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Emergency Med PharmD @ SCVMC. 💜 teaching, pretty infographics, bad jokes & 🍫. EM PGY-2 RPD, BCCCP. Home of the #pharmacyeducationboard & @TILEDPharmD 🙌🏼
8 Sep 19
🚨PSA: #iPhone users! Please set up #MedicalID on your phone-we can see your medical info even with your screen locked. This is SO HELPFUL when you come in and are unable to communicate with us after a terrible accident. 🚑😵 It can help save your life! (1/7)
You can put allergies on Medical ID, emergency contacts, medical conditions, medications you take, blood type, any random medical notes, even organ donation status (and if you aren’t registered, you can register super easily through the app! 🙌🏼) (2/7)
I look for it every time we get an unresponsive patient with an iPhone! Most people haven’t filled it out 😢💔 which is sad. Help us take the best care of you! Otherwise, we’re flying blind for quite a while when you first come in. (3/7)
Read 9 tweets
29 Jun 19
Part 5 #Tramadont #tweetorial
(in which #Tramadont remains a hilariously accurate descriptor of tramadol!)
@NarouzeMD @EMARIANOMD @toby_ashken @DavidJuurlink

CYP2D6 & tramadol is not overrated at all.
Here is a picture of the tramadol metabolism pathway (PMID 11454734) (1/7)
We can agree that M1 is the metabolite which provides opioid analgesic effects. (PMID 10961373) (2/7)
M1 is metabolized by CYP3A4 & CYP2B6 (not CYP2D6 as you suggested) to M5. (PMID 24849324) (3/7)
Read 7 tweets
29 Jun 19
#Tramadont”, a #tweetorial

In response to the last #pharmacyeducationboard about tramadol- some are still doubting whether it has earned the moniker “Tramadont”. Points have been made that as tramadol is metabolized by CYP2D6 in the liver, so are other drugs. Should we (1/11)
just not prescribe anyone anything metabolized in the liver? Touché. The problem with CYP2D6 specifically is that it happens to have the most polymorphisms of all the CYPs enzymes. What does this mean? It means it has the greatest potential variability in activity (2/11)
from one person to another. Not only this, but unlike the other CYPs, it’s expression can vary from being absolutely nonfunctional to being an ultrarapid metabolizer because of the very unique ability of it to be duplicated! No other CYP enzyme does this!! (3/11)
Read 11 tweets
27 Jun 19
#Tramadol, a game of analgesic roulette, will it work or won’t it? Will your patient obtain analgesic effects or will they have a seizure, respiratory depression, or various other side effects...🤷🏼‍♀️that’s why it’s been nicknamed #Tramadont! Its variable effects are (1/3)
attributable to hepatic enzyme CYP2D6;unless you know your pt’s CYP2D6 genetic polymorphism (which I haven’t come across anyone who does)AND a comprehensive list of all of their home meds, don’t prescribe it!🙅🏼‍♀️
#pharmacyeducationboard #twitterx #medtwitter #pharmacogenomics (2/3)
Thank you to our #pharmacyresident for putting this one up, and to @DavidJuurlink & @ToxAndHound for the inspiration. 🙂💡 (3/3)
Read 4 tweets