Discover and read the best of Twitter Threads about #ppis
Most recents (5)
🧵 Reducing unnecessary use of proton pump inhibitors (PPIs)
1/ Many people take #PPIs but up to 50% don’t have a good reason to take them > 8 wks
Read on for tips on how you as a clinician can work together with pts to decide if/how to 🛑 or reduce PPIs
#MedEd #deprescribing
1/ Many people take #PPIs but up to 50% don’t have a good reason to take them > 8 wks
Read on for tips on how you as a clinician can work together with pts to decide if/how to 🛑 or reduce PPIs
#MedEd #deprescribing
2/ Does this person need #PPIs long-term (> 8 wks)?
Find pts who might not need long-term PPI:
1⃣ Flag refill requests
2⃣ Use a poster or video in waiting room
3⃣ Run EMR report
This @bmj_latest article has more tips to help with #deprescribing PPIs: bit.ly/3fisHsT
Find pts who might not need long-term PPI:
1⃣ Flag refill requests
2⃣ Use a poster or video in waiting room
3⃣ Run EMR report
This @bmj_latest article has more tips to help with #deprescribing PPIs: bit.ly/3fisHsT
3/ Indications for long-term #PPIs include:
Barrett’s esophagus, previous bleeding ulcer, chronic NSAID use w/ mod/severe bleed risk, severe esophagitis, Zollinger-Ellison syndrome
If no indication for long-term PPI + no ongoing upper GI symptoms, discuss poss #deprescribing
Barrett’s esophagus, previous bleeding ulcer, chronic NSAID use w/ mod/severe bleed risk, severe esophagitis, Zollinger-Ellison syndrome
If no indication for long-term PPI + no ongoing upper GI symptoms, discuss poss #deprescribing
🧵 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: Online Portraits for BC family physicians
1/7 UBC’s Therapeutics Initiative now has Online #PrescribingPortraits: ti.ubc.ca/portrait
✅ Timely evidence
✅ Personalized, confidential prescribing data
✅ Recommendations to support
#BetterPrescribing & #BetterHealth
1/7 UBC’s Therapeutics Initiative now has Online #PrescribingPortraits: ti.ubc.ca/portrait
✅ Timely evidence
✅ Personalized, confidential prescribing data
✅ Recommendations to support
#BetterPrescribing & #BetterHealth
2/7 Why have a #PrescribingPortrait?
"How do I prescribe compared to others or to evidence standards?"
✅Portrait does NOT tell individual doctors how to practice
✅Portrait DOES promote optimal prescribing based on best available evidence
More here: ti.ubc.ca/portrait
"How do I prescribe compared to others or to evidence standards?"
✅Portrait does NOT tell individual doctors how to practice
✅Portrait DOES promote optimal prescribing based on best available evidence
More here: ti.ubc.ca/portrait
3/7 BC family physicians: How do you prescribe ACEIs and ARBs for #hypertension?
✅Register for your Online #PrescribingPortrait: ti.ubc.ca/portrait
✅View a sample portrait on prescribing of antihypertensives: ti.ubc.ca/2022/01/28/ace…
#BetterPrescribing #MedEd
✅Register for your Online #PrescribingPortrait: ti.ubc.ca/portrait
✅View a sample portrait on prescribing of antihypertensives: ti.ubc.ca/2022/01/28/ace…
#BetterPrescribing #MedEd
H pylori #tweetorial for resistant H pylori
#AGA released CPU in 4/21 revisiting topic of resistance/treatment failures, not a guideline, but the expert opinion @BradSpellberg loves! (1/x)
gastrojournal.org/article/S0016-…
@ABsteward @RushCCH_ID #MedEd #medtwitter #idtwitter
#AGA released CPU in 4/21 revisiting topic of resistance/treatment failures, not a guideline, but the expert opinion @BradSpellberg loves! (1/x)
gastrojournal.org/article/S0016-…
@ABsteward @RushCCH_ID #MedEd #medtwitter #idtwitter
As GN bacteria go, it's an interesting bug:
Highly motile, curved, GNR, #Urease-positive, catalase-positive, oxidase-positive
Related to Campylobacter, for family fun
Nice crossover with our #Gastroenterology colleagues, eh #IDtwitter and @IDSAInfo
(2/x)
Highly motile, curved, GNR, #Urease-positive, catalase-positive, oxidase-positive
Related to Campylobacter, for family fun
Nice crossover with our #Gastroenterology colleagues, eh #IDtwitter and @IDSAInfo
(2/x)
GN, and as such should be sensitive to most #antibiotics that target GN with pretty good susceptibilities over time for:
#amoxicillin #tetracycline #aminoglycoside #nitroimidazole #macrolide
(3/x)
#amoxicillin #tetracycline #aminoglycoside #nitroimidazole #macrolide
(3/x)
A #tweetorial on proton pump inhibitors (PPIs)
Just for fun, which drug class is archetypal of a gastroenterologist? 😉
1/
Just for fun, which drug class is archetypal of a gastroenterologist? 😉
1/
2/
PPIs would be my pick!
The advent of these potent and effective acid suppression medications led to a paradigm shift in the mx of many GI conditions
The market for PPIs is MASSIVE! Just the projected 5 year growth from 2018 - 2023 estimated to be $3.24 billion!
PPIs would be my pick!
The advent of these potent and effective acid suppression medications led to a paradigm shift in the mx of many GI conditions
The market for PPIs is MASSIVE! Just the projected 5 year growth from 2018 - 2023 estimated to be $3.24 billion!
3/
So how do #PPIs work?
A reminder on physiology: this class of drug acts on the gastric parietal cells by irreversibly blocking the hydrogen/potassium adenosine triphosphatase enzyme system (the H+/K+ ATPase, aka the gastric proton pump), hence the elegant name
So how do #PPIs work?
A reminder on physiology: this class of drug acts on the gastric parietal cells by irreversibly blocking the hydrogen/potassium adenosine triphosphatase enzyme system (the H+/K+ ATPase, aka the gastric proton pump), hence the elegant name
