribing #deprescribing
THREAD: SGLT2 inhibitors for #diabetes
1/5 Dr. Jamie Falk @jamisonfalk presented "A Deep Dive into #SGLT2i: What Comes to the Surface for Individuals with Diabetes"
👉🏽Watch the presentation here: bit.ly/3FRCEoM 🧑🏾💻
#T2DM #medsafety #FOAMed #MedEd
1/5 Dr. Jamie Falk @jamisonfalk presented "A Deep Dive into #SGLT2i: What Comes to the Surface for Individuals with Diabetes"
👉🏽Watch the presentation here: bit.ly/3FRCEoM 🧑🏾💻
#T2DM #medsafety #FOAMed #MedEd
2/5 #AdverseEffects for #SGLT2i to be aware of: genital infections, hypovolemia, DKA, amputations
✅Check out the image ⬇️ for the risk estimates
✅Watch @JamisonFalk's presentation here: bit.ly/3FRCEoM🧑🏾💻
#T2DM #medsafety #FOAMed #MedEd #diabetes #ptsafety
✅Check out the image ⬇️ for the risk estimates
✅Watch @JamisonFalk's presentation here: bit.ly/3FRCEoM🧑🏾💻
#T2DM #medsafety #FOAMed #MedEd #diabetes #ptsafety
3/5 Evidence to date for #SGLT2i:
The first of the two new classes of medications for type II diabetes to reduce ↘️ risk of CV #AdverseEvents and mortality
✅Watch @JamisonFalk's presentation here: bit.ly/3FRCEoM🧑🏾💻
#T2DM #medsafety #FOAMed #MedEd #diabetes
The first of the two new classes of medications for type II diabetes to reduce ↘️ risk of CV #AdverseEvents and mortality
✅Watch @JamisonFalk's presentation here: bit.ly/3FRCEoM🧑🏾💻
#T2DM #medsafety #FOAMed #MedEd #diabetes
THREAD: Evidence for oseltamivir for #influenza prevention
1/6 Not much #flu last year, yet almost 14,000 BC residents were prescribed #oseltamivir (Tamiflu) for prevention
✅Flu guidelines bit.ly/3wwGJei
✅Systematic review of Tamiflu safety pubmed.ncbi.nlm.nih.gov/27246259
1/6 Not much #flu last year, yet almost 14,000 BC residents were prescribed #oseltamivir (Tamiflu) for prevention
✅Flu guidelines bit.ly/3wwGJei
✅Systematic review of Tamiflu safety pubmed.ncbi.nlm.nih.gov/27246259
2/6 #Oseltamivir for prevention reduces ↘️ symptomatic influenza by 3%, (NNT=33) with an uncertain effect on asymptomatic #influenza
It likely has a central symptom reducing effect but may not reduce viral transmission
pubmed.ncbi.nlm.nih.gov/27246259
#Tamiflu #prescribing
It likely has a central symptom reducing effect but may not reduce viral transmission
pubmed.ncbi.nlm.nih.gov/27246259
#Tamiflu #prescribing
3/6 #Oseltamivir won’t reduce the risk of developing influenza-like illness though it can make people feel better (i.e. fewer symptoms) and reduces ↘️ fever
There is not enough evidence to say it prevents death, hospitalizations, or flu complications
pubmed.ncbi.nlm.nih.gov/27246259
There is not enough evidence to say it prevents death, hospitalizations, or flu complications
pubmed.ncbi.nlm.nih.gov/27246259
THREAD: Shedding light on the risks of anticholinergic drugs
1/8 NEW information on risk of dementia and harm in the frail elderly. Free #BestEvidence webinar w/ Dr. Aaron Tejani @amtejani on July 14th
✅Registration: ti.ubc.ca/Anticholinergi…
#MedEd #deprescribing #medsafety
1/8 NEW information on risk of dementia and harm in the frail elderly. Free #BestEvidence webinar w/ Dr. Aaron Tejani @amtejani on July 14th
✅Registration: ti.ubc.ca/Anticholinergi…
#MedEd #deprescribing #medsafety
2/8 One of every 14 of the top 200 💊 prescribed in BC has anticholinergic properties
They include: amitriptyline, cyclobenzaprine, fluoxetine, quetiapine, sertraline, trazadone, venlafaxine, zopiclone, citalopram...
👉🏽More here ti.ubc.ca/2018/09/10/113…
#MedEd #deprescribing
They include: amitriptyline, cyclobenzaprine, fluoxetine, quetiapine, sertraline, trazadone, venlafaxine, zopiclone, citalopram...
👉🏽More here ti.ubc.ca/2018/09/10/113…
#MedEd #deprescribing
3/8 What kinds of harms can #anticholingergics cause?
👉🏽Dry mouth 😦
❓Could your patient on an anticholinergic be experiencing bad breath/gum problems/tooth decay/trouble swallowing? 🤔
More here: ti.ubc.ca/2018/09/10/113…
#MedEd #deprescribing
👉🏽Dry mouth 😦
❓Could your patient on an anticholinergic be experiencing bad breath/gum problems/tooth decay/trouble swallowing? 🤔
More here: ti.ubc.ca/2018/09/10/113…
#MedEd #deprescribing
THREAD:5⃣things to know from 5 recent TI Therapeutics Letters👩🏽🔬
1/5: How to choose a good #mirtazapine dose? 🤔
Mirtazapine has a dose response 💊for harm but NOT for efficacy: harm ↗️ after 30mg/day but efficacy doesn't: bit.ly/361LU9E
#MedEd #deprescribing #ptsafety
1/5: How to choose a good #mirtazapine dose? 🤔
Mirtazapine has a dose response 💊for harm but NOT for efficacy: harm ↗️ after 30mg/day but efficacy doesn't: bit.ly/361LU9E
#MedEd #deprescribing #ptsafety
2/5: Want to learn about recent @GovCanHealth #medsafety or international warnings for medications?
Read our Therapeutics Letter on international drug safety advisories: bit.ly/3wc0ar8 ⚠️ 💊
#drugsafety #SegPac #ptsafety
Read our Therapeutics Letter on international drug safety advisories: bit.ly/3wc0ar8 ⚠️ 💊
#drugsafety #SegPac #ptsafety
3/5: Do you like receiving feedback on your #prescribing?👩🏽⚕️💊
Read about Personal Prescribing Portraits: bit.ly/3hkf8WO
#MedEd #deprescribing
Read about Personal Prescribing Portraits: bit.ly/3hkf8WO
#MedEd #deprescribing
THREAD: Trama-DO or Trama-DON'T?
What to know about #tramadol
1/7 Tramadol has multiple mechanisms of action:
- via serotonin & norepinephrine reuptake inhibition
- after metabolism to M1 metabolite, via opioid agonism
bit.ly/3t5o7jC #chronicpain #arthritis #MedEd
What to know about #tramadol
1/7 Tramadol has multiple mechanisms of action:
- via serotonin & norepinephrine reuptake inhibition
- after metabolism to M1 metabolite, via opioid agonism
bit.ly/3t5o7jC #chronicpain #arthritis #MedEd
2/7 People metabolize #tramadol variably 🤔💊
- Some who are ‘ultra rapid’ produce more M1 (opioid);
- Some ‘poor’ metabolizers (~20% with inactive CYP2D6) may have more SSRI/SNRI-like effect
Thus, analgesic & adverse effects are unpredictable
ncbi.nlm.nih.gov/books/NBK315950 #MedEd
- Some who are ‘ultra rapid’ produce more M1 (opioid);
- Some ‘poor’ metabolizers (~20% with inactive CYP2D6) may have more SSRI/SNRI-like effect
Thus, analgesic & adverse effects are unpredictable
ncbi.nlm.nih.gov/books/NBK315950 #MedEd
3/7 Tramadol, once called a ‘safer’ opioid, causes tolerance and withdrawal, and is associated with addiction, overdose, and death
Observational studies show people treated with #tramadol, vs other opioids, are ↗️ likely to engage in prolonged opiate use #chronicpain #arthritis
Observational studies show people treated with #tramadol, vs other opioids, are ↗️ likely to engage in prolonged opiate use #chronicpain #arthritis
THREAD: Tamiflu for #influenza prevention – the evidence
1/6 In 2019 21,000 BC citizens were prescribed Tamiflu (oseltamivir), many to prevent the flu. Flu prevention guidelines. AMMI Canada ammi.ca/?ID=171
Systematic review of Tamiflu safety: pubmed.ncbi.nlm.nih.gov/27246259/
1/6 In 2019 21,000 BC citizens were prescribed Tamiflu (oseltamivir), many to prevent the flu. Flu prevention guidelines. AMMI Canada ammi.ca/?ID=171
Systematic review of Tamiflu safety: pubmed.ncbi.nlm.nih.gov/27246259/
2/6 Tamiflu for prevention ↘️ symptomatic flu (by 3%, NNT=33) with uncertain effect on asymptomatic flu.
One likely explanation is that Tamiflu has a central symptom lowering effect but may not ↘️ viral transmission.
pubmed.ncbi.nlm.nih.gov/27246259
#influenza #flu #tamiflu
One likely explanation is that Tamiflu has a central symptom lowering effect but may not ↘️ viral transmission.
pubmed.ncbi.nlm.nih.gov/27246259
#influenza #flu #tamiflu
3/6 Tamiflu doesn't reduce risk of developing flu-like illness though it can make people feel better (i.e. fewer self-reported symptoms) & reduces fever.
There is not enough evidence to say it prevents death, hospitalizations, or flu complications
pubmed.ncbi.nlm.nih.gov/27246259/
There is not enough evidence to say it prevents death, hospitalizations, or flu complications
pubmed.ncbi.nlm.nih.gov/27246259/
THREAD: Are we using ACEIs & ARBs properly? A TI Tweetorial
1/6: British Columbia doctors give 4.5m scripts/year for ACE inhibitors (ACEIs) & angiotensin receptor blockers (ARBs) to control bp. Goal is to ↘️ mortality & morbidity, not simply to ↘️ bp.
#MedEd #hypertension
1/6: British Columbia doctors give 4.5m scripts/year for ACE inhibitors (ACEIs) & angiotensin receptor blockers (ARBs) to control bp. Goal is to ↘️ mortality & morbidity, not simply to ↘️ bp.
#MedEd #hypertension
2/6 BEST EVIDENCE on ARBs & ACEI for #hypertension
3⃣@CochraneHTN systematic reviews:
ACEs v ARBs for htn bit.ly/34vS0hu
BP lowering efficacy of ACEIs for htn bit.ly/30YNIOX
BP lowering efficacy of ACEIs for htn https://t.co/u8dN378QAe
#MedEd
3⃣@CochraneHTN systematic reviews:
ACEs v ARBs for htn bit.ly/34vS0hu
BP lowering efficacy of ACEIs for htn bit.ly/30YNIOX
BP lowering efficacy of ACEIs for htn https://t.co/u8dN378QAe
#MedEd
3/6 ACEIs over ARBS when considering HARMS 🤔
Both ACEIs & ARBs ↘️ blood pressure to similar extents.... BUT only ACEIs have evidence for a reduction in risk of morbidity & mortality. So they’d be your first choice 🥇
#MedEd #medsafety #ptsafety
Both ACEIs & ARBs ↘️ blood pressure to similar extents.... BUT only ACEIs have evidence for a reduction in risk of morbidity & mortality. So they’d be your first choice 🥇
#MedEd #medsafety #ptsafety
THREAD: Are we using ACEIs & ARBs properly? A TI Tweetorial
1/6: British Columbia doctors give 4.5m scripts/year for ACE inhibitors (ACEIs) & angiotensin receptor blockers (ARBs) to control bp. Goal is to ↘️ mortality & morbidity, not simply to ↘️ bp.
#MedEd #hypertension
1/6: British Columbia doctors give 4.5m scripts/year for ACE inhibitors (ACEIs) & angiotensin receptor blockers (ARBs) to control bp. Goal is to ↘️ mortality & morbidity, not simply to ↘️ bp.
#MedEd #hypertension
2/6 BEST EVIDENCE on ARBs & ACEI for #hypertension
3⃣@CochraneHTN systematic reviews:
ACEs v ARBs for htn bit.ly/34vS0hu
BP lowering efficacy of ACEIs for htn bit.ly/30YNIOX
BP lowering efficacy of ACEIs for htn https://t.co/NCl1dfCCAO
#MedEd
3⃣@CochraneHTN systematic reviews:
ACEs v ARBs for htn bit.ly/34vS0hu
BP lowering efficacy of ACEIs for htn bit.ly/30YNIOX
BP lowering efficacy of ACEIs for htn https://t.co/NCl1dfCCAO
#MedEd
3/6 ACEIs over ARBS when considering HARMS 🤔
Both ACEIs & ARBs ↘️ blood pressure to similar extents.... BUT only ACEIs have evidence for a reduction in risk of morbidity & mortality. So they’d be your first choice 🥇
#MedEd #medsafety #ptsafety
Both ACEIs & ARBs ↘️ blood pressure to similar extents.... BUT only ACEIs have evidence for a reduction in risk of morbidity & mortality. So they’d be your first choice 🥇
#MedEd #medsafety #ptsafety
THREAD: 5 Things You Need to Know About PPIs
For many years, we've dissected the research on Proton Pump Inhibitors (PPIs) 🤔
This thread captures our publications on PPIs that can help you in clinical practice: ti.ubc.ca/?s=ppis
#MedEd #medsafety #DrugEvidence #GERD
For many years, we've dissected the research on Proton Pump Inhibitors (PPIs) 🤔
This thread captures our publications on PPIs that can help you in clinical practice: ti.ubc.ca/?s=ppis
#MedEd #medsafety #DrugEvidence #GERD
2/6 PPI COSTS VARY CONSIDERABLY 💰
Even without differences in efficacy or safety between PPIs, costs can vary x 10. The cheapest in BC? Pantoprazole Mg 40mg or Rabeprazole 10mg. Most expensive: Dexlanzoprazole
More here: ti.ubc.ca/letter99
#MedEd #DrugCosts #GERD
Even without differences in efficacy or safety between PPIs, costs can vary x 10. The cheapest in BC? Pantoprazole Mg 40mg or Rabeprazole 10mg. Most expensive: Dexlanzoprazole
More here: ti.ubc.ca/letter99
#MedEd #DrugCosts #GERD
3/6 RESPONSE IS VARIABLE
1 in 2 pts w/ acid reflux get symptom relief with a PPI (NNT~2) w/in 4-8 wks
Responders notice symptom relief w/in 1-9 days. If no relief in ~2 wks consider 🛑 PPI. Non-acid reflux doesn’t benefit from PPI
More here: ti.ubc.ca/letter99
#MedEd
1 in 2 pts w/ acid reflux get symptom relief with a PPI (NNT~2) w/in 4-8 wks
Responders notice symptom relief w/in 1-9 days. If no relief in ~2 wks consider 🛑 PPI. Non-acid reflux doesn’t benefit from PPI
More here: ti.ubc.ca/letter99
#MedEd
