Episode Details

Episode 29: OSA with Clau.

Obstructive sleep apnea (OSA) can be confused with ADHD in pediatric patients. Dr Carranza explains how to work up and treat OSA in kids. Listen to several adventitious breath sounds as explained by Xeng, and learn what Dormir means. Cruel joke about thalidomide. Contest: Define mittleschmerz.

The sun rises over the San Joaquin Valley, California, today is September 25, 2020.

As allopathic doctors, medications are our most potent tools to fight and prevent diseases. Today, we want to remind everyone about substance abuse and give you an update on a procoagulant agent. 

Substance abuse is a growing problem. Due to increased stress, anxiety, depression, and unemployment, drug abuse is on the rise during the current pandemic[1]. Some medications may not be considered a “drug of abuse” when prescribed alone, but they can be combined with other medications to cause a potentially addictive effect. 

Such is the case of promethazine[2,3], which is usually combined with codeine, dextromethorphan and  expectorants for cough. Promethazine is also used as an antiemetic, for procedural sedation, and for allergic reactions. Promethazine-containing products are abused for their sedative effects. Specifically, when promethazine is combined with opioids, it potentiates euphoria, alleviates withdrawal symptoms and relieves opioid-induced nausea. So, be aware of drugs that can potentially be misused or abused, even when they are not scheduled. Other examples include quetiapine, baclofen, gabapentin, fluoxetine, and more. Examples of OTC medications that can also be misused are diphenhydramine and loperamide.

Now, let’s talk briefly about tranexamic acid. You may remember this medication as a treatment for menorrhagia, and to control bleeding in general. UptoDate stated in December 2019 that this medication is now recommended in patients with moderate Traumatic Brain Injury (TBI) presenting within 3 hours of the event[4]. Interestingly, tranexamic acid is a potent neurotoxin with a mortality rate of 50%, but ONLY when given accidentally via intraspinal route. Remember, it’s safe IV and oral, but NOT intraspinal. Survivors of intraspinal injection often experience seizures, permanent neurological injury, ventricular fibrillation, and paraplegia. Container mix-ups were involved in 3 recent cases[5]. So, this is why checking medication labels is critical.

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This is Rio Bravo qWeek, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program, from Bakersfield, California. Sponsored by Clinica Sierra Vista, Providing compassionate and affordable care since 1971. 

“A life without a cause is a life without effect.” ― Paulo Coelho

Think about your purpose in life, what motivates you? Where do you want to be? Start now to direct your life to get you where you want to be. Claudia Carranza is here with us today, a Wednesday after didactics to discuss another topic

Who are you? 

My name is Claudia Carranza; you might recognize my voice from the “Espanish word of the week”, I am a PGY3 resident in our Rio Bravo Family Medicine residency program. I am married to an internal medicine resident, we have 2 dogs and they keep us really busy going to the dog park, long walks and jogging. 

What did you learn this week? 

This week I learned about obstructive sleep apnea (OSA). I actually had a patient recently with obstructive sleep apnea which persisted despite prior tonsillectomy. I also learned that obstructive sleep apnea in children can present with symptoms similar to ADHD. I thought, I definitely need to read more about management and I would like to focus mostly on pediatrics. 

A lot of patients ask me: what is obstructive sleep apnea? And I would tell them in my own words that “it’s a cond