Calcium channel blockers (CCBs) are widely prescribed medications for various clinical indications in adults and children. They are available in both immediate and long-acting formulations and are generally classified into dihydropyridines and nondihydropyridines, with nondihydropyridines having more cardioselectivity. CCB toxicity is common given the widespread use which leads to serious adverse clinical outcomes, especially in children. Severe CCB toxicities may present with life-threatening bradycardia, hypotension, hyperglycemia, and renal insufficiency. Dihydropyridine toxicity, however, may present with reflex tachycardia instead of bradycardia. Initial patient evaluation and assessment are crucial to identify the severity of CCB toxicity and design the best management strategy. There are different strategies to overcome CCB toxicity that requires precise dosing and close monitoring in various patient populations. These strategies may include large volumes of IV fluids, calcium salts, high insulin euglycemia therapy (HIET), and vasopressors. We hereby summarize the evidence behind the management of CCB toxicity and present a practical guide for clinicians to overcome this common drug toxicity.

Objectives: Saudi Arabia is one of the most diabetes-prone countries in the world. The physician-centered model of care constitutes the standard of care around the country. The study aimed to evaluate the impact of clinical pharmacist care on diabetes management in comparison to standard physician-based care.Materials and methods: a retrospective chart review was conducted of patients with type 2 diabetes mellitus (T2DM) seen by the clinical pharmacist at the Diabetes & Endocrinology Center, King Fahad Specialist Hospital located in Buraydah, Saudi Arabia between September 2019 to June 2020.Results: Thirty-two diabetic patients were included. The mean age is 55.75±10.72 years with 65.6% of patients being females. Hemoglobin A1c (HbA1c) was significantly decreased within nine months compared to baseline (9.33±1.80 vs.10.30±1.66), p=0.017. Conclusions:The multidisciplinary collaborative care involving pharmacists achieved superior diabetes outcomes for patients with diabetes. Involving pharmacists resulted in a significant HbA1c reduction within nine months. Moreover, pharmacists' care helped optimize medication therapy and decreased the frequency of hypoglycemia.

Objective The Centers for Disease Control and Prevention (CDC) provide evidence-based recommendations on vaccine use in the US Current CDC recommendations for the two available pneumococcal vaccine types can be confusing for providers and nursing staff, introducing the potential for administering the wrong product to patients. The pneumococcal vaccine products come with specific recommendations and target-specific patient groups. This intervention aims to improve pneumococcal vaccine practices per CDC recommendations, at primary health-care centers in Saudi Arabia. Materials and Methods This intervention is conducted with nursing staff and mid-level providers. An educational intervention consisting of a five-question assessment questionnaire and containing brief scenario cases on pneumococcal vaccine indication. The assessment questionnaire was administered twice separated by a brief educational session on proper vaccine use by a clinical pharmacist. The educational intervention and the pre/post assessment required 15 min to complete. Assessments were collected, and a pre-intervention assessment was compared with a post-intervention assessment to capture the effect of the educational intervention. Test score changes from the baseline were analyzed via a paired Student’s t -test. Results Eighty-five nursing staff and mid-level providers completed the assessment. Questionnaire scores signaled an improvement trend in both centers, but the results were not statistically significant in center 1 ( p =0.767) and center 2 ( p =0.125). Conclusion Focusing education on nursing staff by clinical pharmacists on proper vaccine use does not appear to be as effective as previously thought. The desire for improvement in practices was evident in the overwhelming desire to participate in the educational session by nursing staff and mid-level providers. However, the results reflect the complex nature of vaccine practices and the need for further training on proper vaccine use for nursing and mid-level providers.

Objectives: This study sought to study how social media addiction and selfmedicating behavior are related in adults in Saudi Arabia. Materials and methods: We utilized an online self-administered survey using multiple-choice questions, free-text comments, and a five-point Likert scale to evaluate selfmedication behavior. We used the validated [Social Media Addiction Scale (SMAS)] to evaluate social media addiction. Survey participation spanned from July 2021 to December 2021. Results: 692 participants responded to the online survey. Approximately 71.5% (n=495) of participants reported no selfmedication practices. Vitamins were the most used among self-medicating participants (10.5%) followed by analgesics (8.5%). The SMAS scale mean was 41.7±8.76 indicating a moderate tendency to social media addiction with no difference between males and females. Social media addiction showed a weak but statistically significant correlation to self-medication r(692)= 0.036 p=0.035. Social media addiction was weakly and adversely correlated to age in a statistical significance correlation r(692)= -0.116 p=0.002. Conclusions: Saudi adults demonstrated moderate inclination towards social media addiction with positive correlation of social media addiction to self-medication and invers correlation to age.

Objectives: Sodium-glucose cotransporter 2 (SGLT2) inhibitors demonstrated a reduction in the risk of death and hospitalization for heart failure and major renal complications in recent clinical trials. However, real-world studies are still limited, especially in Saudi Arabia. This study aims to examine the clinical outcomes of SGLT2 inhibitors in heart failure patients regardless of diabetes status. Materials and methods: A retrospective study was conducted at a single cardiology center in Saudi Arabia. The study spanned from July 2021 to June 2022. The study included adult patients (≥18 years) diagnosed with heart failure with a prior history of using SGLT2 inhibitors for at least 3 months. Results: A total of 45 patients were included in the study. A significant difference was detected among the diabetic and non-diabetic patient groups in baseline diastolic blood pressure (DBP), baseline left ventricular ejection fraction (LVEF) and the use of diabetic medications with (p= 0.008, <0.001, 0.008), respectively. SGLT2 inhibitors use resulted in a trend toward improvements in HbA1C, LVEF and ED visits however, these findings were non-statically significant. Conclusions: This is the first protocol to report outcomes of SGLT2 inhibitors in Saudi heart failure patients regardless of diabetes status. We detected an improvement signal in HbA1C, ED visit frequency and LVEF in both diabetic and non-diabetic groups.Larger studies are warranted to further evaluate outcomes of SGLT2 inhibitors in this patient group regardless of diabetes.