Pulse Newsletter Epocrates
February 2012
Matters of the Heart
In This Issue
Drug & Disease Updates
Clinical Editorial: Love Your Job
FDA MedWatch Alerts
Clinical Tip of the Month
DocAlert Editor’s Pick
Epocrates 1-1-1 Donation Program
Are You Ready To Earn Your Meaningful Use Incentives?
Conference Highlight: Alliance for CME 2012
A New User Experience Awaits
App Highlight: Netter’s Anatomy Flash Cards
EssentialPoints Mobile Details Programs
Mobile Resource Center: Alzheimer’s Disease
Epocrates.com Reinvented
What's This Disease?

As February inspires drugstores nationwide to fill their shelves with heart-shaped boxes of chocolate, cupid figurines, and other romantic kitsch, we’ve filled this issue with slightly off-beat tokens of our love.

“We want to use our intellect to save lives and reduce suffering,” writes Dr. Anne Meneghetti, in her Clinical Editorial distinguishing early-stage intense romantic love from a love for one’s job—via fMRI brain scan. In this month’s DocAlert Editor’s pick, Dr. Monique Yohanan highlights our loved ones’ impact on our own cardiac health. Plus, we’re pleased to announce our new donation program, free featured CME activities, the launch of our lovely new website, and more.

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Clinical Editorial

Clinical Editorial: Love Your Job
Anne Meneghetti, MD
Director, Clinical Communications, Epocrates

Of the many forms of love, biological anthropologist Helen Fisher¹ categorized romance, lust, and deep attachment based on where they light up on functional MRI (fMRI). Early stage, intense romantic love lit the ventral tegmental area (VTA), a dopamine-rich reward center. The VTA also happens to be the spot activated by being dumped by one's beloved, consuming chocolate, or immediately following a cocaine injection. When it comes to loving your job, VTA-activation love is not what I'm talking about.

Ventral Tegmental Area
This is your brain on love: fMRI activity when individuals who have just fallen madly in love look at a photo of their sweetheart¹

I've observed a similarity between the way people talk about their marriage and the way they talk about their job: rarely do they talk about how fantastically marvelous it is. Rather, they are more likely to point out the negative: a particularly challenging patient, insurance coverage hassles, and how hard it is to find office staff who can magically anticipate their every need.

While it may be common to hear complaints from those practicing medicine, to a certain extent I bet that the words we wrote on medical school applications years ago are still true today. We want to use our intellect to save lives and reduce suffering. What we might not have known at the time of writing those med school applications is how one day, certain patients would come along and work their way into our hearts. I don’t know if there’s a place that lights up on fMRI when we have a heartfelt connection with patients, but we can count ourselves fortunate every time it happens.

At Epocrates, our job is to help make your job easier. Let us know how we can help.

¹Image used with permission, HelenFisher.com
Updated Diseases and Conditions
Vitamin D deficiency
Food poisoning
Asthma in children
Bipolar disorder in adults
Acute varicella-zoster
Evaluation of thrombocytopenia
Evaluation of hearing loss
Chronic pain syndromes

New Drug Monographs
(first-time generic for Gastrocrom)
Fleet Enema Extra
(sodium phosphate rectal)
Fleet Saline Enema
(sodium phosphate rectal)
Pedia-Lax Enema
(sodium phosphate rectal)
(chloral hydrate)
(drospirenone/ethinyl estradiol)

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FDA MedWatch Safety Alerts

Prescription drugs: Tysabri (natalizumab): New blood test for JC virus and risk factors for progressive multifocal leukoencephalopathy (PML). Adcetris (brentuximab vedotin): Associated with PML; contraindicated with bleomycin due to increased pulmonary toxicity risk. Gilenya (fingolimod): FDA is evaluating a case of a patient who died within 24 hours of first dose. Polymyxin B for Injection USP and Vecuronium Bromide for Injection: Recalled due to glass particles in vials. Endo Pharmaceuticals Opiate Products: Tablets from one product type may have carried over into the packaging of another product.

OTC products: Liquid Acetaminophen marketed for infants: Because an additional concentration is now available, the dosing device provided with the product should be used to prevent dosing errors. Perfect Image Solutions Topical Hair Regrowth Products: Recalled due to unapproved drug, may present potential health hazards. Vagifresh Ball, Vagifresh Gel: Recalled due to undeclared drug ingredient (benzocaine) and bacterial contamination. Novartis Consumer Health OTC Products: Recalled due to potential presence of foreign tablets, chipped/broken tablets, or gel caps. Eclectic Institute Dietary Supplements: Recalled because of potential Salmonella contamination.

Medical devices: CardioGen-82 PET Scan: Preliminary findings on increased radiation exposure. Ikaria INOmax DS Drug Delivery System: Recalled due to erratic nitric oxide readings. CareFusion AVEA Ventilator: Recalled because it can develop a failure that may lead to lack of ventilation. Respironics, Inc. Trilogy 100 Ventilators: Recalled because they can stop delivering therapy. ShoulderFlex Massager: Repeat warning about reports of strangulation and death. St. Jude Medical, Riata and Riata ST Silicone Endocardial Defibrillation Leads: Recalled because silicone insulation is at risk of abrasion.

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Clinical Tip of the Month

Joshua L. Conrad, Pharm.D.
Managing Editor, Medical Information, Epocrates

We frequently get feedback from our subscribers about how much they love our Pill ID feature. But, sometimes subscribers find it difficult to determine if a pill is peach vs. pink, film-coated vs. gelatin-coated, rectangular vs. square. Here are some of the more interesting tablet shapes and colors out there. How would you classify their shapes?

Interesting Tablet Shapes

The Epocrates app classifies these unconventionally-shaped tablets as having an “other” shape. But, the easiest way to find them when using the Epocrates Pill ID feature is to leave the shape out and search only for the imprint. Once you have the results narrowed down to only a few, you can browse the images to find the one that matches your unknown pill. Using just the imprint code is usually the fastest and most objective way to find unknown pills in Epocrates Pill ID.

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DocAlert Editor’s Pick
Monique Yohanan, MD, MPH

Broken Heart

Last year, we shared with DocAlert readers a review of stress (Takotsubo) cardiomyopathy², also known as “broken heart syndrome”. The condition presents acutely as profound left ventricular dysfunction despite normal coronaries. Studies suggest that it may account for up to 2% of patients presenting with ACS; 81% of those affected are postmenopausal women.
[Free full-text JAMA article PDF]

A new study³ showed that the intense grief experienced in the days following the death of a significant other may increase the risk of cardiovascular events. Myocardial infarction rates were elevated following the death of a loved one, jumping 20-fold within 24 hours of the event, then declining over time. The impact was greatest among individuals at high cardiovascular risk.
[Free full-text Circulation article PDF]

Keep your mobile device updated to receive the latest DocAlert messages and clinical content updates.

²Clinical characteristics and cardiovascular magnetic resonance findings in stress (Takotsubo) cardiomyopathy. JAMA 2011;306:277.
³Risk of acute myocardial infarction after death of a significant person in one's life. Circulation 2012;125(3):491.


Epocrates 1-1-1 Donation Program

Apply now or recommend our program!
Epocrates has launched a new product donation program aiming to assist U.S.-based non-profit organizations whose healthcare professionals work to benefit underserved populations. Is there a medical non-profit organization you contribute to or admire? We want to support them through a donation of 1-year subscriptions to Epocrates Essentials. Recommend our program to an organization you know or apply today.

Learn More

1 Percent Million Year

Are You Ready To Earn Your Meaningful Use Incentives?

Epocrates is ready to assist small practice physicians get there with our certified EHR solution. 2012 is the last year in which physicians who prove they are meaningful users of a certified EHR can receive the maximum incentive payment in the Medicare EHR Program. Beginning in 2013, providers will receive a smaller incentive payment and starting in 2015, those providers that are not meaningful users of a certified solution will see a decrease in their Medicare reimbursements.

In January, CMS reported they had paid over $2.5 billion in incentive payments to eligible providers and hospitals across the country. Don’t miss this opportunity to have your EHR investment funded through these incentives. Check out the CMS EHR website and use their eligibility tool to determine if you qualify.

Epocrates is well prepared to support you on your path to achieving Meaningful Use with Epocrates EHR and the Adoption Advantage Program, our consultative approach to transitioning your practice to using an EHR. To learn more about our certified solution, visit the Epocrates EHR website.


Conference Highlight: Alliance for CME 2012

Epocrates and our partner RealCME recently presented new research regarding engagement and outcomes across different technology platforms.

Good news: statistics show that physician learning outcomes are consistent across mobile and online platforms, meaning you truly can build your knowledge base and earn valuable credit hours anywhere, using our CME app for iOS or the online portal. Explore this month's featured activities, all free of charge to our Epocrates members.


A new user experience awaits.

Application Update

A new version of Epocrates is ready for you, with an icon-centric customizable Epocrates home screen, medical App Directory, integrated features and additional resources within drug monographs, & more.

Once you update from the App Store, please launch the Epocrates app, then swipe to the left screen and tap on "Updates" to access the latest clinical content.


App Highlight: Netter's Anatomy Flash Cards

"As a practicing internist I am constantly looking for anatomy pictures to explain things to my patients. Now there is no more dragging heavy texts from exam room to exam room!"

- Constaj, on iTunes

App Highlight: Netter's Anatomy Flash Cards icon

Navigate through 300+ crystal clear images, in brilliant color with crisp detail. Create your own pinpoints and labels to mark the structures you need to show. Each fully-annotated image details areas of origin, insertion, action, innervation, and anatomical relevance.

These flash cards are based off of the print product of the same name, Netter's Anatomy Flash Cards, Third Edition.

Learn More
All content © Elsevier, Inc.

EssentialPoints Mobile Detail Programs

EssentialPoints Mobile Detail Programs

EssentialPoints Mobile Detail Programs are quick, self-guided, on-demand clinical learning activities on iPhone and Android devices. Earn a free month of Epocrates Essentials clinical reference suite with the completion of any of this month's featured activities covering:

- Type 2 Diabetes
- Local Anesthetics


Mobile Resource Center: Alzheimer’s Disease

The Alzheimer’s Disease mRC offers free access to timely medical news and scientific abstracts selected by George T. Grossberg, M.D., Samuel W. Fordyce Professor of Psychiatry, Saint Louis University School of Medicine.

Learn More
Mobile Resource Center: Alzheimer’s Disease

What's New with Epocrates

Epocrates.com Reinvented

We’re pleased to reveal the new Epocrates.com, rebuilt with the same tailored innovation as our apps—with your needs in mind. Discover improvements such as:

Feature Highlights. Product pages under our “Mobile Products” tab now offer expanded details about all of the point-of-care features included with the app. Read about your colleagues’ experiences, and watch video tutorials.

Who We Are. We’ve added a “Who We Are” section filled with informative graphics and videos about our mission, company news, investor relations, business & content partners, and media resources.

Online Products. From a clean new interface, gain fast access to prescribing information, clinical resources, patient resources and more through Epocrates Online. Plus, view Clinical Updates, FDA MedWatch Alerts, and other valuable online resources.

Take Tour


The Asacol HD monograph in Epocrates Rx contained an error in the Adult Dosing for treatment of active, moderate ulcerative colitis. The revised dosing now appears as 1600 mg PO tid x6wk. Please update your device regularly to ensure that you always have the most current content.

What is this disease?

Test your knowledge!
Can you identify the disease in this image?


Find this image and many others in Epocrates Essentials for iPhone, Android, BlackBerry, and Epocrates Essentials Deluxe for iPhone, Android, and BlackBerry.


Log in to Epocrates Online for continually updated drug information and disease content and images.

Mobile Updates

Update (sync) your device regularly to download free clinical content and news, including new drugs and DocAlert messages.

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