There are two kinds of clinicians—the ones who follow algorithms, and the ones who understand the “why.”

Patients know the difference. Know the WHY!

Join our clinical library today on PATREON!

👉 https://www.patreon.com/PearlsandPrep

Today, we're diving into the surprising world of anxiety disorders and uncovering the fact that the most common one out there is actually a specific phobia. Yep, you heard that right! It’s wild to think that about 1 in 10 people you pass in the grocery store might be dealing with a phobia that keeps them on the sidelines. We'll chat about how these fears often fly under the radar because folks are pretty good at dodging what scares them, so they don’t end up in our clinics. Plus, we’ll break down why exposure therapy is the gold standard for tackling these pesky phobias, and how it can work wonders in just one session. So, grab a snack and settle in, because we’re about to unravel some mind-boggling truths about anxiety that might just change how you think about mental health!

32

The Most Common Anxiety Disorder May Never Walk Into Your Clinic — But We Still Need to Recognize It

Pearls and Prep

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Get ready to dive deep into the wild world of anxiety disorders! This episode is like a treasure hunt where we uncover the surprising truth about the most common anxiety disorder lurking out there. Spoiler alert: it’s not what you might think! We kick things off with a casual chat about the usual suspects: generalized anxiety disorder, social anxiety, panic disorder, and specific phobias. As we sift through the psychiatric literature, we discover that specific phobias reign supreme, affecting 6 to 12% of folks at any given time. Can you believe it? That’s like one in ten people at the grocery store who might be sweating over a spider or avoiding the blood donation chair.

We break down why these phobias often go undiagnosed because, let’s face it, people are pros at dodging their fears. So, we discuss how exposure therapy is the gold standard for treatment, making it quite the unicorn in the DSM-5. We explore how understanding our primal fears can help lighten the load for patients, reminding them that it’s not their fault they’re scared of snakes or heights. It’s all about compassion and clever strategies to help folks reclaim their lives without the burden of those pesky phobias. We laugh, we learn, and we leave you with some serious insights about treating anxiety disorders in a way that’s both effective and empathetic!

Takeaways:

• We learned that specific phobia is the most common anxiety disorder, surprising right?
• The podcast emphasizes that exposure therapy is key for treating specific phobias effectively.
• Patients often avoid situations that trigger their phobias, making them harder to diagnose.
• It's vital to remind patients that having a phobia isn't their fault—it's often tied to evolution!
• We discussed how people can actually have phobias without even realizing it due to past experiences.
• The episode highlights that not all anxiety sufferers will seek help, which is something to be aware of.

Links referenced in this episode:

• patreon.com

The principal focus of this podcast episode revolves around the exceedingly high suicide risk observed during the initial week following psychiatric hospital discharge. In this discussion, we delve into an illuminating multiple-choice question that challenges our understanding of psychiatric vulnerabilities. The episode underscores the alarming statistic that, within the first three months post-discharge, individuals experience a suicide rate that is a staggering one hundred times greater than that of the general population. We explore the complexities surrounding patient discharges and the myriad factors that exacerbate the risks during this critical transition period. Our conversation aims to heighten awareness and incite a proactive approach to safeguarding the mental health of individuals navigating this precarious juncture.

27

The Most Dangerous Window in Psychiatry. Can you guess what it is?

Pearls and Prep

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The podcast delves into a particularly alarming aspect of psychiatric care, highlighting the critical window of vulnerability following a patient’s discharge from inpatient psychiatric treatment. It is revealed that the first week subsequent to discharge poses the highest risk for suicide across all psychiatric demographics, with rates astonishingly elevated—one hundred times that of the general population. This statistic underscores the complexity of psychiatric care, as patients discharged from inpatient settings often return to environments fraught with unresolved issues and instability. The discussion emphasizes the necessity for comprehensive follow-up care and proactive measures to ensure these individuals receive appropriate support as they transition back to their lives outside the hospital. This episode serves as a clarion call to practitioners to recognize the imperative of safeguarding the mental health of patients during this precarious period, advocating for structured post-discharge plans that include timely follow-ups and thorough assessments of patients' social circumstances.

Takeaways:

• The most critical period for suicide risk in psychiatry occurs during the first week post-discharge.
• Patients discharged from psychiatric facilities face a significantly elevated suicide risk compared to the general population.
• Effective follow-up care within days of discharge is essential to mitigate suicide risk.
• Understanding and addressing socioeconomic factors is critical for supporting discharged psychiatric patients.
• Medication changes and discontinuation can precipitate serious mental health crises in vulnerable patients.
• Inpatient psychiatric care provides essential stabilization, yet post-discharge planning is crucial for sustained recovery.

Links referenced in this episode:

• pearlsandprep.com
• patreon.com/pearlsandprep

There are two kinds of clinicians—the ones who follow algorithms, and the ones who understand the “why.”

Patients know the difference. Know the WHY!

Join our clinical library today on PATREON!

👉 https://www.patreon.com/PearlsandPrep

Today, we’re diving into the heavyweight showdown between Seroquel and Lamictal to see which medication packs a better punch for bipolar depression. Spoiler alert: Seroquel takes the first round with its broad FDA indications and sleep benefits, making it a go-to for those restless nights. But don’t sleep on Lamictal just yet – it’s got its own charm for long-term stability and drama-free vibes once you get past the titration period. We’ll break down the efficacy, side effects, and all the juicy details you need to know to help your patients navigate these options. So grab your favorite snack, kick back, and let’s get ready to rumble in this medication matchup!

32

Inside the Ring 🥊: Lamictal vs. Seroquel — A Deep-Dive into 2 of The Bipolar Depression Heavyweights.

Pearls and Prep

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Diving right into the ring, we’re throwing down some heavyweight contenders: Seroquel vs. Lamictal! Both are players in the bipolar depression game, but each has its own unique flair. Seroquel, affectionately known for making you snooze like a baby, is the go-to for those acute moods. It’s FDA approved for the full bipolar buffet, meaning it’s got your back whether you’re in a manic tizzy or feeling like you’re stuck in the depths of despair.

On the other hand, Lamictal is the chill friend, not really there for the short-term chaos but rather hanging out in the background, ensuring you don’t take a nosedive into that dark pit again. Sure, it’s got its own strengths, especially for maintenance, but if you need a quick fix, Seroquel’s your guy. We break down the pros and cons of each, laying it out like a boxing match where no one gets knocked out, but you definitely feel the punches!

Takeaways:

• In the showdown between Seroquel and Lamictal, Seroquel takes the crown for its FDA approval for acute bipolar depression and mania.
• Adherence is key when prescribing medication; the best drug is the one a patient will actually take.
• Seroquel is fantastic for sleep issues, which can be a game changer for patients struggling with bipolar disorder.
• Lamictal is known for being more weight neutral and has less sedation, making it appealing for long-term management.

Companies mentioned in this episode:

• Seroquel
• Lamictal
• Cymbalta

There are two kinds of clinicians—the ones who follow algorithms, and the ones who understand the “why.”

Patients know the difference. Know the WHY!

Join our clinical library today on PATREON!

👉 https://www.patreon.com/PearlsandPrep

We've got a juicy nugget for you today: one in seven patients starting on antidepressants might develop bruxism, which is basically the fancy term for grinding your teeth. Yeah, that’s right, 14% of your patients could be unknowingly clenching their jaws while they sleep. And get this—80% of them won’t even realize it’s happening! We dive into the nitty-gritty of how this can mess with their dental health and lead to some serious side effects, like headaches and tooth sensitivity. Plus, I’ll share some tips on how to spot this sneaky issue and what you can do to help your patients keep their pearly whites in check. Buckle up, it's gonna be a wild ride!

32

1 in 7 of Your Patients Will Experience This Hidden Dental Disaster! And 80% have No Clue!

Pearls and Prep

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Let’s dive into the world of antidepressants and a sneaky side effect that can take your patients by surprise—bruxism! Picture this: one in every seven patients starting on antidepressants might start grinding their teeth without even knowing it. Can you believe that? That’s about 14% of your patient panel! So, if you’ve got 30 patients this week, odds are a couple are clenching their jaws while catching some Zs. And here’s the kicker—80% of them won’t even be aware it’s happening. We’re talking about serious damage to their dental health, folks. Teeth can wear down faster than a kid on a skateboard in a parking lot!

And it’s not just about the teeth; those late-night jaw workouts can lead to morning headaches too. So, how do we tackle this? Our friendly host suggests asking the right questions during check-ups, like, “Hey, are you waking up with headaches?” or “Any jaw pain you didn’t mention?” Getting on top of this could save your patients a lot of dental drama down the line. Switching gears, the podcast also touches on how SSRIs can mess with dopamine levels, leading to these involuntary movements. It’s a bit of a dance in the brain—too much serotonin can suppress dopamine, which is like putting a damper on your groove. But fear not! There are meds out there that can help ease the bruxism without leaving your patients feeling like they’re on a rollercoaster of side effects.

Buspirone is one such gem, known for smoothing things out. It can take the edge off anxiety and help with bruxism, giving your patients a win-win. And if that doesn’t do the trick, there are always other options like mirtazapine, which can help balance things out too. So let’s keep those conversations rolling and make sure our patients aren’t just coming in for meds, but also leaving with a smile—literally!

Takeaways:

• One in seven patients starting antidepressants will develop bruxism, which is wild!
• Eighty percent of patients won't even know they're grinding their teeth at night, yikes!
• Bruxism can cause serious dental issues, including cracked enamel and morning headaches, so watch out!
• Switching to Wellbutrin might help with bruxism and anxiety, but it's not a one-size-fits-all fix!
• Buspirone can be a game changer for managing bruxism while also easing anxiety, talk about a two-for-one deal!
• Always ask your patients about jaw pain or headaches, they might not even realize it's bruxism!

Links referenced in this episode:

• patreon.com

Companies mentioned in this episode:

• Zoloft
• Lexapro
• Effexor
• Paxil
• Cymbalta
• Geodon
• Abilify
• Lanzapine
• Risperidol
• Wellbutrin
• Buspirone
• Mirtazapine

There are two kinds of clinicians—the ones who follow algorithms, and the ones who understand the “why.”

Patients know the difference. Know the WHY!

Join our clinical library today on PATREON!

👉 https://www.patreon.com/PearlsandPrep

Today, we’re diving deep into the tricky world of pharmacotherapy—specifically, figuring out the least appropriate meds for our buddy(mock patinet) Lenny, who’s juggling bipolar one disorder and a hefty dose of life challenges. We’re breaking down why certain meds might not just be a poor fit, but also a potential disaster for someone who's housing insecure. Spoiler alert: Latuda is the big no-no here, thanks to its strict food requirements that could leave Lenny high and dry if he skips a meal. We’ll also chew over some other options like Seroquel and Lamictal, exploring their pros and cons in a real-world context. So, grab your headphones and let’s get those gears turning—it's gonna be a ride!

32

Board Bomb Bonus Episode: This One Wrong Medication Choice Can Blow Up Your Treatment Plan

Pearls and Prep

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Navigating the wild world of pharmacotherapy isn't always a walk in the park, especially when you're dealing with a patient like Lenny, a 34-year-old man with bipolar one disorder who's got a lot on his plate. This episode is all about diving deep into the nitty-gritty of medication management, and let me tell you, it’s a real eye-opener.

We kick things off with Lenny’s story—he's been riding the rollercoaster of depression, living in shelters, and trying to keep his head above water. As we dig into the medication options, we’re not just tossing around names like Seroquel or Lamictal; we’re really getting into the weeds about why certain meds might be a hit or miss for someone like Lenny. You know, it’s all about understanding the social determinants of health and how they play a massive role in treatment outcomes. Lenny’s case challenges us to think critically about what we prescribe. We dissect the pros and cons of each option, exploring not just the medications but also the real-life implications for someone who’s housing insecure.

For instance, while Seroquel might seem like an easy fit because it’s sedative, we’re reminded that Lenny’s already struggling with sleep. And then there’s Latuda, which could be a game-changer, but wait—he can’t take it without food! That’s a huge deal when you’re relying on soup kitchens. Each med comes with its own baggage, and we’re here to unpack it. By the end, we’ve not only examined pharmacotherapy but also the human side of patient care, emphasizing adherence and the importance of patient education. It’s like a crash course in real-world psychiatry—definitely a must-listen for anyone in the field!

Takeaways:

• This episode really emphasized the importance of considering social factors in medication choices.
• We explored Lenny's situation and how his housing insecurity impacts his treatment options.
• Remember, not all meds are created equal; you gotta think about the context too!
• Latuda was highlighted as a deal breaker due to its food absorption requirement.
• Seroquel can be problematic for Lenny since he's already sleeping too much, right?
• We need to ensure our patients can actually adhere to their medications to make them effective.

Companies mentioned in this episode:

• Npc
• Seroquel
• Lamictal
• Latuda
• Vraylar
• Lumateperone
• Caplyta
• Geodon

There are two kinds of clinicians—the ones who follow algorithms, and the ones who understand the “why.”

Patients know the difference. Know the WHY!

Join our clinical library today on PATREON!

👉 https://www.patreon.com/PearlsandPrep

Today, we're diving into the wild world of pharmacokinetics with a case that's got more twists than a soap opera. Our star (MOCK) patient, Desiree, is dealing with bipolar disorder and some serious liver issues, which makes her Depakote treatment a real head-scratcher. The big question on the table is what to do when she's showing signs of toxicity, despite her Depakote levels being in the so-called therapeutic range. Spoiler alert: it’s not as cut and dry as it sounds! We’ll break down why those protein binding levels matter and why sometimes, the obvious answer might just lead you further down the rabbit hole. So grab your coffee, kick back, and let’s untangle this pharmacological puzzle together!

31

Board Bomb 💣: Would You Miss This Depakote Red Flag?

Pearls and Prep

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Let's dive into the juicy details of a case involving our fictional friend, Desiree, a 38-year-old with bipolar one disorder and some serious liver issues. Picture this: she’s on Depakote ER for her acute mania, but guess what? She's starting to feel more sedated than a couch potato on a lazy Sunday. With an albumin level of just 2.6, we’re talking about some potential trouble brewing in the pharmacy department. The question on everyone’s lips is: what do we do next? Do we bump up that Depakote dose, reassure the team, or maybe even add a benzodiazepine for that tremor? Spoiler alert: it’s all about understanding how protein binding works and how low albumin levels can throw a wrench in the works. Let’s break it down and keep our heads straight because this case has some high-yield learning moments that could make or break your practice. After all, we’re not just throwing darts in the dark here; we want to hit the bullseye with our clinical decisions!

Takeaways:

• Today we dive deep into the world of pharmacokinetics, especially with Depakote and its protein binding.
• Understanding albumin levels is crucial because low levels can lead to unexpected drug toxicity.
• Don't just increase medication doses blindly; it could lead to more harm than good.
• Always question the total drug levels in patients with liver issues before making changes.
• Reassuring a team about therapeutic levels without addressing symptoms is like ignoring a fire in a car.
• Being knowledgeable about your prescriptions can make you a top-notch provider that patients trust.

Links referenced in this episode:

• patreon.com
• pearlsandprep.com/show-notes

Companies mentioned in this episode:

• Depakote
• Cymbalta
• Carbamazepine

There are two kinds of clinicians—the ones who follow algorithms, and the ones who understand the “why.”

Patients know the difference. Know the WHY!

Join our clinical library today on PATREON!

👉 https://www.patreon.com/PearlsandPrep

We're diving into a super relevant topic today about long-acting injectables, specifically Invega Sustenna, and trust me, it's packed with pearls to keep you sharp! We’ve got a case of a 24-year-old dude with schizophrenia who's had a tough time sticking to his meds—classic situation, right? So, we're breaking down the nitty-gritty of how to properly initiate this med without leaving your patient hanging. You’ll learn why it's crucial to understand the differences in injection sites and the timing of doses, 'cause nobody wants a delay in treatment when it comes to psychotic symptoms. Stick around for some solid insights that’ll make you the go-to expert in your clinic!

30

Board Bomb Bonus Episode: This Long Acting Injectable (LAI) Question Trips Up Clinicians All the Time

Pearls and Prep

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Diving deep into the realm of long-acting injectables, this episode is like a treasure chest full of pearls for those in the mental health field. We kick things off by exploring a case of a 24-year-old (mock patient) battling schizophrenia, who keeps slipping through the cracks of his treatment plan. It’s like, how many times does he need to be stabilized on risperidone before he gets the memo? We dissect the decision to switch him to Invega Sustena, the long-acting injectable that promises to keep him on track despite his medication hiccups. The host breaks down the nitty-gritty details about how to initiate this medication, emphasizing the importance of understanding the different formulations and their protocols. It’s not just a shot in the dark; it requires a strategic approach to ensure that the patient actually benefits from it! As the discussion flows, we get into the mechanics of how the medication is administered. The host drops some wisdom about the best injection sites—spoiler alert, it’s not the gluteal muscle! Instead, the deltoid muscle takes the spotlight for its quicker absorption rates. This little nugget of info is crucial because it can make all the difference in getting the patient to therapeutic levels faster. And let’s be real, who wants to wait around when dealing with psychotic symptoms? The episode is packed with clinical pearls that not only help in exams but also in real-life patient care, ensuring we’re armed with the knowledge to tackle these challenges head-on. Wrapping things up, we talk about the significance of understanding pharmacokinetics and the unique properties of different medications. It’s all about bridging the gap between theory and practice, and the host encourages listeners to really get into the why behind their treatment decisions. Whether you’re prepping for boards or just looking to up your game in clinical practice, this episode serves up a buffet of insights that are as relevant as they are entertaining. So grab your headphones and get ready to level up your clinical skills!

Takeaways:

• This episode dives into the nitty-gritty of long acting injectables and their protocols.
• Understanding the absorption rates of different injection sites is crucial for effective treatment.
• We explored why certain medications don't require oral overlaps and how to manage patient care better.
• The importance of knowing your meds can really separate the good from the great clinicians.
• In this episode, we covered how to recognize and avoid common pitfalls with medication initiation.
• Being a Patreon member gives you access to a treasure trove of knowledge to enhance your clinical skills.

Links referenced in this episode:

• patreon.com
• show_notes

Companies mentioned in this episode:

• Invega
• Risperidone
• Invega Sustenna
• Respiridone Consta

There are two kinds of clinicians—the ones who follow algorithms, and the ones who understand the “why.”

Patients know the difference.

Know the WHY!

Join our clinical library today on PATREON!

👉 https://www.patreon.com/PearlsandPrep

We’re diving into a wild case today with our girl Bonnie, who's all sunshine and rainbows—except for those pesky positive drug screen results that have us scratching our heads. She's been doing great on her meds, but those results popped up like an unwanted party crasher. We’re tackling how to handle this tricky situation while keeping it chill and compassionate. We’ll break down the next best steps for her care without jumping to conclusions or throwing her off her groove. So, grab your favorite snack and let’s unravel this mystery together—because mental health can be a bit of a rollercoaster, and we’re here for the ride!

30

Board Bomb: This Urine Drug Screen Changes Everything—Now What?

Pearls and Prep

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A mock patient named Bonnie, just 28 years old, walks into our outpatient clinic for her three-month follow-up. She’s been on a couple of meds, trazodone and bupropion, and let me tell you, she’s been feeling great! We’re talking solid sleep and a stable mood. But hold the phone! During her routine screening, we find out her urine drug screen is throwing a curveball with positive results for benzodiazepines and amphetamines. Yikes! Bonnie has never used these substances, and she’s visibly upset about the results. This leads us down a rabbit hole of questions, discussions, and the importance of mental status exams. Is she truly using substances, or is something else at play? We dive deep into the nuances of her case, exploring how medications can sometimes cause false positives, and we end up discussing the best next steps for her treatment while keeping it real and lighthearted. No need to panic, folks, we’re just trying to figure it all out together in a relaxed way!

Takeaways:

• Bonnie's case shows how mental health meds can lead to false positives in drug tests, which can mess with treatment.
• It's crucial to assess patient behavior and context when interpreting urine drug screens, especially in psychiatry.
• Reassuring the patient about their medication's role in false positives is key to maintaining trust.
• Always consider confirmatory testing before making significant medication changes based on initial drug screen results.

Companies mentioned in this episode:

• Dairy Queen
• Wellbutrin
• Trazodone
• Planet Fitness

There are two kinds of clinicians—the ones who follow algorithms, and the ones who understand the “why.”

Be the second on Patreon:

👉 https://www.patreon.com/PearlsandPrep

This podcast episode elucidates the intricacies surrounding the case of a mock patient named Larry, who presents with persistent morning fatigue despite an improvement in his depressive symptoms. The primary focus of our discussion revolves around a critical detail, referred to as the "curveball," which significantly impacts Larry's overall well-being.

Can you catch the curveball??? Spoilers below ***

We explore the implications of his medication regimen, particularly the timing of his Wellbutrin administration, which has inadvertently contributed to his grogginess and reliance on additional sedative medications. By dissecting Larry's case, we aim to highlight the importance of medication timing and its profound effects on patient outcomes. Ultimately, we aspire to foster a deeper understanding of how seemingly minor adjustments in treatment can yield substantial improvements in a patient's quality of life.

20

Catch the Curveball: Can you spot the problem in this mock medication regimen?

Pearls and Prep

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A meticulous examination of a mock patient case, this episode delves into the intricate nuances of pharmacological management as experienced by a 51-year-old male named Larry. His primary complaint revolves around debilitating morning fatigue, despite reporting an improvement in his depressive symptoms. This paradoxical situation prompts an in-depth analysis of his medication regimen, particularly the timing and dosage of Wellbutrin and Lexapro. The discussion emphasizes the critical nature of medication timing, highlighting how Wellbutrin's stimulating effects, when administered in the evening, exacerbate Larry's fatigue rather than alleviate it. Furthermore, the episode elucidates the potential sedative effects of Trazodone and Atarax, which Larry resorts to in an attempt to mitigate his nighttime restlessness. The overarching theme revolves around the necessity of comprehensive patient assessment, wherein the identification of subtle yet pivotal details can significantly alter treatment outcomes. Ultimately, the episode serves as a profound reminder of the importance of tailored pharmacotherapy in enhancing patient quality of life, emphasizing that even seemingly minor adjustments can yield substantial improvements in patient well-being.

Takeaways:

• The patient, Larry, exhibits significant morning grogginess despite an improvement in mood, prompting a critical evaluation of his medication regimen.
• A pivotal aspect of Larry's case is the improper timing of his Wellbutrin dosage, which should ideally be administered in the morning rather than at night.
• In this episode, we emphasize the importance of recognizing subtle yet significant details in patient cases that may influence treatment outcomes.
• The discussion highlights how polypharmacy and mismanagement of medication timing can lead to compounded side effects and patient dissatisfaction.
• We explore the impact of serotonin and dopamine interactions concerning Larry's sexual dysfunction, attributing it primarily to his SSRI treatment.
• Ultimately, adjusting Larry's medication schedule not only aims to alleviate his grogginess but also seeks to enhance his overall quality of life and therapeutic efficacy.

Companies mentioned in this episode:

• Lexapro
• Wellbutrin
• Trazodone
• Atarax

There are two kinds of clinicians—the ones who follow algorithms, and the ones who understand the “why.”

Be the second on Patreon:

👉 https://www.patreon.com/PearlsandPrep

Alright, folks, let’s dive into a real eye-opener about metformin and its under-prescription among patients on second-generation antipsychotics. Believe it or not, only about 2 to 3% of these patients are actually getting the help they need with this medication. Crazy, right? We’re chatting about why this is such a big deal and why we need to step up our game and start prescribing metformin more. It’s not just a cheap and effective option; it’s a lifesaver when it comes to managing weight and preventing serious health problems.

Stick around as we unpack this shocking statistic and ponder why it’s falling through the cracks in the medical world. Diving headfirst into the world of mental health medications, we tackle a shocking reality: when it comes to prescribing metformin alongside second-generation antipsychotics, the stats are enough to make you raise an eyebrow. We're talking a staggering 2-3% of patients actually getting this potentially life-saving med! Yup, you heard that right. With a study from the Lancet revealing that out of 30,000 young patients treated with these antipsychotics, only 677 were co-prescribed metformin in the last month, it's clear we've got a serious issue on our hands.

We chat about why metformin is a game-changer, not just for weight management but also for preventing diabetes and improving overall metabolic health. It’s cheap, effective, and ridiculously underutilized. So, why the hesitation among prescribers? Is it simply forgetfulness or a lack of comfort with the medication? We dig into these questions and more, setting the stage for a deeper dive in our upcoming episodes. Buckle up, folks, because this conversation is just getting started!

Links referenced in this episode:

• patreon.com

Companies mentioned in this episode:

• Lancet
• Metformin

27

PEARL DROP: With SGAs, How Often Is Metformin Actually Used?

Pearls and Prep

[email protected]

https://patreon.com/PearlsandPrep?utm_medium=unknown&utm_source=join_link&utm_campaign=creatorshare_creator&utm_content=copyLink