Rings a Bell

In this episode I welcome on Stacey D’Angelo, a pharmacist, Certified Health & Well-being Coach, and founder of Your Simple Health, a private practice focused on deprescribing and medication optimization. She specializes in helping individuals safely reduce medication use when the risks may outweigh the benefits, through personalized, evidence-based care and shared decision-making. Stacey is also a speaker and educator on deprescribing and has developed continuing education for pharmacists on patient-centred deprescribing strategies. Through her clinical practice and education work, she is passionate about changing the conversation around medications and helping both patients and healthcare professionals recognize when less medicine may be the right medicine. You can find Stacey at https://www.simplehealthpharmacist.com/ or on LinkedIn at https://www.linkedin.com/in/staceydangelo/ 

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~ References, helpful notes and resources, links to socials etc: https://ringsabellpod.kit.com/allthethings 

Timestamps

00:00 - Intro

02:50 - Disclaimers

04:03 - Stacey’s journey toward deprescribing

07:13 - What is deprescribing?

09:00 - What is a prescribing cascade?

11:10 - What percent of Canadian seniors are prescribed 10 or more med classes?

15:09 - Risks of polypharmacy

16:15 - Evaluating a patient for deprescribing

20:20 - Key components of assessing a medication

27:29 - Deprescribing statins

31:34 - Deprescribing PPIs

34:40 - Rebound symptoms vs. withdrawal symptoms

37:30 - Antidepressant deprescribing

40:00 - Linear vs. hyperbolic tapering

44:14 - Factors that increase the risk of withdrawal in deprescribing

48:15 - When meds stop working

50:40 - Evidence based resources for deprescribing

~ Legal Disclaimer:

The information provided on Rings A Bell Podcast is for educational and informational purposes only and does not constitute professional medical advice, diagnosis, or treatment.

Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition or health objectives. Never disregard professional medical advice or delay seeking it because of something you have heard on this podcast.

Reliance on any information provided by Rings A Bell Podcast, its hosts, or guests is solely at your own risk. Listening to this podcast does not establish a doctor-patient relationship.

If you are a medical professional listening to this show, please remember that clinical information moves swiftly these days. I do my best to present up to date information, but it is your responsibility to critically evaluate it before putting it into practice. Because you are a professional. 

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The one, the only, Dr. Shelita Dattani quizzes Kim on the 2025 Hypertension Canada guidelines.

Dr. Shelita Dattani is a nationally and internationally recognized pharmacy leader, advocate, and speaker with over 25 years of experience across community practice, hospital settings, academia, industry and national associations. Shelitta is on the board of Hypertension Canada and knows the 2025 Hypertension Canada guidelines inside and out.

The full guidelines are available at hypertension.ca

If you want to see references from this episode, follow the show on socials, sign up for the email list, donate via "buy me a coffee" or send me an email you can do so using this link: https://ringsabellpod.kit.com/allthethings

Shelita can be found on LinkedIn here: https://www.linkedin.com/in/shelita-dattani-pharmd-a117aa1a/ or on instagram @shelsrx.

You can also email Shelita at [email protected].

Here are the chapters for this episode:

00:00 - Introduction 

04:00 - How big is the hypertension problem in Canada?

10:33 - How does Canada compare to the rest of the globe in terms of hypertension prevalence and management?

15:30 - The case for pharmacist management of uncomplicated hypertension.

19:14 - What is the recommended technique for measuring blood pressure according to the 2025 hypertension Canada guidelines?

22:37 - What proportion of people have white coat hypertension?

23:56 - What is masked hypertension?

24:13 - What is the gold standard for checking blood pressure?

25:52 - Why do we need to keep our feet flat on the floor when checking blood pressure? (and other tips for accurate blood pressure readings).

32:09 - The problem with blood pressure kiosks in pharmacies and the case for a counselling room pharmacist directed blood pressure measurement. 

38:11 - What is the target blood pressure for everyone now?

41:54 - What is the number needed to harm for treating hypertension to 130/80 mmHg?

45:23 - What makes a person high cardiovascular risk and how do we treat their hypertension vs. someone with low cardiovascular risk?

48:36 - What are the recommendations for lifestyle interventions according to the 2025 Hypertension Canada Guidelines?

50:42 - Where do we get most of the sodium in our modern diets?

52:37 - What is the impact of alcohol on blood pressure?

56:51 - What is the pharmacotherapy strategy for treating hypertension according to the 2025 Hypertension Canada Guidelines?

1:03:00 - Do Angiotensin Receptor Blockers cause coughs?

1:04:00 - Can you use an ACE and an ARB together?

1:08:00 - Do we use beta blockers to control uncomplicated hypertension?

1:13:36 - Wrap up

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Are you anxious about what you don’t remember about anxiety therapy? Well have I got a treat for you. Episode 6 of Rings A Bell Podcast! Rami Safi, a pharmacist and psychotherapist (qualifying) brings us the good bad and the ugly of anxiety management. Enjoy a comprehensive overview of pathophysiology, pharmacology and therapeutics with a few helpful tips for managing your own anxiety along the way!

Topics Covered

00:00 - Introduction and housekeeping

00:44 - Rami’s journey from pharmacist to pharmacist and psychotherapist

07:22 - Pervasiveness and importance of anxiety

08:45 - Connection between perfectionism and anxiety

11:30 - Neurotransmitters involved in anxiety disorders

13:22 - Neurobiological difference between panic attack and generalized anxiety disorder

19:25 - Role of the amygdala in fear and anxiety

21:50 - First line treatments for generalized anxiety disorder

26:36 - Rapid nervous system regulation techniques

34:07 - St. John’s Wort risks in anxiety disorders

35:38 - Appropriate times to use benzodiazepines in anxiety treatment

36:11 - Managing side effects of selective serotonin reuptake inhibitors

37:45 - Importance of deprescribing benzodiazepines in elderly people

39:29 - Benzodiazepine pharmacokinetics (volume of distribution) (rate of clearance) (implications in obesity and elderly)

42:25 - Preferred benzodiazepines in elderly people

43:02 - Mechanism of action of buspirone

44:25 - Meds used in psychology with narrow therapeutic window

45:52 - Lithium and kidney function

47:49 - Serious drug interactions with SSRIs

48:45 - Intersection of chronic pain, depression and insomnia

50:35 - moral model of substance use vs. biopsychosocial model of substance use

56:34 - wrap up

Connect with Rami Safi

LinkedIn: https://www.linkedin.com/in/rami-s-98186718/

Wellness Wave Pharmacy in Hamilton: https://wellnesswavepharmacy.ca/ 

All the Links!

Find all the links to all the things (references, resources, buy me a coffee, email list, etc) here: https://ringsabellpod.kit.com/allthethings 

#anxiety #pathophysiology #pharmacology #anxietytherapeutics #therapeutics #continuingeducation#continuingeducation #pharmacy #pharmacylife #pharmacylyfe #pharmacistlife #pharmacistlyfe #itsmyanxiety #weallhaveanxiety #anxietymanagement #ssris #snris #serotonin #dopamine #norepinephrine #panicattacks #bzds #benzos #obesitymedicine #geriatricmedicine #benzodiazepines #diazepam #pharmacokinetics #volumeofdistribution #eliminationhalflife #neurology #psychotherapy #cbt #cognitivebehaviouraltherapy #GAD #generalizedanxietydisorder #SJW #stjohnswort #substanceuse

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• A refresher on bacteriostatic vs. bactericidal antibiotics
• The ACTUAL rates of true penicillin allergy
• Why “walking pneumonia” is more of a slang term than a diagnosis 
• The declining efficacy of azithromycin 
• Where to find up to date resistance patterns
• Some oral options for uncomplicated MRSA
• Adapting prescriptions with confidence
• and much more!

You can purchase Thinkwear at https://lindsay-dixon-shop.fourthwall.com/en-cad 

Enter the giveaway by interacting with the show in the following ways:

• comment or share any of the social media posts about Episode 5
• leave a review on any of the podcast platforms
• Send me your honest thoughts about the show and what I can do to improve it ([email protected])
• Spread the show through word of mouth to a colleague or a friend and then let me know so I can add you to the draw

Find all the links to all the things (references, resources, buy me a coffee, email list, etc) here: https://ringsabellpod.kit.com/allthethings 

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Episode 4 provides

- A refresher on how red blood cells are formed, their lifecycle and inputs

- An overview of the major types of anemia classified by pathophysiology and histology (how the red blood cells look under a slide)

- Some simple physical symptoms that pharmacists can look for in practice and what they might indicate

- A refresher on the major guidelines for iron deficiency anemia including a recent update

- Some excellent case studies detailing the complexity of dealing with patients who have chronic inflammation AND anemia

- New this episode: some semi-useful notes in pdf form from me to you. Merry Christmas ya bunch of hooligans!

Links:

Find all the links to all the things here: https://ringsabellpod.kit.com/allthethings

Find Jenny at: https://www.linkedin.com/in/jenny-hsieh-435828177/

References:

See all the links above.

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Keywords:

insulin sensitivity, metformin, blood sugar management, dietary approaches, microbiome, GLP-1 agonists, functional medicine, probiotics, metabolic health, clinical signs

Summary:

Episode 3 part 1 covers general metabolic health as it relates to pharmaceuticals, the microbiome and nutrition. My guest is Dr. Alex Nataros, a family doctor practicing in Port Hardy, BC.

Subscribe to the Rings a Bell email list here: https://ringsabellpod.kit.com/subscribe

To become a guest on the show email [email protected]

References:

Weight Gain Drugs

https://pmc.ncbi.nlm.nih.gov/articles/PMC6109660/

Weight loss drugs

https://mobile.fpnotebook.com/Endo/Pharm/MdctnsAsctdWthUntntnlWghtLs.htm

Insulin Sensitivity Drugs

Giglio RV, Papanas N, Rizvi AA, Ciaccio M, Patti AM, Ilias I, Pantea Stoian A, Sahebkar A, Janez A, Rizzo M. An Update on the Current and Emerging Use of Thiazolidinediones for Type 2 Diabetes. Medicina. 2022; 58(10):1475. https://doi.org/10.3390/medicina58101475

Laurindo LF, Barbalho SM, Guiguer EL, da Silva Soares de Souza M, de Souza GA, Fidalgo TM, Araújo AC, de Souza Gonzaga HF, de Bortoli Teixeira D, de Oliveira Silva Ullmann T, et al. GLP-1a: Going beyond Traditional Use. International Journal of Molecular Sciences. 2022; 23(2):739. https://doi.org/10.3390/ijms23020739

https://doi.org/10.1016/j.redox.2020.101517 (Mechanisms of Action of metformin in type 2 diabetes: effects on mitochondria and leukocyte endothelium interactions.

Microbiome and obesity: 

https://doi.org/10.1016/j.biopha.2022.112678

Sohail MU, Althani A, Anwar H, Rizzi R, Marei HE. Role of the Gastrointestinal Tract Microbiome in the Pathophysiology of Diabetes Mellitus. J Diabetes Res. 2017;2017:9631435. doi:10.1155/2017/9631435

HMF Metabolic:

Michael DR, Jack AA, Masetti G, et al. A randomised controlled study shows supplementation of overweight and obese adults with lactobacilli and bifidobacteria reduces bodyweight and improves well-being. Sci Rep. 2020;10(1):4183. Published 2020 Mar 6. doi:10.1038/s41598-020-60991-7

UltraFlora Control:

Stenman LK, Lehtinen MJ, Meland N, et al. Probiotic With or Without Fiber Controls Body Fat Mass, Associated With Serum Zonulin, in Overweight and Obese Adults-Randomized Controlled Trial. EBioMedicine. 2016;13:190-200. doi:10.1016/j.ebiom.2016.10.036

Super intense study on personalized nutrition published in cell that I talked too long about :)

Zeevi D, Korem T, Zmora N, et al. Personalized Nutrition by Prediction of Glycemic Responses. Cell. 2015;163(5):1079-1094. doi:10.1016/j.cell.2015.11.001

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- UpToDate as referenced summer 2025

- RxFiles 2023 edition

- Bristol Stool Chart

- probioticchart.ca

- Why you should be careful with psyllium husk fiber supplement. YouTube: 

https://youtu.be/mPHXldh4_H4?si=wtAMhpP2QDCxPlr6

- Cascara Sagrada withdrawal in USA https://www.fda.gov/about-fda/fda-history-exhibits/drug-therapeutics-regulation-us#

- Phenothalein withdrawal from market

https://www.sciencedirect.com/topics/pharmacology-toxicology-and-pharmaceutical-science/phenolphthalein#

- Bisacodyl 

Neurogastroenterol Motil. 2021 Mar 9;33(10):e14123. doi: 10.1111/nmo.14123

Bisacodyl: A review of pharmacology and clinical evidence to guide use in clinical practice in patients with constipation

Maura Corsetti 1,2,, Sabine Landes 3, Robert Lange 4

PMCID: PMC8596401 PMID: 33751780

https://pmc.ncbi.nlm.nih.gov/articles/PMC8596401/

- Stimulant laxatives 

First published online June 16, 2024

Review article: do stimulant laxatives damage the gut? A critical analysis of current knowledge

Peter Whorwell https://orcid.org/0000-0002-5220-8474 [email protected], Robert Lange, and Carmelo Scarpignato 

https://doi.org/10.1177/17562848241249664

- Rhubarb 

https://pmc.ncbi.nlm.nih.gov/articles/PMC8321582/#

- Demulcents

https://www.sciencedirect.com/topics/neuroscience/demulcent#

Lexicomp drug information for: podophyllum, wheat dextrin, phenolpthalein, polyethylene glycol 3350

https://time.com/archive/6617019/medicine-cut-out-the-liver/

• Pharmacology, toxicology, clinical efficacy, and adverse effects of calcium polycarbophil, an enteral hydrosorptive agent. PMID: 6765389

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On this episode of the Rings A Bell Pharmacy Podcast I welcome on Cheen-Young Liu. A bright star from U of T's PharmD program, she schools me on contraception!

References from Cheen-Young:

·     CPS (Compendium of Pharmaceuticals and Specialties) - Contraception

·     Up To Date (I can't remember which specific pages I used, I viewed a lot but didn't necessarily use all of them)

·     Class notes from Dr. Thomas Brown 

·     HC Monograph - TARO-MEDROXYPROGESTERONE INJECTION (https://pdf.hres.ca/dpd_pm/00080310.PDF)

·     HC Monograph - Evra patch (https://pdf.hres.ca/dpd_pm/00077976.PDF)

HC Monograph - NuvaRing (https://pdf.hres.ca/dpd_pm/00077755.PDF)

·     BC College of Pharmacists Conscientious Objection (https://www.bcpharmacists.org/faq/how-does-conscientious-objection-work-pharmacy-practice)

References from Kim:

·     Bone mineral density and Depo-Provera mechanism: Article Titled Estrogen Supplementation with Depot Medroxyprogesterone found at: https://www.aafp.org/pubs/afp/issues/2005/1015/p1602.html

·     Mirena as emergency contraception: This changed my practice article found at https://thischangedmypractice.com/iud-for-emergency-contraception/

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