Core IM | Internal Medicine Podcast

SGLT-2i vs. GLP-1? vs Metformin? How do you balance the cost and coverage of first-line options like metformin, SGLT-2, and GLP-1s? How do you choose between SGLT-2 and GLP-1s for comorbidities like CAD or CKD? And how do you weigh their side effects and practical use?

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🔹 Transcript and Show Notes

Timestamps:

(01:43) | Case 1: Managing Uncontrolled Diabetes in a 47-Year-Old Male

(07:15) | Understanding Cost and Insurance Barriers in Diabetes Care

(09:26) | Case 2: Addressing Weight Gain and Financial Stress in a 52-Year-Old Male

(14:16) | Case 3: Managing Coronary Artery Disease and CKD in a 66-Year-Old Male

(19:41) | Case 4: Severe Obesity and Pain Management in a 59-Year-Old Female

(24:19) | Case 5: High A1C and Vascular Comorbidities in a 67-Year-Old Female

(35:34) | Weighing Side Effects and Practical Use of GLP-1 and SGLT2 Inhibitors

Tags: CoreIM, Primary Care, Endocrinology, Diabetes Mellitus, Type 2 Diabetes, Type 1 Diabetes, Metformin, GLP-1, SGLT2, Insulin, CGM, A1C, DKA, Medical Education, Clinical Reasoning, Hospital Medicine

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What really works when treating HRS? Vasoconstrictors like terlipressin vs. norepinephrine vs. midodrine: how do we decide which to use? Do you give albumin? When do you give Lasix or another diuretic? When is the better choice transplant, dialysis, or even palliative care?

🔹 Sponsor: Oakstone CME

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

🔹 Transcript & Show Notes

Timestamps:

 (00:12) | Introduction and Overview of Hepatorenal Treatment

 (03:38) | Vasoconstrictors Focus: Terlipressin, Norepinephrine, and Midodrine

 (12:32) | Finding the Right Dose of Albumin and Knowing When to Stop

 (15:06) | Volume Management: Balancing MAP, Diuretics, and Creatinine

 (21:42) | Understanding the High Mortality of HRS-AKI

 (32:30) | Transplant, Dialysis, or Palliation Care

Tags: CoreIM, Internal Medicine, Primary Care, Medical Education, IMCore, Physician Assistant, Nurse Practitioner, Medical Student, Hepatorenal Syndrome, HRS-AKI, Cirrhosis, Nephrology, Liver Disease

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* Check out Branch Basics: https://branchbasics.com/COREIM and use the code CoreIM for 15%
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HRS-AKI vs. other causes of AKI in cirrhosis: What do serum or urine sodium clues, albumin challenges, and shifting diagnostic criteria actually reveal about getting the diagnosis right?

🔹 Sponsor: Oakstone CME

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🔹 Transcript & Show Notes

Timestamps:

 (00:57) | Understanding the Pathophysiology of HRS

 (03:42) | How Portal Hypertension Traps the Kidneys

 (10:32) | Sorting the Differential of AKI in Cirrhosis Beyond HRS

 (18:28) | Hyponatremia and Urine Sodium in Advanced Cirrhosis

 (24:04) | Official Diagnosis and Evolving Criteria of HRS

 (29:30) | Albumin: When It Helps and When to Hold Back

 (34:00) | Recap and Future Directions

Tags: CoreIM, Internal Medicine, Primary Care, Medical Education, IMCore, Physician Assistant, Nurse Practitioner, Medical Student, Nephrology, renal, hepatology, Portal Hypertension, Liver Disease

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Our Sponsors:
* Check out Branch Basics: https://branchbasics.com/COREIM and use the code CoreIM for 15%
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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

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

Our Sponsors:
* Check out Branch Basics: https://branchbasics.com/COREIM and use the code CoreIM for 15%
* Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.com
* Check out Washington Red Raspberries: https://redrazz.org


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