Audio Transcript Auto-generated
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Okay, let's move on with Alzheimer disease Part three.
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Um I wanted to go back to the genetic mutation because there was a
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point I wanted to make their that I didn't make the A PPC.
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That first one Beta amyloid precursor protein, the A. P. P.
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That's associated with the 21st chromosome.
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Which
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if we move on,
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who slide was it?
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I'm sorry guys. Hold on.
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Give up. So um
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you can go back here. So the A. P. P. Is associated with the 21st chromosome.
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Trisomy 21 is Down syndrome. So you can see there why Down syndrome.
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I think they have an extra copy of the 21 I'm pretty sure um could
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have an issue with Alzheimer's because they
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already have issues with that 21st chromosome that
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PS one is associated with the 14th chromosome and
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the PS two is associated with the first chromosome.
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So just some things I wanted to note there um it says
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here a childhood with one of these genes has a 50 50 chance
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of inheriting that mutation in a very high risk for um having
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early onset Alzheimer's if they do have the in heritage inherited gene.
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Ah that was the one I want to show that couldn't find.
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Um so see their chromosome 21 trisomy 21 is um
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Down syndrome and it's on that same chromosome that that A P. P. Is located.
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Mhm.
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Due to do. We're going to get there eventually. One more second. Sorry guys
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going into me
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my man today,
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an episode. Okay,
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what do we do with this one? Okay, so Namenda. Namenda comes in. Namenda.
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Ir and Namenda XR remember the last two lectures ago I talked about.
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It has two letters after the drug a lot of times. That means extended release. So X. R.
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Is somehow like extreme release or something like that.
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So you could have sustained release L. A. For long acting S. R.
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For sustained release. Um
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Cr controlled release.
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Uh those usually just denote that they are
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slowly released over time and definitely that you cannot
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cut the pill if it has two letters after it be safe and don't cut the pill.
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So there is a uncompetitive N. M. D. A receptor antagonist. It is usually
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dependent on the blockade of the N. M. D. A.
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Receptor so that the ion channels can't flood when when
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the glutamate activates it and inhibits glutamate induced excite.
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Excite a toxicity that may play a role in neuronal damage.
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It is for moderate to severe alzheimer's and um it's mr stirred
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once a day which is nice before you go to bed.
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There are just one I feel like I did. Um
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Well that's okay you can go over these things 100 times and still that's
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a good thing metabolized in the liver through the set of chrome P.
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4 50 very long half life, 60 to 80 hours. Which is great.
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That's why it's dosed once a day which is
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nice especially for people who have memory issues really?
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Excreted undergoes tubular secretion as it's kind of metabolism
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can cause headache, pain, fatigue, dizziness, nausea, vomiting, diarrhea.
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Um Which they all can but I think that this one cause weight loss.
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Yeah so that's the difference right there.
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An episode causes weight loss where Aricept,
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I'm sorry what Namenda causes weight gain.
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Um anxiety, cough depression, hallucinations, um
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somberness and increased frequency of urination. So kind of opposite.
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So you're not going to have those colon allergic side effects
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as much you have your own instead of lovely side effects.
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But they're not going to be colon ergic side effects. Um
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serious stevens johnson syndrome.
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So that's when you would want to know those serious members are the
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ones that are most common and then the ones that can kill you.
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So um stevens johnson syndrome is serious and so I
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wouldn't know that that's associated with romantic teen drug interactions.
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I'm
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00. C. T. To O. C. T. One. I'm not familiar with that.
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I will have to look at what that means
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because that is something I'm not familiar with.
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It is sensitive to the urine ph if you have a drug that's
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going to change the urine ph that could affect this drug here.
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It is because it is really excreted.
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If you have renal impairment that could be a problem and
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um you're an al colonization. So again if you're changing the ph of the urine.
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That could cause an issue here.
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Okay so I just looked it up and O. C. T. Stands for organic cast iron transfer.
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So it's like a, so it transfers cat ions which about 40% of drugs are through this.
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Um remind me to look that up a little bit more.
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You know remember I graduated 10 years ago and things changed since then.
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This is not one that I learned about in school. So this is kind of something new.
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Um I don't know that much about it except for if you were substrate.
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So this must be an organic cat ion transporter porter. Um So it says here like
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one of the HIV drugs may increase the serum concentrations of of an O. C. T.
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Two substrate. Um
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To see if there's any
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main ones. It's usually it's mostly
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like
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antivirals
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but they're concerned with. Not really that many drugs
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but it's interesting to note.
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So we're going to a little bit more into that organic
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cattle and trans transporter because I'm I'm not familiar with that.
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Okay so here's our drug list chakra in one episode which is our gold standard
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reverse pygmalion galante mormon city which is
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in addition in the herbal Lloyd missile.
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It's the ones that you'll see everybody on
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are going to be Donepezil and memantine mean?
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Um And we're gonna have, the reason why this is important to you is because um
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an episode can affect anesthesia.
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Okay.
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Um I want to mention a couple more things and then I want
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to look at a case real quick on the Donepezil and an anesthesia.
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So um some of the things that are on the horizon as I said,
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we don't have anything great.
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But what's on the horizon is good.
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So they're gonna be targeting the cut, how the beta amyloid plaque,
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beta amyloid plaques.
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You know they're they're cutting at the wrong
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place and that's why they're not soluble anymore.
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And then that's why they build up there.
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Working on that basically the scissors,
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they're uh they're working on the tau proteins to stabilize the membranes.
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Um You know how they get tangles to like not have
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them tangled by working on the tau protein um disease modifiers.
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Ado can new mob is a disease modifier.
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It's a model antibody um that reduces brain amyloid.
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This is the first one that's a disease modifier.
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It's doing really good in clinical trials.
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And um all of these monoclonal antibodies
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barely were around when I was in school. I mean barely.
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So this is something that is my goal to work on in
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the next year is really to learn about these monoclonal antibodies they
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are where medicine is going you can see so many of them
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that have come out in the past 5 to 10 years.
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Um that that is where we're going with that.
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So it's great to know that there is some promise.
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There's over 100 chemicals being studied right now
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for Alzheimer's which is really great to see
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um But the ones we have right now, they're not great.
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So they slow the progression of alzheimer's by about
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six months which is not that much and they
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can reduce the burden of a caregiver by one hour a day by one hour a day.
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So they're just not that great. A lot of people don't even have any effects at all
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and the side effects are not are terrible. So there comes a point where the G. I.
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Side effects and the side effects of the medication are
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worse and the diseases just progressed so far that at that
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to stop the medication, it's not helping them anymore.
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Um The as soon as you stop the medication,
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the side effects go away pretty quickly and you still see the effects
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of the drug for another six weeks after you stopped the medication.
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So that's good.
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The side effects go away quick and the effects of the drug kind of stay around.
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But if you can taper it that's the best thing to do for that. Um
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Okay so this is the case here
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on pub med. They're doing a research. It looks like um
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den episode related inadequate neuromuscular
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blockade during a laparoscopic surgery.
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A case report a 70 year old,
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a 71 year old man was scheduled for a laproscopic gastronomy, gastrectomy,
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he has been taking Donepezil, five mg for dementia,
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General anesthesia was induced with propofol and
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fentaNYL, you guys are a little bit more familiar with the names of these drugs.
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The depth of the neuromuscular blockade was
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monitored for train of for stimulation.
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After the administration of rio caroni.
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Um The train of four ratio decreased to an unusually slow rate. The T. O. F.
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Count was zero was detected seven minutes later.
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After intubation. The T. O. F. Count of one was detected within one minute and a T. O.
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F. Ratio of 12% was detected within two minutes.
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The T. U. F. Count remained at four even with an additional bolus and continuous
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infusion of vibranium
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suggesting resistance to the neuromuscular blocking agent
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instead of propofol and inhaled anesthetic wasn't
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the N. N. B. A.
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Macaroni. Um
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Then the quality of the neuromuscular blocker improved and the T. O.
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train of four account remained at 0-1 for the next 70 minutes.
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No further problems were encountered with
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respect to the surgery and anesthesia and
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the conclusion was that episode may be
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responsible for an inadequate neuromuscular blockade.
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During anesthesia especially a total ivy anesthesia is used.
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Okay so what that says to mean
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that's gonna be a board's question Like first.
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Sure that should be a board's question.
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So I wouldn't know what to do in that sort of situation.
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Um of that case of that type of patient.
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Okay so I guess that's all I have for you guys
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on Alzheimer's that lecture was supposed to last two hours.
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But I mean the thing is is that
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there really is only two slash three drugs that work in any way, shape or form.
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Oh that's what I wanted to tell you about. The the daily.
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I don't know if you guys listen to the daily,
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it's like the second highest podcast um from the new york times and they did
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want on a patient who was having
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trouble getting an investigation into Alzheimer's drug.
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If you want to know what it's like to go through,
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I'm trying to find the episode right now so you guys can listen to.
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Hold on.
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It's called some hope is better than having no hope and it came out july 7th 2021.
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So if you guys got time to listen to it while you're driving in the car or something,
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july 7th 2020 20 2021 on the daily, that some hope is better than having no hope.
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It's pretty interesting to read what people are going through to try
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to get anything describing straws to help their loved ones with Alzheimer's.
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So um that's all I got for you today.
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Uh The extra hour,
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I will find something that we need to add to help
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you with your boards or something like that in the future.
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Okay, Alright guys, have a great day