Core IM | Internal Medicine Podcast

Who’s really at risk for fractures, and how should we be treating them? 

Most fragility fractures occur in patients without osteoporosis. Should we rethink who gets treated? And could just one or two IV infusions (spread years apart) of zoledronate prevent fractures for years? Have the concerns about bisphosphonates been overblown?

Find out all the nuances on this episode of Beyond Journal Club, a series brought to you by Core IM in collaboration with NEJM Group.

🔹 Sponsor: Oakstone CME

Use the code "CORE25" for 25% off: https://www.coreimpodcast.com/MKSAP

🔹 Transcript & Show Notes

Timestamps:

(00:59) | Diagnosing Osteoporosis and Hidden Fracture Risk

(05:38) | Evolution of Bisphosphonate Use in Osteoporosis Treatment

(07:51) | Current Use of Bisphosphonates: Benefits, Risks, and Side Effects

(10:31) | Exploring Non-Bisphosphonate Options for Fracture Prevention

(11:44) | Teriparatide and Alternative Osteoporosis Medications

(14:53) | Inside the Latest Bisphosphonate Clinical Trial

(18:07) | Key Findings from the Zoledronate Fracture Prevention Study

(22:38) | Public Health Impact of Fracture Prevention Strategies

(24:24) | Final Takeaways and Expert Perspectives on Osteoporosis Care

Tags:  CoreIM, Internal Medicine, Primary Care, Medical Education, IMCore, Physician Assistant, Nurse Practitioner, Medical Student, Osteoporosis, Fragility Fractures, Zoledronate, Bone Health

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Medications for orthostatic hypotension! When to initiate treatment, how to use them safely, and what to do when new issues arise during treatment. How do those change if someone has autonomic failure? What do you do when your patient has hypertension AND also has orthostatic hypotension?

🔹 Sponsor: Oakstone CME’

Use the code "CORE25" for 25% off: https://www.coreimpodcast.com/MKSAP

🔹 Transcript & Show Notes

Timestamps (+/- 1-2 mins):

(00:28) | Case Recap: Beyond Non-Pharm Strategies

(03:07) | Midodrine: Timing, Testing, & Supine Hypertension

(06:23) | Fludrocortisone: Benefits vs. Risks

(09:01) | Droxidopa: Evidence, Side Effects, Access Issues

(10:11) | Pyridostigmine & NSAIDs: Secondary Options

(12:31) | Balancing Hypertension and Orthostatic Hypotension

(14:29) | Functional Hypotension & Risk Stratification

(18:45) | Symptomatic Patients: What to Stop, What to Continue

(20:19) | Autonomic Disease: Supine & Nocturnal Hypertension

(21:47) | Bed Elevation, Compression, & Non-Pharm Pearls

Tags: Internal Medicine, Geriatrics, Autonomic Dysfunction, Hypertension, Syncope, Falls, Patient Safety, Medical Education, physician assistant, nurse practitioner, hospitalist, primary care, neurology

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* Check out Eko: https://ekohealth.com/COREIM
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Learn specific, practical ways to counsel patients on non-pharmacologic interventions. What is our goal with OH treatment? Is it the blood pressure number that matters? How do we avoid missing neurogenic causes of orthostatic hypotension (OH)? 

🔹 Sponsor: Oakstone CME’

Use the code "CORE25" for 25% off: https://www.coreimpodcast.com/MKSAP

🔹 Transcript & Show Notes

Timestamps:

(00:05) | Case Presentation: Urinary Retention → Lightheadedness

(02:37) | Defining Orthostatic Hypotension & Prevalence

(04:10) | Why Diagnosis Is Harder Than It Seems

(06:20) | How (and When) to Measure Orthostatic Vitals

(10:06) | Role of Heart Rate in Narrowing the Differential

(14:41) | Rethinking Treatment Goals: Function > Numbers

(17:52) | Recognizing Orthostatic Intolerance Symptoms

(22:14) | Non-Pharmacologic Strategies in the Hospital

Tags: Primary care, Internal Medicine, Physician Assistant, Nurse Practitioner, Geriatrics, Autonomic Dysfunction, Syncope, Falls, Patient Safety, Medical Education

Find the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840

Our Sponsors:
* Check out Eko: https://ekohealth.com/COREIM
* Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.com
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Next time you’re squinting at a chest tube, feel confident you know exactly what to look for and why. Hear it explained in a way that really sticks!

🔹 Sponsor: Oakstone CME’s ACP MKSAP Audio Companion

Use the code "CORE25" for 25% off: https://www.coreimpodcast.com/MKSAP

🔹 Transcript & Show Notes

Timestamps:

(02:50) | Xray vs. POCUS vs. CT for Pneumothorax Diagnosis

(07:29) | Do All PTXs Need Chest Tubes?

(11:55) | Explaining Pneumothorax to Patients

(14:58) | Understanding the Pleural Drainage System

(26:11) | Monitoring Air Leaks with the Water Seal Chamber

(32:27) | Managing Persistent Air Leaks

Tags: CoreIM, Internal Medicine, Pulmonology, Critical Care, Medical Education, 3-Chamber Drainage System, Endobronchial Valves and Pleurodesis

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Our Sponsors:
* Check out Eko: https://ekohealth.com/COREIM
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How do you work up neutropenia? When is neutropenia benign? When do neutrophils recover? How can you diagnose neutropenic fever in the first 15 minutes and start antibiotics in the first 60 minutes? Do you always add MRSA coverages? Only Pseudomonas coverage? When do you add fungal coverage?

🔹 Sponsor: Oakstone CME’s ACP MKSAP Audio Companion

Use the code "CORE25" for 25% off: https://www.coreimpodcast.com/MKSAP

🔹 Transcript & Show Notes

Timestamps:

(02:24) | Approach to Neutropenia & Duffy Null

(11:38) | Dose and duration-dependent neutropenia vs. immune-mediated neutropenia

(19:46) | When do neutrophils recover?

(29:56) | Classifying Neutropenic Fever Syndromes

(29:53) | Strategies for Managing Low-Risk Neutropenic Fever

(33:02) | Antimicrobial Therapy and Duration in Febrile Neutropenia

Tags: CoreIM, Internal Medicine, Oncology, Hematology, Medical Education, Physician Assistant, Nurse Practitioner, Neutropenic Fever Management, Antibiotics

Find the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840

Our Sponsors:
* Check out Eko: https://ekohealth.com/COREIM
* Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.com
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