Ashley & Brooke Barlow PharmD Profile picture
Oct 22, 2019 14 tweets 8 min read Read on X
It’s the time of year again📆when the ASHP Midyear Conference is just around the bend↩️

In reflecting🤔on our experience we thought we’d share 📃

Our top 10 tips to help you excel in the ASHP Clinical Skills Competition!🏆 @ASHPOfficial inspired by @thatpharmgirl (congrats👏🏻)
First things☝️, for those who didnt win ur local competition, embrace ur experience as an opp to learn&grow. It took us 3 yrs to make it to nationals!

The🔑 to success is perseverance!

Tip☝️“Success consists of going from failure to failure without loss of enthusiasm.” #success
To those who made it through round1️⃣, CONGRATULATIONS the competition has just begun! 🎊

It goes without saying, the true foundation to success, is developing a team that works together at its very best! 👯

Tip ✌️: “TEAM” Together👏🏻Everyone👏🏻 Achieves👏🏻 More👏🏻 #teamwork
On the topic of teamwork, when it comes to the written patient case, it’s IMPERATIVE that you & your teammate divey up your strengths! 💪

Tip 3️⃣: Work together as a team to identify the primary problems⏩➗ the work 📚 & put trust in each others strengths to best solve them!
Trust in your knowledge & skills as they will be put to test, no matter what the top problem is don’t forget about primary prevention! 💉

Pharmacotherapy Tip 4️⃣Don’t forget to mention vaccines & chronic medication management!

Don’t procrastinate or forget to vaccinate! 🦠
Now, when under pressure & a 2-hr timeline, we have all been in those situations when we run into a brain freeze 😖🤕🍦

Tip 🖐: USE YOUR RESOURCES!!

ASHP provides excellent DI resources (DiPiro,AHFS Drug Information®,Lexi-comp®) & guideline access to make your EBM tx plan!
With only ✌️ hours to solve a complex patient case, its important to manage your time efficiently & keep a steady pace. 🏃💨⏰

Tip6️⃣: The 🔑 to efficiency is to prioritize & you will succeed! 🙌🏼

Pro tip:🏋🏻‍♂️Don’t forget to spend the last 15 min to double✅✅your work!
Formulating answers 📝 was a collaborative effort 🤝& we recognized the fundamental component to excel in this portion was placing trust in each other.🙌🏼 ❤️

Tip7️⃣ Trust is the glue of life. It’s the most essential ingredient that holds all relationship together!
Times up!⌛️you’ve completed the case..now what to do🤷🏻‍♀️until results are announced the next day⁉️

The interim is nerve-wrecking & easy to get stressed🤯

Tip8️⃣Remain optimistic & promise yourself that all that matters is that you gave it ur very best!

Go out&treat yo self!🍦💃🏻
After your night of food & fun, it comes down to the ⏰to find out the teams that won.

Although everyone sitting in the room considered a competitor 🤼‍♂️
Tip9️⃣we encourage you to introduce yourselves, meet new friends, support each other as you are all in it to win it together!
Now to the🔚, no matter how far you advance, each round you can walk away with a valuable lesson to contribute to ur development. ⛰

We have to admit we would not have succeeded this difficult challenge on our own without our peers, 👩‍🏫, 👨‍👩‍👦‍👦, & 👭 encouraging us from home!
Tip🔟is from the❤️; face each challenge with courage & compassion, be confident in urself, & NEVER GIVE UP!

The moments of happiness we enjoy the most are best when taken by surprise.

"Creating a 🎥 worth a 1000 words u can keep, can help u reflect on all u r able to achieve." Image
To all of those students out there competing, we want to wish you the BEST OF LUCK & YOU WILL ALL DO AMAZING! We are rooting for you! 🥳 #ashp #clinicalskillscompetition
Feel free to share ☝️ tweetorial with your fellow classmates & students!

@wilkespharm @BMCPharmRes @UK_COP @UofSCPharm @umsop @pittpharmacy @ucsfpharmacy @VCUPharmacy

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More from @theABofPharmaC

Jan 7, 2022
Time ⏰ for Part #2 of the Tweetorial 🧵 on the DDI btwn PHT & VPA with a focus on drug metabolism 💊🔄

If you haven’t seen it yet - check out Part 1 by @JimmySuhMD on the albumin interaction btwn PHT & VPA
 
However, that’s only half of the story!⚠️
 
1/n First, let’s discuss basics on phases of drug metabolism 🔄
 
Phase I: Oxidation (ex. CYP450 enzymes)
 
Phase II: Conjugation (ex. Glucuronidation)
 
🎯 Goal 👉🏻 covert drug to an active (pro-drug) or inactive metabolite and ⤴️ solubility ➕ ⤴️drug elimination via urine/bile
2/n What are the key 🔑 metabolic pathways for VPA?

There’s 3️⃣ big ones
 
Phase1️⃣ (~10%)
➢ Substrate of CYP2A6, CYP2B6, CYP2C9
➢ *4-ene metabolite▶️ hepatotoxic ⚠️
 
Phase2️⃣ (~30 – 50%)
➢ Conjugation via glucuronosyltransferase
 
Other▶️Mitochondrial β-oxidation (~40%)
Read 12 tweets
Nov 30, 2021
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
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 Image
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) Image
Read 9 tweets
Sep 21, 2021
Let’s talk CSF 🧠 💦

☝️ What is it & why is it important?
✌️ Key considerations in CSF sampling 🧪 & analysis 🧐 for suspected infection 🦠

A #NeuroTwitter 🧵 inspired by bedside rounds with attending @BuslKatharina & NCC team👏🏻
So to start, what is CSF? 🤔

CSF▶️clear, sterile fluid secreted by choroid plexus 💦 in the ventricles ➡️circulates throughout the subarachnoid space🧠 & spinal canal🦴

⭐️Function▶️ protective barrier 🛡 provides nutrients 🍎& facilitates removal toxins/metabolic byproducts⚠️
Now, let’s discuss🖐key pearls when analyzing CSF🧐for poss infection🦠

1️⃣Consider the source!

Obtained from a…
▶️“Closed”system, ie LP💉?
▶️“Open”system, ie EVD🧠?

⚠️Interpret CSF💦from “open”sys w/caution▶️blood🩸& inflammation🔥from underlying condition are often present
Read 8 tweets
Aug 20, 2021
Now that the salty🧂debate on the TYPE of fluid to use in the ICU has largely been solved, how about the RATE of IVF? 🤔

Back to the BaSICS💦

✅The Balanced Solutions in Intensive Care Study📖 (BaSICS) ▶️compared 333mL/hr vs 999 mL/h

Does IVF rate impact 90-day mortality? 🤔
💡 10, 520 ICU pts randomized 🏥

Fluid volume:

1162 mL in the SLOW infusion group 💦
vs. 1252 mL in the FASTer group

🛑NO difference in☝️ outcome: 90-day mortality (HR 1.03, CI, 0.96-1.11)

🛑No difference in✌️outcomes: RRT, AKI, ventilator free days, ICU/hospital LOS
Notably, when reviewing this study, the baseline characteristics are a key 🔑 consideration

< 5% of the cohort in both groups had sepsis (⬇️ the generalizability in this population) 🦠

Patients with AKI or ESRD were excluded from the trial 💡
Read 5 tweets
May 27, 2021
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
Read 12 tweets
Apr 26, 2021
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🛑
Read 7 tweets

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