Benzodiazapines for anxiety: Psychcast Masterclass

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Thu, 02/14/2019 - 09:42

 

In this episode of the MDedge Psychcast, we join Jeffrey R. Strawn, MD, at the Psychopharmacology Update meeting in Cincinnati, for a lecture on using benzodiazapines for patients with anxiety disorders. Also in this episode, what happens when you have plans to get some work done, but Alexa has other ideas? Dr. RK offers her thoughts on just such a situation – and on practicing what she preaches. You can contact the Psychcast by emailing [email protected].

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In this episode of the MDedge Psychcast, we join Jeffrey R. Strawn, MD, at the Psychopharmacology Update meeting in Cincinnati, for a lecture on using benzodiazapines for patients with anxiety disorders. Also in this episode, what happens when you have plans to get some work done, but Alexa has other ideas? Dr. RK offers her thoughts on just such a situation – and on practicing what she preaches. You can contact the Psychcast by emailing [email protected].

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In this episode of the MDedge Psychcast, we join Jeffrey R. Strawn, MD, at the Psychopharmacology Update meeting in Cincinnati, for a lecture on using benzodiazapines for patients with anxiety disorders. Also in this episode, what happens when you have plans to get some work done, but Alexa has other ideas? Dr. RK offers her thoughts on just such a situation – and on practicing what she preaches. You can contact the Psychcast by emailing [email protected].

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Automated office BP readings

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Wed, 02/06/2019 - 04:00

 

Automated office blood pressure readings appear to be more accurate than routine office readings and BP readings in research settings. Also today, a positive fecal immunochemical test should prompt colonoscopy, mild aerobic exercise speeds recovery for sports concussions, and phase 2 studies of the antiamyloid Alzheimer’s drug crenezumab are stopped.

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Automated office blood pressure readings appear to be more accurate than routine office readings and BP readings in research settings. Also today, a positive fecal immunochemical test should prompt colonoscopy, mild aerobic exercise speeds recovery for sports concussions, and phase 2 studies of the antiamyloid Alzheimer’s drug crenezumab are stopped.

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Automated office blood pressure readings appear to be more accurate than routine office readings and BP readings in research settings. Also today, a positive fecal immunochemical test should prompt colonoscopy, mild aerobic exercise speeds recovery for sports concussions, and phase 2 studies of the antiamyloid Alzheimer’s drug crenezumab are stopped.

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Shifting Part B to D: Who saves?

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Tue, 02/05/2019 - 04:00

 

A shift in Medicare drug coverage from Part B to Part D might save the government money, but might cost patients. Also today, there’s no single treatment for fibromyalgia, obesity-related cancers are increasing in younger adults, and pregnancy problems predict cardiovascular future.

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A shift in Medicare drug coverage from Part B to Part D might save the government money, but might cost patients. Also today, there’s no single treatment for fibromyalgia, obesity-related cancers are increasing in younger adults, and pregnancy problems predict cardiovascular future.

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A shift in Medicare drug coverage from Part B to Part D might save the government money, but might cost patients. Also today, there’s no single treatment for fibromyalgia, obesity-related cancers are increasing in younger adults, and pregnancy problems predict cardiovascular future.

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Aerobic exercise and cognitive decline

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Mon, 02/04/2019 - 09:34

Aerobic exercise significantly improves executive function among adults with below-average fitness. Also today, findings in seropositive arthralgia patients may help to predict rheumatoid arthritis, elevated coronary artery calcification is not linked to increased death risk in active men, and clinical benefits persist 5 years after theymectomy for myasthenia gravis.
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Aerobic exercise significantly improves executive function among adults with below-average fitness. Also today, findings in seropositive arthralgia patients may help to predict rheumatoid arthritis, elevated coronary artery calcification is not linked to increased death risk in active men, and clinical benefits persist 5 years after theymectomy for myasthenia gravis.
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Aerobic exercise significantly improves executive function among adults with below-average fitness. Also today, findings in seropositive arthralgia patients may help to predict rheumatoid arthritis, elevated coronary artery calcification is not linked to increased death risk in active men, and clinical benefits persist 5 years after theymectomy for myasthenia gravis.
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Podcasting, burnout, oncology: Dr. David Henry

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Wed, 02/06/2019 - 10:53

David Henry, MD, is the host of Blood & Cancer, the official podcast of MDedge Hematology/Oncology. In this episode, Nick and Dr. Henry discuss advances and excitement in oncology, as well as the opportunities that podcasting provides and tips for dealing with burnout.

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David Henry, MD, is the host of Blood & Cancer, the official podcast of MDedge Hematology/Oncology. In this episode, Nick and Dr. Henry discuss advances and excitement in oncology, as well as the opportunities that podcasting provides and tips for dealing with burnout.

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David Henry, MD, is the host of Blood & Cancer, the official podcast of MDedge Hematology/Oncology. In this episode, Nick and Dr. Henry discuss advances and excitement in oncology, as well as the opportunities that podcasting provides and tips for dealing with burnout.

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SPRINT MIND with extension planned

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Fri, 02/01/2019 - 04:00

 

A new iteration of the SPRINT MIND hypertension trial will seek to conclusively prove that intensiveblood pressure control decreases the risk of developing mild cognitive impairment. Also today, medical ethics and economics, PTSD after traumatic brain injury may be predicted by race and ethnicity, and aspirin for primary cardiovascular prevention.

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A new iteration of the SPRINT MIND hypertension trial will seek to conclusively prove that intensiveblood pressure control decreases the risk of developing mild cognitive impairment. Also today, medical ethics and economics, PTSD after traumatic brain injury may be predicted by race and ethnicity, and aspirin for primary cardiovascular prevention.

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A new iteration of the SPRINT MIND hypertension trial will seek to conclusively prove that intensiveblood pressure control decreases the risk of developing mild cognitive impairment. Also today, medical ethics and economics, PTSD after traumatic brain injury may be predicted by race and ethnicity, and aspirin for primary cardiovascular prevention.

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Atrial fib guidelines updated, SPRINT MIND published, and more

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Thu, 01/31/2019 - 16:37

This week in cardiology news, revised atrial fibrillation guidelines revamp anticoagulation, the SPRINT MIND results showing that tight BP control staves off mild cognitive impairment are published, the FDA discovers that nitrosamine-contaminated ARBs have been on the market for years, and subclinical hypothyroidism boosts the immediate risk of heart failure.

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This week in cardiology news, revised atrial fibrillation guidelines revamp anticoagulation, the SPRINT MIND results showing that tight BP control staves off mild cognitive impairment are published, the FDA discovers that nitrosamine-contaminated ARBs have been on the market for years, and subclinical hypothyroidism boosts the immediate risk of heart failure.

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This week in cardiology news, revised atrial fibrillation guidelines revamp anticoagulation, the SPRINT MIND results showing that tight BP control staves off mild cognitive impairment are published, the FDA discovers that nitrosamine-contaminated ARBs have been on the market for years, and subclinical hypothyroidism boosts the immediate risk of heart failure.

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Blood & Cancer: A hematology-oncology podcast from MDedge

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Wed, 02/27/2019 - 10:14

 

In the first episode of Blood & Cancer, David Henry, MD (http://bit.ly/2MFDfzm), welcomes Richard J. Gralla, MD (http://bit.ly/2ShsxEv), or the Albert Einstein College of Medicine in New York. The topic today centers around antiemetics and ways to use them. And later, Ilana Yurkiewicz, MD (https://stanford.io/2RXPixR), debuts her segment Clinical Correlations all about hematology care.
Subscribe here:

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By Emily Bryer, DO

  • Highly emetic chemotherapy regimens include cisplatin, dacarbazine, anthracycline, and cyclophosphamide combinations
    • Treatment should include an NK1 receptor antagonist, dexamethasone, and a 5HT3 antagonist
    • All 5HT3 antagonists should be given only once (no evidence that prn or delayed administration is helpful)
    • Olanzapine is an effective antiemetic, although its precise role and dose are undergoing investigation
    • An all-oral regimen for highly emetic could include Netupitant (NK1) and palonosetron (long-acting 5HT3) (NEPA) + Oral Dex + Olanzapine
  • Moderately emetic chemotherapy regimens include irinotecan and taxotere
    • Treatment should include 5HT3 antagonist and dexamethasone
  • Carboplatin causes more emesis than initially thought
    • Improvement with NK1 antagonist yields a 15% decreased risk of emesis
    • Guidelines now recommending NK1 with carboplatin
  • Low emetic chemotherapy regimens include gemcitabine, pemetrexed as single agent
    • Single drug: one dose of corticosteroid or one dose of 5HT3 antagonist
  • Minimal emetic chemotherapy regimens include vincristine or bleomycin
    • No drugs are recommended for acute or delayed nausea/emesis
  • 20 mg Dexamethasone IV (or 12 mg PO 12 mg) should be administered only on day 1 of chemotherapy. Dexamethasone can be spared after that unless cisplatin (would require 2 days of steroids)
  • Marijuana and THC have some antiemetic properties, but are about one quarter as effective as 5HT3 antagonists
  • Lorazepam may be used in anticipatory emesis started a few days prior to chemotherapy

References: 

Ann Oncol. 2014 Jul;25(7):1333-9.

JCSO 2015;13(4):128-30.

JCSO 2016;4(1):11-20.

Contact us: [email protected]

MDedge on Twitter: @mdedgehemonc

Dr. Ilana Yurkiewicz on Twitter: @ilanayurkiewicz

Dr. Yurkiewicz on MDedgehttp://bit.ly/2DItTAb

 

 

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In the first episode of Blood & Cancer, David Henry, MD (http://bit.ly/2MFDfzm), welcomes Richard J. Gralla, MD (http://bit.ly/2ShsxEv), or the Albert Einstein College of Medicine in New York. The topic today centers around antiemetics and ways to use them. And later, Ilana Yurkiewicz, MD (https://stanford.io/2RXPixR), debuts her segment Clinical Correlations all about hematology care.
Subscribe here:

Apple Podcasts

Show Notes

By Emily Bryer, DO

  • Highly emetic chemotherapy regimens include cisplatin, dacarbazine, anthracycline, and cyclophosphamide combinations
    • Treatment should include an NK1 receptor antagonist, dexamethasone, and a 5HT3 antagonist
    • All 5HT3 antagonists should be given only once (no evidence that prn or delayed administration is helpful)
    • Olanzapine is an effective antiemetic, although its precise role and dose are undergoing investigation
    • An all-oral regimen for highly emetic could include Netupitant (NK1) and palonosetron (long-acting 5HT3) (NEPA) + Oral Dex + Olanzapine
  • Moderately emetic chemotherapy regimens include irinotecan and taxotere
    • Treatment should include 5HT3 antagonist and dexamethasone
  • Carboplatin causes more emesis than initially thought
    • Improvement with NK1 antagonist yields a 15% decreased risk of emesis
    • Guidelines now recommending NK1 with carboplatin
  • Low emetic chemotherapy regimens include gemcitabine, pemetrexed as single agent
    • Single drug: one dose of corticosteroid or one dose of 5HT3 antagonist
  • Minimal emetic chemotherapy regimens include vincristine or bleomycin
    • No drugs are recommended for acute or delayed nausea/emesis
  • 20 mg Dexamethasone IV (or 12 mg PO 12 mg) should be administered only on day 1 of chemotherapy. Dexamethasone can be spared after that unless cisplatin (would require 2 days of steroids)
  • Marijuana and THC have some antiemetic properties, but are about one quarter as effective as 5HT3 antagonists
  • Lorazepam may be used in anticipatory emesis started a few days prior to chemotherapy

References: 

Ann Oncol. 2014 Jul;25(7):1333-9.

JCSO 2015;13(4):128-30.

JCSO 2016;4(1):11-20.

Contact us: [email protected]

MDedge on Twitter: @mdedgehemonc

Dr. Ilana Yurkiewicz on Twitter: @ilanayurkiewicz

Dr. Yurkiewicz on MDedgehttp://bit.ly/2DItTAb

 

 

 

In the first episode of Blood & Cancer, David Henry, MD (http://bit.ly/2MFDfzm), welcomes Richard J. Gralla, MD (http://bit.ly/2ShsxEv), or the Albert Einstein College of Medicine in New York. The topic today centers around antiemetics and ways to use them. And later, Ilana Yurkiewicz, MD (https://stanford.io/2RXPixR), debuts her segment Clinical Correlations all about hematology care.
Subscribe here:

Apple Podcasts

Show Notes

By Emily Bryer, DO

  • Highly emetic chemotherapy regimens include cisplatin, dacarbazine, anthracycline, and cyclophosphamide combinations
    • Treatment should include an NK1 receptor antagonist, dexamethasone, and a 5HT3 antagonist
    • All 5HT3 antagonists should be given only once (no evidence that prn or delayed administration is helpful)
    • Olanzapine is an effective antiemetic, although its precise role and dose are undergoing investigation
    • An all-oral regimen for highly emetic could include Netupitant (NK1) and palonosetron (long-acting 5HT3) (NEPA) + Oral Dex + Olanzapine
  • Moderately emetic chemotherapy regimens include irinotecan and taxotere
    • Treatment should include 5HT3 antagonist and dexamethasone
  • Carboplatin causes more emesis than initially thought
    • Improvement with NK1 antagonist yields a 15% decreased risk of emesis
    • Guidelines now recommending NK1 with carboplatin
  • Low emetic chemotherapy regimens include gemcitabine, pemetrexed as single agent
    • Single drug: one dose of corticosteroid or one dose of 5HT3 antagonist
  • Minimal emetic chemotherapy regimens include vincristine or bleomycin
    • No drugs are recommended for acute or delayed nausea/emesis
  • 20 mg Dexamethasone IV (or 12 mg PO 12 mg) should be administered only on day 1 of chemotherapy. Dexamethasone can be spared after that unless cisplatin (would require 2 days of steroids)
  • Marijuana and THC have some antiemetic properties, but are about one quarter as effective as 5HT3 antagonists
  • Lorazepam may be used in anticipatory emesis started a few days prior to chemotherapy

References: 

Ann Oncol. 2014 Jul;25(7):1333-9.

JCSO 2015;13(4):128-30.

JCSO 2016;4(1):11-20.

Contact us: [email protected]

MDedge on Twitter: @mdedgehemonc

Dr. Ilana Yurkiewicz on Twitter: @ilanayurkiewicz

Dr. Yurkiewicz on MDedgehttp://bit.ly/2DItTAb

 

 

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Revamped A fib guidelines

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Thu, 01/31/2019 - 04:00

 

Revised U.S. guidelines revamp the approach to treating atrial fibrillation. Also today, family gun ownership is linked to gun deaths among young children, insulin may be toxic to the placenta in early pregnancy, and ticks are the arthropod ride of choice for pathogens.

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Revised U.S. guidelines revamp the approach to treating atrial fibrillation. Also today, family gun ownership is linked to gun deaths among young children, insulin may be toxic to the placenta in early pregnancy, and ticks are the arthropod ride of choice for pathogens.

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Revised U.S. guidelines revamp the approach to treating atrial fibrillation. Also today, family gun ownership is linked to gun deaths among young children, insulin may be toxic to the placenta in early pregnancy, and ticks are the arthropod ride of choice for pathogens.

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Tardive dyskinesia: Masterclass

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Thu, 02/14/2019 - 15:12

Jonathan Meyer, MD, notes that TD has been the bane of the psychiatrist’s existence for the better part of a half century. In this Masterclass edition from the 2018 AACP Encore meeting in Las Vegas, Dr. Meyer talks about this movement disorder and analyzes how psychiatrists should approach treatment today.

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Jonathan Meyer, MD, notes that TD has been the bane of the psychiatrist’s existence for the better part of a half century. In this Masterclass edition from the 2018 AACP Encore meeting in Las Vegas, Dr. Meyer talks about this movement disorder and analyzes how psychiatrists should approach treatment today.

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Jonathan Meyer, MD, notes that TD has been the bane of the psychiatrist’s existence for the better part of a half century. In this Masterclass edition from the 2018 AACP Encore meeting in Las Vegas, Dr. Meyer talks about this movement disorder and analyzes how psychiatrists should approach treatment today.

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