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FlexNP @rnflex.bsky.social · 5h

My little 7 month old chunk is so damn cute it makes me glad me and the wife are surgically unable to have another lol. Cuz I mean, look at her face!

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FlexNP @rnflex.bsky.social · 5h

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

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FlexNP @rnflex.bsky.social · 9h

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 · 12h

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

Yashar Ali 🐘 @yasharali.bsky.social · 12h

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 · 15h

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 · 15h

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 · 1d

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 · 1d

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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FlexNP @rnflex.bsky.social · 1d

I tried to prescribe valsartan today for a patient and Epic told me his insurance required a prior auth for it and I was just sitting at the keyvoard like this ...

a cat is sitting on a couch with its paws on a laptop .

ALT: a cat is sitting on a couch with its paws on a laptop .

media.tenor.com

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FlexNP @rnflex.bsky.social · 1d

Yeah the PPAR-gamma bit. But yeah cheap, long 1/2 life, low AE/SE

I've been using it in patients with HTN + high trigs with really good success.

Hypothetically, should be synergistic with any GIP agonist as well as statins.

IMHO seems great for metabolic syndrome and/or DM2

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FlexNP @rnflex.bsky.social · 1d

For those of my followers especially in primary care/cards/nephro do you prescribe telmisartan regularly?

If so, do you know it's dual action?

Just curious to see if people know about it

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FlexNP @rnflex.bsky.social · 1d

Cheers! Black IPA + bucatini and meatballs for us tonight with sauce made from garden tomatoes

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FlexNP @rnflex.bsky.social · 1d

Cheers! Black IPA + bucatini and meatballs for us tonight with sauce made from garden tomatoes

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FlexNP @rnflex.bsky.social · 1d

Same here. But approaching 130lbs loss between the two of us. Which is nuts. That's an entire human lost.

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FlexNP @rnflex.bsky.social · 1d

If we could get it for SSRI/SNRI specifically that would be a god send to not have to play roulette to figure out what is gonna help the patient

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FlexNP @rnflex.bsky.social · 1d

That's a fair critique! I don't prescribe it if they have any GI issues for that reason. But I'm like 90% Telmisartan anyways

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FlexNP @rnflex.bsky.social · 1d

I recently had to get an all new fitted suit because the tailor took one look at my old suit and one look at my now skinny ass and laughed and laughed.

Also. Suits are expensive 🙃

But goddamn was it worth it.

Mary Sue ass drugs

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FlexNP @rnflex.bsky.social · 1d

Then of course the firehose of research data that's constantly coming out. It is admittedly hard to keep up at times. Insurers push towards one drug over another etc etc. It's a landscape fraught with hurdles and I hope that doesn't sound like an excuse because it's just reality unfortunately

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FlexNP @rnflex.bsky.social · 1d

Also feels like unspoken here is clinical inertia. It takes years for some data to filter down and oftentimes it never makes it. Why do people prescribe Losartan so much when we have better ARBs(Telmi/Olme)?

It's multifactorial. Memorized some med in school/residency and stuck with it.

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FlexNP @rnflex.bsky.social · 1d

Yeah it's certainly not perfect! But it is interesting to see it work on occasions

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FlexNP @rnflex.bsky.social · 1d

Social food pressures are real! Both also shifted their diets based on their partners new food preferences as well. Fascinating and beneficial knock on effect for some people.

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FlexNP @rnflex.bsky.social · 1d

Fun thing I've noticed in the last couple weeks. Patients who have a partner on a GLP-1 tend to lose weight too without realizing it. One last week down 17lbs and the other yesterday down 12lbs.

They both said the same thing, they felt guilty eating more than their partner.

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FlexNP @rnflex.bsky.social · 1d

I'll still keep prescribing spiro thanks to the knowledge you and #NephJC have imparted upon me.

It's a fun magic trick when I switch an uncontrolled HTN patient maxed on 3 meds to spiro, and suddenly they have perfect BP. They think I have some veiled magic knowledge 😂

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FlexNP @rnflex.bsky.social · 1d

So basically another 3rd line option as far as I can see it as a primary care person? Not to sound dismissive but it'll be expensive!

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FlexNP @rnflex.bsky.social · 2d

You're correct. Initial phase 2 CKD trial finishes up end of November 2025. Currently phase 3 CKD trials ongoing until 2029.

But yeah normal BMI patients it's not a good idea to be on!! 🫣

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