🛑 atrial fibrillation and chronic kidney disease
✅High CHADS-VASc score → high stroke risk

✅High HAS-BLED → high bleeding risk

✅is reasonable to not anticoagulate the following groups of individuals with AF and eGFR <30 mL/min (stages 4 and 5) given our uncertainty of the benefit-to-risk ratio for antithrombotic therapy in these patients:

✅Patients with high frailty

✅Patients with prior life-threatening bleeding or recurrent bleeding

✅Patients with poorly controlled hypertension

#Uptodate2025

Monitoring for metabolic side effects of antipsychotic drugs

🛑 atropine and heart block
✅ 1St degree and 2nd degree (mobize1) 👉 effective

✅ 2nd degree (mobize2) and active ischemia 👉 paradoxical effect in HR👉 worsening degree of AV block

✅ 3rd degree 👉not effective

#Salah

✅بالعربي
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

نقدر نختصرها
✅✅Atropine works only when the block is at the AV node.

✅If the block is below the AV node → it may be ineffective or harmful.

🛑 maintenance dose antiplatelet time in STEMI

✅  prasugrel 10mg daily beginning approximately 24 hours after the loading dose

✅ ticagrelor 90 mg twice daily beginning approximately 12 hours after the loading dose

✅ clopidogrel 75 mg daily and should begin approximately 24 hours after the loading dose

#Uptodate2025

🛑Cangrelor in treatment STEMI
✅Cangrelor is an intravenous P2Y12 inhibitor that is an option for therapy in patients with STEMI in cardiogenic shock or when an oral P2Y12 inhibitor cannot be administered (eg, patients with nausea and emesis)
#Uptodate2025

🛑Switching ticagrelor to clopidogrel

✅For patients who have been receiving ticagrelor, we give the first dose of clopidogrel 12 hours after the last dose of ticagrelor
✅We give a 600 mg loading dose of clopidogrel to all such patients

🛑Switching prasugrel to clopidogrel 
✅For patients who have been receiving prasugrel for five days or less, some of our experts load with clopidogrel 300 mg 24 hours after the last dose of prasugrel, while others do not load.
✅For patients taking prasugrel for >5 days, we do not give a loading dose and begin therapy with clopidogrel 75 mg daily.
#Uptodate2025

🛑Oral decongestants in pregnancy
✅Pseudoephedrine can be used in the second and third trimesters in females without hypertension.

✅Oral decongestants should generally be avoided during the first trimester
#Uptodate2025

🛑NSAIDS and pregnancy
✅ acetaminophen (the preferred analgesic during pregnancy
✅For pregnant patients >20 but ≤28 weeks in whom NSAID use is deemed necessary, the shortest duration (ideally ≤48 hours) and lowest effective dose should be used.

✅For patients >28 weeks, we avoid NSAID use given their associations with adverse outcomes at these gestational ages.

#Uptodate2025

🛑 TB and Lactation
✅Breastfeeding is not contraindicated among patients on treatment for TBI with first-line agents

✅Rifamycins can cause orange discoloration of body fluids including breastmilk, which is expected and considered harmless to patients and their nursing infants

#Uptodate2025

🛑 methotrexate (MTX)and Lactation
✅ MTX is considered contraindicated during breastfeeding
✅ However, it is excreted into breast milk in low concentrations;
✅if there is no acceptable alternative drug compatible with breastfeeding, MTX may be used at doses of ≤25 mg/week

#Uptodate2025

🛑الشخص الطبيعي عندما يكون عنده يوم اجازه من العمل يخرج مع أصحابه أو يشوف فلم


✅انا 👇👇👇😂😂😂😂

🛑 Chronic Coronary Disease and PCI
✅ No clinical trials have shown a survival benefit of PCI over optimal medical therapy (OMT) in
Chronic Coronary Disease
✅بالعربي كذا لايوجد اي ميزه للقسطره القلبيه على الادوية في مريض الشريان المزمن (تصلب الشرايين المستقر )

#ACCP2025

🛑ممكن نلجى لعمل قسطرة قلبيه PCI أو GABG في حاله
✅ مرضى لديهم:
تضيق كبير في الشريان الرئيسي الأيسر Left Main

✅ مرضى لديهم انسداد متعدد الشرايين Multivessel disease
مع ضعف شديد في وظيفة البطين الأيسر LVEF ≤ 35%

🛑drug and Lactation
✅relative infant dose (RID) via breast milk of < 10% of maternal weight-adjusted dose is generally considered safe in breastfeeding

✅RID 10–25%: Use with caution.

✅RID > 25%: Not acceptable during breastfeeding.

#LactMed

🛑بالعربي كذا

🛑بنسبه للأدوية في المرضعات استخدامه يعتمد على نسبه تواجده في الحليب مقارنه بجرعه الأم
✅اذا كان تواجده في الحليب بنسبه اقل 10% من جرعه الأم 👈يمكن استخدامه بأمان في المرضعات
✅اذا كان تواجده في الحليب بنسبه من 10 إلى 25% من جرعه الأم 👈 يستخدم الدواء بحذر في المرضعات
✅اذا كان تواجده في الحليب بنسبه اكثر من 25% من جرعه الأم 👈 غير آمن في المرضعات