Source / episode info

• **Episode:**446
• **Title:**Divine Intervention Episode 446: Divine Patch (Updates/Corrections from Past Episodes)
• **Published:**2023-03-03
• Source:Episode page

One-liner

This episode provides critical updates on board-relevant guidelines, including colon cancer screening starting at age 45, first-line treatments for sulfite poisoning (hydroxycobalamin), C. difficile infection (oral vancomycin/fidaxomicin), and the use of Valbenazine in tardive dyskinesia.

High-yield summary

• Sulfite Poisoning: First-line treatment is Hydroxycobalamine; second-line is Imil nitrite + Thiosulfate.
• Colon Cancer Screening: The recommended starting age has dropped from 50 to 45 years old.
• Antibiotic Updates: For C. difficile infection, the preferred first-line agents are Oral Vancomycin or Fidaxomicin, replacing metronidazole as primary therapy.
• Lyme Disease Management: Antibiotics must be tailored by manifestation: Doxycycline/Cephalexin for meningitis; Doxycycline for carditis (especially stable heart block).
• Tardive Dyskinesia: The new treatment class involves VMAT2 inhibitors, such as Valbenazine, which prevents dopamine release.

Learning objectives

• State the current first-line treatment for sulfite poisoning and explain the mechanism of action for hydroxycobalamin.
• Apply updated guidelines for colorectal cancer screening based on age, family history, and prior colonoscopy findings.
• Differentiate antibiotic choices for Lyme disease manifestations (meningitis vs. carditis).
• Identify the preferred oral antibiotics for Clostridioides difficile infection.
• Recognize Valbenazine as a VMAT2 inhibitor used in treating tardive dyskinesia.

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