Slow Motion: Magnesium in Afib and Fall-Related Injuries with Sleep Aids

Christopher Giuliano, clinical pharmacist, is hosting this week’s episode of The Rounds Table alongside Insaf Mohamad, ambulatory care clinical pharmacist in Internal Medicine.  Together they are covering treatment of atrial fibrillation with rapid ventricular response with magnesium and falls risk with trazadone and benzodiazepines in patients with insomnia.

Atrial fibrillation is the most common cardiac arrhythmia.  Patients with rapid ventricular response can be challenging to manage with multiple pharmacologic options.  Chris shares the LOMAGHI study on low-dose versus high-dose magnesium versus placebo in the management of atrial fibrillation, comparing the improvement in meeting goal ventricular rate.

Managing insomnia is difficult in older adults especially given the side effects associated with certain prescribed sleep aids.  Insaf highlights an article evaluating fall-related injuries (emergency visits or hospitalizations) in patients residing in a nursing home when newly prescribed low-dose trazadone versus benzodiazepines as sleep aids.

Next, for our special segment, Kieran Quinn interviews Ahmed Jakda, palliative care physician and provincial clinical co-lead at the Ontario Palliative Care Network (OPCN), on the type of work OPCN does in the delivery of palliative care and implementation of this in the community.

Finally, The Good Stuff segment.  Chris discusses a drug-delivery device (SOMA) which is a pill swallowed that injects medications into the stomach for distribution into the circulation.  Insaf brings listeners’ attention to an FDA warning to abrupt discontinuation or weaning of patients from opioids.

Like what you hear? Rate us on iTunes!  Chat with us on Twitter at @roundstable and tweet at Chris Giuliano @ChristopherGiu9, Kieran Quinn @kieranlquinn, and Ahmed Jakda @ahmedjakda.

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. LOMAGHI:https://www.ncbi.nlm.nih.gov/pubmed/30025177

2. Trazadone versus Benzodiazepines for Insomnia: https://www.ncbi.nlm.nih.gov/pubmed/30247773

Special Segment

1. Delivery Framework: https://www.ontariopalliativecarenetwork.ca/en/healthservicesdeliveryframework

2. Tools to Support Early Identification of Palliative Care: https://www.ontariopalliativecarenetwork.ca/sites/opcn/files/OPCNToolsToSupportEarlierIdentificationForPC.pdf

3. Ontario Palliative Care Competency Framework: https://www.ontariopalliativecarenetwork.ca/en/competencyframework

Good Stuff

1. SOMA: https://www.nejm.org/doi/full/10.1056/NEJMcibr1901766

2. Sudden discontinuation of opioids: https://www.fda.gov/drugs/drug-safety-and-availability/fda-identifies-harm-reported-sudden-discontinuation-opioid-pain-medicines-and-requires-label-changes

Music Credits

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

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