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12 Jul, 9 tweets, 10 min read
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
30 Jun
THREAD:5⃣things to know from 5 recent TI Therapeutics Letters👩🏽‍🔬

1/5: How to choose a good #mirtazapine dose? 🤔

Mirtazapine has a dose response 💊for harm but NOT for efficacy: harm ↗️ after 30mg/day but efficacy doesn't: bit.ly/361LU9E

#MedEd #deprescribing #ptsafety
2/5: Want to learn about recent @GovCanHealth #medsafety or international warnings for medications?

Read our Therapeutics Letter on international drug safety advisories: bit.ly/3wc0ar8 ⚠️ 💊

#drugsafety #SegPac #ptsafety
3/5: Do you like receiving feedback on your #prescribing?👩🏽‍⚕️💊

Read about Personal Prescribing Portraits: bit.ly/3hkf8WO

#MedEd #deprescribing
Read 6 tweets
Therapeutics Initiative Profile picture
11 May
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
Read 7 tweets
Therapeutics Initiative Profile picture
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
Therapeutics Initiative Profile picture
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
Therapeutics Initiative Profile picture
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
Therapeutics Initiative Profile picture
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

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