🛑Recommendations for the management of venous thromboembolism (VTE) in patients receiving anticancer treatment

✅Apixaban, edoxaban, or rivaroxaban are recommended for the treatment of symptomatic or incidental VTE in patients with cancer without contraindications (class 1).

✅Low molecular weight heparin (LMWH) are recommended for the treatment of symptomatic or incidental VTE in patients with cancer with platelet count>50 000/μL (class I).

✅In patients with cancer with platelet counts of 25 000-50 000/μL, anticoagulation with half-dose LMWH may be considered after a multidisciplinary discussion (class Ilb).

✅Prolongation of anticoagulation therapy beyond 6 months should be considered in selected patients with active cancer including metastatic disease (class lla).

#tips and tricks in cardiology

🛑Vasopressors in septic shock

✅After the first two boluses of fluid challenges assess the diastolic pressure (DP) and/or mean arterial pressure

✅If DP < 50 mmHg or MAP < 65 mmHg start norepinephrine within the first hour of resuscitation @ 0.1 ug/kg/min

✅If central access is not available, consider initiating vasopressor peripherally

✅Vasopressors peripherally should be administered for short period not more than 6 hours

❇️The concentration should not exceed 60 ug/ml

✅Consider echocardiography to assess cardiac function

🛑Assess MAP

✅If MAP < 65 mmHg, titrate norepinephrine up to 0.7 ug/kg/min

✅Consider adding vasopressin @ 0.03 units/min if MAP < 65 mmHg and norepinephrine dose reached 0.25-0.5 ug/kg/min

✅Consider adding epinephrine if MAP<65 mmHg despite norepinephrine and vasopressin

❇️If MAP cannot be achieved with vasopressors, the following measures can be used

✅Minimize sedation and use of midazolam instead of propofol

✅IV hydrocortisone 50 mg every 6 hours or as continuous infusion. Hydrocortisone is suggested to be initiated when the dose of norepinephrine or epinephrine ≥ 0.25 ug/kg/min at least 4 hours of initiation.

✅Terlipressin is NOT recommended as a vasopressor in septic shock patient

#ICU basic

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🛑Bicarbonate therapy in septic shock

✅For adults with septic shock, severe metabolic acidemia (pH s 7.2) and AKI (AKIN score 2 or 3), NaHCO3 can be given

✅75-125 ml NaHCO3 8.4% in 30 min, maximum 500 ml in 24 hours.

✅NaHCO3 should not be used to improve hemodynamics or to reduce vasopressor requirements.

من مشاركه الزميل الدكتور مسعود في اول مؤتمر للصيادلة السريرية في اليمن مناقشه case report كانت بعنون
Medication-Related Challenges in Managing Diabetic Foot Complications: A Case Report

الحاله التي تم مشاركتها المؤتمر
الوقت كان ضيق وفيه نقص اشياء وكانت تركز على ال
Drugs Related Problems

🛑OPIOID ANALGESICS in treatment pain in critically ill  adult patients

✅Patients with bronchospasm – For patients with known or active bronchospasm, fentanyl or hydromorphone is preferred rather than morphine because little histamine is released by these synthetic opioids


✅Patients requiring fluid restriction – Hydromorphone may be useful in fluid-restricted patients with high opioid requirements since it is available in a highly concentrated preparation (10 mg/mL)

✅Patients with hemodynamic instability – For patients with hemodynamic instability, we use shorter-acting agents such as fentanyl rather than morphine, which has a slightly longer duration of action. Morphine also causes more histamine release, which can exacerbate hypotension.

✅Patients with renal and/or hepatic insufficiency – For critically ill patients with renal and/or hepatic insufficiency, we typically select intravenous fentanyl or hydromorphone, with dose adjustments as needed.
Morphine should be avoided due to its renal clearance.

✅In patients with severe multiorgan failure, remifentanil is occasionally selected because its metabolism is not dependent on renal or hepatic function


#UPTODATE2025

🛑NSAIDs analgesics and AKI

✅NSAID use in at-risk patients – We avoid systemic NSAIDs for pain or inflammation in patients with the following:
•✅Volume depletion
•✅Nephrotic syndrome
•✅Heart failure
•✅Cirrhosis
•✅Hypercalcemia

#UPTODATE2025

🛑sulfamethoxazole/trimethoprim and hyperkalemia

✅Hyperkalemia may occur with sulfamethoxazole/trimethoprim and be life threatening  usually reversible following discontinuation

 ✅Hyperkalemia may occur with sulfamethoxazole/trimethoprim and be life threatening  usually reversible following discontinuation 

✅Onset: Varied; usually occurs within 5 to 10 days after sulfamethoxazole/trimethoprim is initiated

✅Risk factors:
• High doses (trimethoprim 20 mg/kg/day)
• Kidney impairment
• Older patients
• Hypoaldosteronism
• Concomitant use of medications causing or exacerbating hyperkalemia

#UPTODATE2025

🛑SGLT2I inhibitors drugs and surgery

✅Sodium-glucose cotransporter 2 (SGLT2) inhibitors – SGLT2 inhibitors (eg, empagliflozin, dapagliflozin, canagliflozin, ertugliflozin, bexagliflozin) should be stopped three to four days before surgery

✅ These agents increase the risk of urinary tract infections and hypovolemia

#New
🛑ATS/CDC/IDSA recommendations on management of drug-susceptible and drug-resistant tuberculosis (TB)

✅A 4-month regimen (2 months of isoniazid, rifapentine, pyrazinamide, and moxifloxacin ➡️followed by 2 months of isoniazid, rifapentine, and moxifloxacin [2HPZM/2HPM])
✅ is generally as safe and efficacious as a 6-month regimen (2 months of isoniazid, rifampin, pyrazinamide, and ethambutol followed by 4 months of isoniazid and rifampin [2HRZE/4HR]) for isoniazid- and rifampin-susceptible pulmonary TB in those aged ≥12 years.

#NEJM watch guidelines 2025

Diabetes and Ramadan: Practical guidelines 2021

1-s2.0-S0168822721005453-main1.pdf

critical care essential therapeutics للدكتور خالد محمد علي كتاب شامل ومفصل للأدوية الضرورية بالرعاية الحرجة ويعتبر هاذا الكتاب هو رفيق أساسي لجميع فرق العناية المركزة؛ الفرق الطبية وفرق الطوارئ والجراحة التي تتعامل مع الأمراض الحرجة والمنقذة للحياة وعلاجاتها الأساسية. الكتاب غني بجميع الأدوية الأساسية والتطبيقات السريرية المستخدمة في إدارة الأمراض الحرجة والطارئة المختلفة والإجراءات الحرجة الأساسية التي يتم شرحها في مناقشات بسيطة للغاية ورسوم توضيحية للملصقات