#remember

✅ All SGLT2i have shown evidence of benefit for HF and CKD.

✅SGLT2i with evidence of ASCVD benefit: canagliflozin, dapagliflozin, and empagliflozin.

✅SGLT2i have decreasing glycemic efficacy as eGFR declines, particularly with eGFR <45 mL/min/1.73 m2, and in this setting, an additional agent may be necessary to achieve glycemic goals.


#UpTodate2024

#remember
🛑Carvedilol does not appear to impair glucose tolerance.
#UpTodate2024

🛑SGLT2 inhibitors drug


⛔️Canagliflozin – Canagliflozin is taken orally before the first meal of the day The initial dose is 100 mg once daily, and it can be increased to 300 mg daily to achieve glycemic goals. In patients with moderate kidney impairment (eGFR 30 to 59 mL/min/1.73 m2), the dose should not exceed 100 mg daily. Canagliflozin should not be given to patients with severe hepatic impairment.
✅No dose adjustment is needed in patients with mild or moderate hepatic impairment


⛔️Dapagliflozin – Dapagliflozin (10 mg once daily) can be taken any time of day with or without food. It is not recommended for use in patients with active bladder cancer
✅. For patients with severely reduced liver function, a starting dose of 5 mg is recommended. There is limited experience in patients with severe hepatic impairment



⛔️Empagliflozin – Empagliflozin is taken orally once daily in the morning with or without food
✅. The initial dose is 10 mg daily, and it can be increased to 25 mg once daily to achieve glycemic goals. In patients taking empagliflozin who have an eGFR 30 to 45 mL/min/1.73 m2, the dose should not exceed 10 mg.
✅Empagliflozin may be used in patients with hepatic impairment

#UpTodate2024

🛑 (SGLT2) inhibitors  and blood pressure

✅reduction in both systolic and diastolic blood pressure (-4 to -6/-1 to -2 mm Hg) has been documented for SGLT2 inhibitors

#UpTodate2024

🛑SGLT2I inhibitors and magnesium


✅In practice, however, SGLT2 inhibitors have been observed to induce mild increases, ranging from 0.1 to 0.24 mg/dL in serum magnesium levels in patients with type 2 diabetes, and this appears to be a class effect
✅The mechanisms for this effect are not well understoo

✅ (SGLT2) inhibitors have been reported to be quite effective in correcting refractory hypomagnesemia, with increases in serum magnesium ranging from 0.3 to 1 mg/dL
✅ Remarkably, this beneficial effect has been observed in both patients with and without diabetes, in both renal and nonrenal hypomagnesemia, and is not consistently associated with reduction in magnesuria

#UpTodate2024

🛑SGLT2 inhibitors and IgA nephropathy (IgAN)

✅ Patients with IgAN and proteinuria should receive treatment with sodium-glucose cotransporter 2 (SGLT2) inhibitors. This approach is similar to that for other patients with CKD and proteinuria.
#UpTodate2024

✅بكذا نختم اليوم هذا كان برعاية ادوية SGLT2I inhibitors الادوية التي عملت طفره خلال اخر خمس سنوات 😂😁

السلام عليكم
محتاج الكتاب ذا pdf لم أجده في أي مكان،
على من يملكه أو يستطيع توفيره يرسله لي ع الخاص
@m_rassam
وأكون له من الشاكرين

#remember

🛑Aldosterone antagonists in ACS and diabetic patients

✅We recommend an aldosterone receptor blocker to all patients with diabetes who meet the following criteria, which were derived from the EPHESUS trial of patients 3 to 14 days after acute MI
●Are receiving an ACE inhibitor and a beta blocker
●Have a left ventricular ejection fraction ≤40 percent
●Have a serum creatinine ≤2.5 mg/dL (221 micromol/L) in men and ≤2.0 mg/dL (177 micromol/L) in women
●Have a serum potassium ≤5.0 mEq/L

#UpTodate2024

Management of adult patients with gastroparesis

🛑بنسبه لمعالجة ال hypoglycemia اذا كان المريض بوعيه وقادر على الاكل والبلع بنعطيه
✅3 to 4 glucose tablets or a tube of gel with 15 grams, 4 to 6 oz fruit juice or non-diet soda, or a teaspoon of honey or table sugar

✅لكن في حاله كان يستخدم ادوية السكر الاتيه
✅taking an alpha-glucosidase inhibitor (eg, acarbose, miglitol, voglibose
وفي هبوط سكري بنعطيه فقط pure glucose (dextrose) مانعطية
other carbohydrates (eg, table sugar [sucrose]) 

لانه راح يقلل هضم وامتصاص هذه الأنواع من الكربوهيدرات نتيجه تاثير ادوية السكر المذكوره

#UpTodate2024

✅If the patient is conscious and able to drink and swallow safely (ie, alert enough to do so and with gag reflex intact), administer a rapidly absorbed carbohydrate (eg, 3 to 4 glucose tablets or a tube of gel with 15 grams, 4 to 6 oz fruit juice or non-diet soda, or a teaspoon of honey or table sugar



✅Patients taking an alpha-glucosidase inhibitor (eg, acarbose, miglitol, voglibose) with symptomatic hypoglycemia should only receive pure glucose (dextrose) orally because digestion and absorption of other carbohydrates (eg, table sugar [sucrose]) will be delayed by these medications and will be less effective in raising blood glucose levels.

#UpTodate2024

السلام عليكم
الي ما عرف يستخدم حساب lexicomp هذه هي الطريقه كيف تسجيل الدخول
اول تدخل الرابط ذا
https://online.lexi.com/lco/action/login

او تبحث بذي الكلمه
Lexicomp login
وتختار أول رابط وتدخل اسم المستخدم وكلمة السر الي نشرناها من قبل
وتتبع بقيه التعليمات في الفيديو

وتقدر منه تدخل
uptodate

#ملاحظة إذا ما ضهر لك كل المعلومات نفس الفيديو غير إلى شكل متصفح كمبيوتر في المتصفح نفسه ب أحط صوره به في التعليق
#massoud

#remember

✅Domperidone may be associated with an increased risk of serious ventricular arrhythmias or sudden cardiac death, particularly with doses >30 mg.
#genebrandax

في نسختة السابعه والحديثه
الدليل الوحيد للبيانات المخبرية الذي كتبه الصيادلة للصيادلة.
كتاب من الجمعية الامريكيه لصيدله يحتوي
المهارات الأساسية في تفسير البيانات المخبرية للمساعدة في تشخيص الأمراض وخاصه لكادر الصيدله السريرية والعامة..

ويضا تفسير الفحوصات المتعلقه بالدواء من حيث تأثيره ومراقبة الفعاليه والإثار الجانبي..

وايضا العوامل المؤثره على الفحوصات..
وفي نهاية كل شابتر ملخص مع حالات بسيطه ك أمثله،
كتاب مخصص لصيدله والصيدلة السريريه في المقام الأول،
وايضا لبقيه التخصصات الطبيه
#massoud

لما تعطي Amoxicillin لمعالجة Acute otitis media لطفل أخذ دواء Amoxicillin خلال ثلاثين يوم الماضية لأي سبب
رده فعل البكتريا المسببه

✅السبب راح يحصل مقاومه ل Amoxicillin
الحل نعطي Amoxicillin clavanic acid
#Salah

🛑morphine in Acute coronary syndrome

✅ Morphine occasionally produces bradycardia and hypotension (vagomimetic effect), which can be managed with atropine (0.5–1.5 mg IV) if necessary

#Marinos ICU

🛑إعادة نشر

طبعا كنت اقول انه atropine 
فعال في جميع مراحل heart block 🤔 في حاله acute(unstable)

لكن قرات انه فعال
في  Ist degree

وفي  2nd degree (Mobize1)
فقط

لكن في
2nd degree (Mobize2)

بالعكس له parodixal effect in HR
يعني ممكن يوطي HR🤔


اما في  3rd degree not effective in HR🥲
#salah

🛑 insulin in DM type 2

✅The initial dose for any basal insulin is 0.2 units per kg daily (minimum 10 units, up to 15 to 20 units).
✅If fasting glucose levels are very elevated (>250 mg/dL [13.9 mmol/L]), A1C is >8 percent, or insulin resistance is severe, initial doses of basal insulin in type 2 diabetes can be higher (eg, 0.3 units per kg or up to 25 to 30 units daily).

#Uptodate2024

🛑bisphosphonates and Hypocalcemia

✅Both oral and IV bisphosphonates can cause transient hypocalcemia, but more frequently after IV than oral administration.
✅ The risk of hypocalcemia is higher and duration longer in patients with hypoparathyroidism, vitamin D deficiency, or inadequate calcium intake.
✅Patients receiving bisphosphonates should take supplemental calcium and vitamin D.
✅However, calcium supplements can interfere with the absorption of bisphosphonates, and they should not be taken for at least one hour after taking oral bisphosphonate
#Uptodate2024