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Cake day: June 11th, 2023

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  • Let me correct a few of these, as well as add why some of these are some really fantastic choices. These are all fairly expensive medications, but many of them are common first line and best choices for the relatively common things they treat. And while this is only for medicare directly, almost everything to do with medicare rolls downhill to private insurance. This will save many many many people a lot of money, or allow people to have the right medicines that would not otherwise be able to afford them.

    Eliquis/Xarelto: Blood thinners. Tons of people on these, and they are safer and more convenient to take than the warfarin they replaced.

    Jardiance/farxiga: Blood sugar medicines, but not just for diabetes type 2, also usable in type 1 as an adjunct to insulin. Also showing a lot of value in both subclasses of heart failure, even in people without diabetes. The data is so good that these are being prescribed for pretty much all heart failure patients as long as they can afford them.

    Entresto: Not for blood pressure, although it does lower blood pressure. Another heart failure drug, far superior to the ACE inhibitors and Angiotensin receptor blockers it replaces as far as heart failure outcomes. Again, prescribed for pretty much all CHF patients that can afford it (and can tolerate the blood pressure lowering effect).

    Fiasp/Novolog: Does not affect speed of insulin, is actually insulin. Short acting formulation, some of the more common ones. Not sure why Humalog/Admelog didn’t also make the cut. Probably next round. I’m sure you’ve all heard on here and reddit the cost of insulin being a major problem for diabetics.

    Januvia: Blood sugar control, but only for type 2, not indicated for type 1. No other benefits. There’s other drugs I think we’d benefit from having on this list over januvia, but I wont’ complain too much.

    Stelara/enbrel I have less familiarity with, not terrible choices from what I know. Quite expensive as all monoclonal antibodies are, and those who benefit from them, REALLY benefit from them.

    Imbruvica I can’t speak to much too.

    Overall this is a list of some of the most useful medicines in general adult medicine the use of which are frequently limited by cost.



  • The term you are looking for with the “death punch” is Commotio Cordis.

    Also, to be more technically accurate, defibrillators are intended to restart a stopped heart, but only some kinds of stops. What people traditionally think of is Asystole (“flatline”), which is complete lack of electrical activity in the heart. Shock won’t do diddly here, they ded.

    Ventricular tachycardia and ventricular fibrillation however have essentially stopped the muscular/mechanical pumping of the heart, because of disjointed electrical activity. This activity is what the defibrillator is intended to reset.

    There’s a 4th type called Pulseless Electrical Activity (PEA) where the electrical function is relatively normal, but something external is preventing pumping. Defib won’t help here either, since the electrical portion is working fine.