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🚨🚨Thread 🚨🚨

Just finished listening to this webinar hosted by Students for Opioid Saftey in Dentistry which featured Dr. Marriott (PROP), Dr. Harold Tu, among others etc.. Image
I was smh throughout the whole thing.. It really is sad that these speakers were feeding lies to these students.. Dr. Tu perpetuated many falsehoods throughout his portion of the talk which I've debunked over and over again.. ImageImage
Dr. Tu also told these students "When we give pain pills we are giving heroin pills" 🤔🤔 i wonder where we have heard that before lol
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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
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
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…
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🚮 tweet alert! Let’s talk why. #TwitteRx #MedTwitter
Pharmacists are highly trained HCPs who are the subject matter experts in medications and treatment. *However* because of really effective MD lobbying, many of us are unable to practice independently, particularly re: decision making on therapeutics 2/
Because of that, when pharmacists practice - especially in the community - they’re doing so under INCREDIBLY strict protocols and standing orders. Literally not allowed to make decisions outside of those - even if those decisions are correct, medically 3/
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#IDtwitter #TwitteRx #obgyntwitter

What is your preferred corticosteroid💊 for #pregnant patients🤰🏽 with severe #COVID19?🤔

🧵below 1/n
🧵2/n
Background
RECOVERY ➡️Dex ⬇️mortality in severe #COVID19
Pregnant patients🤰🏽 INCLUDED 👏🏽👏🏽🙂
Enrolment low n=4, 0.06% of participants 😶
Prednisolone or hydrocortisone used instead of dex Why? 🤔
🧵3/n
Choice of steroid in #pregnancy🤰🏽 usually depends on if treatment for mum or fetus

Hydrocortisone, methypred, prednisone ➡️metabolized to inactive metabolites by placental enzymes
Fetal uptake ~10% maternal exposure
So these steroids are preferred for maternal conditions
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In hospitalized patient with osteomyelitis, what's your preferred approach if you have a bone culture :
KP ESBL R to all Abx except carbapenems and tigecycline & Enterococcus faecalis S to Ampc & tig &VAN #IDTwitter #medtwitter #TwitteRx
Would love to hear @BradSpellberg and @DrToddLee thoughts
@Cortes_Penfield would love to hear your thoughts!
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Healthcare patient primer
How to have a good experience and help the staff
Healthcare workers are under staffed and struggling under the extra burdens of Covid-19
- realize we are struggling and be helpful not a hindrance
- don't expect exceptional customer service,we don't have
the staff right now
- be direct and to the point with what you need,we are overwhelmed and unable to have an extended conversation
Example:
Hi,I need a refill (staff will guide you through the rest)
- if you have a question about vaccinations,testing,making appointments go to
the company website first, all the information is there trust me
- use automation/technology/App most simple things can be accomplished without talking to a staff member
In the store:
- be proactive and have your insurance card, drivers license, covid card, credit card out and
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My tech who contracted Covid passed away unexpectedly. He was not vaccinated. We are shocked, saddened and numb. This was way before his time. This is a wake up call for all of us, both personally and professionally. Vaccinations are important..What we are doing is so important.
We are saving lives. This work is difficult, it's stressful, it's overwhelming and it's a workload burden...BUT what we are doing is making a difference in others lives. Every vaccine is possibly saving someone's son, daughter,grandma or aunt. I'm struggling right now because I
didn't push my friend harder to get vaccinated. I never thought this would lead to his death. The moral of the story is that Covid is real, it's not a joke, and vaccination prevents serious illness. Whatever your hang up over the vaccine, put that aside, don't be selfish because
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I wasn't aware U.S. had liberalized drug laws Michael 🤦🏾‍♂️🤦🏾‍♂️ lol
Once again he is mischaracterizing Portugal's drug policy as if their main objective is to criminalize and send people to jail..
Here is what Dr João Goulão actually said in his speech he gave.. Yes they do still have fines and penalties and jail, but that is not their main objective..
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Fentanyl alongside other medications are on the WHO list of essential medications... It’s important to remember that when discussing this overdose crisis. The fentanyl that has been implicated in ODs are not made in a pharmaceutical lab.. Fentanyl has been used safely for decades
It’s also important to note that the illicit synthesis of these fentanyl analogues are usually from completely novel sources not from the pharmaceutical Janssen products as noted below
It’s important to make this distinction because many patients utilize pharmaceutical fentanyl products safely and for a myriad of different reasons.. We need to be careful and specific regarding the drugs we are discussing in the overdose crisis..
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**Thread **🧵

I don’t know if PROP is intentionally trying to be misleading but at this point there is no way they can be this willfully blind to the data.. This new article written today by their organization is highly misleading. I want to go through some of the things they
mention in their article.. So below they mention deaths from prescription opioids continue to contribute to drug overdose deaths.. 1st problem is that is not entirely accurate, 2nd is they don’t define what a prescription opioid death means.. This statement needs to be qualified.
What is the source, what drugs are involved. The data does not parse this out.. Many of the Rx opioid deaths involves drugs that were diverted, also combined with other drugs as well (psychostimulants, benzos, antidepressants, barbiturates etc) Rx deaths alone is most likely alot
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**Thread**

There has been a disturbing trend of some healthcare providers discussing how racial disparities and socioeconomic disparities have been a protective role for African Americans in order to prevent them from getting opioid therapy and getting “addicted” below documents
some of this.. Thanks @life_is_art___ for sharing this video below. This is a video by Dr. Tauben from the University of Washington School of medicine giving a lecture in 2018 regarding the opioid epidemic.. Quote listed below:
Quote:

“Like all things socioeconomic disparities abound which is good for people of color because their less likely to be exposed to opioids because we dont prescribe them opioids because we dont trust them based on the color of their skin
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Let's talk about "Trans Broken Arm Syndrome", a sadly common problem that prevents transgender people from accessing adequate care, and how as healthcare workers we can stop perpetuating it!
#TwitteRx #MedTwitter #LGBTQ #trans #pride

1/ 🧵
"Trans Broken Arm Syndrome" is the practice of assuming any health problem a transgender patient has is due to their transness, especially hormone therapy. It is also when a trans person's gender history is discussed in-depth when it has no relevance to the problem at hand.

2/🧵
Headaches? GERD? Injury? Clearly it is your hormone therapy, which you should stop. This can prevent trans people from getting adequate care for their issues, and even outside of healthcare, has people assuming our transness is the reason for our sickness and death.

3/🧵
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Alert 🎙Pharmacy Grand Rounds Thread Ahead! 🚨

Last week I had one of my final presentations of the year! With a catchy title😉

Urine for an Update! Updates in the management of metastatic urothelial cancer

Hold your bladders, this is an extensive update! 😂
#oncopharm Image
Bladder cancer can be divided into two ✌️subtypes:
1) Non-muscle invasive: encompasses in-situ and localized disease➡️5-yr OS >70%

2) Muscle invasive: encompasses regional or metastatic disease➡️5-yr OS dismal especially for metastatic disease 😔 Image
Cisplatin=SOC
50% of pts w are ineligible due to older age👵🏻, poor PS, ⬇️ renal function, ⬇️hearing, neuropathy, heart failure 🫀& other comorbities that ⬆️ risk of ⚠️

Carboplatin yields inferior responses➡️NOT 🙅🏻‍♀️ an equal alternative due to ⬇️ OS😢➡️pt left w/minimal tx options Image
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Interesting article from pharmacy times.. Once again i think it greatly misses the mark.. Their answer to slowing the opioid crisis is to reduce opioid prescribing in the hospital.. Once again this obsession with focusing on Rx opioids is misguided

pharmacytimes.com/view/slowing-t…
For almost the past 10 years this crisis has been dominated by illicit fentanyl, and polysubstance abuse.. Stimulants are also on the rise, and some experts are saying we could see a 4th wave involving stimulants.. This crisis is being dominated by an adulterated supply
The way to solve this is to have safe consumption sites, drug testing strips, expanding MAT, etc.. If we know what drugs are causing overdose deaths we can understand how to solve this problem.. Truth is rx opioid deaths alone have been decreasing for some time now as well as
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1/ Forget COVID for a sec! Come read about 🌟𝘱𝘭𝘢𝘤𝘦𝘣𝘰𝘴🌟 instead.

Is placebo effect as powerful as some suggest?
Not really.
But it's surprisingly consistent, & that has important implications in medicine.

I dug up an old student presentation on them.
Let’s dive in🧵 Quote from Emile Coue "...
2/ The term was 1st used in medicine in the 1800s: Treatment "adapted more to please than to benefit".

Even then, the importance of suggestion/placebos/bedside manner/whatever you call it was known to be tremendously important.
3/ A famous early Placebo-controlled trial (i.e. comparing the "treatment" to an identical sham) used wooden rods in place of Perkins Tractors, which were metal rods made of supposedly "special alloys".
It showed they were no more effective in managing the advertised disorders Front cover of early study ...
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What medications 💊 are should be avoided 🛑 or used with caution ⚠️ in patients with Myasthenia Gravis? 🤔

See 👀 the thread 🧵below⤵️ that summarizes an amazing grand rounds presentation by @UKPharmRes PGY1 @AliW_PharmD on key 🔑 medication considerations in MG
1️⃣Antibiotics to avoid or use w/caution🦠 💊

🛑FQs = FDA BBW for ⤴️ risk of MG crisis ➡️ avoid use if possible
⚠️ Macrolides ⤴️ rate of MG crisis (case reports)
⚠️ AG linked to ⤴️ ICU acquired weakness & exacerbate ‼️ MG crisis
📝Risk⬆️ w/neomycin vs. tobramycin & amikacin
Antibiotics considered to be SAFE alternatives to the above include

✅Beta-lactams
✅Tetracyclines
✅Linezolid
✅Bactrim

Ex. In an MG patient who presents 🏥 w/CAP 🫁 ➡️ choose ceftriaxone + doxycycline✅ OVER ceftriaxone + azithromycin🛑
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(1/10) 71 yo F with HTN and ESRD on HD presents to the ED w/ fever 🌡 + back pain, 🧫 BCx + Clostridium septicum. Which test should be considered? 🧐
(2/10) Clostridium septicum [motile, gram +, anaerobic, spore-forming rod] is rare in the GI tract. In colorectal tumor: anaerobic glycolysis = acidic and hypoxic environment ↑ C. septicum spore germination + tumors break down mucosal barrier and ↑ C. septicum blood entry
(3/10) Infxn mortality rates are high (60-79%)

Early diagnosis🩸and aggressive treatment💊of C. septicum are essential.

Colonoscopy is recommended to evaluate for malignancy. What is another gram + organism associated with colon CA?

pubmed.ncbi.nlm.nih.gov/11736823/
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Kolodny frequently states that just because Rx opioids have declined around the same time as increases in overdose deaths climbed up doesn’t mean A caused B.. It’s ironic in his lecture below he states that around the same time opioid sales went up as well as opioid death and
addiction and one caused the other. These all happened around the same time but does that mean one caused the other? Correlation doesn’t equate to causation right? it’s interesting he says that regarding decrease in Rx opioids and increase in ODs, but doesn’t apply the same logic
in his lecture above.. Why is that? It’s because his worldview is so focused on Rx opioids being the cause of everything in this crisis that he doesn’t stay consistent in his reasoning.

#TwitteRx
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***Thread***

Are medications like oxycodone and hydrocodone essentially heroin pills??

Kolodny recently did a townhall discussion last year on the opioid crisis and COVID... and he made some interesting assertions regarding the semi synthetic medications like oxycodone
He stated when you make molecules like oxycodone, hydrocodone you’re essentially making drugs that cross the BBB easier and are more lipophilic. He continued in the video clip above and stated that they are like heroin in creating a rewarding effect due to it crossing the BBB
His assertion that semi synthetic pain medications such as hydrocodone, and oxycodone are essentially “heroin pills” I think is somewhat hyperbolic and I will try to explain why below...

Molecules like heroin, hydromorphone, oxycodone, etc even though they are made to target
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Interesting study done last year looking at the toxicology OD data in British Columbia, Canada.. “They identified by the BC Coroners Service in 2015–2017, were linked to the prescription drug histories of individuals as recorded in BC’s PharmaNet database”
What I like about this descriptive analysis is that they disaggregated the OD data in order to see what drugs were involved in Overdose deaths.. Usually a lot of times you see reported in the media this number so and so died of drug overdose, but what you don’t see reported is
The data disaggregated in order to figure out what drugs were involved.. The chart below shows that from the sample only about 2% of deaths involved prescribed opioids alone in the absence of non-prescribed opioids. The majority of OD deaths involved non prescribed stimulants, Image
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***Thread***

Dependence vs Addiction

I have been seeing this flyer around social media and i wanted to do a quick thread on the difference between the 2.. I think alot of times we tend to mesh these two concepts together or often conflate these terms which can
Cause issues as well.. To start off this flyer states "If you get prescribed opioids, you may end up wishing you hadn't. That's because anyone could become dependent on painkillers like hydrocodone, oxycodone, and fentanyl which can ruin your relationships, health and career"
So this flyer states that dependence can happen when taking opioids Which can cause you to ruin your relationships, career, etc.. So what is dependence? It is considered when you have physical or physiological dependence it is indicated by tolerance and withdrawal symptoms.
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Its interesting even during the time of the mid 90s and the whole Purdue Pharma fiasco that it was mainly fueled by shady, and illicit activity (whether it was shady Pharma practices, pill mills, non medical use, etc) Patients who use pain medications medically based on the
data don't tend to OD.. Throughout the whole history of this opioid crisis its always been fueled by illicit activity.. Having a legal safe supply regulated market can prevent black market activity.. Imagine if we had sensible drug policy i believe we could have
avoided alot of the OD deaths that we have seen throughout the history of the opioid crisis.. We have a chance to implement sensible drug policy. What will the next 10 years look like regarding OD deaths?? Who knows, but i know if we continue on the trajectory were on now
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I'm surprised he hasn't blocked me yet.. 😂😂 But I'm gunna continue to push back on his narrative.. #TwitteRx
@ChadDKollas laying down some facts!! Convo for those who are blocked lol...
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Another one of my colleagues took a nice, cushy MSL job and I just met a new staff pharmacist at my 🏥 who is PGY2 CC-trained and doesn’t WANT to do clinical anymore. At 36, I’m now the “old” one amongst our clinical pharmacist. It’s led me to reflect on why that is. A 🧵: (1/)
Starting out, so many of my residents’ 5-year goals read like this: “I want to work at an academic center where I can teach, precept & do research”. Then after 5 years, they jump ship. What happens? (2/)
For starters, it’s really hard to be on service constantly. Our physician colleagues often get time off-service, but it’s rare in clinical pharmacist positions. It’s hard to balance (and excel!) at non-stop patient care, admin tasks, teaching, research, etc. long term. (3/)
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