Antibiotics in Ear Infections (Otitis Media) - Choosing Wisely #Antibiotics #OtitisMedia #PatientInfo #DecisionAid #Management #Stewardship

Antibiotics in Bronchitis - Choosing Wisely #Antibiotics #Bronchitis #PatientInfo #DecisionAid #Management #Stewardship

Cephalosporin Comparison - Coverage 1st Generation Cefazolin, Cephalexin 2nd Generation Cefaclor, Cefotetan, Cefoxitin, Cefuroxime 3rd Generation Cefixime, Cefotaxime, Ceftazidime, Ceftriaxone 4th Generation Cefepime Ceftaroline: "5th generation" or "advanced generation" - Similar to 3rd generation, but added MRSA coverage Cephalosporins are commonly used antibiotics, but they are not all the same! Here's a simplified review of the 4 generations. Generally the 1st generation has strongest Gram + coverage, and the spectrum transitions to stronger Gram - coverage as we move towards the 4th generation. For example, 4th gen Cefepime has strong Gram - coverage including Pseudomonas. An important cephalosporin to remember is Ceftaroline, which is not included in the 1-4 generations. Ceftaroline may be called the 5th generation, but it does not follow the same spectrum pattern. Ceftaroline is often compared to the same coverage as Ceftriaxone, except it also covers MRSA. Jarred Prudencio, PharmD - https://www.instagram.com/ambcarerx #Cephalosporin #Comparison #Coverage #Generations #Naming #Names #Pharmacology #Antibiotics

Oral Antibiotics for Acne - Indicated for Moderate-to-Severe Acne First-Line Drug Class: Tetracyclines In the last post I reviewed mild acne treatment which consists of TOPICAL products. Now let's talk about oral antibiotics. These can be used for moderate-to-severe acne. However, they should be used IN CONJUNCTION with the topical products previously mentioned. After initiating, reassess patients response to the antibiotics and discontinue them when possible to ensure the shortest duration. First-line is tetracyclines, most commonly used is minocycline since it is best tolerated and there is some evidence showing it more effective than tetracycline. The newest option is sarecycline which is a tetracycline developed specifically for acne treatment. We can also pulse-dose azithromycin for patients who cannot use tetracyclines. #Acne #Oral #Antibiotics #Pharmacology #Management #Dermatology

DPP4 Inhibitors - Normal and Renal Dosing Increase Incretins (GLP-I & GIP) -> Stimulates Insulin, Inhibits Glucagon -> Lowers Blood Sugar (post-prandial) Januvia (sitagliptin) 100 mg Nesina (alogliptin) 25 mg Onglyza (saxagliptin) 5 mg Tradjenta (linagliptin) 5 mg DPP4 inhibitors work by increasing incretins, which will stimulate insulin release in response to food and inhibit glucagon. This mechanism helps lower primarily post-prandial glucose and has very minimal chance of hypoglycemia. One unique thing about this drug class is that you start patients on the highest dose, and only use lower doses if patients have renal insufficiency. This is very different than other medications where you start at the lowest dose and titrate up to effects or target doses. If you see a patient on a lower dose of a DPP4, double check the kidney function to make sure the dose is correct. This drug class has a smaller A1c lowering than others, but is a very tolerable medication with only few side effects. Jarred Prudencio, PharmD - https://www.instagram.com/ambcarerx #DPP4 #Inhibitors #Renal #Dosing #Pharmacology #Management #Diabetes #DM2 #Endocrinology

Diabetes Morning Hyperglycemia - Dawn Phenomenon vs Somogyi Effect When patients FBG's are elevated each morning despite attempts at adjusting medication therapy, it's a good idea to assess the situation to determine if patient is experiencing the normal dawn phenomenon, or if they are actually experiencing Somogyi effect. Both are characterized by morning hyperglycemia, but they are for opposite reasons. All patients (even those without diabetes) experience dawn phenomenon, where the natural changes in growth hormones and insulin levels causes a natural hyperglycemia in the mornings. In patients without diabetes, the pancreas can adjust and release insulin to control the blood sugar. Although rare and not strongly evidenced, it's still good to know about the idea of Somogyi effect. This is when patients experience hypoglycemia in the late nights, and wake up with hyperglycemia as the body's overcompensating response to the hypoglycemia. If a patient actually does experience this, it's important to adjust or decrease the medication to prevent the night hypoglycemia, which would then resolve the morning hyperglycemia. ---- Although there is evidence disproving the Somogyi effect, I have had a patient in which I found them to be experiencing what I think was Somogyi effect. I ended up decreasing their evening insulin dose which actually ended up decreasing their morning FBG. This could have been from other reasons unknown to me since they did not have a CGM at the time for me to fully assess, but maybe? Have you experienced this in your practice? Jarred Prudencio, PharmD - https://www.instagram.com/ambcarerx #Dawn #Phenomenon #Somogyi #Effect #Fasting #Diabetes #Hyperglycemia #Diagnosis #Management #Endocrinology

LABA/ICS Combination Inhalers Long-Acting Beta2 Agonists (LABA) + Inhaled Corticosteroid (ICS) - Commonly used in Asthma Advair AirDuo Respiclick Breo Ellipta Dulera Symbicort Here are the LABA/ICS combination inhalers available - 3 Dry Powder Inhalers (DPI) and 3 HFA inhalers (includes propellant). For the HFA inhalers, they are the traditional type of inhaler that most people think of. These require priming and can be used with a spacer. DPI’s do not have the propellant, so patients need to take a deep quick breath to get the powder into their lungs. These combo LABA/ICS inhalers are very commonly used in asthma, but may also be part of a patients COPD regimen (see one of my old posts for the COPD treatment algorithm). Listed are the normal dosing schedules, but note that each brand has a variety of strengths too. ---- One interesting point is that the fluticasone/salmeterol Respiclick is the only one that is available in a generic form. Breo Ellipta is the only one that is dosed 1 puff once daily. Jarred Prudencio, PharmD - https://www.instagram.com/ambcarerx #LABAICS #Combination #Inhalers #Naming #Names #Pharmacology #Asthma