Discover and read the best of Twitter Threads about #TwitteRx

@PharmDinDOworld

1/Can you ACE this #MedEd & #TwitteRx #Tweetorial on non-allergic drug-induced angioedema? 57yof w/ swelling of face, lips, and tongue w/ no urticarial rash. Meds: valsartan, sacubitril, metformin, simvastatin, sitagliptin, & risperidone. How many meds may be contributing?

2/Drug-induced angioedema (DIA) can be divided into 2 categories
1⃣ Allergic DIA: IgE-mediated release of histamine from mast cells
2⃣ Non-allergic DIA: Increased vascular permeability mostly from disruption of the kallikrein-kinin system (KKS)

3/For non-allergic mediated DIA, easiest to think about changes in bradykinin (BK) activity
🥇- 👇metabolism of BK (and substance P)
🥈- 👆BK production
🥉- 👆BK receptor activity

Read 10 tweets

The Pharma Brewer

@thepharmabrewer

Ok #twitteRX I think it’s time for another thread. After the public very public spat with an RPh in academia, now is a good time to talk about the role of academia and professional organizations in retail pharmacy. 1/

I’ll start by saying that most people in academia and the professional organizations have the best intentions and are likely highly accomplished and talented pharmacists and techs.

With that being said, they are not accomplishing much for us in retail. 2/

Sure they’ve tried to do a lot to expand the role of a pharmacist from immunization to MTM to pushing for provider status to prescribing roles in certain situations. And that’s great but they do little to make sure that we’re given the proper resources to do them. 3/

Read 15 tweets

Ryan Feldman PharmD DABAT

@EMPoisonPharmD

Had the opportunity to be part of a fascinating work. Americas Poison Center Annual report.

A comprehensive poisoning epidemiology study compiled of data from all 55 U.S. Poison Centers

Free 🔗➡️bit.ly/3wbIwWS
Pubmed🔗➡️bit.ly/3wdgeLP

A🧵on emerging trends

This year we highlighted two important trends in addition to baseline poisoning data.

Firstly, THC product exposures have been increasing since 2016, and the demographics are changing. In 2021, edible products (red line) eclipsed plant based marijuana (blue line) for products

The change in products also represents changing demographics. While Adults (gold) comprise the majority of exposures, pediatric<6 (green) is taking an ever increasing share of the THC exposure calls since 2016.

Read 12 tweets

Ryan Feldman PharmD DABAT

@EMPoisonPharmD

A few years ago I made a digital resuscitation game with a working cardiovascular system. A playground to play with pressors/resuscitation.

TODAY I REALIZED I COULD PLAY IT IN Virtual Reality

So I made a video. An 11 part 🧵for VR septic intubation!
#FOAMcc #FOAMed #MedEd

https://twitter.com/EMPoisonPharmD/status/1251976160835178502

Part 2/11

Virtual Reality Septic Shock Resuscitation/Intubation

Video YouTube link here🔗: )

Play game ➡️: rfeldman.itch.io/the-resuscitat…

#Medtwitter #FOAMcc #FOAMed #TwitteRx #MedEd

Part 3/11

Virtual Reality Septic Shock Resuscitation/Intubation

Video YouTube link here🔗: )

Play game ➡️: rfeldman.itch.io/the-resuscitat…

#Medtwitter #FOAMcc #FOAMed #TwitteRx #MedEd

Read 14 tweets

Ryan Feldman PharmD DABAT

@EMPoisonPharmD

Tomorrow is NYE, there will be partying, pills, and powders. Some leading to overdose.

I work in the ER NYE/NYD & expect a few "OD's" from said pills n powders. What exactly is in them?

A 🧵from Camden, a VERY human 28 y.o male, on the illicit drug supply

#MedED #FOAMed

Cam was out with his friends celebrating NYE with some beverages when one of his friends offered him a tan powder. Cam was pretty hesitant at first but..

Eventually peer pressure won. Cam gave it a try.

A few minutes after trying the substance...

Read 27 tweets

Rebecca Smith

@rebeccaraesmith

let’s just break down the cost of midyear for a student real quick…
1) ASHP Membership: $54 #TwitteRx #ASHP22

2) Registration: $340-520

3) Hotels (let’s just stay at the convention hotel cause why would they pick one of the most expensive hotels, right?!?): $278-780 a night. let’s say 3 nights… so $834-2340

Read 8 tweets

Jason Mordino

@JasonMordino

Are you considering making the transition to #medMastodon and #TooteRx from #twitteRx? Then this is your thread for introductions.

2/x
choose an app to use
Mastodon is good, but Metatext is better IMHO because it similar to twitter

A detailed read if interested transponderings.blog/2022/05/21/eig…

3/x open the app and “sign up”. Here you will pic a server. For most #TwitteRx folks that’s med-mastodon.com. Search for it and give it time to “pop up”.

Then create your email and password.

Read 10 tweets

The Pharma Brewer

@thepharmabrewer

Maybe the biggest thing that’s concerning about retail pharmacy is that Walgreens and CVS aren’t concerned about what’s happening. Another #twitteRX 🧵 1/

Currently work conditions are horrible to the point that pharmacies, especially Walgreens are closing pharmacies on a regular basis because they can’t find enough pharmacists to work. 2/

Let’s be crystal clear, there’s no pharmacist shortage, just a shortage of pharmacists willing work in the conditions being offered. But why aren’t they doing anything to change the conditions? That’s the answer I’m afraid to find out. 3/

Read 12 tweets

Joseph Sassine

@JosephSassineMD

Happy to share our review of antiviral treatment of #monkeypox, co-authored with the amazing @EmilySiegrist4 and just published in @CIDJournal! @OUHealth @IDSAInfo @SIDPharm @PaulSaxMD #IDTwitter #TxID #TwitteRx #MedTwitter #OpenAccess

Short 🧵 (1/n)

academic.oup.com/cid/advance-ar…

In this paper, we review three antiviral agents with activity against #monkeypox:
1. Cidofovir
2. Brincidofovir
3. Tecovirimat
(2/n)

For each agent we discuss:
1. Basic Pharmacology
2. Pharmacokinetic Data
3. Animal Data
4. Toxicity
5. Clinical Data in Humans
(3/n)

Read 5 tweets

Andrea Sikora

@AndreaSikora

Increasing pharmacist workload was associated with increased ICU length of stay, reduced quantity of interventions, and reduced intensity of interventions.

pubmed.ncbi.nlm.nih.gov/35678204/

@CritCareMed @SCCM @SCCM_CPP
#TwitteRx #PharmICU

Increasing MRC-ICU score was associated with
1. Higher mortality
2. Longer LOS
3. More medication interventions
4. Increased intensity of medication interventions

^A compelling argument for DEDICATED pharmacotherapeutic expertise on the multiprofessional rounding team.

The @SCCM @ASHP_Official @ACCP Joint Position Statement (pubmed.ncbi.nlm.nih.gov/32826496/) calls pharmacists “essential members of the multiprofessional critical care team,” but we have no standards for pharmacist workload ratios.

Read 11 tweets

Joey Mattingly

@joeymattingly

Jason definitely struck a nerve for many of the #PharmEd & #TwitteRx folks. This is something we’ve discussed quite a bit in Maryland, but it sounds like a larger @ASHPOfficial / @ACCP task force is needed. A few thoughts… (🧵1/10)

https://twitter.com/jasonmordino/status/1526294472941875202

1st: I am very proud to be a #pharmacist & love mentoring pharmacy students & residents on research projects every year…but…the large majority of PharmD grads *do not* have the knowledge/skills to *lead* a research project. We have to acknowledge that. (2/10)

2nd: (Trigger Warning ⚠️) A decent number of faculty members & clinicians are not strong research mentors. Even a faculty member with a PhD can struggle mentoring residents, because mentoring is a skill that needs development - but we just expect it as a given. (3/10)

Read 10 tweets

Bug Pharmacist 💊🧫 Tim Gauthier

@IDstewardship

📸 Now watching @EckerleIsabella about to talk here virtually at #ECCMID2022 @ESCMID

😃 Have been looking forward to this!

💬💬💬 Lots of comments at SM talks on how @Twitter is the primary platform for scientists

#IDtwitter #EpiTwitter #MedTwitter #TwitteRx

Infodemics themselves are like pathogen epidemics

@EckerleIsabella at #ECCMID2022

⚠️⬇️🚨🤔🤣🔴✅📢❌▶️

Emoji use evaluated in misinformation tweets! Very interesting!!

@EckerleIsabella at #ECCMID2022 @ABsteward

Read 5 tweets

Jeff Bettinger, PharmD

@JeffJBettinger

NEW ARTICLE!

“Misinterpretation of the “Overdose Crisis” continues to fuel misunderstanding of the role of prescription opioids”

Written with @GhanaboyPharmd @JeffreyFudin @headdock

#TwitteRx #MedTwitter

A brief 🧵to highlight the FACTS:

dovepress.com/misinterpretat…

This editorial looks to address ongoing #false narratives regarding opioid prescribing and its current role in the #overdosecrisis

In it, we use several excerpts from a recently published news release by PROP, given the distorted reality it represents

supportprop.org/opioid-news/pr…

1️⃣:

We challenge the view that continued reductions in prescription opioids will be the “key to ending this [overdose] epidemic”…

As if cutting prescriptions in half throughout the US the past decade has resulted in reduced overdose deaths 🧐🧐🧐

Read 6 tweets

Jessica Johnson PharmD

@Jessnimm

This DEA case against a pharmacist lists three “red flags” that are laughable. Ready #TwitteRx? Let’s go!!

https://twitter.com/ibdgirl76/status/1507324710417322010

1. As Bev notes - DEA claims pharmacist should have seen a patient’s naloxone Rx as a red flag. Naloxone is the standard of care for most patients who receive and use opioids. In many, many states, it is now mandated to be co-prescribed with opioids.

2. DEA complaint identifies use of “immediate release opioids” as a red flag. Sure. Ok. They’re also explicitly preferred in the only part of the abominable 2016 CDC Opioid Guidelines that reference dosage formulations. Weird!

Read 5 tweets

Andre Kalil, MD MPH

@DrAndreKalil

#Remdesivir new trial just published

Here are the clinical implications:
Canadian trial (CATCO) in hospitalized patients with #COVID19 bit.ly/33uktIf
Compared to ACTT-1 trial bit.ly/3msi1In in patients on supplemental O2 as recommended by guidelines
🧵1/

ACTT-1 Highly Significant Mortality Reduction in Patients on Supplemental Oxygen:
bit.ly/3msi1In
2/

Both CATCO and ACTT-1 trials showed
-No liver or renal toxicity with remdesivir, and
-No safety differences between remdesivir and controls in over 2300 patients

Thus, both trials show that remdesivir is safe, prevents intubation, and reduces mortality
3/

Read 9 tweets

Divya Khandekar

@pharmdiv

Hey #IDTwitter… what are your thoughts on intermittent (e.g. TIW frequency) liposomal amphotericin B (L-AmB) dosing for OPAT?

@MayoPharmRes @MsSmallsO @johnsontannerm @Stevens_AK @SIDPharm #opat #TwitteRx

Let’s look at the evidence… For starters, amphotericin B (AmB) = broad spectrum anti-fungal that binds to ergosterol

1st-line for serious ocular candida, CNS cryptococcus, severe histo/blasto, and mucor

2nd-line for cocci & aspergillosis

pubmed.ncbi.nlm.nih.gov/11801575/

There are 4 formulations of AmB, but the liposomal form (L-AmB) is typically dosed at 3-5 mg/kg/day = ⬇️ nephrotoxicity (vs. deoxycholate) and ⬇️ infusion reactions (vs. ABLC) + liposome allows for ⬆️ tissue conc and a prolonged t1/2.

pubmed.ncbi.nlm.nih.gov/11722981/

Read 10 tweets

Bernie Marini

@Berninini

So #twitterx doesn't throw me in Twitter jail, here are 10 #ASH21 abstracts...as HARRY POTTER characters.

I couldn't decide if I should rank based on "impactful" or "practice changing", so these are some that I think everyone should *read carefully*, and I tried to make it fun!

1. POLARIX = Severus Snape ash.confex.com/ash/2021/webpr… Why? Because of how controversial this is, and also this is a well done study. Should we change practice based on a drug without an OS or QOL benefit? I argue no. Nagini, kill. #lymsm

2. GRAAPH-2014 Study = Dudley Dursley ash.confex.com/ash/2021/webpr… Removing HiDAC from chemo in Ph+ ALL worsened outcomes. A cautionary tale that we can’t get greedy and we need RCT data like this as we “de-intensify” regimens in ALL with novel therapies like blin, TKIs, etc. #leusm

Read 12 tweets

Ghazaleh Moayedi, DO, MPH 🏳️‍🌈 🏳️‍⚧️

@dr_moayedi

🚨 I'm getting reports from pharmacists across #Texas -they are being directed to not fill prescriptions for misoprostol, mifepristone, or methotrexate until they verify that the meds are not for induced #abortion.
#SB4 is harmful to ALL of us, even w/ #SB8 still in effect 1/

🚨 This is a classic solution in search of a problem. *NO ONE* prescribes meds for #abortion in #Texas. We dispense or administer all meds directly to the patient. THE ONLY people that need these drugs in a pharmacy either have a miscarriage, cancer, or autoimmune disease 2/

🚨 Let that sink in. Anti-abortion laws harm *all of us*. I'm urging local and national journalists to start interrogating pharmacies in #Texas about this practice. It's not only ethically bankrupt and discriminatory - it literally serves no purpose. 3/

Read 7 tweets

Ashley & Brooke Barlow PharmD

@theABofPharmaC

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

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)

Read 9 tweets

Shannon Rotolo, PharmD

@sweetchinchilla

As promised, a 🧵 on GoodRx.

Starting off with the basics…

What is it?
GoodRx is a prescription drug price tracking and discount company. It’s essentially another middle man in the messy landscape that is #drugpricing in the US.

But it’s more complicated than that… #TwitteRx

GoodRx is best known for their coupons. They track prescription drug prices and offer patients a discounted price, which varies a bit based on which pharmacy you select.

Here’s an example of what a search for enalapril looks like…
2/17

GoodRx coupons CANNOT be combined with insurance. ❌

Now, this *might* be helpful for a patient who is completely uninsured, or someone on relatively few inexpensive meds who never hits their deductible anyway, but even then, if you ask your pharmacist for a cash price instead…

Read 17 tweets