Podcasts about pharmacologic

Although there is currently no FDA-approved treatment for pruritus in primary biliary cholangitis (PBC), symptoms can be mitigated with nonpharmacologic or pharmacologic agents. In this episode, Marlyn J. Mayo, MD; Stuart C. Gordon, MD; and Pam Rivard, RN, a person living with PBC, discuss the clinical management of pruritus in PBC, including:Pruritus assessment toolsOptimal use of tools, including frequency of assessmentCurrent management of pruritusNonpharmacologic interventionsPharmacologic agentsStrategies to optimize assessment and management of pruritusCollaborative careDevelopment of a treatment planOngoing assessment and adjustment of therapyResources and support for patientsPresenters:Marlyn J. Mayo, MDProfessor of Internal MedicineDivision of Digestive & Liver DiseasesUT Southwestern Medical CenterDallas, TexasStuart C. Gordon, MDProfessor of MedicineWayne State University School of MedicineDirector, Division of HepatologyHenry Ford HealthDetroit, MichiganPam Rivard, RNPerson living with PBCLink to full program: https://bit.ly/3Dnfb2E

Although there is currently no FDA-approved treatment for pruritus in primary biliary cholangitis (PBC), symptoms can be mitigated with nonpharmacologic or pharmacologic agents. In this episode, Marlyn J. Mayo, MD; Stuart C. Gordon, MD; and Pam Rivard, RN, a person living with PBC, discuss the clinical management of pruritus in PBC, including:Pruritus assessment toolsOptimal use of tools, including frequency of assessmentCurrent management of pruritusNonpharmacologic interventionsPharmacologic agentsStrategies to optimize assessment and management of pruritusCollaborative careDevelopment of a treatment planOngoing assessment and adjustment of therapyResources and support for patientsPresenters:Marlyn J. Mayo, MDProfessor of Internal MedicineDivision of Digestive & Liver DiseasesUT Southwestern Medical CenterDallas, TexasStuart C. Gordon, MDProfessor of MedicineWayne State University School of MedicineDirector, Division of HepatologyHenry Ford HealthDetroit, MichiganPam Rivard, RNPerson living with PBCLink to full program: https://bit.ly/3Dnfb2E

Host: Darryl S. Chutka, M.D. Guests: Bruce Sutor, M.D. & Megan R. Leloux, Pharm.D., R.Ph., BCPP Depression is very common both in the U.S. and worldwide. It's estimated that major depression affects over 8% of American adults, representing over 20 million individuals. Fortunately, we now have a variety of pharmacologic options for the management of depression and they're much safer than what we had available in the past. However, we now have so many choices, how do we know which medication is best for our patient? What's the difference between an SSRI and an SNRI? Is there an anti-depressant that's also effective in treating anxiety? Are some medications better for our elderly patients? I'll be asking these questions and more to my guests, psychiatrist Bruce Sutor, M.D., and pharmacist Megan R. Leloux, Pharm.D., R.Ph., BCPP, from the Mayo Clinic as we discuss “Pharmacologic Management of Depression” as part of our “Holiday Stress and Wellness” podcast series. Connect with the Mayo Clinic's School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd. 

Welcome to this OncoAlert Session Round Up during ASH24, focusing on Multiple Myeloma pharmacologic therapies.GMMG-HD7 Trial (JCO Publication)This phase 3 trial evaluated adding isatuximab (Isa) to the standard RVd (lenalidomide, bortezomib, dexamethasone) regimen in transplant-eligible patients with newly diagnosed multiple myeloma. Part 1 randomized 662 patients to Isa-RVd or RVd, followed by autologous stem cell transplantation and a second randomization to lenalidomide or Isa-lenalidomide maintenance. Isa-RVd showed higher minimal residual disease (MRD) negativity rates post-transplant (66% vs 48%) and improved progression-free survival (PFS) with a hazard ratio of 0.70 (P = .0184). Isa-RVd plus lenalidomide maintenance further improved PFS (P = .016), underscoring Isa's role in prolonging MRD negativity and PFS.IMROZ Trial (Phase 3)This trial analyzed Isa-VRd (isatuximab, bortezomib, lenalidomide, dexamethasone) versus VRd in transplant-ineligible patients with newly diagnosed multiple myeloma. Isa-VRd led to significant improvements in PFS and deeper, sustained MRD negativity, with 68.6% achieving MRD negativity by month 36 compared to 50.8% in the VRd group. Isa-VRd also resulted in lower MRD loss rates during maintenance and improved conversion from MRD positivity to negativity, leading to longer PFS. These findings highlight Isa-VRd's potential for faster, durable responses and support its use to improve long-term outcomes in these patients.UK MRA Myeloma XI+ TrialThe phase 3 UKMRA/NCRI Myeloma XI+ trial compared KRdc (carfilzomib, lenalidomide, dexamethasone, cyclophosphamide) to sequential triplet therapies (CRd, CTd) in newly diagnosed multiple myeloma patients. After a median follow-up of 102 months, KRdc improved PFS (56 vs 37 months, hazard ratio 0.69, P < 0.001) across cytogenetic risk groups, with higher MRD negativity rates. Early MRD negativity correlated with better PFS. While overall survival was similar in contemporaneously randomized patients (76% vs 71% at 60 months), non-contemporaneous controls showed an overall survival benefit with KRdc (76% vs 68%, hazard ratio 0.80, P = 0.011). These results emphasize the depth of responses with KRdc, particularly for high-risk patients, and the importance of early MRD negativity for improved PFS and survival.DREAMM-7 Trial (Phase 3)This trial compared belantamab mafodotin (BVd) versus daratumumab (DVd), both combined with bortezomib and dexamethasone, in relapsed/refractory multiple myeloma. BVd demonstrated a significant PFS benefit (36.6 vs 13.4 months, hazard ratio 0.41, P < 0.00001), with higher complete response and MRD negativity rates (25% vs 10%). BVd also showed a longer response duration (35.6 vs 17.8 months) and early trends favoring overall survival (84% vs 73% at 18 months). Median overall survival was not reached, but projections estimate 84 months for BVd versus 51 months for DVd. BVd's safety profile included manageable ocular events, positioning it as a promising option for relapsed/refractory multiple myeloma after first relapse.AQUILA Trial (NEJM Publication)This phase 3 trial evaluated subcutaneous daratumumab as monotherapy versus active monitoring in high-risk smoldering multiple myeloma. Among 390 patients, daratumumab reduced the risk of progression or death by 51% compared to monitoring (hazard ratio 0.49, P < 0.001) after a median follow-up of 65.2 months. At five years, PFS was 63.1% in the daratumumab group versus 40.8% in the monitoring group. Overall survival was higher with daratumumab (93.0% vs 86.9%). Daratumumab was well-tolerated, with hypertension being the most common grade 3 or 4 adverse event (5.7%), and no new safety concerns emerged. Daratumumab significantly delayed progression to active multiple myeloma and improved survival in high-risk patients.Disclosure: Supported by Sanofi.

In this episode, Dr. Michael Garshick discusses the role of pharmacologic interventions in managing inflammation and high-sensitivity CRP (hs-CRP) in cardiovascular (CV) disease. Key topics include the involvement of inflammation in atherosclerosis and atherothrombosis, traditional targets such as dyslipidemia, hypertension, and antiplatelet therapy, and the complexity of targeting inflammation and the inflammasome signaling pathway. He also explores insights from the CANTOS trial on IL-1 beta inhibitors and their impact on CV events and the role of colchicine in reducing CV events and its safety profile. Watch now to learn about the latest advancements in pharmacologic strategies for reducing cardiovascular risk through inflammation management.

Dr. Centor discusses the pharmacologic treatment of type 2 diabetes in light of newer drugs with Dr. Carolyn Crandall.

Guests Cindy Lamendola, MSN, NP, and Patient Champion Sheila Allen discuss prescription treatments for patients with overweight/obesity. Overcoming challenges to treatment, the importance of lifestyle as well as medications for success, and shared decision-making are discussed.PCNA Patient Education Tools on Obesity: https://pcna.net/clinical-resources/patient-handouts/obesity-patient-tools/See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Imagine a world where children with OCD and Tourette's can manage their symptoms without relying solely on medications. In this episode of Pediatric Meltdown, we explore innovative interventions like Habit Reversal Training and ERP Therapy that offer new hope for young patients. Dr. Lia's guest is a listener's favorite, Dr. Colleen Cullinan. She has a gift for taking you inside the child's mind and telling you exactly what they're thinking. She'll talk about the profound impact of intentional, compassionate care and the crucial role of family support in the treatment process. Tune in to discover effective strategies for tackling the emotional and psychological struggles these children face and how these methods pave the way for lasting improvements. [03:13 -17:21] Understanding Isolation and Negative Reinforcement in Mental HealthConcept of breaking the cycle of negative reinforcement and the importance of compassionate interventions.Connection between emotional regulation in various scenarios and therapies like cognitive behavioral therapy and acceptance and commitment therapy.Discussion on how the brain's problem-solving nature struggles with internal experiences, leading to anxiety.Therapies offer solutions that counter the brain's intuitive problem-solving approach.[17:22 - 29:42] Exposure and Response Prevention (ERP) for OCD Emphasis on intentionally facing fears without engaging in compulsive behaviors.Insights into how ERP can be rewarding for families affected by OCD.Challenges and solutions in treating internal obsessions and related mental compulsions.Significance of ERP in helping individuals understand their fears are not dangerous.[29:43 - 41:52] Nonpharmacologic Therapies for OCD, Tics, and Tourette'sOverview of therapies like exposure and response prevention, habit reversal training, and comprehensive behavioral intervention for tics.Discussion of the non-logical and visceral nature of these behaviors and breaking the cycle of negative reinforcement.Strategies for managing compulsive skin picking, including competing responses and awareness.Practice and gradual exposure to triggers as critical parts of treatment.[41:53 - 55:12] Resources and Tools for Comprehensive Behavioral Intervention for TicsIntroduction to CBIT as a detailed treatment involving awareness building and breaking down tics.Challenges in finding CBIT-trained therapists and resources to locate such providers.Mention of the Tourette Association of America and the TLC Foundation for Body Focused Repetitive Behaviors.University training programs in clinical psychology as potential access points for therapists trained in habit reversal training.[55:13 - 59:58] Closing segment TakeawaysLinks to resources mentioned on the showInternational OCD Foundation: https://iocdf.org Tourette's Association of America: https://tourette.orgTLC Foundation for Body-Focused Repetitive Behaviors https://www.bfrb.orgAACAP Facts for Families OCD:

In this episode, my guest is Dr. Zachary Knight, Ph.D., a professor of physiology at the University of California, San Francisco (UCSF), and Howard Hughes Medical Institute (HHMI) investigator. We discuss how the brain controls our sense of hunger, satiety, and thirst. He explains how dopamine levels impact our cravings and eating behavior (amount, food choices, etc) and how we develop and can change our food preferences and adjust how much we need to eat to feel satisfied. We discuss factors that have led to the recent rise in obesity, such as interactions between our genes and the environment and the role of processed foods and food combinations. We also discuss the new class of drugs developed for the treatment of obesity and diabetes, including the GLP-1 agonists semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro). We discuss how these drugs work to promote weight loss, the source of their side effects, and the newer compounds soon to overcome some of those side effects, such as muscle loss. Dr. Knight provides an exceptionally clear explanation for our sense of hunger, thirst, and food cravings that translates to practical knowledge to help listeners better understand their relationship to food, food choices, and meal size to improve their diet and overall health. For show notes, including referenced articles and additional resources, please visit hubermanlab.com. Thank you to our sponsors AG1: https://drinkag1.com/huberman  BetterHelp: https://betterhelp.com/huberman Eight Sleep: https://eightsleep.com/huberman Waking Up: https://wakingup.com/huberman LMNT: https://drinklmnt.com/huberman Timestamps 00:00:00 Dr. Zachary Knight 00:02:38 Sponsors: BetterHelp, Helix Sleep & Waking Up 00:07:07 Hunger & Timescales 00:11:28 Body Fat, Leptin, Hunger 00:17:51 Leptin Resistance & Obesity 00:20:52 Hunger, Food Foraging & Feeding Behaviors, AgRP Neurons 00:30:26 Sponsor: AG1 00:32:15 Body Weight & Obesity, Genes & POMC Neurons 00:39:54 Obesity, Genetics & Environmental Factors 00:46:05 Whole Foods, Ultra-Processed Foods & Palatability 00:49:32 Increasing Whole Food Consumption, Sensory Specific Satiety & Learning 00:58:55 Calories vs. Macronutrients, Protein & Salt 01:02:23 Sponsor: LMNT 01:03:58 Challenges of Weight Loss: Hunger & Energy Expenditure 01:09:50 GLP-1 Drug Development, Semaglutide, Ozempic, Wegovy 01:19:03 GLP-1 Drugs: Muscle Loss, Appetite Reduction, Nausea 01:23:24 Pharmacologic & Physiologic Effects; GLP-1 Drugs, Additional Positive Effects 01:30:14 GLP-1-Plus Development, Tirzepatide, Mounjaro, AMG 133 01:34:49 Alpha-MSH & Pharmacology 01:40:41 Dopamine, Eating & Context 01:46:01 Dopamine & Learning, Water Content & Food 01:53:23 Salt, Water & Thirst 02:03:27 Hunger vs. Thirst 02:05:46 Dieting, Nutrition & Mindset 02:09:39 Tools: Improving Diet & Limiting Food Intake 02:14:15 Anti-Obesity Drug Development 02:17:03 Zero-Cost Support, Spotify & Apple Follow & Reviews, YouTube Feedback, Social Media, Neural Network Newsletter Disclaimer

Un nouvel épisode du Pharmascope est maintenant disponible! Dans de ce 138ème épisode, Nicolas, Isabelle et Olivier discutent d'un problème pas reposant : le syndrome des jambes sans repos. Les objectifs pour cet épisode sont les suivants: Expliquer la présentation clinique, les critères diagnostics et les facteurs de risque du syndrome des jambes sans repos. Conseiller des mesures non-pharmacologiques pour aider les personnes avec un syndrome des jambes sans repos. Discuter des bénéfices et des désavantages associés aux principaux traitements pharmacologiques du syndrome des jambes sans repos Ressources pertinentes en lien avec l'épisode Manconi M, Garcia-Borreguero D, Schormair B, Videnovic A, Berger K, Ferri R, Dauvilliers Y. Restless legs syndrome. Nat Rev Dis Primers. 2021 Nov 3;7(1):80. Trotti LM, Becker LA. Iron for the treatment of restless legs syndrome. Cochrane Database Syst Rev. 2019 Jan 4;1(1):CD007834. Earley CJ, García-Borreguero D, Falone M, Winkelman JW. Clinical Efficacy and Safety of Intravenous Ferric Carboxymaltose for Treatment of Restless Legs Syndrome: A Multicenter, Randomized, Placebo-controlled Clinical Trial. Sleep. 2024 Apr 16:zsae095. Short V, Allen R, Earley CJ, Bahrain H, Rineer S, Kashi K, Gerb J, Auerbach M. A randomized double-blind pilot study to evaluate the efficacy, safety, and tolerability of intravenous iron versus oral iron for the treatment of restless legs syndrome in patients with iron deficiency anemia. Am J Hematol. 2024 Jun;99(6):1077-1083. Wilt TJ, MacDonald R, Ouellette J, Khawaja IS, Rutks I, Butler M, Fink HA. Pharmacologic therapy for primary restless legs syndrome: a systematic review and meta-analysis. JAMA Intern Med. 2013 Apr 8;173(7):496-505. Allen RP, Chen C, Garcia-Borreguero D, Polo O, DuBrava S, Miceli J, Knapp L, Winkelman JW. Comparison of pregabalin with pramipexole for restless legs syndrome. N Engl J Med. 2014 Feb 13;370(7):621-31. Trenkwalder C, Benes H, Grote L, Happe S, Högl B, Mathis J, Saletu-Zyhlarz GM, Kohnen R; CALDIR Study Group. Cabergoline compared to levodopa in the treatment of patients with severe restless legs syndrome: results from a multi-center, randomized, active controlled trial. Mov Disord. 2007 Apr 15;22(5):696-703. Trenkwalder C, Beneš H, Grote L, García-Borreguero D, Högl B, Hopp M, Bosse B, Oksche A, Reimer K, Winkelmann J, Allen RP, Kohnen R; RELOXYN Study Group. Prolonged release oxycodone-naloxone for treatment of severe restless legs syndrome after failure of previous treatment: a double-blind, randomised, placebo-controlled trial with an open-label extension. Lancet Neurol. 2013 Dec;12(12):1141-50. Carlos K, Prado GF, Teixeira CD, Conti C, de Oliveira MM, Prado LB, Carvalho LB. Benzodiazepines for restless legs syndrome. Cochrane Database Syst Rev. 2017 Mar 20;3(3):CD006939. Jadidi A, Rezaei Ashtiani A, Khanmohamadi Hezaveh A, Aghaepour SM. Therapeutic effects of magnesium and vitamin B6 in alleviating the symptoms of restless legs syndrome: a randomized controlled clinical trial. BMC Complement Med Ther. 2022 Dec 31;23(1):1. Wali SO, Abaalkhail B, Alhejaili F, Pandi-Perumal SR. Efficacy of vitamin D replacement therapy in restless legs syndrome: a randomized control trial. Sleep Breath. 2019 Jun;23(2):595-601.

CME credits: 1.50 Valid until: 31-05-2025 Claim your CME credit at https://reachmd.com/programs/cme/optimizing-your-pharmacologic-approach-to-reversing-anticoagulation-for-ich/26809/ Dive deep into the critical care of anticoagulated patients with intracranial hemorrhage (ICH). Our panel of esteemed experts deliver essential insights into the latest treatment approaches, exploring recent data focused on reversing anticoagulation and the neurosurgical management of ICH. This program provides a comprehensive understanding of key strategies proven to be effective in these complex cases, highlighting the most up-to-date guideline-directed, evidence-based practices.

Unjali Gujral, MPH,PhD, and Neeja Patel, MD, discussof public health measures to improve cardiometabolic health and tackle metabolic syndrome.

Summary: In this conversation, Dennis and Ian discuss the new high altitude Clinical Practice Guideline (CPG) in the Joint Trauma System. They cover topics such as acute mountain sickness (AMS), high altitude cerebral edema (HACE), and high altitude pulmonary edema (HAPE). They discuss the pathophysiology, symptoms, diagnosis, and treatment options for these conditions. They also touch on pre-treatment strategies and the use of portable hyperbaric chambers. Overall, the conversation provides a comprehensive overview of altitude-related illnesses and their management. In this conversation, Dennis and Ian discuss the treatment options for altitude illness, specifically AMS, HAPE, and HACE. They cover the use of pharmacologic therapy, oxygen, and portable hyperbaric chambers to stabilize and bring down patients with altitude illness. They also discuss the use of dexamethasone as the primary treatment for HACE and the potential use of hypertonic saline for extreme cases. They touch on the side effects of dexamethasone and the importance of protecting the airway. They also mention the use of acetazolamide for prophylaxis and the benefits of intermittent hypoxic exposure. Finally, they discuss the importance of good nutrition and hydration and the new medic encounter form for recording data on altitude illness. Takeaways: Acute mountain sickness (AMS) occurs when the body does not have enough time to acclimatize to the physiological stress of altitude. High altitude cerebral edema (HACE) is characterized by ataxia and can occur even without AMS symptoms. High altitude pulmonary edema (HAPE) is characterized by decreased exercise tolerance and tachypnea. Assessment of vital signs, such as heart rate and respiratory rate, can help differentiate between altitude illnesses. Portable hyperbaric chambers can be used to stabilize patients with altitude illnesses until they can be brought down to lower altitudes. Pharmacologic treatments, such as acetazolamide and dexamethasone, can be used for prophylaxis and treatment of altitude illnesses. Improvement in symptoms of HAPE can be rapid with oxygen therapy. Pre-treatment strategies, such as using acetazolamide, can help acclimatize the body to altitude before ascent. Pharmacologic therapy, oxygen, and portable hyperbaric chambers can be used to stabilize and bring down patients with altitude illness. Dexamethasone is the primary treatment for HACE, and hypertonic saline may be considered for extreme cases. Side effects of dexamethasone include increased sugar, gastric erosions, gastric bleeding, and adrenal suppression. Acetazolamide can be used for prophylaxis, and intermittent hypoxic exposure may help with acclimatization. Good nutrition, hydration, and iron status are important for preventing altitude illness. The new medic encounter form is a valuable tool for recording data on altitude illness. Thank you to Delta Development Team for in part, sponsoring this podcast. ⁠⁠⁠⁠deltadevteam.com⁠⁠⁠⁠ For more content go to ⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠ Consider supporting us: ⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care

Welcome to our four-episode series: Raising Awareness of Hepatorenal Syndrome Acute Kidney Injury (HRS-AKI). In episode two, our host Muhamad Nadeem Yousaf, MD, speaks with Nikki Duong, MD, to discuss the nomenclature, pharmacological options, and care recommendations for HRS-AKI patients. Each episode of this series corresponds to a journal article from a September 2023 supplement of Clinical Gastroenterology and Hepatology (CGH), the official clinical practice journal of the American Gastroenterological Association, focusing on addressing knowledge gaps in HRS-AKI. To read the related journal articles and claim CME for listening, visit agau.gastro.org. This series is supported by an independent educational grant from Mallinckrodt

Credits: 0.50 AMA PRA Category 1 Credits™, 0.50 ABIM MOC or 0.56 AANP, including 0.56 AANP Pharm     CME/CE Information and Claim Credit: https://www.pri-med.com/online-cme-ce/podcast/practical-approaches-to-the-pharmacologic-treatment-of-obesity  Overview: In this podcast expert faculty will review the available options and discuss best practices for prescribing and monitoring long-term anti-obesity medications (AOM) as an important component of a chronic disease approach to obesity management. The discussion will include the indications, efficacy, safety, and adverse effects of currently FDA-approved AOM as well as the evidence supporting new agents like the GLP-1 receptor agonists and the newly approved dual GIP/GLP-1 receptor agonist tirzepatide. 

Join us as we explore some of the non-pharmacologic treatments for Bipolar Disorder.

Join us for another discussion as we talk about some of the medications available for Bipolar Disorder.

CardioNerds Dr. Rick Ferraro (CardioNerds Academy House Faculty and Cardiology Fellow at JHH), Dr. Gurleen Kaur (Director of the CardioNerds Internship and Internal Medicine resident at BWH), and Dr. Alli Bigeh (Cardiology Fellow at the Ohio State) as they discuss the growing obesity epidemic and how it relates to cardiovascular disease with Dr. Ambarish Pandey (Cardiologist at UT Southwestern Medical Center). Show notes were drafted by Dr. Alli Bigeh. CardioNerds Academy Intern and student Dr. Shivani Reddy performed audio editing. Obesity is an important modifiable risk factor for cardiovascular disease, and it is on the rise! Here, we discuss how to identify patients with obesity and develop an approach to address current lifestyle recommendations. We also discuss the spectrum of pharmacologic treatment options available, management strategies, and some therapy options that are on the horizon. This episode was produced in collaboration with the American Society of Preventive Cardiology (ASPC) with independent medical education grant support from Novo Nordisk. See below for continuing medical education credit. Claim CME for this episode HERE. CardioNerds Prevention PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls and Quotes - Lifestyle & Pharmacologic Management of Obesity Identify obese patients not just using BMI, but also using anthropometric measurements such as waist circumference (central adiposity). Lifestyle modifications are our first line of defense against obesity! Current recommendations emphasize caloric restriction of at least 500kcal/day, plant-based and Mediterranean diets, and getting at least 150 minutes of moderate-intensity weekly exercise. Dive into the root cause of eating and lifestyle behaviors. It is crucial to address adverse social determinants of health with patients to identify the driving behaviors, particularly among those individuals of low socioeconomic status. Newer weight loss agents are most effective at achieving and maintaining substantial weight loss, in particular Semaglutide (GLP-1) and Tirzepatide (GLP-1/GIP). Initiate at a low dose and titrate up slowly. Obesity is a risk factor and potential driver for HFpEF. Targeted treatment options for obese patients with HFpEF include SGLT-2 inhibitors and semaglutide, which recently showed improvement in quality of life and exercise capacity in the STEP-HFpEF trial. Show notes - Lifestyle & Pharmacologic Management of Obesity How do we identify and define obesity? The traditional definition of obesity is based on body mass index (BMI), defined as BMI greater than or equal to 30.0 kg/m2 (weight in kg/height in meters).Recognize that BMI may not tell the whole story. A limitation of BMI is it does not reflect differences in body composition and distribution of fat.Certain patients may not meet the BMI cutoff for obesity but have elevated cardiovascular risk based on increased central adiposity, specifically those that are categorized as overweight.The devil lies in the details of anthropometric parameters. Include waist circumference measurements as part of an obesity assessment of visceral adiposity. A waist circumference greater than 40 inches for men and greater than 35 inches for women is considered elevated. What are some current lifestyle recommendations for obese patients? Lifestyle recommendations are the first line of defense against obesity.Current ACC/AHA guidelines suggest a target of reducing caloric intake by 500 kcal per day. For patients with severe obesity, this number may be higher.Emphasis on hypocaloric plant-based and Mediterranean dietsReduce total carbohydrate intake to 50-130 grams per day.Focus on a low-fat diet with less than 30% of total energy coming from fat with a high-protein diet to main...

In this episode Barbara Howard, MD, FAAP, explains ways pediatricians can streamline the health-maintenance visit using technology. Hosts David Hill, MD, FAAP, and Joanna Parga-Belinkie, MD, FAAP, also speak with Benjamin Masserano, MD, FAAP, about use of pharmacologic restraints for children hospitalized with mental health conditions. For resources go to aap.org/podcast.

Dr. John Fleetham chats with Dr. Paula K. Schweitzer and Dr. Najib Ayas about their articles, "The Combination of Aroxybutynin and Atomoxetine in the Treatment of Obstructive Sleep Apnea (MARIPOSA): A Randomized Controlled Trial" and "Pharmacologic Therapy for Obstructive Sleep Apnea: Are We Seeing Some Light at the End of the Tunnel?"

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter In this “Ask Me Anything” (AMA) episode, Peter explores various pharmacologic tools commonly utilized to improve metabolic health and treat diabetes, including SGLT-2 inhibitors, metformin, and GLP-1 agonists. He examines the available data on these drugs, assessing their comparative effectiveness and their potential in the context of lifestyle interventions. Additionally, he offers insights into whether SGLT2 inhibitors hold promise as geroprotective agents beyond their effects on glycemic control. Next, Peter analyzes the relationship between statin usage and the risk of developing insulin resistance and type 2 diabetes, investigating possible causal pathways and providing insights into strategies for risk reduction. He offers insights on monitoring adverse statin effects and evaluating the need for adjustments, ultimately weighing the trade-off between the risk to overall metabolic health against the benefits of reducing apoB levels through statin use. If you're not a subscriber and are listening on a podcast player, you'll only be able to hear a preview of the AMA. If you're a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #53 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss: Pharmacologic tools for improving metabolic health, and the relationship between statins and insulin resistance [2:00]; SGLT-2 inhibitors: how they work and help to manage type 2 diabetes [4:15]; The history of SGLT2 inhibitors – from discovery to the current state [10:15]; Comparing the various FDA-approved SGLT2 inhibitors [15:00]; Other beneficial effects of SGLT2 inhibitors outside of glycemic control [20:15]; Exploring SGLT2 inhibitors as potential geroprotective molecules [22:45]; The side effects and risks associated with SGLT2 inhibitors [31:45]; Medications, lifestyle interventions, and other considerations for treating diabetes and improving metabolic health [37:45]; Metformin as a tool for pre-diabetics, and how metformin compares to lifestyle interventions [44:00]; How GLP-1 agonists compare to metformin and SGLT2 inhibitors in terms of glycemic control and weight loss [49:15]; Exploring the relationship between statin use and the risk of developing insulin resistance and type 2 diabetes [52:30]; Possible mechanisms of statin-induced insulin resistance and diabetes, and potential mitigation strategies [1:04:30]; How to monitor for adverse effects of statin use and assess the need for adjustments [1:11:45]; Weighing the benefits and risks of statin use: does the diabetes risk outweigh the benefits of lowering apoB with a statin? [1:15:30]; Parting thoughts [1:20:45]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

Drive with Dr. Peter Attia Key Takeaways The truth behind longevity research: there's no evidence to think we'll live to 120+ years old – this should motivate us to move the needle to take action to improve our healthspan It's better to live 90 healthy years than 120 years but the poor quality of life the last 20“What I think people should fixate on is how do I not be really, really frail both physically and cognitively in the last decade of my life.” – Dr. Peter AttiaWe have control over whether we can stay physically active, move under our own power, etc.Take Peter's supplement list with a grain of salt – you might not need the same things he takes; ideally, get your bloodwork done regularlyA very low carbohydrate, low saturated fat diet would lower apoB but not to levels that would make ASCVD irrelevant; it's also probably not a sustainable diet“The most important parameter for determining metabolic health is energy balance. Even the most ‘perfect' diet, if it's in excess of energy balance will produce poor metabolic health.” – Dr. Peter AttiaThe most important factor in diet & nutrition is what you can sustainRead the full notes @ podcastnotes.org View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter In this special episode of The Drive, Peter discusses a variety of topics, breaking away from the typical deep-dive format to explore a wide range of common questions submitted by listeners. Peter tackles subjects like the viability of living to 120 and beyond, addressing some of the optimistic theories regarding achievement of this remarkable feat. Peter then shares his drug and supplement regimen while emphasizing how individualized these protocols need to be. The conversation also touches on lowering apoB, the long-term use of statins, the myth of good vs. bad cholesterol, the complexities of nutrition research, the quest for the ideal diet, and Peter's strategies for hitting daily protein goals. Peter finishes with a discussion about his favorite health-tracking wearables, the role of CGM in non-diabetics, and more. We discuss: Overview of topics and previous episodes of a similar format [2:45]; The viability of living to 120 and beyond: some optimistic theories [4:45]; The potential of mTOR inhibition as a mid-life intervention, and longevity potential for the next generation [13:30]; A framework for thinking about geroprotective drugs and supplements in the context of a lack of aging biomarkers [17:00]; Supplements Peter takes and how his regimen has changed in the last year [26:15]; Pharmacologic strategies to lower ASCVD risk, the limitations of statins, nutritional interventions, and more [36:15]; Misnomers about cholesterol [48:00]; Why nutritional research is so challenging, some general principles of nutrition, and why Peter stopped doing prolonged fasts [50:45]; Optimizing protein intake [59:45]; Wearables for sleep and exercise, continuous glucose monitors (CGM), and a continuous blood pressure monitor on the horizon [1:04:45]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter In this special episode of The Drive, Peter discusses a variety of topics, breaking away from the typical deep-dive format to explore a wide range of common questions submitted by listeners. Peter tackles subjects like the viability of living to 120 and beyond, addressing some of the optimistic theories regarding achievement of this remarkable feat. Peter then shares his drug and supplement regimen while emphasizing how individualized these protocols need to be. The conversation also touches on lowering apoB, the long-term use of statins, the myth of good vs. bad cholesterol, the complexities of nutrition research, the quest for the ideal diet, and Peter's strategies for hitting daily protein goals. Peter finishes with a discussion about his favorite health-tracking wearables, the role of CGM in non-diabetics, and more. We discuss: Overview of topics and previous episodes of a similar format [2:45]; The viability of living to 120 and beyond: some optimistic theories [4:45]; The potential of mTOR inhibition as a mid-life intervention, and longevity potential for the next generation [13:30]; A framework for thinking about geroprotective drugs and supplements in the context of a lack of aging biomarkers [17:00]; Supplements Peter takes and how his regimen has changed in the last year [26:15]; Pharmacologic strategies to lower ASCVD risk, the limitations of statins, nutritional interventions, and more [36:15]; Misnomers about cholesterol [48:00]; Why nutritional research is so challenging, some general principles of nutrition, and why Peter stopped doing prolonged fasts [50:45]; Optimizing protein intake [59:45]; Wearables for sleep and exercise, continuous glucose monitors (CGM), and a continuous blood pressure monitor on the horizon [1:04:45]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

In this episode, we explore a pressing problem in pediatric psychiatry: The disparities in the use of pharmacologic restraints. How can we address these biases in our healthcare system? What role do behavioral interventions play in reducing the need for these measures? Faculty: David Rosenberg, M.D. Host: Richard Seeber, M.D. Learn more about our membership here Earn 0.5 CMEs: CAP Smart Takes Vol. 09 Disparities in Pharmacologic Restraint Use in Pediatric Emergency Departments

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter Ted Schaeffer is an internationally recognized urologist who specializes in prostate cancer. In this episode, Ted delves deep into the realm of prostate health, starting with strategies for vigilance and effective management of the issues that can arise with aging, including urinary symptoms, prostatitis, pelvic pain, and prostate inflammation. Ted sheds light on the popular drug finasteride, renowned for its dual purpose in prostate shrinkage and hair loss prevention, as well as the contentious topic of post-finasteride syndrome. Ted then shifts to the topic of cancer, explaining how androgens, genetics, and non-genetic factors contribute to the pathogenesis of prostate cancer. He provides valuable insights into cancer screening, examining blood-based screening tools like PSA and the use of MRI in facilitating biopsies and their interpretation. Finally, he explores the various treatment options for prostate cancer, including surgical interventions, androgen deprivation therapy, and more. We discuss: Changes to the prostate with age and problems that can develop [3:45]; Behavioral modifications to help manage nocturnal urinary frequency and other lower urinary tract symptoms [8:30]; Pharmacologic tools for treating nocturnal urinary frequency and lower urinary tract symptoms [16:30]; Surgical tools for treating symptoms of the lower urinary tract [26:15]; HoLEP surgery for reducing prostate size [32:30]; Prostate size: correlation with cancer and considerations for small prostates with persistent symptoms [40:30]; Prostatitis due to infection: symptoms, pathogenesis, and treatment [46:45]; Prostatitis caused by factors besides infection [58:45]; How to minimize risk of urosepsis in patients with Alzheimer's disease [1:05:00]; Prostate cancer: 5-alpha reductase inhibitors, how androgens factor into pathogenesis, and more [1:10:00]; Post-finasteride syndrome [1:18:15]; The relationship between testosterone and DHT and the development of prostate cancer over a man's lifetime [1:26:30]; How genetic analysis of a tumor can indicate the aggressiveness of cancer [1:35:15]; Pathogenesis and genetic risk factors of prostate cancer and the use of PSA to screen for cancer [1:37:45]; Non-genetic risk factors for prostate cancer [1:45:45]; Deep dive into PSA as a screening tool: what is PSA, definition of terms, and how to interpret results [1:56:30]; MRI as a secondary screening tool and the prostate biopsy options [2:13:15]; Ted's ongoing randomized trial comparing different methods of prostate biopsy [2:24:00]; Determining when a biopsy is necessary, interpreting results, explaining Gleason score, and more [2:27:00]; Implications of a Gleason score of 7 or higher [2:46:45]; Metastasis of prostate cancer to different body locations, treatment options, staging, and considerations for patients' quality of life and survival [2:53:30]; How prostate cancer surgery has improved [3:09:30];; Questions to ask your neurologist if you are considering prostatectomy for cancer [3:21:45]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

Pharmacologic Therapies for Obesity: The Future is Here   Guest: Kyla M. Lara-Breitinger, M.D. Hosts: Sharonne N. Hayes, M.D. Join us in this expert podcast as we delve into the captivating world of GLP-1 receptor agonists (GLP-1RAs), exploring their profound impact on weight management and cardiometabolic effects.  We also discuss the potential cardiovascular benefits affecting patients with obesity and cardiovascular disease. Topics Discussed: The popularity of the GLP-1RAs Short-term and long-term benefits and consequences Cardiovascular benefits with taking these medications Connect with Mayo Clinic's Cardiovascular Continuing Medical Education online at https://cveducation.mayo.edu or on Twitter @MayoClinicCV and @MayoCVservices. LinkedIn: Mayo Clinic Cardiovascular Services Cardiovascular Education App: The Mayo Clinic Cardiovascular CME App is an innovative educational platform that features cardiology-focused continuing medical education wherever and whenever you need it. Use this app to access other free content and browse upcoming courses. Download it for free in Apple or Google stores today! No CME credit offered for this episode. Podcast episode transcript found here.    

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter In this “Ask Me Anything” (AMA) episode, Peter delves into the critical subject of blood pressure, which is one of the three primary causes of atherosclerosis, along with high apoB and smoking. He begins by unraveling the nature of high blood pressure, its prevalence, and why it often goes undiagnosed. Peter describes in detail the proper way to accurately measure blood pressure and what determines a diagnosis. Next, Peter discusses the actionable steps one can take in response to high blood pressure, shedding light on the extent to which factors like weight loss, exercise, and nutrition can make an impact. He also explores the pharmacological options available and offers valuable insights on how to approach them. If you're not a subscriber and are listening on a podcast player, you'll only be able to hear a preview of the AMA. If you're a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #48 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss: Blood pressure and other risk factors for cardiovascular disease [2:30]; Defining blood pressure and the purpose and meaning of a blood pressure measurement [5:45]; The implications of high blood pressure and the importance of maintaining an optimal level [10:30]; The importance of accurate measurements of blood pressure and how Peter approaches the care of patients at the very top range of “normal” [21:45]; The prevalence of high blood pressure—a hidden epidemic? [24:30]; The consequences of high blood pressure on cardiovascular health, brain health, kidneys, and more [27:45]; Low blood pressure: symptoms and consequences [35:30]; How to properly measure blood pressure [37:45]; Daily variance in blood pressure and the transient changes in blood pressure during exercise [48:00]; Primary hypertension vs. secondary hypertension: what to look for [51:45]; Lifestyle factors impacting blood pressure: weight loss, exercise, and sodium [57:45]; Impact of insulin resistance and type 2 diabetes on blood pressure [1:04:45]; How sleep impacts blood pressure [1:06:45]; Pharmacologic options for managing blood pressure [1:08:00]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

When we think of managing agitated patients we think of medicines – but that shouldn't be our first option. However, medications can be adjuncts to non-pharmacologic means to help keep agitated children safe from harm. This podcast episode hosted by Brad Sobolewski (@PEMTweets) and co-authored by Dennis Ren (@DennisRenMD) is all about age-appropriate pharmacologic management […]

Agitated children should always be treated with dignity and respect. This entails utilizing the least invasive non-pharmacologic means of assisting them, before moving to physical or chemical restraints. This podcast episode hosted by Brad Sobolewski (@PEMTweets) and co-authored by Dennis Ren (@DennisRenMD) is all about age-appropriate non pharmacologic management strategies for agitated children. It is […]

Title: Pediatric Anesthesia Concerns and Management for Orthopedic Procedures Introduction: Providing anesthesia for pediatric orthopedic patients poses unique challenges for anesthesiologists. The approach must consider the psychological development of the child and the prevalence of respiratory infections. Pain management, management of concomitant diseases, and risk reduction for adverse events are crucial aspects of anesthetic care. This blog post will review the perioperative concerns specific to pediatric orthopedic procedures, discuss pain control methods used, and highlight anesthetic considerations for certain surgeries. Listen to Audio via a Free Preview to our AnesthesiaExam Advanced Board Review Course or stay updated via our newsletter below Claim CME Credit Select Pediatric Perioperative Concerns: Anxiety in the Pediatric Patient: Pediatric patients undergoing orthopedic surgery often experience varying levels of anxiety and distress. Preoperative stressors can include unfamiliar environments, procedures, hunger, fear of pain, and separation from parents. Certain risk factors contribute to preoperative anxiety, such as ages 1 to 5 years, shy temperament, prior negative medical experiences, high cognitive levels, and parental anxiety. Unaddressed anxiety can lead to postoperative behavioral changes, including generalized anxiety, separation anxiety, aggression, and nighttime crying. It can also result in higher pain scores and increased pain medication requirements after surgery. Strategies to mitigate preoperative anxiety include presurgical preparation programs involving site visits, videos, books, and child-life interventions. Allowing parental presence during anesthesia induction can help alleviate separation anxiety. Pharmacologic interventions like oral midazolam can improve compliance and reduce negative behavioral changes in the short term. Upper Respiratory Tract Infections (URI): Pediatric patients presenting for orthopedic surgery with current or recent URIs pose a challenge for anesthesiologists and surgeons. Children commonly experience URIs with symptoms like a runny nose, cough, and fever. While the viral infection may reside in the nasopharynx, the lower respiratory tract remains sensitive for up to 6 weeks after URI symptoms have resolved. This increased sensitivity puts patients at risk for perioperative complications like laryngospasm, bronchospasm, and oxygen desaturation. Delaying surgery for 6 weeks after URI resolution is often impractical, as another URI is likely to occur. For elective surgery, severe symptoms and complications warrant postponing surgery, but clear nasal discharge in an otherwise healthy patient may proceed with elective surgery. Clinical decision-making becomes challenging for cases falling between these extremes. Factors such as patient age, comorbidities, prior cancellations, surgery complexity, and urgency are considered when deciding whether to postpone surgery. If elective surgery is delayed, most clinicians would wait 2 to 4 weeks after URI symptom resolution. Anesthetic Management for Orthopedic Procedures: Pain Management: Pain control for pediatric orthopedic patients involves a multimodal pharmacologic approach to minimize opioid requirements. This approach includes non-opioid analgesics, local anesthetics, and regional anesthesia techniques. Regional anesthesia, such as peripheral nerve blocks and caudal anesthesia, is particularly valuable for postoperative pain control. Recent studies have confirmed the safety of regional anesthesia in the pediatric population. Anesthetic Considerations for Select Pediatric Orthopedic Surgeries: Scoliosis Surgery: Anesthetic concerns during scoliosis surgery include optimizing neuromonitoring signals, managing blood loss, preventing positioning-related injuries, and minimizing the risk of postoperative visual loss. Pediatric orthopedic surgeries present unique challenges for anesthesiologists. Effective management of preoperative anxiety, careful consideration of upper respiratory tract infections, and appropriate pain control strategies are essential for successful outcomes. Anesthesiologists must tailor their approach to the specific needs of pediatric patients undergoing orthopedic procedures to ensure their safety and well-being. Reference Wu JP. Pediatric Anesthesia Concerns and Management for Orthopedic Procedures. Pediatr Clin North Am. 2020 Feb;67(1):71-84. doi: 10.1016/j.pcl.2019.09.006. PMID: 31779838; PMCID: PMC7172179. Anesthesiology Board Review Newsletter Subscribe for Discounts, Free Videos, Course Calendar & More! * indicates required Email Address *   Ultrasound Block Course applicable in  Pediatric Anesthesia for Orthopedic Procedures includes: Certificate of Completion Ultrasound Guided Interventional Pain Atlas Continuing Medical Education Credit Online access to Webinar (additional CME Credit) Regional Anesthesia:   Lower Extremity Nerve Blocks for  Femoral Nerve Block   Genicular Nerve Block Sciatic Nerve Block  Popliteal Nerve Block Common Peroneal Block Tibial Nerve Block Block Ankle Block   Upper Extremity Anesthesia for Fractures and Reductions   Brachial Plexus Block Axillary Nerve Block Suprascapular Nerve Blocks Truncal and Fascial Plane Blockade Transversus abdominis plane block Paravertebral Nerve Block Intercostal Nerve Block Erector Spinae  Block PENG Nerve Block IPACK Nerve Block and much more! Caudal Epidural and Spine demonstrations available as well.   Register Now!   Or Email DRosenblum@rmcpain.com to arrange a private workshop with your Department.       NRAP Academy: Ultrasound Guided Regional Anesthesia and Interventional Pain Workshops Subscribe for Discounts, Free Videos, Course Calendar & More! * indicates required Email Address *  

Introduction: Providing anesthesia for pediatric orthopedic patients poses unique challenges for anesthesiologists. The approach must consider the psychological development of the child and the prevalence of respiratory infections. Pain management, management of concomitant diseases, and risk reduction for adverse events are crucial aspects of anesthetic care. This blog post will review the perioperative concerns specific to pediatric orthopedic procedures, discuss pain control methods used, and highlight anesthetic considerations for certain surgeries. Listen to Audio via a Free Preview to our AnesthesiaExam Advanced Board Review Course or stay updated via our newsletter below Claim CME Credit Select Pediatric Perioperative Concerns: Upper Respiratory Tract Infections (URI): Pediatric patients presenting for orthopedic surgery with current or recent URIs pose a challenge for anesthesiologists and surgeons. Children commonly experience URIs with symptoms like a runny nose, cough, and fever. While the viral infection may reside in the nasopharynx, the lower respiratory tract remains sensitive for up to 6 weeks after URI symptoms have resolved. This increased sensitivity puts patients at risk for perioperative complications like laryngospasm, bronchospasm, and oxygen desaturation. Delaying surgery for 6 weeks after URI resolution is often impractical, as another URI is likely to occur. For elective surgery, severe symptoms and complications warrant postponing surgery, but clear nasal discharge in an otherwise healthy patient may proceed with elective surgery. Clinical decision-making becomes challenging for cases falling between these extremes. Factors such as patient age, comorbidities, prior cancellations, surgery complexity, and urgency are considered when deciding whether to postpone surgery. If elective surgery is delayed, most clinicians would wait 2 to 4 weeks after URI symptom resolution. Anxiety in the Pediatric Patient: Pediatric patients undergoing orthopedic surgery often experience varying levels of anxiety and distress. Preoperative stressors can include unfamiliar environments, procedures, hunger, fear of pain, and separation from parents. Certain risk factors contribute to preoperative anxiety, such as ages 1 to 5 years, shy temperament, prior negative medical experiences, high cognitive levels, and parental anxiety. Unaddressed anxiety can lead to postoperative behavioral changes, including generalized anxiety, separation anxiety, aggression, and nighttime crying. It can also result in higher pain scores and increased pain medication requirements after surgery. Strategies to mitigate preoperative anxiety include presurgical preparation programs involving site visits, videos, books, and child-life interventions. Allowing parental presence during anesthesia induction can help alleviate separation anxiety. Pharmacologic interventions like oral midazolam can improve compliance and reduce negative behavioral changes in the short term.   Anesthetic Management for Orthopedic Procedures: Anesthetic Considerations for Select Pediatric Orthopedic Surgeries: Scoliosis Surgery: Anesthetic concerns during scoliosis surgery include optimizing neuromonitoring signals, managing blood loss, preventing positioning-related injuries, and minimizing the risk of postoperative visual loss. Pain Management: Pain control for pediatric orthopedic patients involves a multimodal pharmacologic approach to minimize opioid requirements. This approach includes non-opioid analgesics, local anesthetics, and regional anesthesia techniques. Regional anesthesia, such as peripheral nerve blocks and caudal anesthesia, is particularly valuable for postoperative pain control. Recent studies have confirmed the safety of regional anesthesia in the pediatric population. Pediatric orthopedic surgeries present unique challenges for anesthesiologists. Effective management of preoperative anxiety, careful consideration of upper respiratory tract infections, and appropriate pain control strategies are essential for successful outcomes. Anesthesiologists must tailor their approach to the specific needs of pediatric patients undergoing orthopedic procedures to ensure their safety and well-being. Reference  Wu JP. Pediatric Anesthesia Concerns and Management for Orthopedic Procedures. Pediatr Clin North Am. 2020 Feb;67(1):71-84. doi: 10.1016/j.pcl.2019.09.006. PMID: 31779838; PMCID: PMC7172179. Anesthesiology Board Review Newsletter Subscribe for Discounts, Free Videos, Course Calendar & More! * indicates required Email Address *   Ultrasound Block Course applicable in  Pediatric Anesthesia for Orthopedic Procedures includes: Certificate of Completion Ultrasound Guided Interventional Pain Atlas Continuing Medical Education Credit Online access to Webinar (additional CME Credit) Regional Anesthesia:   Lower Extremity Nerve Blocks for  Femoral Nerve Block   Genicular Nerve Block Sciatic Nerve Block  Popliteal Nerve Block Common Peroneal Block Tibial Nerve Block Block Ankle Block   Upper Extremity Anesthesia for Fractures and Reductions   Brachial Plexus Block Axillary Nerve Block Suprascapular Nerve Blocks Truncal and Fascial Plane Blockade Transversus abdominis plane block Paravertebral Nerve Block Intercostal Nerve Block Erector Spinae  Block PENG Nerve Block IPACK Nerve Block and much more! Caudal Epidural and Spine demonstrations available as well. Register Now! Or Email DRosenblum@rmcpain.com to arrange a private workshop with your Department. NRAP Academy: Ultrasound Guided Regional Anesthesia and Interventional Pain Workshops Subscribe for Discounts, Free Videos, Course Calendar & More! * indicates required Email Address *  

In this podcast, Dr. Kelly Lemieux - a pediatrician with Wayzata Children's Clinic brings some insight into pediatric ADHD, specifically around the history, symptoms and treatment options. Enjoy the podcast. Objectives:Upon completion of this podcast, participants should be able to: Define the differential diagnosis for children presenting with academic difficulties. Utilize the DSM-5 criteria when diagnosing ADHD in children. Identify common co-morbidities for children with ADHD. CME credit is only offered to Ridgeview Providers & Allied Health staff for this podcast activity. After listening to the podcast, complete and submit the online evaluation form.  Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within approximately 2 weeks. You may contact the accredited provider with questions regarding this program at Education@ridgeviewmedical.org. Click the link below, to complete the activity's evaluation. CME Evaluation (**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.)  DISCLOSURE ANNOUNCEMENT  The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition; and are property/rights of Ridgeview.  Any re-reproduction of any of the materials presented would be infringement of copyright laws.  It is Ridgeview's intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker's outside interest may reflect a possible bias, either the exposition or the conclusions presented. Ridgeview's CME planning committee members and presenter(s) have disclosed they have no significant financial relationship with a pharmaceutical company and have disclosed that no conflict of interest exists with the presentation/educational event. Thank-you for listening to the podcast. SHOW NOTES:  *See the attachment for additional information.  ADHD History - 1902 - British pediatrician definition of ADHD- Evolution - 1990s - increase in diagnosis - 2013 - Change in age range for diagnosis Diagnosis - Symptoms - Comorbidities - Concerns for learning disabilities - Diagnostic tools Prevalence - CDC estimates 6 million children (ages 3 to 17) with ADHD (approx. 9.8%) Assessment - Three key symptoms (inattention, hyperactivity, impulsivity) - How ADHD is explained to parents- Standarized tools (including listening to parents) - Neuropsychological testing & Vanderbilts Nonpharmocologic strategics At school - ADHD coach - Therapy - Bounce ball chairs - special study halls - other resources At home - Daily schedules  - reducing disctractions (minimize) - noise cancelling - exercise  Pharmacologic interventions - Risk benefits - Prescribing age - 2 broad categories of medications (stimulants v. non-stimulants)- other medications - limitations Thanks to Dr. Kelly Lemieux for her knowledge and contribution to this podcast. Please check out the additional show notes for more information/resources.

Seth M. Kriha, PharmD identifies guideline recommended treatment to reduce LDL-C, evaluates landmark clinical trials for novel therapeutic agents indicated for treatment resistant hypercholesterolemia and develops a pharmacologic care plan for a patient with treatment resistant hypercholesterolemia. For more pharmacy content, follow Mayo Clinic Pharmacy Residency Programs @MayoPharmRes or the host, Garrett E. Schramm, Pharm.D., @garrett_schramm on Twitter! You can also connect with the Mayo Clinic's School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd. 

Episode 125: Non-opioid Chronic Pain Management Dr. Axelsson and Jesse explain how to treat chronic pain without opioids. Written by Anika Soleyn, MS4, Ross University School of Medicine. Edited by Jesse Lamb, MS3, American University of the Caribbean; Hector Arreaza, MD; and Fiona Axelsson, MD.This is the Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Axelsson:Welcome to the first episode of 2023, Happy new year! Today is January 10, 2023.What is chronic pain?According to the International Association for the Study of Pain, chronic pain is nonstop or reoccurring pain that lasts more than 3 months or beyond the expected clinical course of illness. Chronic pain can adversely affect well-being and quality of life. We used to think of pain as a response to tissue damage, and as the tissue heals, the pain dissipates, but chronic pain is much more complex than that because there may be no evidence of tissue damage, yet the nociceptors keep sending signals to the brain that there is damage.There are 3 options for the management of chronic pain: non-pharmacologic, nonopioid pharmacological and opioid management. CDC recommends a combination of nonpharmacological and non-opioid management for chronic pain. The 7 most common chronic pain conditions are neuropathic pain, fibromyalgia or chronic pain syndrome, osteoarthritis, inflammatory arthritis, low back pain, chronic headache, and sickle cell anemia.Opioids in long-term care facilities.The use of opioids for the treatment of pain is common in the post-acute and long-term care setting. From the AFP Journal, the Choosing Wisely Recommendation states: “Don't provide long-term opioid therapy for chronic non-cancer pain in the absence of clear and documented benefits to functional status and quality of life.” The Society for Post-Acute and Long-Term Care Medicine published a statement in 2018 about the use of opioids. It states that the prescription of opioids should be based on an interprofessional assessment specifying why opioids are needed. When long-term opioids are not being used for cancer, palliative care, or end-of-life care in a long-term facility, a tapering plan must be “individualized and should minimize symptoms of opioid withdrawal while maximizing pain treatment with non-pharmacologic therapies and non-opioid medications”. Long-term opioid prescriptions should be reviewed regularly and take into consideration the potential harms of opioids. Clinicians are encouraged to offer alternatives such as behavioral therapy, non-opioid analgesics, and other non-pharmacologic treatments whenever available and appropriate.Initial assessment: Identify biopsychosocial factors and identify if the source is neuropathic, nociceptive, or central sensitization. This can be a challenging process and it may require several visits to determine the origin of pain. Neuropathic pain is due to nerve damage or irritation while nociceptive pain is due to tissue damage. Central sensitization is an abnormal response of the nociceptive system. There are changes in the nervous system that alter how it responds to sensory input that causes widespread pain with no apparent cause or in response to mild sensory input. Some examples include fibromyalgia, migraines in response to brushing hair, surgical scar pain, etc.Set goals and expectations: It is crucial to set up patient expectations if they have chronic pain. They should understand that pain can be improved to a manageable level but not always eliminated. Patients should have routine follow-up visits with education, and reassurance since they are shown to improve outcomes of pain management. Specific goals such as improved mobility and ability to do certain enjoyable tasks are more reasonable and specific goals than a goal of pain elimination. A good physician-patient relationship and clear communication are essential here. Patients could obviously become deeply upset at the prospect of pain that can't be eliminated, and those who have received opioids for their pain in the past could be even more distraught at the thought of not getting them now or needing to reduce their dose. The physician should be ready to have this discussion with their patients that have chronic pain and be ready to address their concerns appropriately. Reduce catastrophic thinking: Pain is an alarm system letting someone know there is some sort of damage. Because of this, it makes sense that a patient would respond to pain with anxious and catastrophic thinking. Patients who understand their own chronic diseases are more likely to be actively involved in their treatment, so understanding is crucial in the management of pain. Reducing fearful thoughts such as "there must be something wrong," and "hurt means harm'” is an important first step toward pain self-management and making sure the strategies attempted are effective.Rehabilitation: Focused pain clinics often include educational group classes for patients in distress. The programs include explanations for why pain might be present with no pathological factors. It also includes relaxation and mindfulness that help patients soothe themselves during attacks. The brain plays a big role in the experience of pain. Changing how your brain relates physical pain to stress and reducing those psychosocial barriers through self-care helps with pain management. Finding things that make you physically stronger like physical therapy or occupational therapy help, but also increasing mental strength by doing things that make you happy and having a quality social life is a strong determinant of how the brain perceives physical pain. Consistency is key in pain management even after the patient begins to feel better.Non-pharmacologic therapy – Most of what we will talk about today is non-pharmacological treatment. We will discuss the options and goals of different treatments. Chronic pain treatment should start with non-pharmacological approaches and then you can add medications if necessary. Again, these approaches aim to increase functionand reduce progression despite chronic pain. There should be a consistent non-pharmacological regimen, even if medications are added later. The three main approaches will be physical therapy, psychological therapy, and some integrative medicine methods.Physical therapy. The objective of physical therapy is to improve physical function. You should recommend programs that are specific for patients' limitations and the physical therapist should have trained specifically in chronic pain treatment. This ensures they do a proper initial evaluation and select appropriate therapeutic methods such as Therapeutic exercise: Sometimes patients can become so fearful of painful movement that they have deconditioned muscles. In the geriatric population, some patients are so afraid of falling, that they avoid any form of movement whatsoever, therefore almost certainly leading to falls due to deconditioning of those muscles. Adding small amounts of exercise as tolerated can begin to recondition patients and help them build strength. Patients with severe osteoarthritis are more likely to tolerate aquatic exercises. Therapeutic exercise programs may be available at the physical therapy facility or community centers. Patients can even find videos on the internet of tai chi, yoga classes, Pilates, and low-impact fitness programs. Exercise can certainly reduce pain and improve function, with few adverse effects but make sure patients tolerate the exercises and are not pushed beyond their limits. Stretching can also improve range of motion and strength, especially in chronic lower back pain patients. Psychological therapy:Cognitive-behavioral therapy. It is the most researched and recommended psychological treatment for chronic pain. It's normally recommended in conjunction with patient education, physical therapy, and exercise. CBT can be used after introducing meds and/or after surgery. There are 2 components to cognitive behavioral therapy: cognitions and behaviors. CBT addresses the way that patients' thoughts (cognitions) affect their actions and vice versa. This begins with helping patients identify situations and environments that trigger their pain and what they actually experience emotionally, behaviorally, and physically when they have pain.CBT addresses mental responses that may worsen pain, so patients learn to think about how they view their pain. To do this, they use a range of specific behavioral strategies such as relaxation and controlled-breathing exercises, activity pacing, pleasurable activities, improving their sleep, and cognitive reappraisal strategies, such as reframing negative situations to positive or practicing gratefulness.Complementary and integrative health therapies.-Mindfulness-based stress reduction. Mindfulness is the ability to be fully present where we are and what we're doing, and not be overly reactive or overwhelmed by what's going on around us.-Progressive muscle relaxation. For instance, tensing/relaxing muscles throughout the body along with positive imagery and meditation.-Biofeedback. During biofeedback, you're looking at biological signs, and feedback that is being correlated to physical sensations in your body to recognize the correlation between physical signs and symptoms of chronic pain. You're connected to monitors, such as electromyograms or electroencephalograms, to quantify muscle tension, brain waves, heart rate, and blood pressure to see how fluctuations and abnormal numbers physically feel in the body.-Massage therapy. It can relax painful muscles, tendons, and joints and relieve stress. The effect of pressure in certain areas that are tender causes relaxation and secretion of endorphins that can calm pains. That's why massage therapy can actually be addictive for some people, because of the endorphins. Another benefit of massage therapy is that it can help with improved absorption of medications due to improved circulation.There are many other integrative health therapies including Reiki, hypnosis, therapeutic touch, healing touch, and homeopathy. However, these are not well-researched and can't really be endorsed by evidence-based medicine.If patients are interested in trying complementary, integrative health therapy, you can guide them to practices that are at least safe. Some therapies can end up being harmful, such as herbal remedies or supplements with potential toxicities or known interactions with medications, so those should be taken cautiously. Make sure your med list while taking your history includes supplements and herbs patients might be trying. Shirodhara is an Ayurvedic approach to stress relief that involves having someone pour liquid — usually oil, milk, buttermilk, or water — onto your forehead.Herbal or plant-based treatments have also shown some efficacy in published studies. Ginger, turmeric, St John's Wort, and a handful of others seem like they could have some beneficial effects either on their own merit or as an adjunctive with other non-opioid therapies. Caution should be taken, though, as some of them, particularly St John's Wort, have been shown to have negative impacts on serum levels of opioids when used in combination with them due to their effects on the liver cytochrome system. Data is also rather mixed, with some studies showing reasonable efficacy and others showing almost none. If your patients want to take herbal supplements, it is essential to be diligent about checking their efficacy and interactions with other therapies to ensure safety. The physician should also be clear when discussing current medications to ask specifically if they take herbal supplements of any kind, as many patients don't consider these to be “medications” and will omit them during history. Of note, turmeric has to be taken with black pepper for better GI absorption.Weight reduction: A healthy diet and fitness are always recommended. Online guidelines are helpful on topics such as healthy fats, vegetables, avoiding refined sugar, and more. Obesity is a pro-inflammatory state, but it is important not to blame chronic pain problems solely on obesity since patients may still have pain after losing weight. Weight reduction can be a part of that plan, but we should not promise a cure for chronic pain after a patient reaches an ideal weight. Sleep disturbances: Ironically, sleep improves pain, but pain makes sleep more difficult. If patients complain of sleep disturbances, start with behavioral changes, including improved sleep hygiene (keep a regular sleep schedule, exercise regularly, don't use caffeine and caffeinated beverages, don't eat too late at night) and stimulus control (the bed should only be used for two things: sleep and sex, get out of bed if you can't sleep, wake up at the same time every day, and avoid bright screens before bedtime because they confuse your brain); cognitive behavioral therapy (deal with concerns or worries that may interfere with sleep). Treating sleep disturbance may have a positive effect on the treatment of chronic pain. Acupuncture: It involves the insertion of very thin needles through the skin at specific points on the body. Acupuncture is a key component of traditional Chinese medicine and can be considered in patients with chronic pain. There are significant difficulties in studying acupuncture, but randomized trials suggest that acupuncture and placebo may have similar efficacy, and both are superior to no treatment. Pharmacologic therapy – For patients with inadequate analgesia despite nonpharmacologic therapies, we add carefully selected multi-targeted pharmacological therapies based on the type of pain (i.e., nociceptive, neuropathic, central sensitization) For nociceptive pain, start with non-steroidal anti-inflammatory drugs (NSAIDs) while continuing non-pharmacologic treatments. If that doesn't work add a topical agent such as lidocaine, capsaicin, or topical NSAIDs. Consider opioid treatment if neither of those works. For neuropathic pain, start with antidepressants or antiepileptic drugs: tricyclic antidepressants, SNRIs, pregabalin, gabapentin, or carbamazepine in addition to non-pharmacologic therapy. If those medications do not provide relief of pain, then you can consider adding topical agents and then opioids after weighing the risk and benefits. Side effects can be viewed as harmful, but we can use them for our benefit.Opioids are reserved for people with moderate to severe pain who cannot function. Once you identify a treatment that works for the patient, follow-up visits should be continued to promote behavioral changes, monitor therapeutic response, and treat side effects. A pain contract should also be signed.Follow-up visits – Schedule follow-up visits to continue educating patients and their families and caregivers, to continue motivational interviewing, and to monitor improvement. Refer patients who are not making enough progress, such as not reaching goals of function and quality of life, to comprehensive pain programs that can use additional modalities such as injections.Bottom line: Non-pharmacologic options should be considered in the management of all patients with chronic pain. The main non-pharmacologic strategies include physical therapy, psychological therapy, and complementary and integrative therapy. Remember to treat sleep disturbances and obesity as part of your plan. Add pharmacologic agents such as NSAIDs, antidepressants, and anticonvulsants when non-pharmacologic therapies do not help the patient reach their goals. Consider opioids only in moderate to severe pain with loss of function. Opioid prescription is a complex topic that was addressed in episode 31 of this podcast, more than 2 years ago, it is time for an update. Stay tuned, we will talk about opioids soon.____________________________Conclusion: Now we conclude episode number 125, “Non-opioid Chronic Pain Management.” Non-pharmacologic therapy is proven to be effective in the treatment of chronic pain, especially physical therapy, psychological therapy, and some complementary therapy. Medications can be added to non-pharmacologic therapy, mainly NSAIDs, antidepressants, antiepileptic medications, and more. Opioids can be added in disabling chronic pain, but prescription needs to be done cautiously and watchfully. The treatment of chronic pain may be challenging and daunting at times, but fortunately, we have science to back us up with effective ways to help our patients. So, don't be discouraged and trust science! This week we thank Fiona Axelsson, Jesse Lamb, and Hector Arreaza. Audio editing by Adrianne Silva.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________Links:Tauben, David, Brett R Stacey, Approach to the management of chronic non-cancer pain in adults, UpToDate. Last updated on May 06, 2022. Accessed January 10, 2023. https://www.uptodate.com/contents/approach-to-the-management-of-chronic-non-cancer-pain-in-adults.Choosing Wisely Recommendations: Don't provide long-term opioid therapy for chronic non-cancer pain in the absence of clear and documented benefits to functional status and quality of life, American Family Physician, Collections 460, American Academy of Family Physician. Link: https://www.aafp.org/pubs/afp/collections/choosing-wisely/460.html.What is Mindfulness? Mindful.org. https://www.mindful.org/what-is-mindfulness/.Jahromi B, Pirvulescu I, Candido KD, Knezevic NN. Herbal Medicine for Pain Management: Efficacy and Drug Interactions. Pharmaceutics. 2021; 13(2):251. https://doi.org/10.3390/pharmaceutics13020251.Royalty-free music used for this episode: “Good Vibes - Fashionista." Downloaded on October 13, 2022, from https://www.videvo.net/

Devon S. Stonerock, PharmD (@DevonStoneRx) describes the underlying pathophysiology driving the development and progression of aplastic anemia, outlines treatment options based on patient specific factors and recognizes key toxicities, drug interactions, and administration considerations for patients receiving immunosuppressive therapy. For more pharmacy content, follow Mayo Clinic Pharmacy Residency Programs @MayoPharmRes or the host, Garrett E. Schramm, Pharm.D., @garrett_schramm on Twitter! You can also connect with the Mayo Clinic's School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd. 

On this episode, we discuss the various therapeutic options for managing a patient with chronic pain. We discuss nonpharmacological options, anti-inflammatory medications, and other non-opioid pharmacological options. Then, we compare and contrast some of the commonly used opioids and discuss some of the nuances/clinical pearls for individual opioids. Cole and I are happy to share that our listeners can claim ACPE-accredited continuing education for listening to this podcast episode! We have continued to partner with freeCE.com to provide listeners with the opportunity to claim 1-hour of continuing education credit for select episodes. To earn credit for this episode, visit the following link below to reach the post-activity test for this episode: List of podcasts on freeCE.com For existing Unlimited freeCE members, this CE option is included in your membership benefits at no additional cost! Members can simply follow the link above to take the post-test and evaluation for this activity. Use the password PAIN (all caps) to unlock the post-test for this episode. But if you're not currently a freeCE member, we definitely suggest you explore all the benefits of their Unlimited Membership on their website and earn CE for listening to this podcast. CorConsult Rx listeners can save 15% off the purchase of an unlimited membership by entering the discount code “PODCAST2022” at checkout, or by clicking the following link: https://hubs.ly/Q012N0H60 Thanks for listening! We want to give a big thanks to our main sponsor Pyrls. Try out their drug information app today. Visit the website below for a free trial: www.pyrls.com/corconsultrx If you want to support the podcast, check out our Patreon account. Subscribers will have access to all previous and new pharmacotherapy lectures as well as downloadable PowerPoint slides for each lecture. You can find our account at the website below:  www.patreon.com/corconsultrx If you have any questions for Cole or me, reach out to us on any of the following: Text - 415-943-6116 Mike - mcorvino@corconsultrx.com Cole - cswanson@corconsultrx.com AJ - aalford@corconsultrx.com Instagram and other social media platforms - @corconsultrx This podcast reviews current evidence-based medicine and pharmacy treatment options. This podcast is intended to be used for educational purposes only and is intended for healthcare professionals and students. This podcast is not for patients and not intended as advice or treatment.

Divya A. Khandekar, PharmD, MS (@pharmdiv) discusses the basic principles of radiation therapy in the treatment of cancer, describes the etiology and pathophysiology of toxicities caused by radiation therapy and identifies which pharmacological treatments for radiation toxicity management are evidence-based. For more pharmacy content, follow Mayo Clinic Pharmacy Residency Programs @MayoPharmRes or the host, Garrett E. Schramm, Pharm.D., @garrett_schramm on Twitter! You can also connect with the Mayo Clinic's School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd. 

This episode discusses the pharmacologic treatments for BPSD, including the indications for using psychotropic medications as first-line treatment. It also explains when medications are ineffective and when to use them as a temporary measure. Faculty: Lauren Gerlach, D.O. Host: Richard Seeber, M.D. Learn more about our memberships here Earn 1 CME: Management of Behavioral and Psychological Symptoms of Dementia Overview of Pharmacologic Treatment for BPSD

Nikitha Yagnala, PharmD (@nikithayagnala) recognizes the physiologic consequences of sleep disturbances in critically ill patients, discusses the mechanisms of sleep promotion for pharmacologic sleep agents and outlines appropriate utilization of pharmacologic sleep agents in critically ill patients. For more pharmacy content, follow Mayo Clinic Pharmacy Residency Programs @MayoPharmRes or the host, Garrett E. Schramm, Pharm.D., @garrett_schramm on Twitter! You can also connect with the Mayo Clinic's School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd. 

A new research paper was published in Oncotarget's Volume 13 on November 2, 2022, entitled, “MK256 is a novel CDK8 inhibitor with potent antitumor activity in AML through downregulation of the STAT pathway.” Acute myeloid leukemia (AML) is the most lethal form of AML due to disease relapse. Cyclin dependent kinase 8 (CDK8) is a serine/threonine kinase that belongs to the family of Cyclin-dependent kinases and is an emerging target for the treatment of AML. MK256, a potent, selective, and orally available CDK8 inhibitor was developed to target AML. In this new study, researchers Jen-Chieh Lee, Shu Liu, Yucheng Wang, You Liang, and David M. Jablons from the University of California San Francisco and Touro University sought to examine the anticancer effect of MK256 on AML. “In CD34+/CD38- leukemia stem cells, we found that MK256 induced differentiation and maturation.” Treatment of MK256 inhibited proliferation of AML cell lines. Further studies of the inhibitory effect suggested that MK256 not only downregulated phosphorylated STAT1(S727) and STAT5(S726), but also lowered mRNA expressions of MCL-1 and CCL2 in AML cell lines. Efficacy of MK256 was shown in MOLM-14 xenograft models, and the inhibitory effect on phosphorylated STAT1(S727) and STAT5(S726) with treatment of MK256 was observed in vivo. Pharmacologic dynamics study of MK256 in MOLM-14 xenograft models showed dose-dependent inhibition of the STAT pathway. Both in vitro and in vivo studies suggested that MK256 could effectively downregulate the STAT pathway. In vitro ADME, pharmacological kinetics, and toxicity of MK256 were profiled to evaluate the drug properties of MK256. “Our results show that MK256 is a novel CDK8 inhibitor with a desirable efficacy and safety profile and has great potential to be a promising drug candidate for AML through regulating the STAT pathway.” DOI: https://doi.org/10.18632/oncotarget.28305 Correspondence to: Jen-Chieh Lee -jenchieh.lee@ucsf.edu, Shu Liu - shu.liu@ucsf.edu Keywords: AML, CDK8, kinase inhibitor, STAT pathway, xenograft Video: https://www.youtube.com/watch?v=8bRgqTg9-c8 About Oncotarget: Oncotarget (a primarily oncology-focused, peer-reviewed, open access journal) aims to maximize research impact through insightful peer-review; eliminate borders between specialties by linking different fields of oncology, cancer research and biomedical sciences; and foster application of basic and clinical science. To learn more about Oncotarget, visit Oncotarget.com and connect with us on social media: Twitter – https://twitter.com/Oncotarget Facebook – https://www.facebook.com/Oncotarget YouTube – www.youtube.com/c/OncotargetYouTube Instagram – https://www.instagram.com/oncotargetjrnl/ LinkedIn – https://www.linkedin.com/company/oncotarget/ Pinterest – https://www.pinterest.com/oncotarget/ LabTube – https://www.labtube.tv/channel/MTY5OA SoundCloud – https://soundcloud.com/oncotarget For media inquiries, please contact: media@impactjournals.com

Hemodynamic stability is crucial after any operation. Dr. Scott Cameron discusses some of the nuances of medication management for patients who have undergone surgery on their aorta.

In this episode, we discuss the interventions found to be efficacious in youth with ADHD. Specifically, would treatment with stimulants be effective at reducing irritability in youth with ADHD?  Faculty: Jim Phelps, M.D.  Host: Richard Seeber, M.D. Learn more about our memberships here Earn 0.5 CMEs: Quick Take Vol. 39 A Mini-Review of Pharmacologic and Psychosocial Interventions for Reducing Irritability Among Youth With ADHD

To dilate or not to dilate, that is the question Dr. Lori Provencher asks Dr. David S. Friedman as they discuss the results of his Ophthalmology Glaucoma article “Acute Angle-Closure Attacks Are Uncommon in Primary Angle-Closure Suspects after Pharmacologic Mydriasis.” Acute Angle-Closure Attacks Are Uncommon in Primary Angle-Closure Suspects after Pharmacologic Mydriasis. Friedman, David S. et al. Ophthalmology Glaucoma. In press.

Umbrella: HF, Non-pharmacologic Approach to HF

Chuck Sawyer is the Special Assistant to the President at Northwestern Health Sciences University, NWHSU, located in Bloomington, Minnesota. Chuck argues for a different approach to pain management given the opioid epidemic and the overuse of opioid narcotics to treat acute pain and chronic pain. Of particular concern is extending the use of chiropractic treatments and acupuncture for Medicaid and Medicare patients. Chuck explains, "And fast forward to the present day, we now have ten programs, with our chiropractic program continuing to be the largest. But we've added acupuncture at both the master's and doctoral levels, and we have a program in therapeutic massage. More recently, programs in other allied health careers including medical assisting, medical laboratory science, radiologic technology, and radiation therapy. We have a post-bachelors pre-health program for students with bachelor's degrees who are seeking enrollment in medical schools and dental schools, and two online programs just launched in integrative health and wellness and functional nutrition." "Then you get to the age of 65, and all of a sudden, now your coverage, and even though your access to care is still good in the Medicare program, your coverage is very limited. So aging into Medicare is a problem. And so it's time really for Medicare to catch up with what's happening on the commercial side, and particularly now with the heightened emphasis on non-pharmacologic options for treating pain. It's time for Medicare to broaden its coverage so that patients don't have to pay out of pocket for services that are covered in the Medicare program when provided by healthcare professionals, other than chiropractic doctors and acupuncturists." #NWHSU #TreatingPain #IntegrativeHealth #AlternativeMedicine #Acupuncture #ChiropracticDoctors #PainManagement #Opioids #NonDrugTreatment #NonPharmacologic #Medicaid #Medicare nwhealth.edu Download the transcript here

Chuck Sawyer is the Special Assistant to the President at Northwestern Health Sciences University, NWHSU, located in Bloomington, Minnesota. Chuck argues for a different approach to pain management given the opioid epidemic and the overuse of opioid narcotics to treat acute pain and chronic pain. Of particular concern is extending the use of chiropractic treatments and acupuncture for Medicaid and Medicare patients. Chuck explains, "And fast forward to the present day, we now have ten programs, with our chiropractic program continuing to be the largest. But we've added acupuncture at both the master's and doctoral levels, and we have a program in therapeutic massage. More recently, programs in other allied health careers including medical assisting, medical laboratory science, radiologic technology, and radiation therapy. We have a post-bachelors pre-health program for students with bachelor's degrees who are seeking enrollment in medical schools and dental schools, and two online programs just launched in integrative health and wellness and functional nutrition." "Then you get to the age of 65, and all of a sudden, now your coverage, and even though your access to care is still good in the Medicare program, your coverage is very limited. So aging into Medicare is a problem. And so it's time really for Medicare to catch up with what's happening on the commercial side, and particularly now with the heightened emphasis on non-pharmacologic options for treating pain. It's time for Medicare to broaden its coverage so that patients don't have to pay out of pocket for services that are covered in the Medicare program when provided by healthcare professionals, other than chiropractic doctors and acupuncturists." #NWHSU #TreatingPain #IntegrativeHealth #AlternativeMedicine #Acupuncture #ChiropracticDoctors #PainManagement #Opioids #NonDrugTreatment #NonPharmacologic #Medicaid #Medicare nwhealth.edu Listen to the podcast here

In this second episode of a two-part mini-series, we feature Dr. Nadia Haddad, a Colorado psychiatrist, and Dr. Ricky Dhaliwal, an emergency medicine physician, as they discuss the various treatment modalities for substance-induced psychosis. They explore pharmacologic treatments, inpatient and outpatient treatments, and ways that emergency providers can improve their care for psychiatric patients with comorbid medical conditions. Lastly, they consider the different causes for repeat visits from mentally ill patients.    Key Points:   Pharmacologic treatments for substance-induced psychosis are similar to those for other types of psychosis; these include medications like Zyprexa, Haldol, and, as a third-line treatment, IM Thorazine.  Droperidol is used more commonly in the emergency setting, compared with the psychiatric setting.  Given the risk for respiratory depression from Zyprexa combined with benzodiazepines, psychiatrists may choose to use Thorazine or Haldol/Ativan/Benadryl instead.  It is important to reassess patients after substances wear off to determine whether they meet criteria for admission to inpatient psychiatry, though psychiatric assessments are limited by geographic constraints. The admitting psychiatry team will reassess the patient to differentiate substance-induced psychosis vs other psychoses; often this includes obtaining collateral. Helpful notes from the ED include: medications administered or restraints placed (can help extrapolate a patient's level of agitation), vital signs, prior records.  Some people will be more open about suicidality while intoxicated and less open about it while sober so it is important to obtain additional information for corroboration.  On average, patients stay in the detox unit for 3-4 days, though some may stay longer for protracted substance-induced psychosis if they have a long-standing history of daily substance use.  It is important to discharge patients with quick follow-up and potential placement into the various mental health programs including partial hospitalization, residential, or outpatient programs. Emergency rooms can improve by taking psychiatric patients seriously, especially when they are transferred to the hospital from a psychiatric facility for medical management.  Repeat visits stem partially from the ambivalence that accompanies substance use disorders, including patients' difficulty in giving up the substance due the purpose it may serve in their lives.  Many substance use disorder programs are siloed from the medical system, which pose a challenge to interdisciplinary communication. 

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers perinatal psychiatry with Dr. Tuong Vi Nguyen, Assistant Professor, Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University and Scientist, RI-MUHC, Brain Repair and Integrative Neuroscience (BRaIN) Program, Centre for Outcomes Research and Evaluation.    The learning objectives for this episode are as follows:   By the end of this episode, you should be able to… Define the field of reproductive psychiatry Discuss the possible neurobiological pathways impacting mood and cognition during the reproductive cycle of women.  Discuss the influence of sociocultural gender roles on psychopathology.    List the DSM-V diagnostic criteria of premenstrual dysphoric disorder. Recall the epidemiology of premenstrual dysphoric disorder. Describe the steps in the diagnostic evaluation for premenstrual dysphoric disorder. List lifestyle and psychopharmacologic interventions for premenstrual dysphoric disorder. Discuss common mental health concerns during the perimenopausal period. Guest: Dr. Tuong Vi Nguyen   Hosts: Nima Nahiddi (PGY4), Audrey Le (PGY1), and Arielle Geist (PGY2)    Audio editing by: Audrey Le   Show notes by: Arielle Geist    Interview content: Introduction - 00:00 Learning objectives - 01:00 Defining the field of perinatal psychiatry - 01:50 Discussing neurobiological pathways impacting mood and cognition during the reproductive cycle - 02:47 The influence of sociocultural gender roles on psychopathology -05:28 DSM-V criteria of premenstrual dysphoric disorder - 11:18 Epidemiology of premenstrual dysphoric disorder - 13:40 Diagnostic evaluation of premenstrual dysphoric disorder - 14:38 Management of premenstrual dysphoric disorder  Pharmacologic - 17:45 Lifestyle - 24:15 Perimenopausal period - 24:45 Closing comments - 31:39   Resources: Brzezinski, A., Brzezinski-Sinai, N.A., & Seeman, M.V. (2017). Treating schizophrenia during menopause. Menopause, 24(5), 582-588. doi: 10.1097/GME.0000000000000772. Epperson, C.N., Steiner, M., Hartlage, A., Eriksson, E., Schmidt, P.J., Jones, I., & Yonkers, K.A. (2012). Premenstrual dysphoric disorder: evidence for a new category for DSM-5. The American Journal of Psychiatry, 169(5), 465-475. DOI: 10.1176/appi.ajp.2012.11081302 Marsh, W.K., Gershenson, B., & Rothschild, A.J. (2015). Symptom severity of bipolar disorder during the menopausal transition. International Journal of Bipolar Disorders, 3(1), 35. DOI: 10.1186/s40345-015-0035-z Soares, C.N., Almeida, O.P.,  Joffe, H., & Cohen, L.S. (2001). Efficacy of estradiol for the treatment of depressive disorders in perimenopausal women a double-blind, randomized, placebo-controlled trial. Archives of General Psychiatry, 58(6), 529-534. doi:10.1001/archpsyc.58.6.529 Weber, M.T., Maki, P.M., & McDermott, M.P. (2013). Cognition and mood in perimenopause: A systematic review and meta-analysis. The Journal of Steroid Biochemistry and Molecular Biology, 142, 90-98. https://doi.org/10.1016/j.jsbmb.2013.06.001   References: Kornstein S.G., & Clayton, A.H. (2004). Sex differenes in neuroendocrine and neurotransmitter systems. In Women's mental health: A comprehensive textbook (pp.3-30). Guilford Press.  Chrisler, J. C., & Johnston-Robledo, I. (2002). Raging hormones?: Feminist perspectives on premenstrual syndrome and postpartum depression. In M. Ballou & L. S. Brown (Eds.), Rethinking mental health and disorder: Feminist perspectives (pp. 174–197). Guilford Press. American Psychiatric Association. (2013). Depressive disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596.   CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.   For more PsychEd, follow us on Twitter (@psychedpodcast), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at psychedpodcast@gmail.com. For more information, visit our website at psychedpodcast.org.