@NatureRevGenet

@NatureRevGenet

Therapeutics Initiative

@Drug_Evidence

THREAD: #Prescribers, how do YOU respond to Conflicts of Interest (COI)? 👀

1/8 This thread looks at the issues highlighted in our TI Therapeutics Letter on COI

👉🏼Full Letter: ti.ubc.ca/letter136

#ConflictofInterest #MedEd #MedicalEthics

2/8 Kirsten is a clinical pharmacist attending a primary care conference👩🏽‍⚕️

When a keynote speaker reports financial relationships💰with several drug companies, Kirsten takes note🤨

Find out why she prefers #MedEd free of commercial sponsorship: ti.ubc.ca/letter136

3/8 Key Opinion Leaders (KOLs)

It's common practice to cultivate “expert” KOLs who are crucial to market success💵of a new drug

Payments to KOLs are reported in USA but similar disclosure does NOT exist in Canada
go.nature.com/39XdVVq

#FinancialInterests #ConflictofInterest

Read 9 tweets

Therapeutics Initiative

@Drug_Evidence

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

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

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

Read 7 tweets

Therapeutics Initiative

@Drug_Evidence

THREAD: Primary #hypertension therapy: after thiazides, an ACEI or an ARB?

1/8 Nearly 650,000 British Columbians took an ACEI or ARB in 2021

Our new TI Therapeutics Letter reiterates evidence for one of the most common primary care tx choices: ti.ubc.ca/letter133

#MedEd

2/8 Lower #BloodPressure not the Main Goal

#Antihypertensives lower various measures of blood pressure (BP) 💊

But... not all BP lowering drugs are proven to reduce both morbidity & mortality

👉🏾ti.ubc.ca/letter133

#MedEd #prescribing #hypertension

3/8 The importance of clinical outcomes

Basing decisions on which drug lowers #BloodPressure the best cannot guarantee the best clinical outcomes

Read our Therapeutics Letter on optimal 1st and 2nd line treatments: ti.ubc.ca/letter133

#MedEd #prescribing #hypertension

Read 9 tweets

Therapeutics Initiative

@Drug_Evidence

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: bit.ly/3nLCEje 👨🏾‍💻

#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: csepguidelines.ca 🏊🏾‍♂️🏃🏾‍♀️🚶🏾

#Exercise #prescribing #twitterRx #BetterHealth

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

#Exercise #prescribing #twitterRx #BetterPrescribing

Read 6 tweets

PeopleInPain

@SpeakPain2Power

What’s the deal w/ people in #pain using #opioids? (Read entire thread.) We are not “drug addicts.” We are physically DEPENDENT on our meds, which we need to function w/out pain (i.e, to function). Physical dependence occurs on heart meds & #antidepressants too. #ThisIsUs

And I am not trying to stigmatize #addiction here. But rly, let’s talk; chronic pain patients (#CPPs) have been forced to KILL themselves due to untreated pain, due to bad #policy, due to the #stigma, foolishness & financial incentives of others. This has a name: opiophobia…

If you took me off ALL opioids, I (like most #painpatients) would go through ugly opioid #withdrawals (and make sure to poop/puke on YOU for causing them)! 😂

And even after months of “abstaining,” and withdrawals disappearing, I would be “clean” in the eyes of the world, but…

Read 10 tweets

Therapeutics Initiative

@Drug_Evidence

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

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

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

Read 7 tweets

Therapeutics Initiative

@Drug_Evidence

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

@GovCanHealth

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

3/5: Do you like receiving feedback on your #prescribing?👩🏽‍⚕️💊

Read about Personal Prescribing Portraits: bit.ly/3hkf8WO

#MedEd #deprescribing

Read 6 tweets

Therapeutics Initiative

@Drug_Evidence

@corinne_hohl

THREAD - What if we could track and record repeat Adverse Drug Events? 🤔 💊

1/6: Register for our May 12 #BestEvidence webinar, as @corinne_hohl talks about Assessing the Impact of Information Continuity on Health Outcomes: bit.ly/3ap4FGO #MedEd

2/6: Why do Adverse Drug Events (ADEs) matter?

Each year in British Columbia, ADEs account for:
👉240,000 emergency dept (ED) visits
👉480,000 days in hospital
👉approx. 1 in 9 adult ED visits

More here: bit.ly/2Q7UGi8
#drugsafety #ptsafety #MedEd

3/6: In Canada, adverse drug events 💊 cause or contribute to almost 2⃣million emergency department visits annually 😯 🆘

See publication list here: actionade.org/referenced-art…

#MedEd #ptsafety #prescribing

Read 7 tweets

Therapeutics Initiative

@Drug_Evidence

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/

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

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/

Read 7 tweets

Cochrane Hypertension

@CochraneHTN

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

@CochraneHTN

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

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

Read 7 tweets

Therapeutics Initiative

@Drug_Evidence

@CochraneHTN

Read 7 tweets

Therapeutics Initiative

@Drug_Evidence

THREAD: Ten Commandments for patient-centred treatment 🧾

1/11 A TI Tweetorial on the “Ten Commandments’ of the New Therapeutics

Revisiting timely words of medical wisdom from the BMJ
bjgp.org/content/65/639…

#MedEd #prescribing

@LessIsMoreMed

2/11 1st Commandment:

Thou shalt have no aim except to HELP patients, according to the GOALS they wish to achieve 👩‍⚕️
bjgp.org/content/65/639…

Shared decision-making lessons from @LessIsMoreMed: lessismoremedicine.com/hands-on

#MedEd #TreatmentGoals

@thenntgroup

3/11 2nd Commandment:

Thou shalt always seek knowledge of BENEFITS, HARMS, COSTS of treatment & share this knowledge at all times
bjgp.org/content/65/639…

Try these:
ti.ubc.ca/therapeutics-l…
@thenntgroup
medi-mouse.com
pac.bluecross.ca/pharmacycompass

#MedEd #ptsafety

Read 12 tweets

Cochrane Hypertension

@CochraneHTN

THREAD: High blood pressure (hypertension) – what does the best evidence say❓

1/13 A practical tweetorial for clinicians, patients and carers

#hypertension #HTNevidence #MedEd 🩺👩‍⚕️

2/13 What is #Hypertension❓

Hypertension (high blood pressure) is a very common condition, and is associated with increased 📈 risk for strokes, heart attacks and premature death, so it's worth asking some questions 🤔

#HTNevidence #MedEd #prescribing

3/13 What about SCREENING for #hypertension❓

Screening for high blood pressure might not be that helpful 😯 and early🕗detection of mild hypertension may not significantly impact health‐related costs in the long term nor improve health outcomes: bit.ly/35P2mcz

Read 9 tweets

Therapeutics Initiative

@Drug_Evidence

THREAD: High blood pressure (hypertension) – what does the best evidence say❓

1/13 A practical tweetorial for clinicians, patients and carers

#hypertension #HTNevidence #MedEd 🩺👩‍⚕️

2/13 What is #Hypertension?

Hypertension (high blood pressure) is a very common condition, and is associated with increased📈 risk for strokes, heart attacks and premature death 💀, so it's worth asking some 🤔👩🏾‍💻

#TIevidence #MedEd #prescribing

3/13 What about SCREENING for #hypertension?

Screening for high blood pressure might not be that helpful 😯 and early 🕗 detection of mild hypertension may not significantly impact health‐related costs in the long term nor improve health outcomes: bit.ly/35P2mcz

Read 8 tweets

Dr Sharon Rees

@reesprescribe

Series 8 starting today #ramipril Day 1:The concept for the 1st angiotensin converting enzyme inhibitor (ACEI) was derived from snake venom in the 1950s. An orally active version was eventually found & captopril was licensed in 1981 for hypertension & heart failure #prescribing

Day 1 #ramipril (cont): Improved ‘me too’ ACEI versions followed, such as #ramipril, approved in the UK in 1989. Captopril now out-moded, but still used in paediatrics #prescribing

Day 2: Long-acting, high affinity ACEIs, e.g #ramipril, highly successful in cardiovascular and renal space, re h-tension, heart failure, post-MI prophylaxis & nephropathy. Ramipril one of the most prescribed ACEI in UK: Jan 2019 total CCG items ~ 2.5 mill & cost >3m #prescribing

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