Podcasts about Warfarin

Kiera is joined by the tooth-healer himself, Jason Dent! Jason has an extensive background in pharmacy, and shares with Kiera where his pharmaceutical experience has bled over into dentistry. This includes the difference between anti-quag and anti-platelet and which medications are probably safe, what to do to shorten the drag time in the pharmacy, how to write prescriptions most efficiently, and more. Episode resources: Subscribe to The Dental A-Team podcast Schedule a Practice Assessment Leave us a review Transcript: The Dental A Team (00:00) Hello, Dental A Team listeners. This is Kiera and today is a really awesome and unique day. It is, think the second time I've had somebody in the podcast studio with me live for a podcast and it's the one and only Jason Dent. Jason, how are you? I'm doing well. Good morning. Thanks for having me. It is crazy. I I watch Instagram real like this all the time where people are like in the podcast and they're hanging out on two chairs and couches and now look at us. We're doing it. Cheers. Cheers.   That was a mic cheer for those of you who are only listening, but yeah, Jace, how does this feel to be on the podcast? It's weird. Like I was not nervous at all talking about it. I got really nervous as soon as you hit play. So if I stumble over my words, please forgive me ahead of time. Well, Jason, I appreciate you being on the podcast because marketing had asked me to do a topic about teledentistry and I was like, oh shoot, that's like not my forte at all. so   You and I were actually chatting in the hot tub. call it Think Tank session and you and I, we have a lot of good ideas that come from that Think Tank. A lot of business. no phones. That's why. We do leave our phones out. But I was talking to Jason and this is actually a podcast we had talked about quite a while ago. Jason has a lot of information on pharmacy. And if you don't know, Jason isn't really, we were going through all of it last night. It's kind of a mock in the tub. And I think it's going to be great because I feel like this is an area, I'm working at Midwestern and   knowing about how dentists, pharmacology was surely not your favorite one. Jason actually helps a lot of dentists with their clearances. And so we were talking about it and I like it will just be a really awesome podcast for you guys to brush up on pharmacology, different things from a pharmacist's side. So Jason, welcome. Thank you. Yeah, no, we were talking about it and here's like, what should I talk about on the podcast next? I have all these different topics and she's like, what do you know? And the only real interaction I have with dentists is doing clearances for procedures. We get them all the time, which makes sense.   Lots of people are on blood thinner, I've always told Kiera, like, hey, I could talk about that. Like, that's kind of a passion of mine. I'm not a dentist. Or my name is Jason Dent. So in Hebrew, Jason means tooth. No, no, no, sorry. Nerves are getting to me. Jason means healer and Dent means tooth. So my name means tooth healer. So, here's a little set. Hold on, on, hold Can we just talk about? I brought that up before you could talk about it more. So.   My name means tooth healer but I did not become a dentist. I know you wanted me to become a dentist. did. I don't know why. I enjoy medicine. I know what you're going to get to already. The things you're going to ask me. There's been years of this. But nevertheless, that's my name. We'll get that out of the way. But you did give me a great last name. So I mean, it's OK. You're All is fair and love here. SEO's up for that. But yeah, Jason, I'm going to get you right into the show. And I'm going to be the host. And we're going to welcome to the podcast show. Jace, how are you?   Good, good, good. Good, good, good. So by getting into clearances, right? This is what you're kinda talking about with you know, before we get to clearances, I actually wanted Jason, for the listeners who don't know you, who haven't talked to you, who don't know, let's kinda just give them like, how did you go from, Kiera wanted you to be a dentist, to now Jason, you are on the podcast talking as our expert on pharmacy. fantastic. I've always really loved medicine, a ton. As a kid getting headaches and taking Excedrin, like you just feel like a miserable pile of crap.   and then you take two pills and all of a sudden you feel better. Like that's amazing, like how does that happen? Also getting ear aches as a kid, just being in so much pain and then taking some medicine and you start feeling a lot better. I always had a lot of appreciation for that. I've always been mechanically inclined. I went to, started doing my undergrad and took biology and learned about ATP synthase, which is a spinning enzyme that's inside the mitochondria, like a turbine engine. I used to work on small engines on my dirt bike and thought that is so cool. So I really got wrapped up into chemistry.   All the mechanics of chemistry really pulled me in. I'm not getting goosebumps. checking. I usually get goosebumps when I think about chemistry. But it's so cool. You think an engine's awesome, like pistons and camshafts and pressures, the cell is the same thing. It's not as loud, so it's not as cool. But it's fascinating. that's why we're like. ⁓   chemistry and really got into coagulation. So I did my residency after pharmacy school. we went to Arizona for three years. ⁓ You did and your main focus, you were never wanting to be the guy behind the counter. No, I haven't done that. Yeah. No, I love them though. I've always really want to go clinical. ⁓ But I love my retail ⁓ pharmacists. They're amazing resources. And ⁓ I use the retail pharmacist every day still to this day, but I went more the clinical route, really love the chemistry aspect of it.   did my doctorate degree and then I did my residency in Reno. Reno's kind That's how we got here everybody. Welcome to Reno. Strategically placed because I was really interested in critical medicine and where we're located we cover a huge area. So we pull in to almost clear, we go clear to Utah, clear to California, all of Northern Nevada. We get cases from all over. So we actually are kind like the first hub of care for lot of areas. So we really get an eclectic mixture of patients that come in that need-   all kinds of different cases that are coming to them. So it's what I really wanted. So I did my residency in critical care there. And then for the next 10 years, I worked in vascular medicine with my final five years being the supervisor of the clinic. Ran all the ins and outs of that. So my providers, two doctors were on our view. So when we talk about dentistry, talk about production, those kinds of things, totally get it. My doctors were the exact same way, my vascular providers. ⁓   There's some pains there, right? You wanna be seeing patients as much as possible, being able to help as many people, keeping the billing up. And had other nurse practitioners, four practitioners, a fleet of MAs, eight pharmacists. We also had that one location we had, going off the top of my head, I think we had eight locations running as well. And we took care of all the different kinds of vascular cases that came to us. Most common was blood clots, ⁓ which is just a...   which is an easier way of saying VTE. There's so many different ways to say a blood clot. Like you might hear patients say, I've had a PE or a DVT or a venous thromboembolism or a clot in my leg, right? They're all clots, but in different locations. Same with an MI, and MI can be a clot as well. ⁓ there's a lot of, everybody's kind of saying the same thing, but sometimes the nomenclature can make it sound hard, but it really is actually pretty simple.   No. And Jason, I love that you went through, you've been in like, and even in your, ⁓ when you were getting your doctorate, you were in the ER. You also worked in retail pharmacy. remember you having a little sticker on your hand. And retail pharmacy, I have a lot of respect for those guys. They have a lot of pressure on them. and then you also, ⁓ what was that test that you had to take that? I don't know. You were like studying forever for it. ⁓ board certification for, ⁓ NABP. Yeah. So I did that board certification as well.   And now you've moved out of the hospital side onto another section in your career. Now in the insurance, right? So it's really, really interesting. So now I'm on the other side reading notes and evaluating clinical appropriateness and trying to help patients with getting coverage and making those kinds of determinations. So yeah, I've really jumped all over. Really love my clinical days. I know. don't I don't I do miss them. But yeah, kind of had a good exposure to a lot of.   pharmacy a lot a lot of dentists actually with all the places that come through which Jason I really appreciate that and honestly I know you are my spouse and so it's fun to have you on but when I go into conversations like this I don't know any of this information and so finding experts and Jason I think here's me talk more about dentistry and my business than I do hear about him on pharmacy so as we were chatting about this I really realized you are a wealth of knowledge because you've been on the clinical side so you've done a lot of patient care and you've seen how   medications interact and I know you've had a few scares in your career and ⁓ you've known some physicians that have had a few scares and ⁓ you've seen plenty of patients pass away working in the ER and gosh in Arizona drownings were such a big deal. I remember when you were in the ER on your rotations I'd be like who died today? Like tell me the stories and you've really seen and now going on to the insurance side I felt like you could just be such a good wealth of knowledge because I know dentists are sometimes so   I would say like maybe just a little more anxious when it comes to medications. I know that dental students from Midwestern were like here was like four months and we had to like pass it, learn it. And Jason, you've done four years plus clinical residency, plus you've been in it. And something I really love about Nevada Medicine is they've been so collaborative with you.   like your heart, your cardiologist, they diagnose and then they send to you to treat with medicine and... Yeah, I've been really lucky being here in Reno too. The cardiology team has been amazing to work with. We started a CHF program, sorry, congestive heart failure program for patients. So we would collaborate with cardiologists. They'd see the cardiologists and then they send them to the pharmacist to really manage all the medications. So there's pillars of therapy ⁓ called guideline directed medical therapy and the pharmacist would take care of all that. So that's gonna be your...   your beta blockers, your ACEs, your ARBs, your Entresto, which would be a little bit better, spironolactone. So just making sure that all these things are dosed appropriately, really monitoring the heart, and make sure that patients are getting better. we've had real positive outcomes when the, sorry, this is totally off topic. do, talk about that study. When we looked at when patients were coming to see our pharmacists in our clinic that we started up, the patients were half as likely to be readmitted. And this was in 2018, and our pharmacists,   We're thinking about all the medications. We're usually adjusting diabetes medications too at the same time. Just kind of naturally just taking care of all the medications because we kind of got a go ahead from the providers, a collaborative practice agreement that we could make adjustments to certain medications within certain parameters. So we weren't going rogue or maverick, but we were definitely trying to optimize our medications as much as possible. And then years later, some studies came out with, I'm sure you've seen Jardins and Farseegh. not trying to, I'm not.   I don't get any kickback from them. I have no conflicts to share. But because our pharmacists were really optimizing that medication, those medications were later shown to reduce hospitalizations and heart failure, even though they're diabetes medications. Fascinating. So it wasn't really the pharmacists. It was just the pharmacists doing as much as they can with all the tools that were in front of them. And then we found out that the patients were going back to the hospital.   half as much as regular patients. So, yeah, being here, it's been so amazing to work with providers here. the providers here want help, want to help patients, don't have an ego. I mean, I just, it's awesome. I love it. I do love how much I think Jason sees me geek out about dentistry and I watching Jay's geek about his pharmacy and how much he loves helping patients. And ⁓ really that was the whole idea of, all right.   Dentistry has pharmacy as a part of it. And I know a lot of dentists are sending in clearances and I know working in a chair side, it would be like, oh no, if they're on warfarin or on their own blood clot, you guys, honestly don't even know half of what I'm talking about because this is not my jam, which is why Jason's here. But I do know that there was always like, well, we got to talk with their provider. And so having Jason come in and just kind of explain being the pharmacist that is approving or denying or saying yes or no to take them off the blood thinners in different parts, because you have seen several dental   I don't know what they're called. What is it? Clarence's? that what comes to you? don't even know. All day my mind, it's like, here is the piece of paper that gets mailed to you to the pharmacist and then you mail it back. So whatever that is. But Chase, let's talk about it because I think you can give the dentist a lot of confidence coming from a pharmacist. What you guys see on that side. When do you actually need to approve or disapprove? Let's kind of dig into that. Yeah. Well, first of all, I think I'm not a replacement for any kind of clinical judgment whatsoever. Every patient's different. But the American Diabetes Association, you   I work with diabetes a lot. American Dental Association has some really great guidelines on blood thinners and I would always reference them. I actually looked at their website today. Make sure I'm up to speed before I get back on this again. They have resources all around making decisions for blood thinners. And I think the one real important thing in putting myself in the shoes of a dentist or any kind of staff that's around a patient that's in a chair, if they say I'm on a blood thinner, right, a flag goes up. At least in my mind, that's what goes up.   Like, okay, how do we get across this bridge? And I think the important thing to really distinct right then when they say they're on a blood thinner is that is kind of a slang word for a lot of different medications, right? Like it's the overarching word that everybody pulls up saying, I'm on a blood thinner. It's like, okay, but I don't know what say. It's like, I have a car. You're like, okay, do you have a Mazda? Do you have?   Toyota, Honda, what do you have? or even worse it'd be like saying I have a vehicle, right? So when somebody says they're on a blood thinner, it opens up a whole box of possibilities of what they're Blood thinners are also, doesn't, when they're taking these types of medications that are quote unquote a blood thinner, it doesn't actually thin the blood, like adding water to the blood, if that makes sense, or like thinning paint, or like thinning out a gravy, right? It doesn't do the same thing. Blood thinners, really what they're doing is they're working on the blood, which.   which is really cool, try not to tangent on that. ⁓ When they're working on the blood, it's not thinning it per se, but it's making it so that the proteins or platelets that are in it can't stick together and make a cloth quite as easy. So whenever somebody's on a blood thinner, I usually ask, what's the name of the blood thinner that you're on? It's not bad that they use that slang, that's okay, on the same page, but it's really broken into two different classes. There's anticoagulant and antiplatelet.   And a way to kind of remember which is which, when residents would come through our clinics, the way that I teach them is a clot is like a brick wall. You know, it's not always a brick wall. Usually the blood is a liquid going through. But once they receive some kind of chemical message, it starts making a brick wall with the mortar, which is the concrete between the and the bricks, the two parts. When it's an anti-quagent, it's working on that mortar part. When it's an anti-platelet, it's working on the bricks part, right? You need both to make a strong clot or strong brick wall.   But if you can make one of them not work, obviously like if your mortar is just water, it's not working, right? You're not gonna make a strong brick wall. So that's kind of the two deviants right there. So that's what I do in my mind real quickly to find out because antiplatelets are usually, so that's gonna be like your Plavix, Ticagrelor, Brilinta. And hold on, antiplatelets are bricks? Good job, bricks. They're the bricks. And so the reason I was thinking you could remember this because I'm, antiplatelets, it's a plate and a plate is more like a brick.   And anti coagulant, I don't know why quag feels like mortar to me, like quag, like, know, it's like slushy in the blood, like it's coagulating. It's a little bit of that, like, honestly, I'm just thinking like coagulated blood is a little bit more mortar-ish. And so platelet is your plate, like a brick, and anti-quag is like.   the gilly between the bricks. Okay, okay, I got it. Yeah, so there's an exception to every rule, but when they're on that Don't worry, this is Kiera, just like very basic. You guys are way smarter listening to this, and that's why Jason's here. No, no, you helped me pass pharmacy school. When we were doing all the top 200, you helped me memorize all know what flexorill is, all right? That's a muscle relaxant. Cyclo? I don't know that part. It's a cyclo, because you guys are cycling and flexing. I don't actually know. just know it's a muscle relaxant, so that's about as far as I got. When we're looking at antitick platelets, so that's the brick part, so that's going to be your, you know,   Hecagrelor, Breitlingta, Clopidogrel is the most common one. It's the cheapest one, so probably see that one the most. Those, I mean, there's an exception to every rule, but that's generally being used after like a stent's placed in the heart. It can be used for VTE, there's some out there, but that's pretty rare. But also for some valves that are placed in the hearts, it can be used for that as well. So antiplatelet, really thinking more like a cardiac event, right? Like I said, there's always an exception to every rule, but that's kind of where my mind goes real quickly, because we're gathering information from the patient.   They're on anticoagulant. Those are like going to be the new ones that you see commercials for all the time. So Xeralto, Alequis, those are the two big ones right now. They're replacing the older one. And also we were supposed to do a disclaimer of this is current as of today because the ADA guidelines do change. this will be current as of today. And Jason, as a pharmacist, is always looking up on that. I had no clue that you are that up to speed on dental knowledge. so just throwing it out there that if you happen to catch his podcast,   a few years back that obviously check those guidelines for sure. But the new ones are the Xarelto and Eloquist. They're replacing the older ones of warfarin. Warfarin's been around for a really long time. We've seen that one. Those are anti-coagulants. So when you're looking, when a patient says that, generally they're on that medication because they've possibly had a clot in the past or they have a heart condition called atrial fibrillation. Those are kind of the two big ones. Like I said, there's always caveats to it, but that's kind of where my mind goes real quickly. And then,   as far as getting patients cleared, the American Dental Association has really good resources on their website. You can look at those and they're always refreshing that up. They even say in their own words that there's limited data around studying patients in the dental chair and with anticoagulants or anti-platelets. It's pretty limited. There's a few studies, some from 2015, some from 2018. There's one as recent as 2021, which is nice. But really, all of those studies come together and it's really more of an expert consensus.   And with that expert consensus, they have kind of simplified things for dentistry, which is really nice. ⁓ comparing that to, we have more data for like total hip replacement, total knee replacement. We have a lot of data and we know really what we should be doing around then. But going back to dentistry, we don't have as much information, so they always say use clinical judgment, but they do give some really great expert guidance on that. So if a patient's on an anticoagulant, ⁓   they generally recommend that it doesn't need to be stopped unless there's a high bleeding risk for a patient. as a provider or as a clinician in the practice, you can be looking at high bleeding risk. Some things that make an oral procedure a little bit lower risk is one, it's in the compressible site, right? Like we can actually put pressure on that site. That's the number one way to stop bleeding is adding pressure. It's not like it's in the abdominal cavity where we can't get in and can't apply pressure. So number one, that kind of reduces the bleeding risk.   is number one. Two, we can add topical hemostatic agents. Dentists would know that better than me. There's a lot of topical ways to do that. So not only pressure, but there's those things as well. And also, but there are some procedures that are a little bit more likely to bleed. And that's where you and dentists would come in hand in What's the word in APO? Oh, the APOectomy. I got it right. Good job. like, didn't you tell me last night that the ADA guideline was like what?   three or four or more teeth? great question. So you can extract one to three teeth is what their expert consensus One to three teeth without. Without really managing or stopping anticoagulation or doing anything like that. I think that's some good guidance from them. I'm gonna add a Jasonism on that though. So with warfarin, I do see why dentists would be a little bit more conservative or worried about stopping the warfarin because warfarin isn't as stable as these newer agents. Warfarin, the levels.   quote unquote levels can go really high, they can go really low. And if the warfarin levels are high, they're more likely to bleed. So I do think it makes sense to have a really recent INR. That's how we measure what the warfarin's doing. I think that makes a lot of sense, but the ADA guidelines really go into the simplification version of all these blood thinners. Generally, it's recommended to not stop them because the risk of stopping them outweighs the benefit of stopping them in almost every case. Almost every case.   ⁓ So when you're with that patient, right, they say I'm on a blood thinner, finding out which kind of blood thinner that they're on, you find out that they're on Xeralto, right? How long have you been on Xeralto for? I've been on it for years. You don't know exactly why, but if they haven't had any recent bleeding, you're only gonna remove one tooth. ⁓ You can do what's called a HasBlood score. That kind of looks at the bleeding risk that they'd have. That'd be kind of going a notch above, but in my mind, removing one tooth isn't a real serious bleeding risk. I'd love to hear from my dentist friends if they...   disagree, right, but ADA says one to three tooth removals, extractions, that's the fancy word. Extractions, yeah, for extracting teeth out. Is not really that invasive. Sure. It's not that high risk, so it's usually perfectly fine. So if a patient was on Xarelto, ⁓ no other, this is in a vacuum, right? I'm not looking at any other factors, which you should be looking at other factors. I would be perfectly fine to just remove one to two.   And when those clearances come in, because dentists do send them, talk about what happens. You guys were working in the hospital and you guys would get these clearances all the time. do. We get them so often. I mean, we get like four or five a day. We'd love to give it to our students, student pharmacists, and ask them what to do. And they would usually look up the American Dental Association guidelines and come up with something. We're like, yep, that's what we say too. In fact, we say it so many times a day that we have a smart phrase.   which just blows in the information real quickly and faxes it right back to the So it's like a copy paste real quick. So what I wanted to point out when Jason told me this is dentists like hearing this and learning this, this can actually save you guys a ton of time to be able to be more confident, to not need to send those clearances on. And we were actually talking last night about how I think this might be a CYA for dentists. like, as we were talking, I think Jason, you seeing so many other aspects of medicine, like you've literally seen patients die, you've seen other areas.   And so coming from that clinical vantage point, we were realizing that dentists, we are so blessed to live in an injury. I enjoy dentistry because possibly there's someone dying, not super high, luckily in dentistry. The only time that I have actually had a doctor have a patient pass away, and it was only when they were completely sedated and doing ⁓ some other things, but that was under the care of an anesthesiologist. And so that's really our high, high risk. And so hearing this, Jason,   That was one of the reasons I wanted him to come on is to give you doctors more confidence of do we have to always send to a pharmacist? I mean, hearing that on the pharmacy side, they're just sending these back and not to say to not see why a to not cover this because you might be questioning like, well, do I really need to? But you also were talking about some other ways of so number one, you guys are just going to copy back the 88 guidelines. So so 88 guidelines. Yeah. And I think that that gives a lot of confidence to a provider or a dentist is that you can go to the 88 guidelines and read them, right? Like you're listening to some   nasally monotone pharmacist on a podcast. Rumor has it, people love him at the hospital. were like, you're the voice, he's been told he has a good radio So for the clinic, I was the voice. Like, yeah, you've reached the vascular clinic, right? And they're like, oh my gosh, you're the voice. But sorry, you me distracted. That'll be your next career, Jace. You're going to be a radio host. OK. I would love that. I love music. But you're hearing from a nasally guy, but you can actually read the ADA guidelines. You just go right to the ADA, click on Resources, and under Resources, it has the   around anticoagulants, I think that's the best way to get a lot of confidence about it because they have dentists who are the experts making calls on these. I'm just reiterating what they say, but I think it makes a lot of sense to help providers. And the reason why my heart goes out to you as well is having the providers that used to work underneath me, they're always looking for our views, which is a fancy way of making sure that they're drilling and filling. Can I say that? Yeah, can say drilling and filling. They're being productive, right? They're being productive, right?   They're always looking to make sure if a patient's canceling, like get somebody in here. Like I need to be helping people all day long. That's how I, we keep the lights on. That's how I help as many people. And so if you have a patient coming in the chair and it has an issue, they say I'm on Xeralto. Well, you can ask real quickly, why are you on Xeralto? I had a clot 10 years ago. my gosh. Well, yeah, we're pretty good to go. Then I'm not worried. We're only removing one tooth or we're just doing a cavity or a cleaning. Something like that. Shouldn't be an issue whatsoever because there's experts in the dental. ⁓   in the dental society, the ADA guidelines that recommend three teeth or less, minimally invasive. They really recommend if it's gonna be really high bleeding risk. And clinically, that's where you would come in, ⁓ or yourself. know, apioectomy is one that's like on the fence line. I don't know where implants set. though, and like we were talking, implants aren't usually like a date of procedure. Most people aren't popping in, having tooth pain, and we're like, let's do an implant. Now sometimes that can be the case, but typically that one's gonna have   a few other pieces involved. And so that is where you can get a clearance if you want to. ⁓ But we were really looking at this of like so many dentists that I know that you've seen will just send in these clearances because they are. And I think maybe a way to help dentists have more confidence is because you know, I love routines. I love to not have to remember things. So why don't we throw it in, have the team member set it up where every quarter we just double check the ADA guidelines. Are there any updates? Are there any other things that we need to do on that? That way you can just see like   getting into the language of this, of what do I need to do? Because honestly, you guys, know pharmacy was not a big portion for it, so, recommending different parts, but I think this is such a space where you can have confidence, and there's a few other things I wanna get to, and I you- I some pearls too. Okay, go. I'm so when she get me into talking about drugs, I'm not gonna stop. So, some other things around that too is these newer blood thinners like Xarelto Eloquist, they now have reversal agents, so a lot of providers in the past were really worried about bleeding because we can't turn it off. We can turn those off. Warfarin has reversal as well, right?   So I'm looking at these patients. It's really low risk. It's in the mouth, generally speaking. Very rarely are they a high bleeding risk. Now if you're doing maxillofacial surgery, this does not apply, right? This does not apply whatsoever. you're like general dentist, you're pediatric dentist. Yeah, yeah, and it's kind of on the fly. So just trying to really help you to be able to take care of those patients on the moment, have that confidence, look at the ADA guidelines, have that in front of you. I don't think it's a bad thing to ever...   check with their provider if you need to. If you're thinking, I feel like I should just check with the provider, I would never take that away from you. But I just want to kind of steer towards those guidelines that I have to help. But what did you want to share? No, yeah, I love that. And I think there were just a few other nuggets that we were chatting about last night that can help dentists just kind of get things passed a little bit easier. So you were mentioning that if they were named to their cardiologist, what was it? was like, who is the last? Great question. Yeah, when a patient's on a blood thinner,   It could be prescribed by the cardiologist. It could be prescribed by the family provider or could have been punted to like a vascular clinic like where I was working. It can go to any of those. And when you send that fax, right, if it goes to the cardiologist and it's supposed to go to the family care provider, like it just kind of goes, goes nowhere, right, from there. So I think it's a really good idea to find out who prescribed it last. If the patient doesn't know who prescribed their blood thinner last, you can call their pharmacy. I call pharmacies all day long.   I have noticed in the last year, they are way easier to get a hold of, which has made my job a lot easier, working on the insurance portion. So reaching out to the pharmacy, finding out who that provider is and sending it to them, because they should be able to help with that. I thought that was a good shift in verbiage that you had of asking instead of like the cardiologist, because that's who you would assume was the one. But you said like so many times you guys would take care of them, and then they go back to family practitioner, and you guys would get the clearances, but you couldn't clear because you weren't overseeing. So just asking the patient.   who prescribed their medication for them last time. That way you can send the clearance to the correct provider. then- And they might not know. You know patients, right? They're like, I don't know, my mom's or else, I don't know who gave it to me. Somebody told me I need to be on this. But at least that could be another quick thing. And then also we were talking last night about-   ⁓ What are some other things that dentists can do when like writing scripts to help them get what I think like overarching theme of everything we discussed is one how to help dentists have less I think drag through pharmacy. ⁓ Because pharmacy can take a little while and so perfect we now know the difference between anti-quag and anti-platelet. We know which medications are probably safe. We know we can check the ADA guidelines so that we were not having to do as many clearances. We also know if they're on a medication to find out and we do need a clearance.   who we can go to for the fastest, easiest result. And now, in talking about prescriptions, you had some really interesting tips that you could share with them. Yeah, so with writing prescriptions, right, pharmacies are pharmacies. So I'm not gonna say good thing or bad thing. There are challenges working with pharmacies. I'm not gonna play that down at all. ⁓ If you're writing prescriptions and having issues and kickbacks from pharmacies, there's some interesting laws around ⁓ writing prescriptions. Say that you're trying to ⁓ prescribe   augmentin, you know, 875 BID, and you tell the patient, hey, I want you to take this twice a day for seven days, and then you put quantity of seven, because you're moving fast, right? You want it for seven days, quantity of seven. Quantity would actually be 14, right? It's not that big of a deal. Anybody with common sense would say if you're taking a pill for twice a day for seven days, you need 14 tablets. But LAHA doesn't allow pharmacists to make that kind of a change, unfortunately. They have to follow what you're saying there. So you're going to get a...   An annoying callback that says, you wrote for seven tablets. I know you need 14. Is that OK? Just delays things, right? So ⁓ I really like the two letters QS. That's Q isn't queen. S isn't Sam. Yeah. It stands for quantity sufficient. So you don't have to calculate the amount of any medication that you're doing. So for me, as a pharmacist, when I was taking care of patients, I hated calculating the amount of insulin they would need for an entire month. So I would say.   Mrs. Jones needs 15, I'd say 15 units ⁓ QD daily. ⁓ And then I say QS, quantity sufficient, ⁓ 90 day supply through refills. So the pharmacy can then go calculate how much insulin that they need. I don't have to even do that. So anytime you're prescribing anything, I like that QS personally. So that lets the pharmacy use ⁓ common sense, as I like to call it, instead of giving you a call. I think that's super helpful. I also thought of one thing too.   going back to blood thinners is when it's kind of like a real quick, like they're not gonna have you stop the blood thinner at all. like you're seeing if you can stop the blood thinner for a patient, there's some instances it's just not gonna happen. And that's whenever they've been, they've had a clot or a stroke or a heart attack within the last three months. Three months. Yeah, that's kind of like the.   Because so many people are like, they had a heart thing like six years ago. And so I think a lot of my dentists that I worked with were like, we got to stop the blood thinners. But it sounds like it's within three months. Yeah, well, I'm just the time. Like this is general broad strokes. What I'm just trying to say is when you want to expect a no real quick. Got it. Right. So because benefits of stopping a blood thinner within those first three months of an event is very, very risky versus the, you know, the benefit of reducing a little bit of blood coming out of the mouth. Right. Like that's not that bad.   when somebody's had a stroke or a heart attack or pulmonary embolism, a clot in the lung, like we can't replace the lung, heart or brain very easily. We can replace blood a lot better. We've got buckets of it at most hospitals have buckets of it, right? So I'm always kind of leaning towards I'd rather replace blood than tissue at all times. So that's kind of a quick no. If they've had one those events in the last three months, we are really, really gonna watch their brain instead of getting.   root canal, right? Like really worried about them. So you'll just say no. And they could the dentist still proceed with the procedure or would you recommend like a three month wait? Or is it provider specific way the pros and cons because sometimes you need to get that tooth out. Great question. think then it's going to come into clinical. That's that's when you send in the clearance, right? Like, and it's great to reach out to the provider who's managing it for you. But I think it's kind of good to know exactly when you get a quick no quick no is going to be less than three months.   ⁓ Or when it's going to be like a kind of a typical, yeah, no problem. If it's been no greater than six months, they're on the typical anticoagulants or alto eloquence. Nothing crazy is going on for them. You're only removing two teeth. This is very, very low risk. But again, I'd urge everybody to read the ADA guidelines. That way you feel more comfortable with it. I'm not as eloquent as they do. They do a real good job. So I don't want to take any of their credit. I think they do a real good job of simplifying that and making you feel confident with providing.   more timely care for patients. Which is amazing. And Jayce, one last thing. I don't remember what it was. You were talking about the DEA and like six month rule. yeah. Let's just quickly talk about that and then we'll wrap this because this is such a fascinating thing for me last night. Yeah. So when comes to prescribing controlled substances, most providers have to have a DEA license. OK. First of all, though, what's your take on dentist prescribing controlled substances? ⁓ I don't think, you know, I worked on the insurance side of things. Right. And I look at the requirements for the   as the authorizations, what a patient, the criteria a patient needs to hit in order to qualify for certain medications. A lot of times for those controlled substances, they have pretty significant issues going on, like fibromyalgia or cancer-related pain or end-of-life care versus we don't, in all my scanning thread, I don't have a ⁓ perfect picture memory. Sure. But I don't usually see oral.   pain in there. There is some post-operative pain that can be covered for those kind of medications but I really recommend to keep those lower and in fact in a lot of our criteria it recommends you know have they tried Tylenol first, they tried, have they filled NSAIDs or are they contraindicated with the patient. So really they should be last line for patients in my two cents but there's always going to be a caveat to the rule right? Of course. comes through that has oral cancer and you're taking   like that would make sense to me. Got it, so then back to the DEA. Yeah, okay. Okay, ready. So as a provider, you should be checking the, if you're doing controlled substances, you should be checking the prescription drug monitoring program, or sometimes called the PDMP, looking to see if patients are getting ⁓ controlled substances from another provider. So it's really just a check and balance to make sure that they're not going from provider to provider to getting too many narcotics and causing self harm or harm to others.   And so with checking that PDMP before prescribing, I think a lot of providers do that. A lot of softwares that I'm aware of, EMRs, electronic medical records, sometimes have links so that you can do that more quickly. However, I don't think it's as intuitive that they need to be checking that every six months in some states. And like here in Nevada, you're supposed to be checking it every six months, not for a patient, but for your actual DEA registration to see if anybody else is prescribing underneath you. Because if you don't check that every six months, you could get in some serious trouble with...   not only DEA, but even more the Board of Pharmacy and your state. Now, I don't know all 50 states, so I check with your state to see if you need to be checking that every six months, but set an alarm just to check that real quickly, keep your nose clean. ⁓ I've had providers, I've had to remind to do that. And if somebody was using your account, prescribing narcotics, you'd never know unless you went and checked that PDMP.   Yeah, I remember last night you were like, and if that was you, I would not want to be you. The Board of Pharmacy is going to be real excited to find you. So that was something where I was like, got it. So, and we all know I'm big on let's make it easy. And Jason, I love that you love this so much and you just brought so much value today. And like also for me, it's just fun to podcast. fun. Yeah. But I got a nerd out on my world a little bit. Bring it into yours. I work with dentists or at least you know, when I was working in Vascular Clinic all day long. Great questions that would come through. Yeah.   So I think for all of us, as a recap on this is number one, I think setting yourself ⁓ some cadences. So maybe every quarter we check our ADA guidelines and we check our, what is it, PDMP. PDMP. so each state, so they call it Prescription Drug Monitoring Program. We need that. Yeah, but there are different acronyms in different states, though. That's just what it's called in Nevada. I forget what it is in California, but you can check your state's prescription monitoring program, make sure that opioids aren't being prescribed under your name. Got it. So we just set that as a cadence.   We know one to three teeth most likely if they're on a blood thinner is According to the 88 as of today is good to go You know things that are going to get a quick know are going to be within the last three months of the stroke the heart attack or the Clot I'm thinking like the pulmonary embolus. Yeah, that's what we're trying to prevent   Those are gonna be quick knows and then if we're prescribing, let's do QS. We've got quantity is sufficient so that we're not getting phone calls back on those medications that we are. And then on narcotics, just being a bit more cautious. Of course, this is provider specific and in no way, or form did Jason come on here to tell you you are the clinical expert.   Jason's the clinical expert on medications. And if you guys ever have questions, I know Jason, you geek out and you want to talk to people so that anyone wants to chat shop. Be sure to reach out and we'll be able to connect you in. we've even talked about possibly, so let me know listeners. You can email in Hello@TheDentalATeam.com of ask a pharmacist anything. I talked to Jason. I was like,   We'll just have them like send in questions and maybe get you back on the podcast or we do a webinar. But any last thoughts, Jace, you've got of pharmacy and dentistry as we as we wrap up today? No, I think that's pretty much it. So check the ADA guidelines. I think it's really good to have cross communication between professions. Right. If you're working with the pharmacy, CVS, Walgreens or something like that or Walmart, I know that it can be challenging. Right. They're under different pressures. You're under different pressure. So I think ⁓ just coming in with an understanding, not being angry at each other.   you know what mean, is super beneficial and working together. When it comes to it, every dentist that I've talked to is actually worried about their patient. Every pharmacist that I've worked with is really worried about the patient as well. So we're trying to accomplish the same thing, but we have different rules and our hands are bound in different ways that annoy each other, right? Like I know Dr. Jones, want 14 tablets, but you said seven. And I know Common Sense says I should give them 14, but I've got to make that change.   knowing that their hands are tied by the law. They can't use as much common sense, which is aggravating. I mean, that's why I love what I gotta do here. I gotta just kind of help a lot more and use common sense and improve patient care. But those kinds of things I think are really beneficial as you work together and then not being so afraid of blood thinners, right? So I think those guidelines do a great job of giving you confidence and not worrying about the side effects. And there's a lot of things that you can do locally for bleeding.   You have a lot of control over that. I think that's pretty cool, the tools they have. Yeah. And at the end of the day, yes, you are the clinician. You are the one who is responsible for this. so obviously, chat, but I think collaborating, talking to other pharmacists, talking to them in your state, finding out what are the state laws, things like that I think can be really beneficial just to give you peace of mind and confidence. And again, dentistry, are maybe a bit more risk adverse because luckily we don't have patients dying That's great thing. Yeah, that's fantastic. I want my dentists to be risk adverse. I think so too. But Jason, I appreciate you being on the podcast today.   And for all of you listening, ⁓ more confidence, more clarity, more streamline to be able to serve and help our patients better. if we can help you in any way or you've got more questions, reach out Hello@TheDentalATeam.com. And as always, thanks for listening. I'll catch you next time on the Dental A Team podcast.  

Q-BANK: https://patreon.com/highyieldfamilymedicineIntro (0:35),Venous leg ulcers (1:45),Arterial (ischemic) ulcers (2:58),Diabetic foot ulcers (4:42),Pressure injuries (6:10),Pyoderma gangrenosum (8:24),Burns (9:36),Stevens-Johnson Syndrome / Toxic Epidermal Necrolysis (13:12),Warfarin necrosis (14:33),Necrotizing fasciitis (15:21),Rocky Mountain Spotted Fever (16:22),Erythema nodosum (17:35),Lipoma (19:08),Epidermal inclusion cyst (20:00),Dermatofibroma (20:51),Cherry hemangiomas (21:52),Seborrheic ketatosis (22:37),Actinic keratosis (23:41),Basal cell carcinoma (24:47),Squamous cell carcinoma (26:24),Melanoma (28:05),Kaposi sarcoma (30:29),Mycosis fungoides (31:26),Practice questions (32:50)

Episode 376 The Snobs discuss their top 10-6 video games of all time among other things. Our Patreon: https://www.patreon.com/bgsnobs Email: boardgamesnobs@gmail.com Follow/join us at: Board Game Snobs Discord https://www.instagram.com/boardgamesnobs/ Board Game Snobs Facebook Group

Water filters are surrounded by plastic. Won't we be exposed to microplastics by filtering our water?I'm 80 with borderline osteoporosis. Is working out with light weights okay for me?I have latent autoimmune diabetes. Is taking metformin appropriate until I have a need to start insulin?I'm taking warfarin. Can I safely take a hair growth supplement for women?

Stu Levitan welcomes the biographer of modern Madison, award-winning columnist Doug Moe, for a conversation about his latest book, Saving Hearts and Killing Rats: Karl  Paul Link and the Discovery of Warfarin. It's the first detailed look at one of the most important and most honored biochemists of the 20th century — the brilliant, unconventional, and seemingly bipolar University of Wisconsin scientist whose discoveries led to two synthetic compounds: the rat-killing Warfarin and the heart-saving Coumadin. And all because at the depths of the Great Depression a St. Croix farmer turned to his state government to learn why his cows were dying of internal bleeding after eating sweet clover hay that had gone bad. It's quite a story about quite a scientist, which Doug Moe tells quite well.

In this episode of the Intelligent Medicine podcast, Dr. Ronald Hoffman and Leyla Muedin engage in their weekly Q&A session, addressing listener questions on medical and nutritional topics. Dr. Hoffman discusses the lack of comprehensive nutrition education in medical schools and highlights a recent proposal by RFK Jr. to mandate nutrition courses under threat of losing federal funding. The conversation also covers the impact of various medical conditions and treatments on bone health, including the effect of Warfarin on osteoporosis. They explore the significance of sun exposure for circadian rhythms and overall health, delving into how to safely optimize sun intake. The episode concludes with practical advice on managing iron levels, particularly ferritin, and the implications it has for overall health.

In this episode of the Intelligent Medicine podcast, Dr. Ronald Hoffman and Leyla Muedin engage in their weekly Q&A session, addressing listener questions on medical and nutritional topics. Dr. Hoffman discusses the lack of comprehensive nutrition education in medical schools and highlights a recent proposal by RFK Jr. to mandate nutrition courses under threat of losing federal funding. The conversation also covers the impact of various medical conditions and treatments on bone health, including the effect of Warfarin on osteoporosis. They explore the significance of sun exposure for circadian rhythms and overall health, delving into how to safely optimize sun intake. The episode concludes with practical advice on managing iron levels, particularly ferritin, and the implications it has for overall health.

Darshan H. Brahmbhatt, Podcast Editor of JACC: Advances, discusses a recently published original research paper on A Comparison of Outcomes With Apixaban, Rivaroxaban, and Warfarin for Atrial Fibrillation and/or Venous Thromboembolism.

What is the best method to heal a urinary tract infection?What is the difference between hypertension and pulmonary hypertension?I have osteoporosis and take Warfarin. How can I support my bone health?Would you put someone with my lipid profile on a statin?Would urolithin A help increase my energy? Or must I succumb to age limits?

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.

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/  

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

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

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.

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/