Pregnancy & Prescription Pads: Maternal Ondansetron Use, Renal Function in Pregnancy and Assessing Prescribing and Deprescribing Patterns

Kieran Quinn is back on the Rounds Table this week with Michael Fralick, general internist at the University of Toronto. This week they are covering four articles in rapid-fire style on maternal first trimester ondansetron and fetal outcomes, assessment of outpatient antibiotic prescribing patterns, creatinine in the peri-partum period, and a pharmacist-led intervention for deprescribing.

The vast majority of women will experience nausea and vomiting during pregnancy.  First, Mike covers an article on maternal use of ondansetron in the first trimester and the risk of developing cardiac malformations or oral cleft abnormalities.

In 2015, the diagnostic code classification scheme called the International Classification of Diseases, which indicates why patients come to hospital, was changed.  Since then there was no longer a scheme to decipher if antibiotics were appropriately being prescribed.  Kieran discusses a cohort study in which hospital codes were compared to antibiotic prescriptions to assess the appropriateness of outpatient antibiotic prescribing for children and non-elderly adults with private insurance.

There is limited data on many topics related to pregnancy and internal medicine.  What can we expect for the creatinine in pregnancy? Mike covers a cross- sectional study in Ontario on serum creatinine levels before, during, and after pregnancy.

About 30 percent of older individuals are prescribed inappropriate medications.  Kieran covers the D-PRESCRIBE trial on the effect of a pharmacist-led educational intervention on inappropriate medication prescriptions in community-dwelling older adults.

Finally, The Good Stuff segment.  Mike shares an article on a new oral medication semaglutide for type 2 diabetes mellitus and the primary trial behind this.  Kieran shares a recent release in the Journal of Palliative Medicine on the top ten tips for palliative care physicians on medical cannabis that can be useful knowledge for all physicians.

Like what you hear?  Rate us on iTunes!  Chat with us on Twitter at @roundstable and tweet at Kieran Quinn @kieranlquinn and Michael Fralick @FralickMike.

Interested in helping us evaluate our podcast episodes? We’re currently recruiting a panel of residents to serve as regular reviewers for the show. If you’re interested, email wkwong@qmed.ca.

The Papers

1. Maternal First Trimester Ondansetron: https://jamanetwork.com/journals/jama/article-abstract/2718793

2. Outpatient Antibiotic Prescribing: https://www.bmj.com/content/364/bmj.k5092

3. Serum Creatinine in Pregnancy: https://jamanetwork.com/journals/jama/article-abstract/2720718

4. Pharmacist Led Intervention:https://jamanetwork.com/journals/jama/article-abstract/2714531

Good Stuff

1. Semaglutide: https://www.pharmacytimes.com/resource-centers/diabetes/oral-semaglutide-demonstrates-benefits-for-patients-with-type-2-diabetes

2. Medical Cannabis Tips for Physicians: https://www.liebertpub.com/doi/full/10.1089/jpm.2018.0641?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed

3. Cannabinoid Dosing for Pain Management: http://annals.org/aim/article-abstract/2720157/brief-commentary-cannabinoid-dosing-chronic-pain-management

Music Credits

The Rounds Table Theme Music by Brendan Quinn, Creative Director and Composer, Vapor RMW

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