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Primary Care Update

Primary Care Update

By Mark Ebell

Four healthily skeptical primary care physicians discuss the latest in primary care medicine. Join Essential Evidence Editor Mark Ebell MD, Rush University's Kate Rowland MD, MSU Professor of Medicine Gary Ferenchick MD, and POEMs co-founder Henry Barry MD, MS for this fast-paced weekly update on evidence-based primary care.
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Episode 150: EXXUA for depression, ubrogepant for migraine, PCI for stable angina, and a simple way to communications

Primary Care UpdateMar 11, 2024

00:00
30:37
Episode 150: EXXUA for depression, ubrogepant for migraine, PCI for stable angina, and a simple way to communications

Episode 150: EXXUA for depression, ubrogepant for migraine, PCI for stable angina, and a simple way to communications

This week, Gary, Kate, Henry and Mark discuss a newly approved medication for major depression in adults, initiation of abortive therapy using ubrogepant during migraine prodrome, the value of PCI for patients with stable angina, and a simple intervention to improve communication with hospitalized patients. And a quiz!


Mar 11, 202430:37
Episode 149: afib risk scores, tai chi and cognition, flu vax, and managing gallstones

Episode 149: afib risk scores, tai chi and cognition, flu vax, and managing gallstones

This week join us as Kate, Mark, Henry and Gary discuss clinical prediction tool for patients using DOACs for atrial fibrillation, the benefits of cognitively enhanced tai chi, whether high dose recombinant flu vaccine is useful in adults 50-64, and watching patients with symptomatic gallstone disease. 


Feb 26, 202432:58
Episode 148: meds for alcohol withdrawal, opioids and stimulants, and treating agitation in AD

Episode 148: meds for alcohol withdrawal, opioids and stimulants, and treating agitation in AD

This week, Kate, Henry and Mark discuss pharmacotherapy for alcohol use disorder, using opioids in adults with cancer pain who also use non-medical stimulants, and brexpiprazole for agitation in patients with Alzheimer's dementia.


Feb 13, 202423:19
Episode 147: TENS for post-op pain, Alzheimer's meds, and delivering bad news

Episode 147: TENS for post-op pain, Alzheimer's meds, and delivering bad news

Join Kate, Mark, Henry and Gary as they talk about: TENS for pain after cesarean delivery, cholinesterase inhibitors and risk of falls, a meta-analysis of the new Alzheimer’s drugs, and telephone delivery of bad news


Jan 30, 202432:38
Episode 146: nasal suction for infants, amitriptyline for IBS, aspirin to prevent CRC, and talking about hard things

Episode 146: nasal suction for infants, amitriptyline for IBS, aspirin to prevent CRC, and talking about hard things

This week, join Henry, Kate, Gary and Mark as they discuss 4 great studies: home suction devices for infants with bronchiolitis, amitriptyline for adults with irritable bowel, high-dose aspirin for preventing colorectal cancer, and communicating about serious illness and end of life.


Jan 17, 202431:58
Episode 145: DAPT for dementia, BP control post-stroke, managing CHD, and probiotics for IBS

Episode 145: DAPT for dementia, BP control post-stroke, managing CHD, and probiotics for IBS

This week, Kate, Henry, Mark and Gary discuss antiplatelet medications to prevent dementia, post-stroke blood pressure control, the latest guideline for managing patients with chronic cardiac disease, and probiotics for patients with irritable bowel syndrome.


Jan 03, 202436:08
Episode 144: cellulitis prognosis, chronic migraine tx, long COVID tx, and drugs for lipids

Episode 144: cellulitis prognosis, chronic migraine tx, long COVID tx, and drugs for lipids

This week Kate, Mark, Henry and Gary talk about how long it takes for lower extremity cellulitis to improve, how long it takes for CGRP monoclonal antibodies to take effect in adults with chronic migraine, whether CBT is effective for fatigue in patients with long COVID, and outcome data for various lipid lowering therapies. Plus a painful quiz, and Gary learns what an umbrella review is!


Dec 21, 202330:24
Episode 143: sponges for acne, renal colic, breast CA overdiagnosis, BP cuff size

Episode 143: sponges for acne, renal colic, breast CA overdiagnosis, BP cuff size

This week, Kate, Mark, Gary and Henry will discuss a possible new agent for acne, analgesia in adults with renal colic, breast cancer overdiagnosis in older women, and the importance of BP cuff size. Plus a Dickensian quiz.


Dec 05, 202326:37
Episode 142: Tdap in pregnancy, atogepant for migraine, POCUS for SBO and gastroparesis

Episode 142: Tdap in pregnancy, atogepant for migraine, POCUS for SBO and gastroparesis

This week, join Kate, Mark, Henry and Gary (from his carport) as they discuss third trimester Tdap for prevention of infant pertussis, atogepant for preventing migraines, POCUS for diagnosing small bowel obstruction, and whether any medications work for treating gastroparesis


Nov 22, 202330:12
Episode 141: an app to reduce drinking, e-cigs to quit smoking, and does ADHD lead to substance use

Episode 141: an app to reduce drinking, e-cigs to quit smoking, and does ADHD lead to substance use

This week, we give Henry the day off, leaving Kate, Mark and Gary to discuss a new app to reduce unhealthy alcohol use, whether e-cigarettes can help you quit smoking, and whether taking stimulant meds for ADHD increases the risk of substance use down the road. And the quiz, and a book recommendation ("A Voyage for Madmen").

Nov 08, 202324:60
Episode 140: Mg+ for CP, amox challenge, ACP guidelines, and carotid surgery

Episode 140: Mg+ for CP, amox challenge, ACP guidelines, and carotid surgery

This week Kate, Mark, Gary and Henry discuss magnesium to prevent cerebral palsy, amoxicillin challenge in the primary care clinic for suspectec PCN non-allergy, new ACP guidance on colorectal cancer screening, and surgery for carotid disease.

Oct 24, 202330:41
Episode 139: U=U, tetracyclines and teeth staining, metformin to prevent long COVID and the best med for onychomycosis

Episode 139: U=U, tetracyclines and teeth staining, metformin to prevent long COVID and the best med for onychomycosis

  • This week, Kate, Mark, Gary and Henry discuss viral loads and risk of HIV transmission, tetracyclines and dental staining in kids, metformin to prevent long COVID in obese and overweight adults, and the effectiveness of terbinafine pulse therapy for ugly toenails


  • Oct 10, 202327:06
    Episode 138: Deprescribing, meds for neuropsych symptoms in dementia, and lowering BP too much

    Episode 138: Deprescribing, meds for neuropsych symptoms in dementia, and lowering BP too much

    While Mark is biking, Kate, Henry and Gary talk about a deprescribing intervention for older adults in the hospital, medications for managing neuropsychiatric symptoms in adults with dementia, and harms associated with aggressive BP lowering in hospitalized older adults.


    Sep 30, 202330:38
    Episode 137: amox/mono, hearing aids, stem cells for knee OA, and preventing T2DM

    Episode 137: amox/mono, hearing aids, stem cells for knee OA, and preventing T2DM

    This week, Kate, Mark, Henry and Gary talk about whether amoxicillin really causes a rash in kids with mono, whether hearing aids improve cognition in the elderly, stem cell injections and knee OA, and nonpharmacologic approaches to preventing type 2 DM.

    Sep 18, 202329:56
    Episode 136: Beers, testosterone harms, opioids for back and neck pain, and SDOH

    Episode 136: Beers, testosterone harms, opioids for back and neck pain, and SDOH

    This week, join Mark, Kate, Henry and Gary as they discuss screening for social determinants of health, the updated Beers List of naughty medications, the value of opioids for acute back and neck pain, and testosterone and adverse events.

    Aug 29, 202334:40
    Episode 135: osteoporosis treatment, evolocumab, mifepristone for adenomyosis, and ambulatory BP

    Episode 135: osteoporosis treatment, evolocumab, mifepristone for adenomyosis, and ambulatory BP

    This week, Kate, Gary, Mark and Henry discuss treatments for osteoporosis in post-menopausal women, the effect of adding evolocumab to a statin - a reanalysis of the FOURIER trial, using mifepristone for painful adenomyosis, and real world data comparing 24-hour ambulatory BP with clinic readings.

    Aug 16, 202332:34
    Primary Care Update Episode 134

    Primary Care Update Episode 134

    This week, Kate, Gary, Henry and Mark discuss some fun throwbacks to 2003, the new first line medications for treating T2DM, whether you can take a diuretic at bedtime, and how to manage perioperative antihypertensive medications. And a quiz. Get CME credit at iafp.com just for listening, go to their education Web page.

    Aug 02, 202328:12
    Episode 133: bilirubin in infants, rest after concussion, child abuse, and why words matter

    Episode 133: bilirubin in infants, rest after concussion, child abuse, and why words matter

    This week, join Kate, Henry, Gary and Mark as they discuss point of care bilirubin tests for neonatal jaundice, guideline for evaluating children in close contact with abused children, early return to activity after concussion, and terminology preferences by patients being treated for substance use disorder.

    Jul 19, 202325:30
    Episode 132: new drug for hot flushes, screening for autism, and steroids for pneumonia

    Episode 132: new drug for hot flushes, screening for autism, and steroids for pneumonia

    This week, Kate, Henry and Mark discuss a new drug therapy for vasomotor symptoms of menopause, the accuracy of the M-CHAT tool for autism, and the value of steroids for severe community-acquired pneumonia. And Henry tells a joke about hot air balloons. And the quiz.

    Jul 03, 202328:59
    Episode 131: non-STEMI management in frail elderly, diagnosing secondary HTN in kids, and RSV vaccine for pregnant women

    Episode 131: non-STEMI management in frail elderly, diagnosing secondary HTN in kids, and RSV vaccine for pregnant women

    This week, while Gary tries to learn French in of all places France, Kate, Mark and Henry discuss management of non-STEMI in frail older adults, identifying children with secondary hypertension, and RSV vaccination in pregnant women

    Jun 21, 202325:04
    Episode 130: bempedoic acid, polypills and dementia, prophylaxis for STIs, and interpreting asymptomatic CAD

    Episode 130: bempedoic acid, polypills and dementia, prophylaxis for STIs, and interpreting asymptomatic CAD

    This week Kate, Gary, Henry and Mark talk about bempedoic acid for the prevention of ASCVD, the polypill and cognitive decline in the elderly, post-exposure prophylaxis in persons at high risk of STIs, asymptomatic CAD and subsequent AMI risk. And do you know how long ankle arthroplasties last?


    Jun 13, 202334:55
    Episode 129: estimating mortality in acute HF, a new migraine drug, and 15 year f/u of the largest RCT of prostate CA treatment

    Episode 129: estimating mortality in acute HF, a new migraine drug, and 15 year f/u of the largest RCT of prostate CA treatment

    Kate, Gary and Henry discuss 3 new studies: a clinical decision support tool to assess mortality risk in patients presenting with acute heart failure, a new intranasal medication for treating acute migraine attacks, and the pros and cons of different approaches to treatment of low grade prostate cancer.

    May 25, 202331:01
    Episode 128: BP targets, treatment resistant depression, angry and disruptive patients, and putting infants to bed

    Episode 128: BP targets, treatment resistant depression, angry and disruptive patients, and putting infants to bed

    This week our intrepid team of primary care physicians (Kate Rowland, Henry Barry, Gary Ferenchick and Mark Ebell) discuss treatment of resistant depression in older adults, recognizing and managing angry and disruptive patients, the best way to settle a cranky infant, and the AAFP 2022 Guideline on BP targets in adults with hypertension.

    May 10, 202330:36
    Episode 127: LDL targets, genicular nerve blocks, adding cytology to HPV, and HCTZ to prevent stones

    Episode 127: LDL targets, genicular nerve blocks, adding cytology to HPV, and HCTZ to prevent stones

    This week, Henry, Kate, Gary and Mark discuss: treating to LDL target or intensity-based statin therapy for adults with CAD, genicular nerve blocks for pain relief in adults with DJD, the value of adding cytology to HPV for cervical cancer screening, and HCTZ for preventing kidney stone recurrence 

    May 02, 202326:44
    Episode 126: screening for genital herpes, semaglutide for obesity, ACG guideline on lower GI bleed, and whether invasive management is helpful for stable CAD

    Episode 126: screening for genital herpes, semaglutide for obesity, ACG guideline on lower GI bleed, and whether invasive management is helpful for stable CAD

    This week, Gary, Kate, Henry and Mark discuss 2 new studies and 2 new guidelines: screening for genital herpes infections from the USPSTF, semaglutide injections in obese adolescents, ACG guidelines for acute lower GI bleeding, and invasive vs. noninvasive management of patients with stable CAD. And Henry manages to not talk about baseball!

    Apr 11, 202329:38
    Episode 125: reducing seizure frequency, antidepressants for pain, and periop anticoagulation

    Episode 125: reducing seizure frequency, antidepressants for pain, and periop anticoagulation

    Kate is at the Cubs opener today, so you'll have to settle for Mark, Gary and Henry as they discuss reducing seizures in young kids, the best antidepressants for managing pain, and new ACCP guidelines for peri-operative management of anticoagulation and antiplatelet agents.

    Mar 31, 202326:46
    Episode 124: etonogestrel and lactogensis, celiac guidelines, FODMAPS for IBS, and a new CV drug

    Episode 124: etonogestrel and lactogensis, celiac guidelines, FODMAPS for IBS, and a new CV drug

    This week, join Kate, Henry, Gary and Mark as they discuss: immediate insertion of etonogestrel contraception and lactogenesis, ACG Guideline for managing patients with celiac disease, FODMAPS diet for irritable bowel, and a new way to lower cholesterol and reduce CV events.  

    Mar 20, 202333:48
    Episode 123: mindfulness, PRP for Achilles rupture, lecanab for Alzheimer's, and VTE prophylaxis post-fracture

    Episode 123: mindfulness, PRP for Achilles rupture, lecanab for Alzheimer's, and VTE prophylaxis post-fracture

    This week, Kate, Gary, Henry and Mark discuss mindfulness based stress reduction for anxiety, platelet rich plasma for Achilles tendon ruptures, lecanamab for Alzheimer’s, and VTE prevention after fracture. Is aspirin sufficient?

    Mar 01, 202325:01
    Episode 122: predicing dementia, incentives to quit smoking, HP eradication for dyspepsia, and comparison of diabetes meds

    Episode 122: predicing dementia, incentives to quit smoking, HP eradication for dyspepsia, and comparison of diabetes meds

    Join Kate, Mark, Gary and Henry as they discuss whether we should (or can) use biomarkers to predict mild cognitive impairment or dementia, financial incentives to promote smoking cessation, the efficacy of HP eradication for functional dyspepsia, and results of the glycemic control arm of the GRADE Trial.

    Feb 15, 202332:57
    Episode 121: vitamin C for sepsis, probiotics for halitosis, and dyspepsia evaluation

    Episode 121: vitamin C for sepsis, probiotics for halitosis, and dyspepsia evaluation

    This week, Kate, Henry and Mark discuss vitamin C for sepsis, probiotics for treating halitosis, and new UK guidelines for evaluation of dyspepsia. Plus a quiz: how much time do we primary care docs spend every day delivering preventive services?

    Feb 01, 202324:20
    Episode 120: sleepy time for kids, crenezumab for Alzheimers, prognosis after TKA, and intermittent fasting
    Jan 18, 202332:24
    Episode 119: insomnia treatment, when to take HTN meds, colonoscopy effectiveness, and chlorthalidone vs HCTZ

    Episode 119: insomnia treatment, when to take HTN meds, colonoscopy effectiveness, and chlorthalidone vs HCTZ

    An action packed episode with some truly landmark studies to discuss. Join Kate, Henry, Gary and Mark as they discuss drug treatment of insomnia, when to take your anti-hypertensive meds, whether colonoscopy is effectiveness, and chlorthalidone vs HCTZ. 

    Jan 04, 202332:55
    Episode 118: hyperbilirubinemia, diabetic neuropathy, acute heart failure, and screening for CVD

    Episode 118: hyperbilirubinemia, diabetic neuropathy, acute heart failure, and screening for CVD

    This week, Kate, Gary, Henry and Mark discuss a new guideline for managing jaundice in babies, treating painful diabetic peripheral neuropathy, acetazolamide for patients hospitalized with CHF, and screening for CVD in older men.

    Dec 10, 202227:55
    Episode 117: the plague, treatment of prediabetes, asymptomatic bacteriuria, and the value of pyuria

    Episode 117: the plague, treatment of prediabetes, asymptomatic bacteriuria, and the value of pyuria

    This week, Mark, Kate, Henry and Gary discuss black Friday, black Death; long term outcomes of managing patients with impaired glucose tolerance or "pre-diabetes" (Henry hates that term); treating asymptomatic bacteriuria in nursing home residents; and the significance of microscopic pyuria in asymptomatic patients.

    Nov 27, 202230:34
    Episode 116: Polypills, yoga for migraine, best 2nd drug for DM, and Paxlovid for omicron
    Nov 09, 202232:57
    Episode 115: bisphosphonates and mortality, COVID rebound, and 2 IBS treatments

    Episode 115: bisphosphonates and mortality, COVID rebound, and 2 IBS treatments

    This week, join Mark, Kate, Gary and Henry as they discuss 4 studies: mortality reduction from the treatment of osteoporosis, hypnosis for patients with IBS, COVID rebound syndrome, and low FODMAP diets in patients with IBS.

    Oct 29, 202230:31
    Episode 114: cannabis for chronic pain, scaphoid fractures, and steroids for renal colic

    Episode 114: cannabis for chronic pain, scaphoid fractures, and steroids for renal colic

    On this week's podcast, our intrepid trio of family physicians discusses cannabis for chronic pain, treatment of scaphoid fractures in adults, and adding dexamethasone to ketorolac for adults with renal colic.

    Oct 12, 202226:16
    Episode 113: POC respiratory panels, fever in adults, and CV benefits of SGLT-2's

    Episode 113: POC respiratory panels, fever in adults, and CV benefits of SGLT-2's

    Today Kate, Gary and Henry talk about point of care respiratory panels for children, outcomes of controlling fever in adults, and SGLT2 inhibitors and heart failure. Mark is enjoying Murphy's in Cork but still managed to do the post-production.

    Sep 28, 202227:06
    Episode 112: buckle fractures, tirzepatide for obesity, and stroke risk with severe carotid stenosis
    Sep 14, 202224:01
    Episode 110: pharmacogenomics, functional abdominal pain in kids, vitamin D and fractures, and a T2DM guideline

    Episode 110: pharmacogenomics, functional abdominal pain in kids, vitamin D and fractures, and a T2DM guideline

    This episode, Henry, Kate, Mark and their colleague Gary Ferenchick from MSU discuss: pharmacogenomic-guided antidepressant therapy, non-drug interventions for children with functional abdominal pain, Vitamin D and fracture risk in the elderly, and NICE guideline for persons with T2DM.

    Sep 03, 202228:36
    Primary Care Update: Remembering John Hickner, MD, MS

    Primary Care Update: Remembering John Hickner, MD, MS

    Our mentor, colleague, fellow podcaster, and dear friend John Hickner died peacefully at home on August 22nd at age 72. As we grieve, we want to share some stories about John that exemplify why he was the kindest, most thoughtful, and most decent person we have had the privilege to know. 

    Sep 02, 202216:12
    Episode 109: motivational interviewing for weight loss, urate lowering in gout, and screening for anal cancer.

    Episode 109: motivational interviewing for weight loss, urate lowering in gout, and screening for anal cancer.

    This week Kate, Henry and Mark discuss motivational interviewing for weight loss, intensive vs standard urate lowering in persons with gout, and screening high risk persons for anal cancer.

    Aug 17, 202222:27
    Episode 108: LDL and mortality, cost-effectiveness of Alzheimer drugs, and surgery for ortho problems

    Episode 108: LDL and mortality, cost-effectiveness of Alzheimer drugs, and surgery for ortho problems

    This week, Kate, Henry and Mark discuss how much statins lower mortality, the cost-effectiveness of the new crop of Alzheimer's drugs, and whether surgery is helpful for a range of orthopedic conditions. 

    Aug 03, 202221:54
    Episode 107: TENS for renal colic, secondary HTN in kids, and evaluating chest pain

    Episode 107: TENS for renal colic, secondary HTN in kids, and evaluating chest pain

    This week, Kate, Mark and Henry will discuss secondary hypertension in children, TENS for persons with renal colic, and CTA vs angiography in persons with suspected stable CAD.

    Jul 20, 202221:49
    Episode 106: hMKPX (OK, monkeypox), screening for afib, and aducanumab for Alzheimer dementia

    Episode 106: hMKPX (OK, monkeypox), screening for afib, and aducanumab for Alzheimer dementia

    John has the week off, so Kate, Mark and Henry plow forward rudderless and talk about monkeypox (sorry, WHO, we're not calling it hMKPX, buy a vowel), screening for atrial fibrillation, and our new candidate for worst drug ever: aducanumab for Alzheimer dementia.

    Jul 06, 202224:03
    Episode 105: coronary calcium CT, what happens to prediabetics, an RCT of ketamine, and 1 vs 2 antidepressants

    Episode 105: coronary calcium CT, what happens to prediabetics, an RCT of ketamine, and 1 vs 2 antidepressants

    This week, Kate, Mark, Henry and John discuss the added value of coronary calcium scores, the natural history of prediabetes in older adults, using ketamine in suicidal persons, and whether antidepressant combination or monotherapy is better in severe or refractory depression. 

    Jun 22, 202227:16
    Episode 104: stress urinary incontinence, thyroid meds, Achilles tendon rupture, and HEPA for COPD

    Episode 104: stress urinary incontinence, thyroid meds, Achilles tendon rupture, and HEPA for COPD

    Kate, John, Henry and Mark (he set his alarm this time) are back to talk about a new treatment for female stress urinary incontinence, air cleaners for preventing COPD exacerbations in smokers, surgery vs non-operative management of Achilles tendon rupture, and whether switching among levothyroxine generics is a problem.

    Jun 08, 202227:40
    Episode 103: rosacea treatment, Dr. Google, and vitamin D and COVID

    Episode 103: rosacea treatment, Dr. Google, and vitamin D and COVID

    This week Mark slept in, so Kate, John and Henry talk about British guidelines for treatment of rosacea, what to do when Dr. Google comes to the office, and Vitamin D and COVID.

    May 26, 202229:02
    Episode 102: Prevention of preterm delivery, statins during pregnancy, and aromatherapy for postmenopausal symptoms

    Episode 102: Prevention of preterm delivery, statins during pregnancy, and aromatherapy for postmenopausal symptoms

    This week, Kate leads us on a special Mother's Day edition focused on women's health. Topics discussed by Kate, John and Henry (Mark is in Würzburg busily pontificating) include prevention of preterm delivery, statins during pregnancy, and aromatherapy for postmenopausal symptoms.

    May 10, 202225:22
    Episode 101: new VTE guidelines, weight loss drugs, and increased CV risk post-COVID

    Episode 101: new VTE guidelines, weight loss drugs, and increased CV risk post-COVID

    This week Kate, Henry and Mark discuss updated guideline recommendations for treatment of VTE, weight loss drugs, and the increased risk of cardiovascular events following COVID-19 infection. John has the week off.

    Apr 29, 202226:23