Discover and read the best of Twitter Threads about #deprescribing
Most recents (13)
🧵 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
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
⚠️ 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
⚠️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
🧵 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
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
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
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
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
💊PCN IIF vs DES SMR Priorities
🧐Some Unintended Consequences 🤔
(Sorry about the acronyms)
“
#SMR in #PCN should follow four high-level principles delivering:
▶️ Shared decision-making
▶️ Personalised Care
▶️ Safety
▶️ Effectiveness
“
🧵 Thread 1/12
🧐Some Unintended Consequences 🤔
(Sorry about the acronyms)
“
#SMR in #PCN should follow four high-level principles delivering:
▶️ Shared decision-making
▶️ Personalised Care
▶️ Safety
▶️ Effectiveness
“
🧵 Thread 1/12
#SMR should target 🎯 people with complex or problematic polypharmacy at greatest risk of med related harms, ergo those:
1️⃣ in care homes
2️⃣ with polypharmacy >=10 meds
3️⃣ on meds associated with errors
4️⃣ with severe frailty
5️⃣ on addictive pain meds
All agree so far?
🧵 2/12
1️⃣ in care homes
2️⃣ with polypharmacy >=10 meds
3️⃣ on meds associated with errors
4️⃣ with severe frailty
5️⃣ on addictive pain meds
All agree so far?
🧵 2/12
Naturally the devil is as always in the detail
For example, only GPs & nurses or pharmacists with IP & advanced Hx taking & Exam techniques can deliver #SMR
For pharmacists means enrolled on or completed @CPPEPCPEP (acronyms++)
-OR-
CPPE Certified equivalence to PCPEP
🧵3/12
For example, only GPs & nurses or pharmacists with IP & advanced Hx taking & Exam techniques can deliver #SMR
For pharmacists means enrolled on or completed @CPPEPCPEP (acronyms++)
-OR-
CPPE Certified equivalence to PCPEP
🧵3/12
(1/4)
#Prämedikationsambulanz
in der prämed-ambulanz sitzt eine ältere dame. sie hat sich bei einem sturz den unterarm gebrochen. es ist bereits der 3. sturz und die 2. fraktur innerhalb der letzten 12 monate. im gespräch kommen wir auch auf ihre medikamente zu sprechen.
#Prämedikationsambulanz
in der prämed-ambulanz sitzt eine ältere dame. sie hat sich bei einem sturz den unterarm gebrochen. es ist bereits der 3. sturz und die 2. fraktur innerhalb der letzten 12 monate. im gespräch kommen wir auch auf ihre medikamente zu sprechen.
(2/4)
#Polypharmazie
„nach dem ersten sturz hatte ich schmerzen am steißbein. ich habe ibuprofen und einen magenschutz erhalten. nach dem 2. sturz und der hüftoperation konnte ich ohne schlafmittel nicht mehr einschlafen.“ berichtete sie mir. hinzu kommen ihre blutdrucktabletten.
#Polypharmazie
„nach dem ersten sturz hatte ich schmerzen am steißbein. ich habe ibuprofen und einen magenschutz erhalten. nach dem 2. sturz und der hüftoperation konnte ich ohne schlafmittel nicht mehr einschlafen.“ berichtete sie mir. hinzu kommen ihre blutdrucktabletten.
(3/4)
#Deprescribing
letztlich nimmt sie 7 tabletten täglich. etwa 20% aller patient:innen nehmen dauerhaft drei oder mehr medikamente täglich ein. ob diese polypharmazie langfristig den patient:innen mehr nützt als schadet, kann bis dato immer noch nicht belegt werden.
#Deprescribing
letztlich nimmt sie 7 tabletten täglich. etwa 20% aller patient:innen nehmen dauerhaft drei oder mehr medikamente täglich ein. ob diese polypharmazie langfristig den patient:innen mehr nützt als schadet, kann bis dato immer noch nicht belegt werden.
THREAD: Bring it down safely! ↘️💊
1/6 6⃣tweets about our new TI Therapeutics Letter 134: Finding the lowest effective dose for non-opioid #analgesics
👉🏾 Full Letter: ti.ubc.ca/letter134
#MedEd #medsafety #prescribing #BetterPrescribing
1/6 6⃣tweets about our new TI Therapeutics Letter 134: Finding the lowest effective dose for non-opioid #analgesics
👉🏾 Full Letter: ti.ubc.ca/letter134
#MedEd #medsafety #prescribing #BetterPrescribing
2/6 Consistent evidence that minority of pts get clinically meaningful pain relief from any dose of:
✅#Cyclobenzaprine (at best 1/4)
✅#Duloxetine (at best 1/6)
✅#Gabapentin / #Pregabalin (at best 1/6)
👉🏾ti.ubc.ca/letter134
#MedEd #ptsafety #BetterPrescribing #prescribing
✅#Cyclobenzaprine (at best 1/4)
✅#Duloxetine (at best 1/6)
✅#Gabapentin / #Pregabalin (at best 1/6)
👉🏾ti.ubc.ca/letter134
#MedEd #ptsafety #BetterPrescribing #prescribing
3/6 Gabapentin, pregabalin, duloxetine:
A 2021 Canadian systematic review found NNT (numbers needed to treat) of 6-7 for "clinically meaningful benefit" (defined as ≥30% reduction in pain or pain & function)
👉🏾ti.ubc.ca/letter134
#MedEd #BetterPrescribing #deprescribing
A 2021 Canadian systematic review found NNT (numbers needed to treat) of 6-7 for "clinically meaningful benefit" (defined as ≥30% reduction in pain or pain & function)
👉🏾ti.ubc.ca/letter134
#MedEd #BetterPrescribing #deprescribing
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
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
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
👉🏽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
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
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
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 about Personal Prescribing Portraits: bit.ly/3hkf8WO
#MedEd #deprescribing
1/n
Attention, deprescribers 💊
What are 10 critical #deprescribing articles you should probably know about?
@wadddee and I have asked that very question and compiled a list of our top 10 #deprescribing articles essential for all deprescribers! 👇
Attention, deprescribers 💊
What are 10 critical #deprescribing articles you should probably know about?
@wadddee and I have asked that very question and compiled a list of our top 10 #deprescribing articles essential for all deprescribers! 👇
2/n
We chose 10 articles (out of many candidates!) that, in our opinion, together provide an overview of the field of #deprescribing. This covers the mindset and complexity of deprescribing, the development and testing of new interventions, and perspectives on future research.
We chose 10 articles (out of many candidates!) that, in our opinion, together provide an overview of the field of #deprescribing. This covers the mindset and complexity of deprescribing, the development and testing of new interventions, and perspectives on future research.
3/n
We described the selections in more detail in a blog post at the @Deprescribing Blog 👉 deprescribing.org/news/10-import…
Here we will BRIEFLY highlight each of the articles!
Okay, here we go! 👇
We described the selections in more detail in a blog post at the @Deprescribing Blog 👉 deprescribing.org/news/10-import…
Here we will BRIEFLY highlight each of the articles!
Okay, here we go! 👇
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
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
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
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
A thread about covid & how improving our metabolic health might help👇
I'm an NHS GP with an interest in T2 diabetes.
It's been clear since early in the pandemic that people with poor metabolic health, particularly T2D, obesity & high BP are at an increased risk.
1/10
I'm an NHS GP with an interest in T2 diabetes.
It's been clear since early in the pandemic that people with poor metabolic health, particularly T2D, obesity & high BP are at an increased risk.
1/10
Suspicious that SARS-CoV-2 thrives in elevated blood sugar, I've been advising my patients to make some simple dietary changes:
1. CUT OUT SUGAR
2. AVOID PROCESSED FOOD (it's high in sugar & other unhealthy stuff)
3. REDUCE CARBS (carbs convert to sugar in the body)
2/10
1. CUT OUT SUGAR
2. AVOID PROCESSED FOOD (it's high in sugar & other unhealthy stuff)
3. REDUCE CARBS (carbs convert to sugar in the body)
2/10
I've seen some really impressive results:
❤️Reduced Blood Pressure
💉 Improved Blood Sugar
⚖️ significant weight improvement
Some have put their T2D into remission 👏
I'm hopeful their improved metabolic health will reduce their risk of severe infection 💪
3/10
❤️Reduced Blood Pressure
💉 Improved Blood Sugar
⚖️ significant weight improvement
Some have put their T2D into remission 👏
I'm hopeful their improved metabolic health will reduce their risk of severe infection 💪
3/10
@dianamswancutt @shayla__love Truly excellent article, Shayla.
I know you couldn't cover everything -- @angpeacock1111 represents the epidemic of misdiagnosis & overprescribing affecting millions of people. Issues around psychosis are fascinating to academics, but there's a larger public health issue..../1
I know you couldn't cover everything -- @angpeacock1111 represents the epidemic of misdiagnosis & overprescribing affecting millions of people. Issues around psychosis are fascinating to academics, but there's a larger public health issue..../1
@dianamswancutt @shayla__love @angpeacock1111 Please consider another in-depth article on the patient movement represented in Medicating Normal. It is huge. There is a large peer support underground helping people deprescribe themselves -- they can't find doctors who know how to taper. Millions are looking for this help. /2
@dianamswancutt @shayla__love @angpeacock1111 Millions have been misdiagnosed & overprescribed. GPs mostly do this, but #psychiatry ignores it.
This is a patient movement that is not academic anti- or critical psychiatry, but very angry with #psychiatry for not stepping up for patient safety in #psychiatric treatment. /3
This is a patient movement that is not academic anti- or critical psychiatry, but very angry with #psychiatry for not stepping up for patient safety in #psychiatric treatment. /3
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
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
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
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
Low carb helps BP Our paper out today🥂 #mdpiijerph Substantial & Sustained Improvements in Blood Pressure, Weight & Lipid Profiles from a Carbohydrate Restricted Diet: An Observational Study of Insulin Resistant Patients in Primary Care 1/5 mdpi.com/1660-4601/16/1… @IJERPH_MDPI
2/5 Low carb helps BP As Insulin via renal sodium (salt) retention helps put BP up. Low carb helps sort this Our paper out today🥂 #mdpiijerph An Observational Study of Insulin Resistant Patients in Primary Care 1/5 mdpi.com/1660-4601/16/1… @IJERPH_MDPI
3/5 Low carb helps BP despite 21.5% #deprescribing of drugs for hypertension that are usually lifelong Our paper out today HURRAH 🥂 #mdpiijerph An Observational Study of Insulin Resistant Patients in Primary Care 1/5 mdpi.com/1660-4601/16/1… @IJERPH_MDPI
