April & May Recap 2024
We are back with another monthly post for our paid subscribers. In this post, we also share a number of fun things that are more personal, interesting, and meant to create a closer community around RxTeach.
Summer is upon us! This recap will cover TWO months, one of which (April) will be free for all. May recaps and our personal thoughts will be reserved for our paid-subscribers (thank you for the support!)
We are back with another monthly post for our paid subscribers. In this post, we also share a number of fun things that are more personal, interesting, and meant to create a closer community around RxTeach. We hope you enjoy it! If you're only interested in our free content, that's great! We will never put up a paywall for all of our posts. With that in mind, if you want to help fund disease prevention and research efforts, this is your chance! Reminder that all profits are donated to preventative medicine education and cancer research. We're excited about this chance to contribute to some of the efforts that we care about most and we genuinely hope you consider contributing!
April Article Recaps
Antiepileptics with Rx Cheatsheets:
- We collaborated with Kaleigh Steelman, PharmD and founder of Rx Cheatsheets (@rx.cheatsheets on Instagram)! Her full handout on antiepileptic is available at the bottom of the article.
- Seizure: Sudden, uncontrolled electrical disturbance in the brain which can cause changes in behavior, movements, feelings, and consciousness. Epilepsy: A neurological disorder that causes seizures or unusual sensations and behaviors. Treatment can control episodes. Some children will outgrow the condition as they age.
- There was a new classification of seizure types implemented in 2017 by the International League Against Epilepsy: focal onset, generalized onset, and unknown onset.
- There are numerous antiepileptic medications on the market. Based on the pathophysiology of the seizure and the mechanism of action of the medication, only certain medications can treat specific seizures. It is not a "one size fits all."
- In addition, antiepileptics are known for interacting with multiple medications, mainly through CYP450.
- Other considerations with antiepileptics include sexual dysfunction, bone health, and suicidal ideation.
- If you consider yourself a contemplative individual, our new Insightful Ponderings newsletter is for you! Check them out at in the link above.
The BEST Predictor of Life-Span:
- This article covers the results of a study by Kokkinos et al. in 2022 titled Cardiorespiratory Fitness and Mortality Risk Across the Spectra of Age, Race, and Sex.
- The all-cause mortality risk in the bottom 20th percentile of performers was 4x higher (HR: 4.09; 95% CI: 3.90-4.20) than extremely fit individuals.
- The fittest subjects were 4x less likely to die of all causes! Being in the least fit group was more dangerous than having any comorbidity (CKD, smoking, diabetes, atrial fibrillation, etc...)
- The mortality HRs for extremely fit individuals aged 50-59 was 0.22 and 0.27 for individuals aged 80-95.
- A migraine is an episodic disorder of disabling headaches generally associated with nausea and/or phonophobia and photophobia.
- Neuropeptides involved in the pathophysiology: substance P, Calcitonin gene-related peptide (CGRP), and neurokinin A. The major hormone involved in the pathophysiology is serotonin.
- The stages of a migraine include prodrome, aura (roughly 25% of individuals experience this), migraine headache, and migraine postdrome.
- Treatment for acute migraine can consist of numerous modalities;
- Avoiding triggers (i.e. stress, note eating, weather, sleep disturbances, perfume/odor, etc.)
- Avoiding medication overuse
- Non-pharmacologic options (noninvasive neuromodulation devices, behavioral therapies, acupuncture)
- Pharmacologic treatment options (charts/tables for treatment and prevention are included in the article for your reference)
- NSAIDs
- Ergots
- Triptans
- 5-HT1F receptor agonists
- CGRP receptor antagonists
Should Clinical Trial Results Expire? REDUCE-AMI Study:
- The REDUCE-AMI Study found NO BENEFIT from adding long-term beta-blocker treatment in patients with acute myocardial infarction (MI) who have a preserved ejection fraction.
- Providers should always be assessing whether or not clinical trial data is relevant to them, and they should ask themselves these questions:
- Was the comparator arm a standard of care that I would use in my practice?
- Does the patient population look anything like the patients I treat?
- Do the inclusion and exclusion criteria make sense based on what I know about the disease?
- If old clinical trial data is based on standards of care and medical practices that are no longer relevant, I think they should be tested again. The burden of proof must be met, otherwise, how can we ethically recommend medications to patients?
