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Ashley & Brooke Barlow PharmD Profile picture
@theABofPharmaC
Oct 27, 2019 • 3 tweets • 2 min read • Read on X
OP-timizing anticoagulation in the Peri-OPerative period. 🏥💉 @accpcritprn @accpcardprn #ACCPAM19 #ACCP Image
Optimization through risk stratification. All about weighing the risk of thrombosis vs. the risk of bleeding. Audrey stressed the importance of individualizing the plan to restart AC based on patient specific factors! Image
But it’s clear to say, bridging anticoagulation should be put at bay! Literature suggests bridging only increases the risk of bleeding without any reduction in the risk of thrombosis! @AccpPeriopPRN Image

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More from @theABofPharmaC

Ashley & Brooke Barlow PharmD Profile picture
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
Ashley & Brooke Barlow PharmD Profile picture
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
Ashley & Brooke Barlow PharmD Profile picture
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
Ashley & Brooke Barlow PharmD Profile picture
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
Ashley & Brooke Barlow PharmD Profile picture
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
Ashley & Brooke Barlow PharmD Profile picture
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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