Sorry some dumb medical questions from a PGY1
I have some really dumb questions, if anyone would be willing to answer them!
1. Do you hold all GDMT or just the beta blocker during heart failure exacerbation? What about Farxiga? Is Amlodipine or Nifedipine contraindicated in HFrEF/HFpEF?
2. Are there any formal guidelines on when to start pharmacology for weight loss, such as Phentermine-topiramate?
3. How do you know if a chest tube is currently to suction, on water seal, or clamped?
4. How exactly do you diagnose DKA? Do you need...
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Source: Student Doctor Network - September 16, 2023 Category: Universities & Medical Training Authors: lotsofquestions101 Tags: Internal Medicine and IM Subspecialties Source Type: forums
Chemotherapy induced peripheral neuropathy
88yo with h/o chemotherapy induced neuropathy in BLE. Tried gabapentin, duloxtine, lyrica, topamax, ALA, topical lido/voltaren/menthol/capsaicin, TENS. Pt not interested in SCS, worried about sedation. Lives alone and also given age, I've tried to hold off on TCAs...but I may need to go that route as pain is worsening. What else can I offer? LESI?? (Source: Student Doctor Network)
Source: Student Doctor Network - August 22, 2023 Category: Universities & Medical Training Authors: oneforfighting Tags: Pain Medicine Source Type: forums
Topiramate
Curious what everyone’s experience has been with topiramate and it’s many many off label uses. I had a conversation with someone the other day who frequently used it for weight loss, mdd, ocd, sleep, Alcohol deprenence and other off label uses. I’ve never really used it because in my minds eye there’s always something that is “better“ in each given category of use and frankly I’m just not very familiar with it. What has the group seen by way of efficacy in all of its off label uses? My...
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Source: Student Doctor Network - June 1, 2023 Category: Universities & Medical Training Authors: medhead1990 Tags: Psychiatry Source Type: forums
Psychiatrist treating obesity?
Given that some of the antiobesity medications (Contrave, stimulants, even phentermine-topiramate) as well as nonpharmacological options such as therapy (lifestyle modification, behavioral activation, motivational interviewing) are within the scope of practice for psychiatry, I was wondering how common it is for psychiatrists to be treating obesity outside of antipsychotic-induced weight gain?
There are many more medications that we may not use (orlistat, GLP-1 agonists although this is...
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Source: Student Doctor Network - April 21, 2022 Category: Universities & Medical Training Authors: clozareal Tags: Psychiatry Source Type: forums
Good resource for tapering AED's and other meds?
I'm working to clean up some awful med regimens in a clinic where NP used to work. I routinely see folks on Trileptal, Topamax and Tegretol. I know we often can use epocrates for dosing but for how to taper these, do you guys have any suggestions or is there a good quick resource I can use?
It's quite disappointing some of the management I've seen at this clinic. (Source: Student Doctor Network)
Source: Student Doctor Network - January 11, 2020 Category: Universities & Medical Training Authors: ryerica22 Tags: Psychiatry Source Type: forums
Depakote
Hi,
I have a patient with Bipolar Dx who is doing beautifully on Depakote. However, she is concerned about her weight gain (she's been taking it for a few months). She is taking 750 mg of the Delayed Release. I would like to taper it off and start her on Lamictal or Topamax. I was wondering generally, how do you guys taper Depakote to discontinue?
I hate taking the medication away as she is doing so well.
Thanks (Source: Student Doctor Network)
Source: Student Doctor Network - September 30, 2017 Category: Universities & Medical Training Authors: ara96 Source Type: forums
What would you do?
Patient is a female 30 years old. Has seen other psychiatrists in the past all with the same diagnosis: schizoaffective depressive type. Takes Zyprexa and Paxil and Topamax for migraines. She is on disability and going to school. She says she hopes to work for a bank. You continue treatment she appears to be doing well. She hits a bump in the road and almost dies. Turns out she was drinking her way through college. (Medical report shows her lipase rose to 1200). She goes to rehab and comes...
What would you do? (Source: Student Doctor Network)
Source: Student Doctor Network - September 20, 2017 Category: Universities & Medical Training Authors: Maggie Martin Source Type: forums
Less common anticonvulsants for neuropathic pain states
Gaba/lyrica/topamax are commonly used for neuropathic pain states, as well as antidepressants and topicals.
How about the other anticonvulsants? Does anyone try tegretol or any others before resigning these people to stim? (Source: Student Doctor Network)
Source: Student Doctor Network - August 4, 2017 Category: Universities & Medical Training Authors: Timeoutofmind Source Type: forums
