Phosphate Dosing - Units and Terminology Confusion

A previous discussion was about selecting a phosphate repletion product.  Selecting a drug product can be confusing because of the similar names of the various formulations - which are not interchangeable.  Harm can come if one is unaware of the other electrolytes (sodium and potassium) that are necessarily included in the phosphate salt drug.  This discussion aims to clarify further confusion that is possible with regards to terminology and also units (and yes, we'll include just a bit of math).  We will also give a clear example where a published trial could lead someone to a wrong conclusion if they do not mind their units.

Phosphorus Repletion: Products and their Electrolytes

Monitoring and balancing electrolytes seems to be an inevitable daily function of physicians and other healthcare professionals in the internal medicine and intensive care settings.  Sodium, potassium, magnesium, calcium, and phosphorus seem to constantly need attention when a patient is ill in the hospital (and also because you're checking them every day, sometimes with and sometimes without good reason).  

Heart Failure with Preserved Ejection Fraction - Managing Comorbidities

Heart failure (HF) is a complex condition characterized by signs of volume overload or symptoms such as dyspnea, exercise intolerance, and fatigue. Being a syndrome, HF is not explained by one unifying pathophysiologic cause.  Rather, various mechanisms lead to the deficit between the amount of blood delivered and the amount of blood that needs to be delivered through the body to maintain homeostasis.  HF is defined as the previously mentioned signs or symptoms being caused by structural or functional cardiac abnormalities plus either 1) elevated natriuretic peptides (e.g., BNP) or 2) objective evidence of

Goodbye to Andexanet Alfa (AndexxaⓇ)

Andexanet alfa (Andexxa) made its quiet exit from the U.S. market just a few weeks ago.  It's an interesting story so in case you missed it, I'll recap what andexanet alfa is, or rather was, and what happened that led to its removal.  Being pulled from the U.S. market may have come to a surprise for some considering its main study (ANNEXA-I) was stopped early for successfully meeting its main efficacy outcome. While having a trial stopped early for superior efficacy results sounds good on the surface, it can have negative ramifications on other aspects of the clinical inquiry (explained below).

Treating Insomnia in Older Adults: Doxepin Highlights

The American Geriatrics Society recently published their Alternative Treatments to Selected Medications in reference to the most recent update to the AGS Beers Criteria in 2023.  This guidance is helpful because while the 2023 AGS Beers Criteria warned about which medications were "potentially inappropriate" in older adults, they left clinicians guessing by not offering suggestions as to which medications should alternatively be used.

Dyspnea Associated with Ticagrelor

Ticagrelor is an antiplatelet medication that is commonly used for a number of cardiovascular conditions.  Its mechanism is similar to that of antiplatelet medications clopidogrel and prasugrel in that it inhibits P2Y12 ADP receptors on platelets, preventing platelet activation and aggregation.  Ticagrelor is different from clopidogrel and prasugrel in that it binds reversibly to the receptor and, importantly, it is administered as the active compound.  This contrasts with clopidogrel and prasugrel which require metabolic activation by CYP450 enzymes and are therefore susceptible to drug interactions and altered activation in those with polymorphic CYP450 phenotypes (clopidogrel requires two CYP450 enzyme steps for