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By rray, 15 August, 2023

Fall prevention strategies for pts at uarr risk include wt bearing and muscle strengthening exercises along w individualized multifactorial interventions e g vision assessment and tx balance training and environmental assessment and modification 26

By rray, 14 August, 2023

Fall prevention strategies for pts at uarr risk include wt bearing and muscle strengthening exercises along w individualized multifactorial interventions e g vision assessment and tx balance training and environmental assessment and modification 31

By rray, 14 August, 2023

Fall prevention strategies for pts at uarr risk include wt bearing and muscle strengthening exercises along w individualized multifactorial interventions e g vision assessment and tx balance training and environmental assessment and modification 18

Which age group in the U.S. had the highest percent increase in suicides from 2021 to 2022?

45-64 years

25-44 years

10-24 years

≥65 years

You are correct. CDC reports that there were 10,433 deaths from suicide from 2021 to 2022 in the U.S. for persons ≥65 years, an 8.1% increase from the previous year.

There were 15,632 suicides among persons ages 45-64 and 16,843 suicides for persons ages 25-44, a 6.6% and 0.7% increase respectively, from the previous year.

In contrast, the number of deaths by suicide—6,529—decreased 8.4% for persons ages 10-24.

(PubMed)—A 52-yo man w/ cyanotic congenital heart dz, complicated by Eisenmenger syndrome, functional New York Heart Assn class II-III, and recurrent SVT, presented to the ED w/ bradycardia of 30 bpm. Resting ECG showed sinus arrest. Previously, the pt was well controlled on medical tx alone. Ultimately, a temporary pacemaker was needed x3 days until cardiac sx stabilized. Other conditions: chronic HCV (genotype 1B), primary biliary cholangiopathy, hypothyroidism, and chronic kidney dz (KDIGO 2). PMHx: HAV, HBV, TB. Current meds: allopurinol, amiodarone, ferric hydroxide, ledipasvir/sofosbuvir, levothyroxine, metoprolol, sildenafil, torsemide, and ursodeoxycholic acid (ursodiol).

Which drug combo may have led to serious bradycardia and sinus arrest?

amiodarone and ledipasvir/sofosbuvir

allopurinol and torsemide

levothyroxine and ursodeoxycholic acid (ursodiol)

ledipasvir/sofosbuvir and torsemide

amiodarone and ledipasvir/sofosbuvir

You are correct. While awaiting cardiologist approval to hold amiodarone or switch to an alternative drug (which was recommended to avoid this potentially serious interaction), the pt inadvertently took a dose of ledipasvir/sofosbuvir while still taking amiodarone. This combo likely caused severe bradycardia and sinus arrest. Coadministration of amiodarone and sofosbuvir is not recommended w/o close ECG monitoring.

Of note, the pt’s worsening hepatitis C was later successfully treated using elbasvir/grazoprevir x12wk. This did not appear to significantly impact his concurrent amiodarone tx, as demonstrated by stable ECG results.

Source article: Weiss L, Wustmann K, Semmo M, Schwerzmann M, Semmo N. Elbasvir/grazoprevir, an alternative in antiviral hepatitis C therapy in patients under amiodarone treatment. Case Rep Gastroenterol. 2018 Jan-Apr; 12(1): 92–98. Published online 2018 Feb 21. doi: 10.1159/000486951. More info is available in the free full-text Case Rep Gastroenterol article PDF at PubMed Central.

By rray, 11 August, 2023

Fall prevention strategies for pts at uarr risk include wt bearing and muscle strengthening exercises along w individualized multifactorial interventions e g vision assessment and tx balance training and environmental assessment and modification 26

Fall prevention strategies for pts at uarr risk include wt bearing and muscle strengthening exercises along w individualized multifactorial interventions e g vision assessment and tx balance training and environmental assessment and modification 31

Fall prevention strategies for pts at uarr risk include wt bearing and muscle strengthening exercises along w individualized multifactorial interventions e g vision assessment and tx balance training and environmental assessment and modification 18

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