Podcasts about Warfarin

Thank you for joining us for our 2nd Cabral HouseCall of the weekend! I'm looking forward to sharing with you some of our community's questions that have come in over the past few weeks…   Kay: Hi Dr. Cabral, About a year ago, before I discovered you and your podcasts, my husband and I invested in a $4000 Tempurpedic mattress. I know that memory foam is generally synthetic and was wondering if you have recommendations to reduce any toxic effects? The instructions when we first received the mattress were to allow it to "air out" for a day, which we did. We now also sleep with an air filter in our bedroom. Any other suggestions or comments about Tempurpedic or memory foam mattresses in general? Thank you.                                                                                                                          Anonymous: Hi, this has been happening for a while & I am wondering what it means. When I wake up the inside of my nose stigns quite a lot. Sometimes it also happens during the day or it lasts throughout the day but mostly it's the worst as soon as I wake up. It's really annoying and then I usually rub my nose on the outside a lot until it subsides but it's so weird and I have no idea what it means. Please help!                                                                                                                                Lindsay: Hi Dr Cabral, I looked over your information already given on acid reflex. I have two questions. What are the long term effects of omeprazole. What is a natural alternative? Thank you, Lindsay                                                                               Anonymous: Hello Dr. C, I hope you're doing well. I wanted to reach out regarding an issue I've been experiencing. I have noticed an increase in heart rate after consuming alcohol. I never had any issues with occasional drinking prior. However, since having my first child and taking nearly two years off from alcohol, I now experience a racing heart whenever I drink. I've tried staying well-hydrated beforehand, but the issue persists. I have done a FM detox + Parasite detox in this 2 year period as well. I'm curious to hear your thoughts on what might be causing this change, especially since it wasn't a problem in the past. Could it be a histamine issue or an overflowing rain barrel still?                                       Jennifer: Thank you for all you do, Dr. Cabral! Your energy and drive inspire me! My Dad has to take Warfarin to thin his blood. What may be root causes for thickening of the blood? Where do I start?   Thank you for tuning into this weekend's Cabral HouseCalls and be sure to check back tomorrow for our Mindset & Motivation Monday show to get your week started off right! - - - Show Notes and Resources: StephenCabral.com/3341 - - - Get a FREE Copy of Dr. Cabral's Book: The Rain Barrel Effect - - - Join the Community & Get Your Questions Answered: CabralSupportGroup.com - - - Dr. Cabral's Most Popular At-Home Lab Tests: > Complete Minerals & Metals Test (Test for mineral imbalances & heavy metal toxicity) - - - > Complete Candida, Metabolic & Vitamins Test (Test for 75 biomarkers including yeast & bacterial gut overgrowth, as well as vitamin levels) - - - > Complete Stress, Mood & Metabolism Test (Discover your complete thyroid, adrenal, hormone, vitamin D & insulin levels) - - - > Complete Food Sensitivity Test (Find out your hidden food sensitivities) - - - > Complete Omega-3 & Inflammation Test (Discover your levels of inflammation related to your omega-6 to omega-3 levels) - - - Get Your Question Answered On An Upcoming HouseCall: StephenCabral.com/askcabral - - - Would You Take 30 Seconds To Rate & Review The Cabral Concept? The best way to help me spread our mission of true natural health is to pass on the good word, and I read and appreciate every review!  

As we work our way through the alphabet from A to Z in my drug pronunciation series, we're on the letter “J.” I wanted to pick a popular generic drug name that starts with “J” for today's episode. It turns out that the letter “J” should be avoided in naming generic drugs, according to the United States Adopted Names Council. Therefore, there are very few generic drug names that start with the letter “J.” Instead, I chose a brand-name drug that starts with “J.”   Thank you for listening to episode 320 of The Pharmacist's Voice ® Podcast. The FULL show notes (including all links) are on https://www.thepharmacistsvoice.com/podcast.  Select episode 320.    If you know someone who would like to learn how to say Jantoven or warfarin, please share this episode with them. Subscribe for all future episodes. This podcast is on all major podcast players and YouTube. Popular links are below. ⬇️   Apple Podcasts   https://apple.co/42yqXOG  Spotify  https://spoti.fi/3qAk3uY  Amazon/Audible  https://adbl.co/43tM45P YouTube https://bit.ly/43Rnrjt   Click the link below to learn about drug nomenclature rules from the United States Adopted Names Council. https://www.ama-assn.org/about/united-states-adopted-names/united-states-adopted-names-naming-guidelines    This is the 50th episode in my drug pronunciation series. In this episode, I divide warfarin and Jantoven into syllables, tell you which syllables to emphasize, and share my sources. The written pronunciations are below. Practice saying both until you master them. Repetition is the key to mastery.   Warfarin = WAR-far-in Emphasize WAR, and slur “far” and “in” together. It should sound like, “fur-in.”  Sources: The USP Dictionary Online, MedlinePlus, and my 20+ years of experience   Jantoven = JAN-to-ven Emphasize JAN. Then, say "tow" (like a tow truck) and "ven" (like eleven) Sources: Medication Guide for Jantoven on DailyMed on the NIH Website   Recommend a drug name for this series via email: kim@thepharmacistsvoice.com   ⭐️ Click the link https://bit.ly/3AHJIaF to sign up for The Pharmacist's Voice ® monthly email newsletter!    Host Background: Kim Newlove has been an Ohio pharmacist since 2001 (BS Pharm, Chem Minor). Her experience includes hospital, retail, compounding, and behavioral health. She is also an author, voice actor (medical narrator and audiobook narrator), podcast host, and consultant (audio production and podcasting).    Links from this episode  USP Dictionary Online (Subscription-based resource) USP Dictionary's pronunciation guide (Free resource, American Medical Association's website)  Warfarin on MedlinePlus (accessed March 5, 2025) https://medlineplus.gov/druginfo/meds/a682277.html  Jantoven medication guide on the DailyMed/NIH website https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=19a69a72-ac5d-45d5-a94d-a5aaecbe4730  The Pharmacist's Voice Podcast Episode 318, Pronunciation Series Episode 49 (ipratropium) The Pharmacist's Voice Podcast Episode 316, Pronunciation Series Episode 48 (hyoscyamine) The Pharmacist's Voice Podcast Episode 313, Pronunciation Series Episode 47 (guaifenesin) The Pharmacist's Voice Podcast Episode 311, Pronunciation Series Episode 46 (fluticasone) The Pharmacist's Voice Podcast Episode 309, Pronunciation Series Episode 45 (empagliflozin) The Pharmacist's Voice Podcast Episode 307, Pronunciation Series Episode 44 (dapagliflozin) The Pharmacist's Voice Podcast Episode 304, Pronunciation Series Episode 43 (cetirizine)  The Pharmacist's Voice Podcast Episode 302, Pronunciation Series Episode 42 (buspirone)  The Pharmacist's Voice Podcast Episode 301, Pronunciation Series Episode 41 (azithromycin) The Pharmacist's Voice Podcast Episode 298, Pronunciation Series Episode 40 (umeclidinium) The Pharmacist's Voice Podcast Episode 296, Pronunciation Series Episode 39 (Januvia)  The Pharmacist's Voice Podcast Episode 294, Pronunciation Series Episode 38 (Yasmin) The Pharmacist's Voice Podcast Episode 292, Pronunciation Series Episode 37 (Xanax, alprazolam) The Pharmacist's Voice Podcast Episode 290, Pronunciation Series Episode 36 (quetiapine)  The Pharmacist's Voice Podcast Episode 287, pronunciation series ep 35 (bupropion) The Pharmacist's Voice Podcast Episode 285, pronunciation series ep 34 (fentanyl) The Pharmacist's Voice Podcast Ep 281, Pronunciation Series Ep 33 levothyroxine (Synthroid) The Pharmacist's Voice ® Podcast Ep 278, Pronunciation Series Ep 32 ondansetron (Zofran) The Pharmacist's Voice ® Podcast Episode 276, pronunciation series episode 31 (tocilizumab-aazg) The Pharmacist's Voice ® Podcast Episode 274, pronunciation series episode 30 (citalopram and escitalopram) The Pharmacist's Voice ® Podcast Episode 272, pronunciation series episode 29 (losartan) The Pharmacist's Voice Podcast Episode 269, pronunciation series episode 28 (tirzepatide) The Pharmacist's Voice Podcast Episode 267, pronunciation series episode 27 (atorvastatin)  The Pharmacist's Voice Podcast Episode 265, pronunciation series episode 26 (omeprazole) The Pharmacist's Voice Podcast Episode 263, pronunciation series episode 25 (PDE-5 inhibitors) The Pharmacist's Voice Podcast Episode 259, pronunciation series episode 24 (ketorolac) The Pharmacist's Voice ® Podcast episode 254, pronunciation series episode 23 (Paxlovid) The Pharmacist's Voice ® Podcast episode 250, pronunciation series episode 22 (metformin/Glucophage) The Pharmacist's Voice Podcast ® episode 245, pronunciation series episode 21 (naltrexone/Vivitrol) The Pharmacist's Voice ® Podcast episode 240, pronunciation series episode 20 (levalbuterol) The Pharmacist's Voice ® Podcast episode 236, pronunciation series episode 19 (phentermine)  The Pharmacist's Voice ® Podcast episode 228, pronunciation series episode 18 (ezetimibe) The Pharmacist's Voice ® Podcast episode 219, pronunciation series episode 17 (semaglutide) The Pharmacist's Voice ® Podcast episode 215, pronunciation series episode 16 (mifepristone and misoprostol) The Pharmacist's Voice ® Podcast episode 211, pronunciation series episode 15 (Humira®) The Pharmacist's Voice ® Podcast episode 202, pronunciation series episode 14 (SMZ-TMP) The Pharmacist's Voice ® Podcast episode 198, pronunciation series episode 13 (carisoprodol) The Pharmacist's Voice ® Podcast episode 194, pronunciation series episode 12 (tianeptine) The Pharmacist's Voice ® Podcast episode 188, pronunciation series episode 11 (insulin icodec)  The Pharmacist's Voice ® Podcast episode 184, pronunciation series episode 10 (phenytoin and isotretinoin) The Pharmacist's Voice ® Podcast episode 180, pronunciation series episode 9 Apretude® (cabotegravir) The Pharmacist's Voice ® Podcast episode 177, pronunciation series episode 8 (metoprolol)  The Pharmacist's Voice ® Podcast episode 164, pronunciation series episode 7 (levetiracetam) The Pharmacist's Voice ® Podcast episode 159, pronunciation series episode 6 (talimogene laherparepvec or T-VEC)  The Pharmacist's Voice ® Podcast episode 155, pronunciation series episode 5 Trulicity® (dulaglutide)  The Pharmacist's Voice ® Podcast episode 148, pronunciation series episode 4 Besponsa® (inotuzumab ozogamicin) The Pharmacist's Voice ® Podcast episode 142, pronunciation series episode 3 Zolmitriptan and Zokinvy The Pharmacist's Voice ® Podcast episode 138, pronunciation series episode 2 Molnupiravir and Taltz The Pharmacist's Voice ® Podcast episode 134, pronunciation series episode 1 Eszopiclone and Qulipta Kim's websites and social media links: ✅ Monthly email newsletter sign-up link https://bit.ly/3AHJIaF  ✅ LinkedIn Newsletter link https://bit.ly/40VmV5B ✅ Business website https://www.thepharmacistsvoice.com ✅ Get my FREE eBook and audiobook about podcasting ✅ The Pharmacist's Voice ® Podcast https://www.thepharmacistsvoice.com/podcast ✅ Drug pronunciation course https://www.kimnewlove.com  ✅ Podcasting course https://www.kimnewlove.com/podcasting  ✅ LinkedIn https://www.linkedin.com/in/kimnewlove ✅ Facebook https://www.facebook.com/kim.newlove.96 ✅ Twitter https://twitter.com/KimNewloveVO ✅ Instagram https://www.instagram.com/kimnewlovevo/ ✅ YouTube https://www.youtube.com/channel/UCA3UyhNBi9CCqIMP8t1wRZQ ✅ ACX (Audiobook Narrator Profile) https://www.acx.com/narrator?p=A10FSORRTANJ4Z ✅ Start a podcast with the same coach who helped me get started (Dave Jackson from The School of Podcasting)! **Affiliate Link - NEW 9-8-23**      Thank you for listening to episode 320 of The Pharmacist's Voice ® Podcast.  If you know someone who would like this episode, please share it with them!

'Tis the Season! Tina and Leah delve into myrrh's historical and modern uses, including its uses for gum health, wound healing, and its role as an antiseptic. The doctors also touch on its potential anti-cancer properties, interactions with blood thinners like Warfarin, and the FDA's approval of myrrh as a food additive. The episode aims to educate listeners about the traditional and scientific aspects of myrrh while emphasizing the importance of consulting a doctor before applying any information.Maud Grieve's book, A Modern Herbal (published 1931)Interaction with the medication Warfarin/CoumadinThe Complete German Commission E Monographs (link to Amazon; we may receive a small commission at no cost to you if you purchase)Support the showOur website: https://www.thecancerpod.com Join us for live events, and more!Email us: thecancerpod@gmail.com We are @TheCancerPod on: Instagram Twitter Facebook LinkedIn THANK YOU for listening!

Discover the importance of the most neglected nutrient: magnesium! Magnesium can aid in heart attack prevention, support heart health, and improve your overall well-being. Learn more about magnesium deficiency symptoms and why magnesium is vital for cardiovascular health. DATA: https://www.ahajournals.org/doi/full/... Today I want to share some lesser-known heart health tips and how magnesium may help lower heart attack risk. Common heart problems such as plaquing, blood clots, atrial fibrillation, and hypertension are all related to magnesium deficiency. Testing for magnesium deficiency is almost impossible because only 1% is in the blood. The majority of magnesium is inside the cells. Heart medications such as calcium channel blockers, beta-blockers, Warfarin, and medications used to treat high blood pressure work using mechanisms similar to magnesium. Magnesium acts as a natural calcium channel blocker and helps regulate calcium, lower blood pressure, lower adrenaline, and relax the muscles. People deficient in magnesium often feel tired, especially after exercise. They may also experience migraine headaches. Without enough magnesium, vitamin D cannot work. Alcohol, refined sugar, starches, genetics, stress, low stomach acid, drugs, and antibiotics can interfere with the absorption of magnesium. Consuming ultra-processed foods increases your demand for magnesium and could cause you to become deficient. Many sources of magnesium, like spinach, almonds, and chocolate, are high in oxalates. Magnesium glycinate is a great choice for people looking to get more magnesium.

Let's talk about the health benefits of turmeric. One study found that curcumin was just as effective as ibuprofen at reducing pain from arthritis without side effects! It's also shown to be as effective as aspirin. Another study showed that curcumin had comparable results to Prednisone in reducing inflammation for rheumatoid arthritis, asthma, and IBS. It has also been shown to produce antidepressant effects similar to Prozac and Zoloft. Curcumin has anti-diabetic properties and effects similar to Metformin. It also has anticoagulant properties similar to aspirin and Warfarin. Research has shown that curcumin has benefits similar to statins and can help reduce LDL cholesterol and triglycerides. One study compared curcumin to 5-fluorouracil, a chemotherapy drug. Turmeric has been shown to be as effective as anti-inflammatory drugs, especially for irritable bowel disease and digestive problems. It may also help reduce blood pressure and inhibit pathogens, especially fungi. To prepare turmeric water, combine ½ teaspoon of turmeric powder, a pinch of black pepper, and half of a lemon in a glass of warm water. To prepare golden milk, combine ½ teaspoon of turmeric, ¼ teaspoon of cinnamon, and a pinch of black pepper in a cup of milk or coconut milk. Heat the mixture and remove from heat just before it comes to a boil. You can also add turmeric to a smoothie with berries and kefir. If you have a cough, try drinking a cup of hot water with a teaspoon of turmeric and a tablespoon of raw honey. DATA: https://www.ncbi.nlm.nih.gov/pmc/arti... https://pubmed.ncbi.nlm.nih.gov/10404... https://pubmed.ncbi.nlm.nih.gov/23832... https://www.ncbi.nlm.nih.gov/pmc/arti... https://www.sciencedirect.com/science... https://www.ncbi.nlm.nih.gov/pmc/arti... https://www.sciencedirect.com/science... https://pubmed.ncbi.nlm.nih.gov/17101... https://pubmed.ncbi.nlm.nih.gov/23142... https://www.ncbi.nlm.nih.gov/pmc/arti...

It's been a long time, but we are back!Apologies on the audio quality from Dr. Jenkins. Apparently he was recording from inside a cardboard box.Today we talk about important, practice changing studies in internal medicine from the last several months. What's the best anticoagulant in patients with cirrhosis and atrial fibrillation? Why do doctors use so much unfractionated heparin for acute PE? Should we still be using beta blockers in patients with acute MI? Does finerenone improve outcomes in HFpEF? Is continuous infusion of antibiotics better than intermittent? And will the cefepime vs piperacillin-tazobactam battle ever end?Apixaban, Rivaroxaban and Warfarin in Cirrhosis for AFAnticoagulation Trends for Acute PEBeta Blockers for Acute MI with Normal EF Finerenone for HFpEF FINEARTS-HFContinuous vs Intermittent Infusion of Beta-Lactams BLING IIIProlonged vs Intermittent Infusions of Beta-Lactams Meta-analysisPiperacillin-Tazobactam vs Cefepime for SepsisRecurrent SBP in Patients on Secondary Prophylaxis

飛碟聯播網《飛碟早餐 唐湘龍時間》2024.09.17 週二醫療保健單元 潘懷宗的醫學新知時間《12種不與咖啡一起服用的藥物》 大多數歐美中年人（台灣也不少）早上起床後的例行公事，就是： 如廁盥洗→喝咖啡→早餐→吞藥（白開水）→上班。只要其中同時出現「吞藥」和「喝咖啡」這兩個項目，不論其先後順序，都是本篇文章討論的範圍。所謂「一起服用」的意思是說，在藥物治療的作用期間內，不要喝咖啡，而不是僅僅不使用咖啡吞藥丸而已。 舉例來說，葡萄柚（汁）中含有「呋喃香豆素」（Furanocoumarin），會抑制小腸及肝臟中的代謝酵素（Cytochrome P-450 3A4），由於許多藥物皆需要該酵素進行代謝，若大量食入（淺嚐1~2瓣OK，果汁不行），就會造成藥物血中濃度飆高，進而增加藥物不良反應的發生機率，而且，「呋喃香豆素」抑制酵素的作用時間，可以長達數小時，甚至2~3天，所以在服用降壓藥、降血脂藥、抗心律不整藥或免疫抑制劑等藥物的整個作用期間內，都不應該吃葡萄柚（汁）。 近日，英國《每日郵報》記者（Emily Joshu）特別邀請藥劑師（Jennifer Bourgeois）詳列了12類藥物，不應該和咖啡一起服用，提醒歐美人注意。以下為醫學院藥理教授，認為相當有通識教育意義，特別加註簡化並修改些小錯誤後，供大家參考。 1. 抗憂鬱藥 根據美國CDC估計，12歲以上的美國人中有1/10以上服用抗憂鬱藥，約3,700萬人。而抗憂鬱藥有許多種類，目前最常開出的第一線藥物SSRI（選擇性血清素回收抑制劑），像是Zoloft（樂復得）、Lexapro（立普能） 和 Fluoxetine（禧濱）等的藥物，並不會和咖啡因有交互作用。只有老一代的抗憂鬱藥（目前很少使用，但並非完全不用），如三環類藥物和單胺類氧化酶抑制劑 （MAOIs），才需要小心，它們會阻止身體正常代謝咖啡因，可能導致血壓升高，造成不良反應。一般情況下，咖啡因會以尿液形式經由腎臟排出，然而，這些藥物會中斷這個過程，使咖啡因在體內停留更久，這就會導致持續的高心跳和高血壓，這類藥物是：Fluvoxamine（氟伏沙明）、Phenelzine（苯乙肼）、Tranycypromine （反苯環丙胺） 等等。 2. 不需醫生處方的綜合感冒藥和鼻塞藥 有將近3/4的美國成年人使用非處方感冒藥和過敏藥來緩解症狀。其中許多含有興奮劑--「偽麻黃鹼」（Pseudoephedrine），它可以讓血管收縮，減少鼻黏膜的腫脹和充血，緩解鼻塞。然而，偽麻黃鹼同樣會刺激大腦中負責「戰鬥或逃跑」的警覺性神經細胞，如果與咖啡一起服用，會加劇這項效果，讓你覺得緊張和焦慮。市面上許多綜合感冒藥（含治鼻塞）或是專門治療鼻塞（Sudafed/速達菲）的藥物裡面，都含有偽麻黃鹼，大家應該詳細檢視成分，在服藥治療期間內，避免喝咖啡。若真的忍不住，服藥前4小時或服藥後2小時，才喝咖啡。 3. 糖尿病藥物 約2000萬的美國人有糖尿病，服用「庫魯化」（Metformin）藥物，甚至有200萬病患（1/10）使用胰島素，這都是想要維持血糖在標準範圍內。雖然糖尿病藥物並不會與咖啡因產生直接的交互作用，可是，當你喝咖啡時，就會增高血糖值，讓你的藥物療效降低，不利於病情，尤其是如果裡面又含有奶油和糖的話。根據美國糖尿病協會的研究，飲用任何含咖啡因的飲料都會增加血糖值。因此，量測您的血糖值，以確定您是否可以在服藥時喝咖啡。 4. 抗生素 抗生素用於治療細菌感染，根據美國CDC估計，每年約有2.3億次的感染事件，相當多。有些抗生素會抑制咖啡因的代謝，導致血中咖啡因的濃度增加。例如： 速博新（Ciprofloxacin），通常用於治療泌尿道感染、膀胱感染、感染性腹瀉和鼻竇感染，若與咖啡一起服用，就可能會導致心跳加速和感到緊張（feeling jittery）。 5. 抗凝血劑 約800萬的美國人需使用抗凝血劑來預防血栓，根據克利夫蘭診所統計，華法林（Warfarin）是歷史最久，最常開出的抗凝血劑，約占美國全部抗凝血劑處方中的1/4（也就是200萬人）。若與咖啡一起服用，可能會導致出血過多的事件，因為咖啡因會抑制華法林的分解，使藥物在體內的濃度升高，就算只是被紙割到等的輕傷，都可能會導致過度出血。不過，新一代的抗凝血劑「艾必克」（Eliuis），已經不會和咖啡因引起這些交互作用了，請認明你所吃的是哪一種抗凝血劑。若真的非喝不可，吞藥後至少要等6~8個小時。 6. 降壓藥 美國藥學院協會估計，每年有1.17億張降壓藥的處方籤，開給2,600萬的美國人，包括： 紓壓寧、康肯、達利全（β-Blockers）等藥物。這些藥物希望能降低血壓並阻止腎上腺素的作用，以便改善血液流動，並降低心跳，讓心臟不必那麼辛苦地工作。但當你喝咖啡或任何含咖啡因的飲料時，它就會加快你的心跳並升高血壓，這雖然不是直接的藥物交互作用，但更像是在對抗降壓藥的療效，相當不明智，不合邏輯，因此不應該和咖啡一起服用。若真的非喝不可，服藥前4小時或服藥後2小時，方可淺嚐一杯。 7. 甲狀腺功能低下藥物 治療甲狀腺功能低下會使用「左旋甲狀腺素」（Levothyroxine），甲狀腺功能減退症是美國處方最多的藥物之一，每年總共有2300萬張處方簽。然而，這類藥物若與任何食物或咖啡一起服用，會降低藥物吸收率達50% 之多，因此，服用左旋甲狀腺素的人應該是在飯前，空腹用白開水服藥，等30~60分鐘後，才可以進食或喝含咖啡因的飲料。 8. 阿茲海默症藥物 目前每10個65歲以上的美國成年人中就有一個被診斷出患有阿茲海默症，這是最常見的失智症。治療這種疾病症狀的藥物稱為「膽鹼酯酶抑制劑」，像是「愛憶欣」（Donepezil）和「憶思能」（Rivastigmine），可以防止乙醯膽鹼的分解，乙醯膽鹼是一種有助於記憶形成和思考的神經化學物質。若與咖啡一起服用時，咖啡因會收緊血腦屏障，使得藥物更難進入大腦，產生療效。非喝不可時，應該選在吞藥前四小時或吞藥後兩小時。 9. 骨質疏鬆症藥物 骨質疏鬆症是骨骼隨著時間的推移而變得脆弱或易斷的疾病，據美國CDC估計，有1000萬50歲以上的美國人患有此病，嚴重時，即使連咳嗽等輕微的壓力也會導致肋骨骨折，醫學界目前使用雙磷酸鹽類藥物，例如： 「安妥良」（Risedronate）和「骨維壯」（Ibandronate），來抑制蝕骨細胞，減緩骨質破壞，若與咖啡一起服用時，會導致它們無法被身體正常吸收，從而降低療效，建議吞藥後等待大約兩個小時才能喝咖啡。此類藥每月口服一次，服藥當日早上起床後，第一餐前空腹，保持上半身直立姿勢以一整杯冷開水（約 200 cc）整粒吞下（勿嚼碎或吸吮），服藥後半小時內不得躺下，不要進食。 10. 氣喘藥物 在美國，近2500萬人患有氣喘，支氣管擴張劑是用來放鬆和擴張氣道的處方藥。然而，若將「胺非林錠」（Aminophylline）和「喘克」（Theophylline）等支氣管擴張劑與咖啡一起服用，就會加劇藥物副作用，像是： 煩躁和不安，特別是剛剛開始使用這類藥物的病患，因為每個病人的反應不盡相同。您可以自行小心觀察，建議在服用這些藥物之前或之後四個小時，才喝咖啡。 11. 過動症藥物 根據CDC的數據，接近但不到1/10的17歲以下美國孩童被診斷出患有過動症，約4,100萬張處方簽被開出。過動症藥物像是： 阿德拉爾（Adderall）和利他能（Ritalin）等，可以強化腦中多巴胺和正腎上腺素等的神經傳導訊號，以改善注意力、專注力和控制衝動。然而，若與咖啡一起服用，會降低療效，產生過動，原因是咖啡因屬於中樞興奮劑，會興奮神經細胞，應該避免。 12. 抗思覺失調症狀的藥物 根據克利夫蘭診所數據，大約有400萬美國人正在服用抗思覺失調症狀的藥物，例如： 「可致律」（Clozapine）、「理思必妥」（Risperidone）和「金菩薩」（Olanzapine）等，這些藥物通常用於治療《思覺失調症》和《雙相情感障礙症》等疾病所特有的思覺失調症狀，期望透過調節多巴胺和血清素等神經傳導物質來減輕思想上和視覺上的兩項幻覺，由於咖啡因會增加藥物血中含量，所以應該遠離咖啡才是。 原文網址：https://www.chinatimes.com/opinion/20240905002864-262110?chdtv ▶ 《飛碟早餐》FB粉絲團 https://www.facebook.com/ufobreakfast/ ▶ 飛碟聯播網FB粉絲團 https://www.facebook.com/ufonetwork921/ ▶ 網路線上收聽 http://www.uforadio.com.tw ▶ 飛碟APP，讓你收聽零距離 IOS：https://reurl.cc/3jYQMV Android：https://reurl.cc/5GpNbR ▶ 飛碟Podcast SoundOn : https://bit.ly/30Ia8Ti Apple Podcasts : https://apple.co/3jFpP6x Spotify : https://spoti.fi/2CPzneD Google 播客：https://bit.ly/3gCTb3G KKBOX：https://reurl.cc/MZR0K4 -- Hosting provided by SoundOn

In this podcast recorded in early August, James Cave (Editor-in-Chief) and David Phizackerley (Deputy Editor) talk about the September issue of DTB. They discuss the editorial (https://dtb.bmj.com/content/62/9/130) that highlights some of the challenges associated with NHS England's national medicines optimisation measures for Integrated Care Boards. They talk about the MHRA's recent safety alert on the risk of an interaction between tramadol and warfarin (https://dtb.bmj.com/content/62/9/131), which was prompted by a coroner's prevention of future deaths report (summarised in a DTB article in March https://dtb.bmj.com/content/62/3/36). The main article reviews the evidence for icosapent ethyl for cardiovascular risk reduction (https://dtb.bmj.com/content/62/9/135).   Please subscribe to the DTB podcast to get episodes automatically downloaded to your mobile device and computer. Also, please consider leaving us a review or a comment on the DTB Podcast iTunes podcast page. If you want to contact us please email dtb@bmj.com. Thank you for listening.

It is now uncommon to see warfarin therapy initiated for stroke prevention. However, quality patient care is never a “one-size-fits-all” approach.  New evidence from the FRAIL-AF trial suggests that some of our most vulnerable older adults might be better off maintained on a vitamin K antagonist rather than (automatically) switched to a direct oral anticoagulation (DOAC).   Guest Author:  Matthew Cantrell, PharmD, BCPS Music by Good Talk

DISCLAMER >>>>>>    The Ditch Lab Coat podcast serves solely for general informational purposes and does not serve as a substitute for professional medical services such as medicine or nursing. It does not establish a doctor/patient relationship, and the use of information from the podcast or linked materials is at the user's own risk. The content does not aim to replace professional medical advice, diagnosis, or treatment, and users should promptly seek guidance from healthcare professionals for any medical conditions.   >>>>>> The expressed opinions belong solely to the hosts and guests, and they do not necessarily reflect the views or opinions of the Hospitals, Clinics, Universities, or any other organization associated with the host or guests.       Disclosures: Ditch The Lab Coat podcast is produced by (Podkind.co) and is independent of Dr. Bonta's teaching and research roles at McMaster University, Temerty Faculty of Medicine and Queens University. Welcome back to "Ditch the Lab Coat," the podcast where we explore the fascinating world of health and medicine with a skeptical eye. I'm Dr. Mark Bonta and In today's episode, Dr. Kaplovitch dives deep into the different types of blood clots and the importance of personalized treatment. He explains that not all blood clots are created equal - some predominantly affect the veins, while others can travel to the lungs and become life-threatening. We discuss the various risk factors that can lead to blood clot formation, from genetic conditions to long plane rides, and Dr. Kaplovitch offers practical advice on managing this complex disorder.We also touch on the fascinating history behind some blood thinning medications, like warfarin, which was originally used as rat poison! Dr. Kaplovitch clarifies the distinctions between its toxic properties and medical use. Throughout our conversation, we emphasize the importance of transparently counseling patients about the risks and benefits of different treatments. Dr. Kaplovitch highlights the abundance of research in the field of thrombosis and how it informs the personalized approach he takes with his patients.So join us as we simplify these complex medical concepts and explore the latest advancements in blood clot prevention and treatment. As always, remember that this podcast is for informational purposes only and does not substitute for professional medical advice. Let's ditch the lab coat and dive in!04:24 Experienced medical student impresses with professionalism.09:02 Blood clots can travel to lungs, fatal.12:14 Prolonged sitting at desk may increase thrombosis risk.16:01 Minority with blood clots can improve naturally.18:45 Clot busters have significant risk of bleeding.20:59 Treatment options for preventing blood clot complications.25:39 Passion for vascular medicine, citing primary literature.29:26 Newer blood thinners may have advantages.31:37 Warfarin inhibits clotting by blocking vitamin K.36:09 Balancing blood thinness for health benefits is crucial.37:22 Maintain optimal blood thinness to prevent risks.42:22 Minor bleeding from gut might not require action.46:27 Consistent blood thinner use is crucial.50:05 Discussing evolving thrombosis practices, specifically genetic testing controversies.51:24 Testing for clotting disorders requires informed discussion.57:02 Advancements in personalized medicine revolutionize treatment.58:45 Hip hop slang reference and deep thrombosis.

In this podcast recorded in early July, James Cave (Editor-in-Chief) and David Phizackerley (Deputy Editor) continue to ignore political and sporting events and talk about the August issue of DTB. They discuss the editorial that highlights the growth in the use of psychotropic medication in children and young people and some of the challenges associated with this trend. They talk about a study that assessed the harms of changing frail older people with AF from warfarin to a DOAC. The main article is an overview of the evidence for fezolinetant for the treatment of menopausal vasomotor symptoms.

Send us a Text Message. Join Dr. Michael Koren as he and Brad Mahlof continue their engaging and informative conversation on healthy eating. In this episode, Brad shares his insights and tips on cooking delicious, healthy meals while navigating dietary restrictions. From managing vitamin K intake for patients on Warfarin to creating low-sodium and gluten-free dishes, Brad offers practical advice for maintaining a nutritious diet without sacrificing flavor. Learn about the benefits of spices like turmeric, garlic, and omega fatty acids, the importance of meal prep, and strategies for cooking for people with specific medical conditions. Whether you're a food enthusiast or someone looking to improve your health, this episode provides valuable knowledge and inspiration for healthier eating. Tune in to discover how you can make your meals tasty and health-conscious. Talking Topics:Managing Dietary restrictions with Creativity and FlavorPractical Advice for Healthy Meal PrepIncorporating Beneficial Ingredients for Overall HealthConnect with Brad on Instagram or his website.Part 1: Healthy Oils & Fresh Fish - Release Date: June 26, 2024Part 2: Healthy Eating for Your Health Risk - Release Date: July 3, 2024Recording Date: May 23, 2024Be a part of advancing science by participating in clinical researchShare with a friend. Rate, Review, and Subscribe to the MedEvidence! podcast to be notified when new episodes are released.Follow us on Social Media:FacebookInstagramTwitterLinkedInWant to learn more checkout our entire library of podcasts, videos, articles and presentations at www.MedEvidence.com Powered by ENCORE Research GroupMusic: Storyblocks - Corporate InspiredThank you for listening!

In this video, we'll discuss some of ginger's health benefits and when it may not be an appropriate remedy. For thousands of years, ginger has been used as a powerful remedy for many conditions. Some of the amazing benefits of ginger include: • Antimicrobial properties • Anti-inflammatory properties • Anti-diabetic properties • Anti-cancer properties • Helping with menstrual pain • Helping with arthritis • Increasing HDL • Improving heartburn One of the most well-known uses of ginger is its ability to relieve nausea. Ginger can help with nausea associated with chemotherapy, pregnancy, menstruation, and surgery. Ginger has some contraindications, so it may not always be the best remedy for you. Don't take ginger if you're on Warfarin or other blood thinners like aspirin. Ginger helps thin the blood, so you also won't want to take it if you have a bleeding disorder. Ginger inhibits insulin, so don't take it if you're on insulin. Ginger can lower blood pressure, so avoid it if you're taking blood pressure medication. Ginger also stimulates the gallbladder, so don't consume it if you have gallstones. DATA: https://www.ncbi.nlm.nih.gov/pmc/arti... https://www.ncbi.nlm.nih.gov/books/NB...

Dr. Ellen Uppuluri provides perspective on anticoagulation management in postpartum women based on a case report and the research surrounding it. Full text of the manuscript is available at: https://accpjournals.onlinelibrary.wiley.com/doi/10.1002/phar.2917.

Today's sponsor of the Top 10 Anticoagulant Drug Interactions podcast is FreedAI. Freed listens, transcribes, and writes medical documentation for you. FreedAI is offering a discount exclusive to RLP listeners! Users will get $50 off their first month with Freed! Use the discount code: RLPPOD Apixaban is one of the most commonly used anticoagulants and there are some drug interactions you need to be aware of. Take a listen and find out! Warfarin concentrations can substantially be elevated by drugs that inhibit CYP2C9. I cover a few of them in my top 10 anticoagulant drug interactions.

Contributor: Travis Barlock MD Educational Pearls: Thrombolytic therapy (tPA or TNK) is often used in the ED for strokes Use of anticoagulants with INR > 1.7 or  PT >15 Warfarin will reliably increase the INR Current use of Direct thrombin inhibitor or Factor Xa inhibitor  aPTT/PT/INR are insufficient to assess the degree of anticoagulant effect of Factor Xa inhibitors like apixaban (Eliquis) and rivaroxaban (Xarelto)  Intracranial or intraspinal surgery in the last 3 months Intracranial neoplasms or arteriovenous malformations also increase the risk of bleeding Current intracranial or subarachnoid hemorrhage History of intracranial hemorrhage from thrombolytic therapy also contraindicates tPA/TNK Recent (within 21 days) or active gastrointestinal bleed Hypertension BP >185 systolic or >110 diastolic Administer labetalol before thrombolytics to lower blood pressure Timing of symptoms Onset > 4.5 hours contraindicates tPA Platelet count < 100,000 BGL < 50 Potential alternative explanation for stroke-like symptoms obviating need for thrombolytics References 1. Fugate JE, Rabinstein AA. Absolute and Relative Contraindications to IV rt-PA for Acute Ischemic Stroke. The Neurohospitalist. 2015;5(3):110-121. doi:10.1177/1941874415578532 2. Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the Early Management of Patients with Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke a Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association. Vol 50.; 2019. doi:10.1161/STR.0000000000000211 Summarized by Jorge Chalit, OMSII | Edited by Jorge Chalit

Show notes at pharmacyjoe.com/episode912. In this episode, I’ll discuss whether standard doses of apixaban are as effective as warfarin in severe obesity. The post 912: Are Standard Doses of Apixaban as Effective as Warfarin in Patients With Severe Obesity? appeared first on Pharmacy Joe.

Show notes at pharmacyjoe.com/episode912. In this episode, I’ll discuss whether standard doses of apixaban are as effective as warfarin in severe obesity. The post 912: Are Standard Doses of Apixaban as Effective as Warfarin in Patients With Severe Obesity? appeared first on Pharmacy Joe.

For this topic, we will be discussing the importance of anticoagulant therapy, what it is, what to avoid, what to watch for, and what to report.

Dr. Mike Olson, former EM PA and now ENT attending sits down to talk about epistaxis with Alex and Venk. We go through a pragmatic approach to epistaxis, discuss some nuance cases including telangiectasia, hypertension, and anticoagulation.  interventions are key, what patients are most likely to suffer a bad outcome and more. CONTACTS X - @AlwaysOnEM; @VenkBellamkonda YouTube - @AlwaysOnEM; @VenkBellamkonda Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch Email - AlwaysOnEM@gmail.com REFERENCES & LINKS Ingason AB, et al. Warfarin is associated with higher rates of epistaxis compared to direct oral anticoagulants: a nationwide propensity score-weighted study. J Intern Med. 2022 Sep;292(3):501-511 Thomg JF, et al. A prospective comparative study to examine the effects of oral diazepam on blood pressure and anxiety levels in patients with acute epistaxis. Journal of Laryng & Otol. 2007. (121)124-129 Terakura M et al. Relationship between blood pressure and persistent epistaxis at the emergency department: a retrospective study. J Am Soc Hypertens. 2012 Jul(4):291-295 Lee CJ, et al. Evaluation of the relationship between blood pressure control and epistaxis resource after achieving effective hemostasis in the emergency department. J Acute Med. 2020 mar 1;10(1)27-39  

In this podcast recorded in early February, James Cave (Editor-in-Chief) and David Phizackerley (Deputy Editor) talk about the March 2024 issue of DTB. They discuss the editorial highlighting the important work that the founders of The Medical Letter, Worst Pills, Best Pills and Drug and Therapeutics Bulletin did to scrutinise the safety of medicines and the need to challenge the processes by which medicines are licensed, appraised, commissioned and promoted. They review a coroner's Prevention of Future Deaths report that highlighted an interaction between tramadol and warfarin. They also talk about a study that compared the emergency contraceptive efficacy of levonorgestrel plus piroxicam with levonorgestrel plus placebo. The main article considers the effectiveness of low or very low calorie diets in achieving remission of type 2 diabetes.   Link Mathew R. Prescribing isn't a single act—getting it right requires time and effort. BMJ 2024;384:q279 (https://www.bmj.com/content/384/bmj.q279) Please subscribe to the DTB podcast to get episodes automatically downloaded to your mobile device and computer. Also, please consider leaving us a review or a comment on the DTB Podcast iTunes podcast page (https://podcasts.apple.com/gb/podcast/dtb-podcast/id307773309). If you want to contact us please email dtb@bmj.com. Thank you for listening.

On this episode of the Real Life Pharmacology podcast, I take a dive into the most common mechanisms of drug interactions. Below I list some of the common drug interactions seen in practice and how they work! Opposing Effects Many drugs will work on various receptors throughout the body. To use as an educational point, there is no better example to point to than the beta receptor. Beta-blockers are frequently used in clinical practice for their ability to lower blood pressure and slow the heart rate. Both of these beneficial actions are primarily achieved by blocking the effects of beta-1 receptors. Some beta-blockers have action on alternative beta receptors. Propranolol is one such beta-blocker that is classified as a non-selective beta-blockers. This means that in addition to the positive effects on beta-1 receptors, it can also have blocking effects on beta-2 receptors. The blockade of the beta-2 receptor by propranolol can also be life-changing. It can directly oppose beta-2 agonists like albuterol from having their beneficial effects of opening up the airway. Enzyme Inhibition Medication metabolism is arguably the largest and most clinically significant source for drug interactions. Medications that are primarily metabolized by enzymes in the liver can be greatly affected if we affect how those enzymes work. CYP3A4 is one of the most well studied and well-known enzymes that can impact hundreds to maybe even thousands of drugs. Apixaban is an oral anticoagulant that is broken down at least in part by CYP3A4. By using a CYP3A4 inhibitor like erythromycin, there is the potential to raise concentrations of apixaban. This could lead to a higher risk of bleeding. Enzyme Induction Carbamazepine is a drug that you must know. This drug is a potent enzyme inducer. This differs significantly from an enzyme inhibitor and will have the exact opposite clinical effect. Drugs that are inactivated by liver enzymes will be inactivated more quickly in a patient taking an enzyme inducer. Going back to our prior apixaban example above, carbamazepine can induce CYP3A4 and facilitate a more efficient and swifter breakdown of the drug. Bleeding will be less likely. The risk for treatment failure, usually in the form of a blot clot, will be more likely.  Here's more information from the past on carbamazepine. Alteration in Absorption Binding interactions can be consequential and are one of the most common types of drug interactions. Many medications have the potential to bind one another in the gut. This can lead to lower concentrations of a specific medication. Calcium and iron are two of the most common examples of medications that can bind other drugs. Alteration in Protein Binding By remembering that unbound drug is an active drug, you should appreciate the risk for protein binding alterations. A significant number of medications can bind proteins in the bloodstream. As this occurs, that drug is not freely available to create physiologic effects. When another medication is added that can also bind these proteins, this can displace other medications and increase the quantity of free drug in the bloodstream. This essentially allows for enhanced physiologic effects. Warfarin is a medication that is highly protein-bound. When another drug is added that can kick warfarin off of those protein binding sites, it can free up warfarin which will increase the likelihood of elevating the patient's INR and increase their bleed risk. Alteration in Renal Elimination Some drugs can alter the way other medications are eliminated through the kidney. Chlorthalidone, like all thiazide diuretics, has the potential to block the excretion of lithium from the kidney. This can lead to lithium toxicity. This type of interaction, while significant, is much less common than drug interactions involve the liver and CYP enzyme pathways.   Effects on Transporters One of the last types of drug interactions is the effe...

On this podcast episode, I discuss fenofibrate pharmacology, adverse effects, kinetics, drug interactions, and much more! Fenofibrate is typically only used for hypertriglyceridemia. The primary risk of hypertriglyceridemia is pancreatitis so we treat these levels because of this risk. LFTs elevation has been associated with fenofibrate use as well as myopathy. In the presence of myopathy, checking CPK may be considered. Fenofibrate is a weak CYP2C9 inhibitor. Warfarin and phenytoin are two important medications that may be affected by the use of fenofibrate.

Gain an understanding of the barriers and facilitators to warfarin patient self management in US. Full text available open access at: https://accpjournals.onlinelibrary.wiley.com/doi/10.1002/jac5.1879.

In this week's episode we delve into the world of cardiac catheterization and speak with Assistant Professor of Pediatrics at USC, Dr. Neil Patel about a recent work he co-authored at Children's LA about continuation of anti-coagulation during catheterization. Does AC have to be stopped to safely perform a catheterization? Are there certain cases or patients in whom the risk may be especially high? What about NOACs or DOACs? When should closure devices be considered? These are amongst the questions posed to Dr. Patel this week.DOI: 10.1007/s00246-023-03097-x

Welcome to my podcast. I am Doctor Warrick Bishop, and I want to help you to live as well as possible for as long as possible. I'm a practising cardiologist, best-selling author, keynote speaker, and the creator of The Healthy Heart Network. I have over 20 years as a specialist cardiologist and a private practice of over 10,000 patients. The episode discusses common cardiac drugs and some potential drug interactions. It covers aspirin, warfarin, clopidogrel, proton pump inhibitors, beta blockers, ACE inhibitors, digoxin, nitrates, and amiodarone. Notably, grapefruit can increase serum levels of beta blockers, calcium channel blockers, and some statins, potentially leading to toxicity. Warfarin's effects can be altered by foods high in vitamin K like leafy greens. Clopidogrel's effectiveness may be reduced when taken with proton pump inhibitors like omeprazole. Combining nitrates with phosphodiesterase inhibitors like sildenafil can cause profound blood pressure drops. The host recommends being aware of possible drug interactions and maintaining regular communication with doctors.

Which of the following educational advisories is MOST warranted for a patient taking warfarin (Coumadin) following a total knee arthroplasty? Find it all out in the podcast!  Be prepared for the NPTE so that you can pass with flying colors! Check out www.ptfinalexam.com/podcast for more information and to stay up-to-date with our latest courses and projects.

Commentary by Dr Sharath Kumar

Cancer inherently increases the risk of Deep Vein Thrombosis and Pumlmonary Embolism. This is merely a nuisance for some, while others experience significant morbidity, leading to hemodynamic instability and potential death. Historically known as "the great masquerader" with pulmonary embolisms, we explore signs, symptoms, and different approaches to treatment. Warfarin remains the original and is still an option for patients, but have better therapies emerged like direct oral anticoagulants (DOACs)? The short answer is yes, but tune in as we dive again into systematic reviews and give you a summarised version of everything you should know.Useful Links:Statpearls DVT: https://www.ncbi.nlm.nih.gov/books/NBK507708/Anticoagulation for thrombus in malignancy: https://www.uptodate.com/contents/anticoagulation-therapy-for-venous-thromboembolism-lower-extremity-venous-thrombosis-and-pulmonary-embolism-in-adult-patients-with-malignancy?search=cancer%20induced%20DVT&source=search_result&selectedTitle=4~150&usage_type=default&display_rank=4For more episodes, resources and blog posts, visit www.inquisitiveonc.comFind us on Twitter @InquisitiveOnc!If you want us to look at a specific trial or subject, email us at inquisitiveonc@gmail.comArt courtesy of Taryn SilverMusic courtesy of Music Unlimited: https://pixabay.com/users/music_unlimited-27600023/Disclaimer: This podcast is for educational purposes only. If you are unwell, seek medical advice. Hosted on Acast. See acast.com/privacy for more information.

Title: Cardiology Grand Rounds: Lessons Learned from DOAC's and the New Factor XI Anti-thrombotic Therapies Being Studied Speaker: Manesh R. Patel, MD Chief, Division of Cardiology Co-Director, Duke Heart Center Duke Clinical Research Institute Duke University, Durham, NC Disclosures: Research Grants: PACIFIC-AF: Bayer, Janssen, Heartflow, Idorsia, NHLBI, Novartis Advisory Board/Consulting: Bayer, Janssen, Heartflow, Medscape Objectives: •Understand the Net-Benefit of Warfarin and then NOACs in AFib •Understand the use of NOACs and limitations •Understand the Factor XI therapy and promise in A. Fib

Normal 0.8 - 1.2 Therapeutic Levels of Warfarin 2.0 – 3.5 Indications Evaluate therapeutic doses of Warfarin Identify patients at higher risk for bleeding Identify cause of: Bleeding Deficiencies Description International normalized ratio(INR) takes results from a prothrombin time test and standardizes it regardless of collection method. What would cause increased levels? Disseminated Intravascular Coagulation (DIC) Liver disease Vitamin K deficiency Warfarin What would cause decreased levels? Too much vitamin K Estrogen containing medications such as birth control

In this week's podcast, Neurology Today's editor-in-chief discusses the association between gout and neurodegenerative diseases, tenecrteplase vs.warfarin for acute stroke, expedited cognitive decline after a heart attack.

Today we have a special guest, Dr. Joel Topf, board-certified nephrologist and medical educator extraordinaire. Our listeners will likely recognize Dr. Topf from his prolific tweeting @Kidney_boy, as well as his numerous appearances on the Curbsiders podcast. He is a co-founder of the NephJC on Twitter, and host and founder of the NephJC podcast Freely Filtered. He is also host of the podcast Channel Your Enthusiasm, a deep dive monthly recap of the nephrology textbook Clinical Physiology of Acid Base and Electrolyte Disorders by Dr. Burton Rose (who, incidentally, is the creator of the original UpToDate). Dr. Topf wrote his own book on fluids, electrolytes and acid-base homeostasis.  He's the co-editor for the fourth edition of Nephrology Secrets and the first edition of The Handbook of Critical Care Nephrology. Dr. Topf joined us to talk about a new paper he co-authored on osmotic demyelination syndrome and hyponatremia. I'm also joined by Dr. Mita Hoppenfeld, hospitalist at the University of Utah, to talk about a new DOAC vs warfarin trial in On-X aortic valves, whether it's better to avoid hypertension or hypotension around time of surgery, and the diagnostic accuracy of CT abdomen scans without contrast. Check it out! Osmotic Demyelination and HyponatremiaApixaban vs Warfarin for On-X Aortic ValvePerioperative Blood Pressure Strategies Diagnostic Accuracy of CT Abdomen Without ContrastMusic from Uppbeat (free for Creators!):https://uppbeat.io/t/soundroll/dopeLicense code: NP8HLP5WKGKXFW2R

This episode covers the history, mechanism of action, lab monitoring, indications, reversal and special considerations for Warfarin or otherwise known as Coumadin. One of the most common oral anticoagulants seen in critical care.    For further reading: https://emcrit.org/ibcc/coag/ https://emcrit.org/emcrit/reversal-safe-smart/ https://emcrit.org/ibcc/reverse/  

This week, please join author Xuerong Wen, Associate Editor Sandeep Das, and Guest Host Mercedes Carnethon as they discuss the article "Comparative Effectiveness and Safety of Direct Oral Anticoagulants and Warfarin in Patients With Atrial Fibrillation and Chronic Liver Disease: A Nationwide Cohort Study." Dr. Carolyn Lam: Welcome to Circulation on the Run, your weekly podcast summary and backstage pass of the journal and its editors. We're your co-hosts. I'm Dr. Carolyn Lam, associate editor from the National Heart Center and Duke National University of Singapore. Dr. Greg Hundley: And I'm Dr. Greg Hundley, associate editor, Director of the Poly Heart Center at VCU Health in Richmond, Virginia. Dr. Carolyn Lam: Greg, I'm so excited about today's feature paper. It deals with the important condition where atrial fibrillation exists in patients with chronic liver disease and what do we do for anticoagulation in these patients. It's a comparative effectiveness and safety study of direct oral anticoagulants compared with warfarin in these patients. A huge, wonderful, important study that we're going to discuss. But before we get there, I'd like to tell you about some papers in this issue and I'd like you to tell me about some too. You got your coffee? Dr. Greg Hundley: Absolutely. Dr. Carolyn Lam: All right. I'll go first In this paper that describes a quantitative prognostic tool for the mitral valve prolapse spectrum and it's derived from the new mitral regurgitation international database quantitative or MIDA-Q registry, which enrolled more than 8,000 consecutive patients from North America, Europe, Middle East. And these were patients all diagnosed with isolated mitral valve prolapse or MVP in routine clinical practice of academic centers, all of which also did prospective degenerative mitral regurgitation quantification. The MIDA-Q score was calculated based on characteristics collected in routine practice combining the established MIDA score, which integrated guideline based markers of outcomes like age, New York Heart Association status, atrial fibrillation, LA size, pulmonary artery pressure left ventricular and systolic, I mentioned, and ejection fraction. Integrating that with scoring points based on the degenerative mitral regurgitation quantitation that is measuring effective regurgitant orifice and volume. Dr. Greg Hundley: Very interesting Carolyn. So a scoring system that combines clinical information with what we might assess with echocardiography like regurgitant volume or regurgitant orifice area. So how well did this mortality risk score perform? Dr. Carolyn Lam: So the new score was associated with an extreme range of predicted survival under medical management and that ranged from 97% to 5% at five years for the extreme score ranges. And it was strongly, independently and incrementally associated with long-term survival over all the markers of outcomes. So the authors concluded, and these by the way were authors led by Dr. Maurice Serrano from Mayo Clinic, Rochester, Minnesota. These authors concluded that the score should allow integrated risk assessment of patients with mitral valve prolapse to refine clinical decision making in routine practice and ultimately reduce degenerative mitral regurgitation under treatment. Dr. Greg Hundley: Wonderful description Carolyn. Well I'm going to switch to the world of electrophysiology, Carolyn. And so as you know, the Brugada syndrome is an inherited arrhythmia syndrome caused by loss of function variants in the cardiac sodium channel gene SCN5A and that occurs in about 20% of subjects. And these authors led by Dr. Dan Roden at Vanderbilt University School of Medicine identified a family with four individuals diagnosed with Brugada syndrome, harboring a rare missense variant in the cardiac transcription factor, TBX5, but no SCN5A variant. And upon identifying these individuals, their objective was to establish TBX5 as a causative gene in Brugada syndrome and to define the underlying mechanisms by which it would be operative. Dr. Carolyn Lam: Oh wow. So a new gene variant. So what was the relationship? Dr. Greg Hundley: Right Carolyn? So using induced pluripotent stem cell derived cardiomyocytes from members of the affected family, multiple electrophysiologic abnormalities were detected in these cardiomyocytes including decreased peak and enhanced late cardiac sodium current. In these cells these abnormalities were entirely corrected by CRISPR/Cas9 mediated editing of that TBX5 variant and transcriptional profiling and functional assays in unedited and edited pluripotent stem cell derived cardiomyocytes showed direct SCN5A down regulation caused decreased peak sodium current and that reduced PDGF receptor expression and blunted signal transduction to phosphoinositide-3-kinase. And interestingly, PDGF receptor blockade markedly prolonged normal induced pluripotent stem cell derived cardiomyocyte action potentials. And also Carolyn interestingly in this study they did a separate analysis. It reviewed plasma levels of PDGF in the Framingham Heart Study and they found that they were inversely correlated with the QT corrected interval. And so Carolyn, these results established decrease SCN5A transcription by the TBX5 variant as a cause of Brugada syndrome and also reveal a new general transcriptional mechanism of arrhythmogenesis of enhanced late sodium current caused by reduced PDGF receptor mediated phosphoinositide-3-kinase signaling. Dr. Carolyn Lam: Wow. Wow, that's significant. Thanks Greg. So this next paper is also really important and could change the practice in the field of cardiac resynchronization therapy or CRT. You see, it suggests that the practice of what we do now, which is combining right bundle branch block with intraventricular conduction delay patients into a single non-left bundle branch block category when we select patients for CRT, that this may not be the way to go. So let's go back a bit and remember that benefit from CRT varies with QRS characteristics and individual trials are actually underpowered to assess the benefit for relatively small subgroups. So the current authors led by Dr. Friedman from Duke University Hospital and colleagues, therefore performed a patient level meta-analysis of randomized trials of CRT to assess the relationship between QRS duration and morphology with outcomes. Dr. Greg Hundley: Very interesting Carolyn. So another wonderful paper from the world of electrophysiology in trying to understand optimal mechanisms to resynchronize the ventricle in patients with differing bundle branch blocks or intraventricular conduction delays. So what did they find? Dr. Carolyn Lam: They found that patients with intraventricular conduction delays and a QRS duration of 150 milliseconds or more, CRT was associated with lower rates of heart failure hospitalizations and all cause mortality. The magnitude of CRT benefit among these patients with the interventricular conduction delay of 150 milliseconds or more and those with the left bundle branch block of 150 milliseconds or more were similar. In contrast, there was no clear CRT benefit for patients with a right bundle branch block of any QRS duration, although the authors could not rule out the potential for benefit at a markedly prolonged QRS duration. So they concluded that the practice of combining right bundle branch block with intraventricular conduction delay patients into a single non-left bundle branch block category when we make patient selections for CRT is not supported by the current data. And in fact, patients with an intraventricular conduction delay of 150 milliseconds or more should be offered CRT as is done for patients with a left bundle branch block of 150 milliseconds or more. Dr. Greg Hundley: Wow, Carolyn, so really interesting point. No clear CRT benefit for patients with right bundle branch block regardless of the QRS duration. Well we've got some other articles in the issue. I'll describe a couple from the mail bag. There's a Research Letter from Professor Lassen entitled "Risk of Incident Thromboembolic and Ischemic Events Following COVID-19 Vaccination Compared with SARS-COV2 Infection." Also Bridget Kuhn has a wonderful Cardiology News piece entitled "Collaborative Care Model Helps Heart Failure Patients Meet End-of-Life Goals." Dr. Carolyn Lam: There's an exchange of letters between Doctors Donzelli and Hippisley-Cox regarding that risk of myocarditis after sequential doses of COVID-19 vaccine, there's an AHA Update by Dr. Churchwell on continuous Medicaid eligibility, the lessons from the pandemic. There's an On My Mind paper by Dr. Parkhomenko on Russia's war in Ukraine and cardiovascular healthcare. Wow, what an issue. Thanks so much, Greg. Shall we go on to the feature discussion? Dr. Greg Hundley: You bet. Dr. Mercedes Carnethon: Well welcome to this episode of Circulation on the Run podcast. I'm Mercedes Carnethon, associate editor of the journal Circulation and Professor and Vice Chair of Preventive Medicine at the Northwestern University Feinberg School of Medicine. I'm very excited to be here today with Xuerong Wen and Sandeep Das, my fellow associate editor here at Circulation to talk about a wonderful piece by Dr. Wen and colleagues from the University of Rhode Island. So welcome this morning Xuerong and thank you so much for sharing your important work with us. Dr. Xuerong Wen: Thank you Dr. Carnethon. It was great meeting you all and I'm the Associate Professor of Pharmacoepidemiology and Health Outcomes at the University of Rhode Island. I'm happy to introduce my study to everyone. Dr. Mercedes Carnethon: Well thank you so much and thank you as well Sandeep for identifying this fantastic article and bringing it forth. Dr. Sandeep Das: Thanks Mercedes. It's great to be with you. Dr. Mercedes Carnethon: Great. Well let's go ahead and get into it. There's so much here to talk about. So Dr. Wen and colleagues studied the comparative effectiveness and safety of direct oral anticoagulants or DOACs and warfarin in patients with atrial fibrillation and chronic liver disease. So this is such an important topic. Can you tell us a little bit about what your study found? Dr. Xuerong Wen: So our study is a comparative effectiveness and the safety analysis using a national health administrative data from private health plans. So we compared the risk of hospitalized ischemic stroke, systemic embolism and major bleeding between DOACs and warfarin in patients with atrial fibrillation and chronic liver disease. So we also had to had compare to these primary outcomes between apixaban and rivaroxaban in the study population. So our studies show that among patients with atrial fibrillation and chronic liver disease, DOACs as a class was associated with lower risk of hospitalization of ischemic stroke and systemic embolism and major bleeding, compared with warfarin. And when compared risk outcomes between individuals apixaban has lower risks as compared to rivaroxaban. So that's our study results. Dr. Mercedes Carnethon: Well thank you so much. This seems like such an important question. We hear a lot about DOACs and some of their risks as well as their considerable benefits. I think what leaves me the most curious is why did you choose to pursue this question and in particular in patients with both atrial fibrillation and liver disease. So why was the intersection of these two particular conditions of interest to your study team? Dr. Xuerong Wen: That's a great question. So the liver actually plays a central role in both the synthesis of coagulation factors and the metabolism of anticoagulant drugs. And the clearance of the anticoagulants in liver ranges from 20% to 100% for DOACs and warfarin. So in clinical practice anticoagulation abnormalities and elevated risk of spontaneous or unprovoked venous thrombotic complications have been reported in patients with liver disease. While these patients with cirrhosis were excluded from the clinical trials of DOACs and also population based, the real world experience is very limited. So that is why we initiated this retrospective cohort study and based on the real world data in this specific population. Dr. Mercedes Carnethon: Oh, thank you so much for explaining that. I definitely learned a lot and really enjoyed reading the piece. I think it was very well organized and well written and I know that our readership will appreciate it. It obviously stood out to you as well, Sandeep. Can you tell me a little bit about why you thought that this would be an excellent piece for circulation? Dr. Sandeep Das: Yeah, absolutely. Thanks for the question. So in the broad field of what we call observational comparative effectiveness research, so basically that's using large observational data sets to try to answer important clinical questions and it's a really challenging thing to do. I mean we're all very familiar with the idea of using randomized trials to assess important clinical questions because of the structure of that design allows you to mitigate some of the effects of confounding. Here, it has to be done analytically. So what's the important factor that really drives you towards a great observational comparative effectiveness piece? So first the clinical importance. I feel a little guilty because I'm old enough to remember when warfarin was the only option available, but really as a clinician, or every patient, I really prefer DOACs over warfarin just for ease of use and lifestyle. So there's a huge sort of importance to the question. Second, the patients with chronic liver disease were excluded from the larger RCTs and the DOAC trials. So really we don't have the answer to the question already. It's an important question. Obviously the bleeding risk is tied up with the liver, warfarin directly antagonizes vitamin K, so there's real questions about safety and so this is the perfect storm and then on top of it was a really well done and well executed study. So when this came across my desk, the very first thing I thought was not, "Is this something that we're interested?" But rather, "How do we make it better? How do we make it more useful to the reader?" This had me from hello. Dr. Mercedes Carnethon: Well thanks so much. We rarely have the opportunity when we read an article to be able to ask the authors questions. So Sandeep, I know that you had mentioned that you had some follow up questions as well. Dr. Sandeep Das: Yeah. So the real thought that I have then is would you argue based on this that we know enough that we should change our practice? And that do you feel comfortable advocating that people now prescribe DOACs to these patients? Dr. Xuerong Wen: I would say yes. Okay. Although this is not a clinical trial, but our study is actually systematically compare the effectiveness and safety between DOAC users and also the warfarin users. And if you look at our table one, we compare with so many variables between these two users and we use the propensity score adjustment and we after propensity score weighting and the two control group almost balanced. And I know right now FDA actually suggested that emulate the trial using the large real world data to do the emulated trial. So our study actually conducted is based on the large population using large data and we use the propensity score weighting to control all this potential compounding factors. Although there are still some limitations in this study. I think we mentioned that in the discussion section and we discussed all potential compounding factors that still may exist. And also there are some misclassifications and out of all this limitations and we still found the two drugs performed differently in this specific population. So we feel that comfortable to say that a DOAC drug performs better than warfarin. And also I think based on other studies that based on the clinical trial in the general population, DOAC drug is performs much better than warfarin and considering that the clearance in liver for DOAC is less than warfarin. So plus all this information together, I think DOAC may be safer than wafarin in the patients with AF and chronic liver disease. Dr. Sandeep Das: Yeah, I would say that I agree that these data, even if you're skeptical about observational CT generally, which I admit that I tend to be, these are really reassuring data that at least the DOACs are... There's absolutely nothing that suggests that they're any worse than warfarin and all of the sort of soft indications for ease of use and patient happiness really would seem to favor DOACs. So I think this is the sort of rare observational CT paper that may actually change my practice. Dr. Mercedes Carnethon: I have a follow-up question, Xuerong, related to the design and as well your strategy to address differences between the groups. So inverse probability weighting is certainly a standard in the field to be able to manage differences between groups when you have a situation where can't, where it's not a randomized trial. Do you as well, and educate me, I admit I'm an epidemiologist whose methodological skills are sometimes challenged. Do you have the opportunity using this design and with inverse probability weighting to evaluate subgroup effects? So my specific question is were you able to determine whether or not these associations were similar based on age and gender in particular? Dr. Xuerong Wen: That's a great question. We did conducted a lot of subgroup study but not by age or gender. We conducted I think this study in a lot of subgroups using the propensity score weighting, but the subgroup that I think we did a subgroup like a patient with a different chronic liver disease. So that's what we did. And we also tested different methods inverse probability score weighting. So we did trimming and we used a different percentage of trimming and to see how that affect the study results. So we have done a lot of subgroup studies. We did not check the age and the gender, but that's a very good point. Maybe later, well I'll ask my student to do that. Dr. Mercedes Carnethon: Well, you're a good mentor. So I think that is a really certainly an appropriate approach. Sandeep, did you have additional questions? Dr. Sandeep Das: No, I wish I had thought of yours before you did. I think exactly the older age, women, racial ethnic groups that are underrepresented historically in trials. I think that that's really, again, the sweet spot of this observational research. We definitely, and NH definitely working on trying to increase enrollment of all these groups in our CTs. However, while we wait for that, I think that's exactly what we should be doing. Dr. Mercedes Carnethon: Well that's great. And Xuerong, you really alluded to really, I think what is one of my final questions related to what do you think based on what you have observed in this study, what do you see as the next steps in the research field for your team, your students, or other people who are carrying out this type of work? Dr. Xuerong Wen: Well, that's a great question. We currently have a couple of more manuscripts ongoing in this field, and we will continue conducting the comparative effectiveness and analysis to compare drugs head to head as well as developing and implementing new methodologies to this field. And we hope our study provides real world evidence for clinical decision making, prescribing anticoagulants to patients with atrial fibrillation and chronic liver disease. We also expect the physicians and researchers more and more value the real world data studies, especially when clinical trials are not feasible or ethical. Dr. Mercedes Carnethon: Well, thank you so much. That was such an excellent vision that you provided us with and we're just very grateful that you submitted this fantastic work to the journal Circulation. I know that our readers will enjoy really digging in. The podcast is meant as a teaser to bring you to the journal so that you can read about this wonderful work by Dr. Wen and colleagues. So again, thank you. I'm Mercedes Carnethon, joined with my associate editor partner here, Dr. Sandeep Das. And thank you very much for spending your time with us today, Dr. Wen. Dr. Xuerong Wen: Thanks for this great opportunity to disseminate my study with us, thank you. Dr. Sandeep Das: Thanks Mercedes. Dr. Mercedes Carnethon: Thank you for joining us for this episode of Circulation on the Run. Dr. Greg Hundley: This program is copyright of the American Heart Association 2023. The opinions expressed by speakers in this podcast are their own and not necessarily those of the editors or of the American Heart Association. For more, please visit ahajournals.org.

Download the cheat: https://bit.ly/50-meds  View the lesson:   Generic Name warfarin Trade Name Coumadin Indication venous thrombosis, pulmonary embolism, A-fib, myocardial infarction Action disrupts liver synthesis of Vitamin K dependent clotting factors Therapeutic Class Anticoagulant Pharmacologic Class coumarins Nursing Considerations • contraindicated with bleeding, severe hypertension • can cause bleeding • aspirin and NSAIDs can increase risk of bleeding • azole antifungals increase effects of warfarin • cimetadine(Tagamet) increases warfarin levels • obtain full history of supplements and herbs • large amounts of vitamin K may antagonize effects of warfarin • assess for signs of bleeding • therapeutic levels: PT 1.3-1.5, INR 2.5-3.5 • instruct patient to report any signs of bleeding • patient should not drink alcohol • bleeding times need to be monitored frequently • vitamin K is antidote

Efficacy and Safety of Intensive Versus Nonintensive Supplemental Insulin With a Basal-Bolus Insulin Regimen in Hospitalized Patients With Type 2 Diabetes: A Randomized Clinical Study | Diabetes Care | American Diabetes Association (diabetesjournals.org)   randomized noninferiority study from Emory University, 224 hospitalized patients with longstanding type 2 diabetes  Both groups received basal/bolus insulin; both the starting dose and subsequent changes were specified by the study protocol. Additional premeal SSI was added to scheduled premeal bolus doses.randomized to either intensive SSI (at BG >140 mg/dL) or nonintensive SSI (at BG >260 mg/dL) before meals and at bedtime.  Mean baseline glycosylated hemoglobin (HbA1c) was 9%, and 60% of patients were using insulin at home. Patients with a presenting glucose level of >400 mg/dL or diabetic ketoacidosis were excluded.  Outcome---Mean daily BG level, hypoglycemia, severe hyperglycemia, percent of BGs in the target range (70–180 mg/dL), and the amount of total, basal, or prandial insulin used did not differ between groups. However, significantly fewer patients in the nonintensive group than in the intensive group received SSI (34% vs. 91%).   COMMENTAlthough this is a single-center study, its results are persuasive and suggest that a less-intense SSI regimen can achieve similar glucose outcomes in hospitalized patients with type 2 diabetes who are receiving basal/bolus insulin. It also could decrease nursing treatment burden. As we move slowly toward more continuous glucose monitoring in hospitals, reducing use of SSI is another opportunity to achieve similar results with less staff burden and more patient comfort.  Comparative Effectiveness and Safety Between Apixaban, Dabigatran, Edoxaban, and Rivaroxaban Among Patients With Atrial Fibrillation: A Multinational Population-Based Cohort Study: Annals of Internal Medicine: Vol 175, No 11 (acpjournals.org) In a retrospective study, investigators accessed five electronic health databases from Europe and the U.S. to compare >500,000 new DOAC users with newly diagnosed atrial fibrillation. Follow up varied from 1.5 to 4.5 years.   In propensity score–adjusted analyses, patients who received apixaban had significantly less gastrointestinal (GI) bleeding did those who received any of the other three drugs (hazard ratios, 0.7–0.8). This result was consistent among older patients and those with chronic kidney disease (CKD). Risk for stroke or other systemic embolism, intracranial hemorrhage, and all-cause mortality did not differ significantly among DOACs.    COMMENTThis is the largest comparison of individual DOACs, and it demonstrates similar efficacy among all agents. Although apixaban was associated with less GI bleeding, absolute percentages of GI bleeds ranged from ≈2% to ≈3.5% for all DOACs; therefore, apixaban's statistically significant safety benefit might amount to marginal clinical benefit for any individual patient. I might turn to apixaban for patients at high risk for GI bleeding (and those with CKD), but all DOACs remain reasonable options for preventing thromboembolism in most patients with atrial fibrillation. Ellenbogen MI et al. Safety and effectiveness of apixaban versus warfarin for acute venous thromboembolism in patients with end-stage kidney disease: A national cohort study. J Hosp Med 2022 Oct; 17:809. (https://doi.org/10.1002/jhm.12926. opens in new tab)  . In an industry-funded retrospective study, investigators used a national database (years, 2014–2018) and propensity score–adjusted analysis to compare outcomes among >11,500 patients with ESRD and newly diagnosed VTE who received either apixaban or warfarin.Only 2% of patients received apixaban in 2014, but 47% received apixaban in 2018.during the 6 months following initiation of therapy, apixaban — compared with warfarin  associated with significantly lower incidence of major bleeding (10% vs. 14%), including intracranial bleeding (1.8% vs. 2.5%) and gastrointestinal bleeding (8.6% vs. 10.4%). Recurrent VTE and all-cause mortality were similar in the two groups.   VTE and creatine clearence less than 30 then I think apixaban is the drug of choice—I would like to see this study don't with afib and done with exclusively

Get a free nursing lab values cheat sheet at NURSING.com/63labs   What is the Lab Name for International Normalized Ratio (INR) Lab Values? International Normalized Ratio   What is the Lab Abbreviation for International Normalized Ratio? INR   What is International Normalized Ratio in terms of Nursing Labs? International normalized ratio(INR) takes results from a prothrombin time test and standardizes it regardless of collection method.   What is the Normal Range for International Normalized Ratio? 0.8 – 1.2 Therapeutic Levels on Warfarin 2.0 – 3.5   What are the Indications for International Normalized Ratio? Evaluate therapeutic doses of Warfarin Identify patients at higher risk for bleeding Identify cause of: Bleeding Deficiencies   What would cause Increased Levels of International Normalized Ratio? Disseminated Intravascular Coagulation (DIC) Liver disease Vitamin K deficiency Warfarin   What would cause Decreased Levels of International Normalized Ratio? Too much vitamin K Estrogen containing medications such as birth control

Download the cheat: https://bit.ly/50-meds  View the lesson: https://bit.ly/MethylphenidateConcertaNursingConsiderations    Generic Name methylphenidate Trade Name Ritalin, Concerta Indication ADHD, narcolepsy Action improves attention span in ADHD by producing CNS stimulation Therapeutic Class central nervous system stimulant Pharmacologic Class none Nursing Considerations • can cause sudden death, hypertension, palpitations, anorexia, hyperactivity, insomnia • may decrease effects of Warfarin and Phenytoin • do not use with MAOIs • monitor cardiovascular system • monitor for behavioral changes • monitor for dependence • do not consume caffeinated beverages “Drug Holiday” used to assess dependence and status

Warfarin was the best rat poison in history. It's also, now, one of the most important, life-saving—and freakishly unlikely—drugs in the history of medicine...Our Sponsors:* Check out Rosetta Stone and use my code TODAY for a great deal: https://www.rosettastone.com/Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Pulmonary embolism, coffee, when DOACs don't work, lipoprotein (a), and the marginal benefits of current CV therapy are the topics John Mandrola, MD, discusses in this week's podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I. Pulmonary Embolism - Positive Data on Thrombectomy Catheter That Avoids Thrombolytics in Acute PE https://www.medscape.com/viewarticle/981322 - Acute Outcomes for the Full US Cohort of the FLASH Mechanical Thrombectomy Registry in Pulmonary Embolism https://eurointervention.pcronline.com/article/acute-outcomes-for-the-full-us-cohort-of-the-flash-mechanical-thrombectomy-registry-in-pulmonary-embolism - PEERLESS Study https://clinicaltrials.gov/ct2/show/NCT05111613 - Ultrasound-facilitated, Catheter-directed, Thrombolysis in Intermediate-high Risk Pulmonary Embolism (HI-PEITHO) https://clinicaltrials.gov/ct2/show/NCT04790370 - A Prospective, Single-Arm, Multicenter Trial of Catheter-Directed Mechanical Thrombectomy for Intermediate-Risk Acute Pulmonary Embolism: The FLARE Study https://doi.org/10.1016/j.jcin.2018.12.022 II. Coffee Again - Coffee Linked to Reduced Cardiovascular Disease and Mortality https://www.medscape.com/viewarticle/981518 Enough With the Coffee Research and Other Distractions https://www.medscape.com/viewarticle/883709 - The impact of coffee subtypes on incident cardiovascular disease, arrhythmias, and mortality: long-term outcomes from the UK Biobank https://doi.org/10.1093/eurjpc/zwac189 III. DOAC and Mechanical Valves - PROACT Xa Trial of Apixaban With On-X Heart Valve Stopped https://www.medscape.com/viewarticle/981644 - Artivion Follows Recommendation to Stop PROACT Xa Clinical Trial https://investors.artivion.com/news-releases/news-release-details/artivion-follows-recommendation-stop-proact-xa-clinical-trial - PROACT Xa - A Trial to Determine if Participants With an On-X Aortic Valve Can be Maintained Safely on Apixaban https://clinicaltrials.gov/ct2/show/NCT04142658 - Dabigatran versus Warfarin in Patients with Mechanical Heart Valves https://www.nejm.org/doi/full/10.1056/nejmoa1300615 IV. Lipoprotein(a) - Aspirin Primary Prevention Benefit in Those With Raised Lp(a)? https://www.medscape.com/viewarticle/981602 - Aspirin for Primary Prevention of Cardiovascular Events in Relation to Lipoprotein(a) Genotypes https://www.jacc.org/doi/full/10.1016/j.jacc.2022.07.027 - A Randomized Trial of Low-Dose Aspirin in the Primary Prevention of Cardiovascular Disease in Women https://www.nejm.org/doi/full/10.1056/nejmoa050613 - Effect of Aspirin on Disability-free Survival in the Healthy Elderly https://www.nejm.org/doi/full/10.1056/NEJMoa1800722 - Effect of Aspirin on Cardiovascular Events and Bleeding in the Healthy Elderly https://www.nejm.org/doi/full/10.1056/NEJMoa1805819 - Effect of Aspirin on All-Cause Mortality in the Healthy Elderly https://www.nejm.org/doi/full/10.1056/NEJMoa1803955 You may also like: Medscape editor-in-chief Eric Topol, MD, and master storyteller and clinician Abraham Verghese, MD, on Medicine and the Machine https://www.medscape.com/features/public/machine The Bob Harrington Show with Stanford University Chair of Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact: news@medscape.net

This week on Pharm5: Terlivaz (terlipressin) for hepatorenal syndrome Pfizer's mRNA flu vaccine (enroll here: https://bit.ly/3DMRO0r) Potential triple-action drug for diabetes or weight loss Warfarin use in AFib with rheumatic heart disease CVS and Walmart settle; Walgreens heads to court References Terlivaz. Package Insert. Mallinckrodt Pharmaceuticals; 2022. Pharmacypracticenews.com. https://bit.ly/3xHxgTm. Published September 15, 2022. Accessed September 22, 2022. Biggins SW, Angeli P, Garcia‐Tsao G, et al. Diagnosis, evaluation, and management of ascites, spontaneous bacterial peritonitis and Hepatorenal Syndrome: 2021 practice guidance by the American Association for the study of liver diseases. Hepatology. 2021;74(2):1014-1048. doi:10.1002/hep.31884 Pfizer initiates phase 3 study of mrna-based influenza vaccine. Pfizer. https://bit.ly/3dBgvCx. Published September 14, 2022. Accessed September 22, 2022. Mitchel L. Zoler PD. Triple threat: Novel agent shows potent T2D Weight Loss. Medscape. https://wb.md/3SmPWzK. Published September 22, 2022. Accessed September 22, 2022. A1C and weight change results: Mounjaro™ (tirzepatide). Mounjaro. https://bit.ly/3DNdutI. Accessed September 22, 2022. Connolly SJ, Karthikeyan G, Ntsekhe M, et al. Rivaroxaban in rheumatic heart disease–associated atrial fibrillation. New England Journal of Medicine. 2022;387(11):978-988. doi:10.1056/nejmoa2209051 Knauth D. CVS, Walmart reach $147.5 million opioid settlement with West Virginia. Medscape. https://wb.md/3BGNWeK. Published September 22, 2022. Accessed September 22, 2022.

On this podcast episode, I discuss cephalexin pharmacology, adverse effects, drug interactions, and much more! Penicillin allergies and cross-reactivity are common questions with regard to the use of cephalexin and discuss this briefly in the podcast episode. Cephalexin is a first-generation cephalosporin with its primary sweet spot bein gram-positive bacteria like Staph and Strep species. Warfarin, probenecid, zinc, and a couple of others are potential medications that can interact with cephalexin. I discuss this further in this podcast episode.

Welcome to Doctor Warrick's Podcast Channel. Warrick is a practicing cardiologist and author with a passion for improving care by helping patients understand their heart health through education. Warrick believes educated patients get the best health care. Discover and understand the latest approaches and technology in heart care and how this might apply to you or someone you love.

How does a 1500 IU fixed dose of Kcentra stack up to FDA-approved variable dosing for reaching a specific INR target? Let's talk about it.  Click HERE to leave a review of the podcast!Subscribe HERE!References:All references for Episode 78 are found on my Read by QxMD collectionDisclaimer: The information contained within the  ER-Rx podcast episodes, errxpodcast.com, and the @errxpodcast Instagram page is for informational/ educational purposes only, is not meant to replace professional medical judgement, and does not constitute a provider-patient relationship between you and the authors. Information contained herein may be accidentally inaccurate, incomplete, or outdated, and users are to use caution,  seek medical advice from a licensed physician, and consult available resources prior to any medical decision making. The contributors of the ER-Rx podcast are not affiliated with, nor do they speak on behalf of,  any medical institutions, educational facilities, or other healthcare programs.Support the show

We're back!   Let's talk what to do with Warfarin/coumadin, DOACs, antiplatelets/aspirin at the time of EGDs and Colonoscopy based on the most recent guidelines in the spring

Contributor: Aaron Lessen, MD  Educational Pearls: Direct Oral Anticoagulants (DOACs) have surpassed Warfarin and Lovenox® for anticoagulation as they do not require injection and allow for easier discharge. In the ED, they are commonly prescribed after PE or DVT diagnosis.  Common DOACs are Apixaban (Eliquis®) and Rivaroxaban (Xarelto®). There has not been a direct head to head study comparing outcomes.  2 large observational studies evaluated the recurrence of clots and bleeding risk in patients with newly prescribed Eliquis® or Xarelto® for DVT or PE. Both studies found that Eliquis® had superior outcomes.  Further data is required to determine the preferred DOAC. A randomized trial comparing the two DOACs is upcoming with enrollment ending in 2023.  References Dawwas GK, Leonard CE, Lewis JD, Cuker A. Risk for Recurrent Venous Thromboembolism and Bleeding With Apixaban Compared With Rivaroxaban: An Analysis of Real-World Data. Ann Intern Med. 2022;175(1):20-28. doi:10.7326/M21-0717 Aryal MR, Gosain R, Donato A, et al. Systematic review and meta-analysis of the efficacy and safety of apixaban compared to rivaroxaban in acute VTE in the real world. Blood Adv. 2019;3(15):2381-2387. doi:10.1182/bloodadvances.2019000572 Image from: Bristol-Myers Squibb Company. Eliquis 10 Million Patients and Counting. Sec.gov. https://www.sec.gov/Archives/edgar/data/14272/000114036119003478/s002621x16_425.htm. Accessed June 12, 2022.   Summarized by Kirsten Hughes, MS4 | Edited by John Spartz MS4 & Erik Verzemnieks, MD   The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at https://emergencymedicalminute.org/cme-courses/ and create an account.  Donate to EMM today!

Actress Rue McClanahan was beloved for playing the sassy Southern Belle, “Blanche Devereaux,” on TV's The Golden Girls. But behind the smiles, Rue's life was blighted by heartbreak, disease and reported near-death experiences. Her cause of death was officially called a stroke—an event most commonly caused by a blood clot in the brain. But Rue was taking the drug Warfarin, a powerful anticoagulant prescribed to prevent blood clots. So why did the actress die of a stroke at the age of 76? World renowned Forensic Pathologist, Dr. Michael Hunter digs in to analyze every detail of of the actress' medical history to reveal if other drugs played a part in the mystery of what killed Rue McClanahan. Like what you hear and want more true crime and mystery? Go to https://www.reelz.com/podcasts/

In this week's replay episode we review the important topic of anticoagulation of the Fontan patient. We speak with hematology researcher, Dr. Chantal Attard of The Murdoch Children's Research Institute of The University of Melbourne about a recent cross-sectional study comparing multiple factors in patients with Fontan circulation on aspirin vs. warfarin. What were the demonstrable differences in outcome? Are there ways to make the use of warfarin more safe? What about novel anticoagulants - what is their possible role and what evidence exists for their use in this setting? Dr. Attard provides many key 'takeaways' this week! doi: 10.1016/j.jtcvs.2020.12.102