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FlexNP @rnflex.bsky.social · 2h

I only prescribe Rosu and pitavastatin alpha statins only

FlexNP @rnflex.bsky.social · 3h

That it's named .statinhell 😂😂

a man in a black turtleneck is standing in front of a window and the word perfection is on the screen

ALT: a man in a black turtleneck is standing in front of a window and the word perfection is on the screen

media.tenor.com

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FlexNP @rnflex.bsky.social · 6h

And I definitely don't like these sort of targeted trial emulations but it at least gives us an idea of potential benefit and once again the answer may well be GLP1 meds are like metabolic magic.

FlexNP @rnflex.bsky.social · 6h

"Tirzepatide (HR 0.53 [95% CI 0.40, 0.71]) and semaglutide (HR 0.81 [0.72, 0.90]) were associated with a significant reduction in the risk of incident major adverse liver outcomes" Tirzepatide again with an almost comical reduction but given it's mechanism on triglycerides that would make sense.

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FlexNP @rnflex.bsky.social · 6h

The next frontier for GLP-1 meds is liver disease. Semaglutide already has an indication for MASH now. Tirzepatide has a trial starting up in the next month for liver disease. This target trial emulation shows what we might see from such a trial.

pubmed.ncbi.nlm.nih.gov/40980971/

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FlexNP @rnflex.bsky.social · 6h

That's it exactly

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FlexNP @rnflex.bsky.social · 9h

Me as primary care NP who figured out how to bypass hematology for ordering iron infusions for my iron deficiency anemia patients who can't tolerate oral iron and are symptomatic AND get insurance to cover it:

CC: @shematologist.medsky.social

a man is screaming with the words " unlimited power " behind him

ALT: a man is screaming with the words " unlimited power " behind him

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FlexNP @rnflex.bsky.social · 9h

Absolutely!!! I mean CAD, HTN, HLD, prediabetic and fatty liver in addition to the OSA. He's literally a walking time bomb for poor outcomes and is also EXACTLY the patient who would benefit the most from a GLP-1 med!

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FlexNP @rnflex.bsky.social · 10h

I think probably late 2018-2019. Second place would be the first 6 months of covid.

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FlexNP @rnflex.bsky.social · 11h

It's so annoying! He's an ideal candidate! He also has HTN and CAD so yes let me prescribe him a stimulant 🤬🤬🤦🤦

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FlexNP @rnflex.bsky.social · 11h

I feel like @thetirednurse.bsky.social can gripe with me. Patient with moderate sleep apnea. Compliant with CPAP for last 3 months. Asks for Zepbound as insurance covers for OSA.

Prior auth denied. They want him to try phentermine for his OSA first.

Uh. Phentermine is not indicated for OSA 🙃😐

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FlexNP @rnflex.bsky.social · 12h

The gnashing of teeth today is gonna be delicious.

FlexNP @rnflex.bsky.social · 1d

We're getting my 7.5 month old her MMR next week even tho it means getting her one extra shot. Don't trust RFK at all at this point. Pediatrician onboard with it because of *waves hands all of this*

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FlexNP @rnflex.bsky.social · 1d

Things I talk to my patients about myself:

My weight loss journey

My daily statin

My struggle with anxiety

It builds trust. It shows you give a damn.

I don't just prescribe things to push drugs. I have struggled too. I take meds. I understand! I'm human too.

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FlexNP @rnflex.bsky.social · 1d

Rhetorical question for all the nephrology peeps who follow me but is it bad that your GFR goes from 89 to 27 in a matter of a month 🫣

FlexNP @rnflex.bsky.social · 1d

Well only sent 1 patient to the ER today from a primary care office. It was almost 3. 🫣🫣🫣 Yeesh.

Do not like that level of acuity on a random Thursday!

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FlexNP @rnflex.bsky.social · 1d

Well only sent 1 patient to the ER today from a primary care office. It was almost 3. 🫣🫣🫣 Yeesh.

Do not like that level of acuity on a random Thursday!

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FlexNP @rnflex.bsky.social · 1d

But I'm not even sure it'll be adjunctive at this point. There's a market for it but it's not a big one. GLP1 meds will take all the MASH/early liver disease and reverse it on their own. I think the market here is more for severe liver disease but that's a small market

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FlexNP @rnflex.bsky.social · 1d

Oh no Novo what are you doing with this deal 😬😬😬

FGF21 analogs for MASH work but they're slow, don't have the benefits of GLP1 meds and will be overtaken by GLP1 multi-agonists for MASH treatments.

Novo to Buy Akero for Up to $5.2 Billion for Liver Disease Boost

Novo Nordisk A/S agreed to buy Akero Therapeutics Inc. for as much as $5.2 billion to expand its portfolio in a type of liver disease that’s linked to obesity.

www.bloomberg.com

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FlexNP @rnflex.bsky.social · 1d

Creatinine or Cystatin-C GFR? Or does he prefer both?

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FlexNP @rnflex.bsky.social · 2d

Both my children now vaccinated against COVID 19 including my 7 month who obviously has never been vaccinated against it.

You can put up hurdles RFK but I will keep my children safe and healthy no matter what it takes.

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FlexNP @rnflex.bsky.social · 2d

Our queen speaks. Alive, thriving and as nonplussed as always.

Yashar Ali 🐘 @yasharali.bsky.social · 2d

BREAKING

In a new video, Dolly Parton, the Queen of America, says she’s going to be ok.

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FlexNP @rnflex.bsky.social · 2d

Yes but also at the same time the drugs act on the hypothalamus(primarily for the appetite suppression effects) and the hypothalamus controls body temp and sensations of warm/cold so may be a spill over effect of the drugs on thermoregulation as well.

FlexNP @rnflex.bsky.social · 2d

Downside of being on a GLP-1 as the weather turns colder. The reminder that these drugs mess with your thermoregulation.

How you'll find me in my office today:

a man is sitting in front of a computer wearing a hat and gloves .

ALT: a man is sitting in front of a computer wearing a hat and gloves .

media.tenor.com

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FlexNP @rnflex.bsky.social · 2d

Yeah I mentioned that in the write up that no one uses 1.5mg anymore but when they started this trial they didn't have the AWARD-11 data yet.

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FlexNP @rnflex.bsky.social · 2d

I did a whole blog post about it. The all cause mortality benefit and the high risk CKD outcomes are mind bogglingly incredible.

GIP: SURPASSing all expectations

Part 3 of the GIP series, cardiac benefits of GIP and a deep dive of the remarkable SURPASS CVOT trial results

the-incretins.beehiiv.com

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