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Therapeutics Initiative Profile picture
@Drug_Evidence
Jul 12, 2021 • 9 tweets • 10 min read • Read on X
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THREAD: Shedding light on the risks of anticholinergic drugs

1/8 NEW information on risk of dementia and harm in the frail elderly. Free #BestEvidence webinar w/ Dr. Aaron Tejani @amtejani on July 14th

✅Registration: ti.ubc.ca/Anticholinergi…

#MedEd #deprescribing #medsafety
2/8 One of every 14 of the top 200 💊 prescribed in BC has anticholinergic properties

They include: amitriptyline, cyclobenzaprine, fluoxetine, quetiapine, sertraline, trazadone, venlafaxine, zopiclone, citalopram...

👉🏽More here ti.ubc.ca/2018/09/10/113…

#MedEd #deprescribing
3/8 What kinds of harms can #anticholingergics cause?
👉🏽Dry mouth 😦

❓Could your patient on an anticholinergic be experiencing bad breath/gum problems/tooth decay/trouble swallowing? 🤔

More here: ti.ubc.ca/2018/09/10/113…

#MedEd #deprescribing
4/8 What kinds of harms can #anticholingergics cause?
👉🏽Decreased GI motility 😦

❓Do pts have heartburn, trouble swallowing, hard small stools/constipation? Are they on an anticholinergic? 💊🤔

Therapeutics Letter: ti.ubc.ca/2018/09/10/113…

#MedEd #deprescribing
5/8 What kinds of harms can #anticholingergics cause?
👉🏽Blurred vision 👀

❓Do your pts on anticholinergics have trouble focussing when switching from looking at close object to object in distance (or vice versa)?

More here: ti.ubc.ca/2018/09/10/113…

#MedEd #medsafety
6/8 What kinds of harms can #anticholinergics cause?
👉🏽Urinary issues

❓Do your pts pee but don’t feel like they are completely empty? Or have difficulty starting to pee? Could be an anticholinergic drug 💊

See ti.ubc.ca/2018/09/10/113…

#MedEd #deprescribing
7/8 What kinds of harms can #anticholingergics cause?
👉🏽Cognitive effects 😕

❓Do your pts have difficulty concentrating, feel confused or maybe see things that are not there? Could be an anticholinergic drug.

More here: ti.ubc.ca/2018/09/10/113…

#MedEd #medsafety
8/8 Find out more in our free #BestEvidence webinar w/ @amtejani on July 14:

Shedding light on the risks of anticholinergic drugs: NEW information on risk of dementia and harm in the frail elderly 💊

✅Registration: ti.ubc.ca/Anticholinergi…

#MedEd #deprescribing
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More from @Drug_Evidence

Therapeutics Initiative Profile picture
Nov 30, 2022
🧵 How well do you know your dopamine antagonists? 💊💊

1/ Using these drugs safely requires that clinicians & patients appreciate their important #AdverseEffects, which are not always well understood

👉🏽ti.ubc.ca/letter139

#MedEd #prescribing #deprescribing #medsafety
2/ #AdverseEffects may include:

⚠️ Drug-induced #Parkinsonism
-↘️ or slowed movements, rigidity/tremor/unsteadiness, facial expression loss

⚠️ #Akathisia
-intense internal restlessness or desire to move (which may be mistaken for anxiety)

👉🏽Pt videos: ti.ubc.ca/letter139
3/ #AdverseEffects may include:

⚠️Acute dystonic reaction
-sudden, involuntary, often painful muscle spasm

⚠️Dyskinesia
-repetitive, involuntary movements...can be associated with cognitive decline

👉🏽Pt experience videos: ti.ubc.ca/letter139

#MedEd #ptsafety #drugsafety
Read 7 tweets
Therapeutics Initiative Profile picture
Nov 3, 2022
🧵 Reducing unnecessary use of proton pump inhibitors (PPIs)

1/ Many people take #PPIs but up to 50% don’t have a good reason to take them > 8 wks

Read on for tips on how you as a clinician can work together with pts to decide if/how to 🛑 or reduce PPIs

#MedEd #deprescribing Image
2/ Does this person need #PPIs long-term (> 8 wks)?
 
Find pts who might not need long-term PPI:
1⃣ Flag refill requests
2⃣ Use a poster or video in waiting room
3⃣ Run EMR report
 
This @bmj_latest article has more tips to help with #deprescribing PPIs: bit.ly/3fisHsT
3/ Indications for long-term #PPIs include:

Barrett’s esophagus, previous bleeding ulcer, chronic NSAID use w/ mod/severe bleed risk, severe esophagitis, Zollinger-Ellison syndrome
 
If no indication for long-term PPI + no ongoing upper GI symptoms, discuss poss #deprescribing Image
Read 7 tweets
Therapeutics Initiative Profile picture
Sep 15, 2022
🧵 Reducing #PrescribingCascades ⬇️

1/ What are #Prescribing Cascades?

1⃣ A drug is prescribed 💊
2⃣ #AdverseEvent occurs but is misinterpreted as a new medical condition ⚠️
3⃣Another drug is prescribed for the drug-induced adverse event 💊💊

ti.ubc.ca/letter138 #MedEd Image
2/ Anticholinergics ➡️ cognitive dysfunction ➡️ drugs for #dementia

#Anticholinergic 💊 block acetylcholinergic neurotransmission in the brain, impairing cognition & memory

Can lead to new Rx or ↗️ acetylcholinesterase inhibitor doses

ti.ubc.ca/letter138 #MedEd #FOAMed Image
3/ Drugs for #dementia ➡️ incontinence ➡️ anticholinergics

Conversely, AChE-I can cause urinary or fecal incontinence, that may "cascade" to prescription of an #anticholinergic

👉🏽 full Letter here: ti.ubc.ca/letter138

#MedEd #PrescribingCascades #MedTwitter Image
Read 10 tweets
Therapeutics Initiative Profile picture
May 26, 2022
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 Profile picture
May 16, 2022
THREAD: Online Portraits for BC family physicians

1/7 UBC’s Therapeutics Initiative now has Online #PrescribingPortraits: ti.ubc.ca/portrait

✅ Timely evidence
✅ Personalized, confidential prescribing data
✅ Recommendations to support

#BetterPrescribing & #BetterHealth Image
2/7 Why have a #PrescribingPortrait?

"How do I prescribe compared to others or to evidence standards?"

✅Portrait does NOT tell individual doctors how to practice
✅Portrait DOES promote optimal prescribing based on best available evidence

More here: ti.ubc.ca/portrait Image
3/7 BC family physicians: How do you prescribe ACEIs and ARBs for #hypertension?

✅Register for your Online #PrescribingPortrait: ti.ubc.ca/portrait

✅View a sample portrait on prescribing of antihypertensives: ti.ubc.ca/2022/01/28/ace…

#BetterPrescribing #MedEd Image
Read 8 tweets
Therapeutics Initiative Profile picture
Mar 28, 2022
THREAD: How best to treat Urinary Tract Infections?

1/6 Our new TI Therapeutics Letter 135 describes the best approach for treating symptomatic, uncomplicated lower urinary tract infections (UTIs)

👉🏽ti.ubc.ca/letter135

#MedEd #FOAMed #UTIs #BetterPrescribing
2/6 Use symptoms, not tests to diagnose UTIs:

Uncomplicated lower UTI can be diagnosed with > 90% probability if pt has 2 or more of dysuria, urgency, and frequency, and no vaginal discharge.

This is less reliably predicted for older women.

👉🏽ti.ubc.ca/letter135

#MedEd
3/6 No need to culture:

✅Fewer than 2% of urine cultures meaningfully impact choice of treatment or need for follow-up
✅Most guidelines recommend against culture for
symptomatic uncomplicated #UTIs

👉🏽ti.ubc.ca/letter135

#MedEd #BetterPrescribing #BetterHealth
Read 7 tweets

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