LithiumFrom March 2018, What’s Your (Code) Status?
Lithium is often used to treat bipolar disorder. Dosing begins at 300 mg od and can range up to 1800 daily. Adverse effects are most likely to affect GI, renal, cardiac, neurologic systems as well as the thyroid and parathyroid glands. Toxicity can be either acute or chronic. Regular monitoring …15min 55Adrien Selim, MD
Erectile Dysfunction (ED) - Part 2From March 2018, What’s Your (Code) Status?
Erectile dysfunction is common,so it behooves primary care providers to be comfortable engaging our patients in conversation about the condition. Many factors can cause erectile dysfunction, including medications, DM, and OSA. It’s important to remember that if blood flow to the penis is …12min 50Vanessa Cardy, MD
Things I Do But Should I - GoutFrom March 2018, What’s Your (Code) Status?
Adrien and Vanessa cover the vexing topic of Gout Prophylaxis in the context of uric acid lowering therapy options. They discuss the pros and cons of using different medications to help prevent a gout flare when starting allopurinol. And because they are badass rebels, they also review NOT using …11min 18Vanessa Cardy, MD and Adrien Selim, MD
Things I Do But Should I - Vitamin D Levels and Frequency of DosingFrom February 2018, The Tragically Sore Hip
Vitamin D is a vitamin in flux, at least with regards to how much we should be recommending our patients take and the frequency with which they should take it. Vaness and Adrien sift through the evidence and conclude that weekly or monthly dose is adequate for most patients. They also remind us …8min 33Adrien Selim, MD and Vanessa Cardy, MD
Paper Chase #3 | AC Use and Risk of Ischemic Stroke and BleedingFrom February 2018, The Tragically Sore Hip
in patients who develop afib secondary to another medical condition like COPD or ACS, this study demonstrates that the benefit of anticoagulation in not strong and can be associated with a higher risk of bleeding.5min 19Andrew Buelt, DO and Joe Weatherly, DO
Knee Osteoarthritis (OA)From February 2018, The Tragically Sore Hip
Jake and Andrew break down the data for us on knee OA treatments. Lo and behold, there is not a lot of evidence!18min 54Andrew Buelt, DO and Jake Anderson, MD
Antidepressants Low DownFrom February 2018, The Tragically Sore Hip
With a solid knowledge of SSRIs, SNRIs, and bupropion, Dr. Hersevoort believes that primary care providers can manage 95% patients who have depression. Referral to psychiatry is recommended if you are consider augmenting therapy with anti-psychotics.10min 17Shawn Hersevoort, MD, MPH and Rob Orman, MD
The COMPASS TrialFrom February 2018, The Tragically Sore Hip
This branch of the COMPASS trial examined 3 anticoagulation strategies in patients with “stable atherosclerotic disease”: rivaroxaban 5mg BID, ASA 100mg od + placebo BID, ASA 100 BID + rivaroxaban 2.5 mg BID. Casey’s analysis focused on the ASA groups, not the NOAC alone group. He concludes that …13min 36Casey Parker, MD
Contact Dermatitis and EczemaFrom February 2018, The Tragically Sore Hip
In this chapter, Malcolm Thaler shares his tips and tricks for the diagnosis and management of contact dermatits and atopic dermatitis. For contact dermatitis, look for causal irritants and allergens. For treatment, Malcolm recommends starting with high potency steroids and tapering to lower …14min 48Malcolm Thaler, MD and Heidi James, MD
Cancer & ThrombosisFrom February 2018, The Tragically Sore Hip
Tom Deloughery shares his wisdom on all things cancer and thrombosis. First, he reviews why patients with cancer are more likely to have clots, then reviews some aspects of thrombosis that are unique to this population. Lastly, he discusses treatment standards, nuances and controversies.18min 54Tom Deloughery, MD and Matthieu DeClerck, MD
DeprescribingFrom January 2018, A Feverish Frenzy!
Deprescribing medications is never more important than it is in the palliative context. Vanessa recommends using the 123 ABC (see written summary) approach to reviewing medications with patients, their families and team members.14min 48Vanessa Cardy, MD and Brandon Grove, MD
Paper Chase #1 | Biotin Supplements Screw up Lab Tests? What the…?From January 2018, A Feverish Frenzy!
This JAMA article discusses the clinically relevant effect of biotin supplementation on multiple standard laboratory tests. It serves as a reminder to ask our patients about their supplement use and it can impact their lab results.5min 35Andrew Buelt, DO and Joe Weatherly, DO
Case of the Month - Hidradenitis SuppurativaFrom January 2018, A Feverish Frenzy!
Andrew and Adrien review the pathophysiology, diagnosis and treatment of hidradenitis suppurativa. Treatments options are determined in part based on the Hurley staging system. Non-pharmacologic treatments include weight loss and wearing loose fitting clothes. Treatment options include topical and …19min 47Adrien Selim, MD and Andrew Buelt, DO
Paper Chase #3 | The COMPASS TrialFrom January 2018, A Feverish Frenzy!
Adding Rivaroxaban to aspirin therapy resulted in 1% fewer composite cardiovascular outcomes, but cause a 1% increase in bleeds. Andrew and Joe conclude that Rivaroxaban does not offer benefits above aspirin alone in the study population.5min 47Andrew Buelt, DO and Joe Weatherly, DO
Spinal StenosisFrom January 2018, A Feverish Frenzy!
In this review, Jordan discusses the pathogenesis and treatment of spinal stenosis. Depending on your patient’s age and your center’s practice pattern, either a CT or an MRI can be done to help confirm the clinical diagnosis. Conservative treatments include physical therapy and medications such as …13min 25Jordan Roberts, PA-C
Paper Chase #2 | Transdermal Estrogen Keeps the Sex Drive AliveFrom January 2018, A Feverish Frenzy!
The paper Taylor et al compared the effectiveness of oral vs transdermal estrogen in the management of decreased libido in post-menopausal women. Transdermal estrogen appears to be superior in the studied population.6min 58Andrew Buelt, DO and Joe Weatherly, DO
Grave’s Disease - Part 2From January 2018, A Feverish Frenzy!
Treatment of Graves disease varies depending on patient characteristics and available options. Methimazole is generally preferred over prophylthiouracil (PTU) though PTU is the drug of choice in the first trimester of pregnancy. Radioiodine ablation may be considered in patients who fail or have …14min 51Tania Gallant, MD and Heidi James, MD
Paper Chase #5 | Concerning a Cholesterol Drug We’ve Never Heard Of: AnacetrapibFrom January 2018, A Feverish Frenzy!
Dollars to donuts, the CETP inhibitors like anacetrapib are not part of your primary care pharmacologic arsenal. And this study shows why they never will be.5min 8Andrew Buelt, DO and Joe Weatherly, DO
New Hypertension Guidelines: Friend, Foe, or Foolishness??From December 2017, New Hypertension Guidelines: Friend, Foe, or Foolishness??
Andrew and Heidi discuss the new AHA Hypertension guidelines that were released in November. Spoiler: even though they try really, really, REALLY hard to keep an open mind, our intrepid podcasters are not impressed. •9min 11Heidi James, MD and Andrew Buelt, DO
HIV Pre-Exposure ProphylaxisFrom December 2017, Jingle, Jingle
When taken daily, pre-exposure prophylaxis for HIV can prevent up to 99% of HIV infections in high risk individuals. Truvada, which consists of emtricitabine and tenofovir, is generally well tolerated, with rare incidence of GI side effects and renal impairment. Remember to screen for other STIs in …22min 10Amy Stulman, AGNP-BC, Jess Pinder, AGNP-BP, and Spencer Blackman, MD