December Recap 2025

We are back with another monthly post for our paid subscribers. In this post, we also share a number of fun things that are more personal, interesting, and meant to create a closer community around RxTeach. We hope you enjoy it! If you're only interested in our free content, that's great! We will never put up a paywall for all of our posts. With that in mind, if you want to help fund disease prevention and research efforts, this is your chance! Reminder that all profits are donated to preventative medicine education and cancer research through student scholarships. We're excited about this chance to contribute to some of the efforts that we care about most and we genuinely hope you consider contributing!

Article Recaps

Circulating Tumor DNA: Overview and Application:

• ctDNA (liquid biopsy) consists of tumor-derived DNA fragments in blood and enables non-invasive, real-time molecular profiling across the cancer continuum, supported by advances in NGS and digital PCR.
• Clinical uses include genomic testing for treatment selection, early monitoring of treatment response, detection of minimal residual disease (MRD), and prediction of relapse—often preceding radiologic findings.
• Assay approaches vary (tumor-informed vs tumor-agnostic; dPCR vs NGS), each balancing sensitivity, breadth, and clinical application depending on tumor type and disease stage.
• Future directions focus on multi-omic liquid biopsies, AI-enhanced analysis, and validation of ctDNA as a surrogate endpoint, positioning ctDNA to personalize therapy intensity and transform oncology care.

2026 GOLD Report Updates:

• Earlier diagnosis is a major focus, with updated screening algorithms and risk profiles aimed at identifying at-risk patients sooner, addressing the significant global underdiagnosis of COPD.
• Exacerbation risk criteria have shifted, where even a single moderate or severe exacerbation in the prior year now signals increased clinical risk, prompting earlier reassessment and intervention.
• New concepts and frameworks were introduced, including “disease activity” to assess disease trajectory and a reorganized pharmacologic treatment algorithm separating new starts from maintenance therapy.
• Emerging technologies are acknowledged, such as digital inhalers, remote monitoring, and AI tools, supporting a move toward more proactive, individualized COPD management.

DOTS Journal Club:

• DOTS evaluated dalbavancin as step-down therapy for adults with complicated S. aureus bacteremia who had already cleared blood cultures, comparing a 2-dose dalbavancin regimen to 4–8 weeks of standard IV therapy.
• The primary DOOR outcome did not show superiority, but dalbavancin demonstrated noninferior clinical efficacy to standard of care, with similar rates of failure, complications, mortality, and quality of life.
• Dalbavancin reduced reliance on prolonged IV access, with fewer discontinuations and potential advantages for patients at high risk for PICC-related complications (e.g., PWID, housing instability).
• Clinical takeaway: DOTS supports dalbavancin as a reasonable, noninferior step-down option for carefully selected patients, though generalizability is limited and cost, patient selection, and follow-up remain key considerations.

Comparison and Competition:

• Comparison can be constructive when intentional, serving as feedback and motivation if directed toward people you admire for their competence, drive, and character rather than as a source of self-judgment.
• Unhealthy comparison distorts progress, especially when measuring yourself against those further along in their journey or against traits outside your control, leading to doubt and burnout instead of growth.
• Competition doesn’t have to be external—it can be framed as improving against your past self, effort, or understanding, while external competition should only be used if it supports personal growth.
• Key takeaway: pursue goals you genuinely care about, not those imposed by others, and prioritize rest and sustainability to maintain long-term fulfillment and avoid burnout.

Orphan Drugs and Their Market Implications:

• Orphan drug incentives have transformed rare disease R&D, with policies like the U.S. Orphan Drug Act driving investment through tax credits, fee waivers, and market exclusivity for conditions affecting small patient populations.
• Scientific and clinical innovation has accelerated, leading to breakthroughs in gene therapy, enzyme replacement, and precision medicine, often providing first-in-class treatments for previously untreatable diseases.
• High prices and access challenges remain major concerns, prompting payers to use utilization management, value-based contracts, and health technology assessments as orphan drug approvals continue to rise.
• Ongoing policy debates focus on sustainability, balancing innovation with affordability through potential reforms such as tighter eligibility, pricing transparency, and conditional exclusivity tied to clinical value and access.

ACLS Pharmacotherapy Review Part 1:

• Epinephrine remains the cornerstone of ACLS, indicated for all cardiac arrest rhythms, with timing based on rhythm (after 2 shocks for VF/pVT; immediately for asystole/PEA) and consistent adult dosing of 1 mg IV/IO every 3–5 minutes.
• Amiodarone and lidocaine are reserved for refractory VF/pVT, used after the third shock, with amiodarone offering broad antiarrhythmic effects and lidocaine serving as an effective alternative based on provider preference and patient factors.
• Pharmacologic mechanisms drive clinical effects and risks, with epinephrine’s α- and β-adrenergic activity improving perfusion at the cost of increased myocardial oxygen demand, while amiodarone and lidocaine alter cardiac ion channels to suppress malignant arrhythmias.
• Pharmacy pearls are critical in codes, including correct dosing, dilution compatibility (e.g., amiodarone in D5W only), awareness of adverse effects and drug interactions, and practical strategies to streamline medication delivery during resuscitation.