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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Episode 5 provides:

• 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!

Thinkwear Collective!

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 (ringsabellpodcast@gmail.com)
• 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

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 

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- 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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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 ringsabellpodcast@gmail.com

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 peter.whorwell@mft.nhs.uk, 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#

References from Kim:

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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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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