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
4/6: Yet, possibly fewer than5⃣% of adverse drug events are reported to oversight bodies, so you might ask,” Why don’t Clinicians Report Adverse Drug Events?”

It’s a good❓and Dr. Hohl has some answers here: publichealth.jmir.org/2018/1/e21/

#drugsafety #MedEd #ptsafety
5/6: At least 33% of preventable adverse drug events requiring a hospital visit are repeat events? 😯💊🩺

These could be prevented with more effective ways of communicating relevant adverse drug event information: cmajopen.ca/content/7/3/E4…

#MedEd #drugsafety #prescribing
6/6: Dr. Corinne Hohl’s ActionADE project:

A provincial initiative to improve adverse drug event reporting + integrate these data into electronic medical records for better communication and better patient safety 👩‍⚕️💊 👪

More here: actionade.org

#MedEd #ptsafety
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More from @Drug_Evidence

24 Apr
THREAD: Dr. John Mandrola: “The more you see, the harder the medicine gets”

1/7 Some new views on legacy prescriptions: Beta-blockers, ASA & #statins by Dr. John Mandrola

(based on @drjohnm presentation hosted by @drug_evidence Oct 17, 2020: bit.ly/32fsPiA)

#MedED
2/7 Example 1: Beta blockers in heart failure 💊♥️

Observational studies suggest beta-blockers for heart failure tx beyond 3 years are NOT associated with beneficial outcomes 😯

These findings challenge current recommendations: bit.ly/3acX9P7

#MedEd #deprescribing
3/7 Ex. 2: How about beta blockers to treat MIs, looking at research from pre-reperfusion & reperfusion eras?

Large meta-analysis of about 60 trials, with > than 100,000 pts found NO difference from using beta blockers in the reperfusion era: bit.ly/3dfvn6u

#MedEd
Read 8 tweets
28 Jan
THREAD: Trama-DO or Trama-DON'T?
What to know about #tramadol

1/7 Tramadol has multiple mechanisms of action:
- via serotonin & norepinephrine reuptake inhibition
- after metabolism to M1 metabolite, via opioid agonism

bit.ly/3t5o7jC #chronicpain #arthritis #MedEd
2/7 People metabolize #tramadol variably 🤔💊

- Some who are ‘ultra rapid’ produce more M1 (opioid);
- Some ‘poor’ metabolizers (~20% with inactive CYP2D6) may have more SSRI/SNRI-like effect

Thus, analgesic & adverse effects are unpredictable
ncbi.nlm.nih.gov/books/NBK315950 #MedEd
3/7 Tramadol, once called a ‘safer’ opioid, causes tolerance and withdrawal, and is associated with addiction, overdose, and death

Observational studies show people treated with #tramadol, vs other opioids, are ↗️ likely to engage in prolonged opiate use #chronicpain #arthritis
Read 8 tweets
12 Dec 20
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
7 Oct 20
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
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/NCl1dfCCAO

#MedEd Image
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
25 Sep 20
THREAD: 5 Things You Need to Know About PPIs

For many years, we've dissected the research on Proton Pump Inhibitors (PPIs) 🤔

This thread captures our publications on PPIs that can help you in clinical practice: ti.ubc.ca/?s=ppis

#MedEd #medsafety #DrugEvidence #GERD
2/6 PPI COSTS VARY CONSIDERABLY 💰

Even without differences in efficacy or safety between PPIs, costs can vary x 10. The cheapest in BC? Pantoprazole Mg 40mg or Rabeprazole 10mg. Most expensive: Dexlanzoprazole

More here: ti.ubc.ca/letter99

#MedEd #DrugCosts #GERD
3/6 RESPONSE IS VARIABLE

1 in 2 pts w/ acid reflux get symptom relief with a PPI (NNT~2) w/in 4-8 wks

Responders notice symptom relief w/in 1-9 days. If no relief in ~2 wks consider 🛑 PPI. Non-acid reflux doesn’t benefit from PPI

More here: ti.ubc.ca/letter99

#MedEd
Read 7 tweets
24 Jun 20
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
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
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

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