“It didn’t work.” This episode breaks down practical treatment options (dosing options for naltrexone, acamprosate, topiramate, gabapentin) and counseling pearls to help you meet patients where they are and support their recovery. Also discover blind spots in detox and rehab centers.

🔹Transcript and Show Notes

🔹 Explore ACP’s Substance Use Disorder Education Hub for videos and an AI-powered patient simulation to practice alcohol-use conversations: https://www.coreimpodcast.com/SUDhub

Alcohol Use and Chronic Health Conditions Mini Video Series

01:55 | #1: Naltrexone

12:06 | #2 Acamprosate

16:15 | #3: Topiramate

21:12 | #4: Other meds

29:31 | #5: Detox and rehab blind spots 

Tags: CoreIM, Medical Education, Addiction Medicine, Alcohol Withdrawal, Addiction Treatment, GLP-1, pharmacology

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Have you ever lost a patient and found yourself thinking about them long after the shift ended? This episode explores the grief clinicians can carry after a patient dies, including the losses that aren’t always obvious. We also discuss ways to work through that grief, recognize when it becomes complicated, and lean on your team for support.  

🔹Transcript and Shownotes

04:12 | What is Clinician Grief?

10:02 | Types of Losses

10:22 | Loss of a close relationship with a particular patient

12:56 | Loss due to a professional's identification with the pain of family members

13:56 | Loss of one's unmet goals and expectations and one's professional self-image and role

18:47 | Loss related to one's personal system of beliefs and assumptions about life

21:30 | Past unresolved losses or anticipated future losses

23:29 | The death of the self

25:44 | Coping

Tags: CoreIM, Medical Education, Clinician Wellbeing, Burnout, Secondary Traumatic Stress, Complicated Grief, Coping With Grief, Medical humanities, medical ethics

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How to choose between RUQ ultrasound, CT, HIDA, MRCP, EUS, and ERCP based on the clinical picture? When should you move from diagnostic imaging to therapeutic ERCP, and what should you know about sphincterotomy, stents, and stone removal? Plus, how to interpret bile duct dilation without jumping straight to obstruction?

🔹Sponsor: Oakstone CME

Use the code "CORE25" for 25% off: https://www.coreimpodcast.com/MKSAP

🔹Transcript and Shownotes

02:11 | Pearl 1: Gallbladder Problems Spectrum

07:33 | Pearl 2: Choose Imaging Strategically: Start with RUQUS, Escalate as Needed

14:34 | Pearl 3: Biliary Tree Diagnostics

19:19 | Pearl 4: Invasives that are Diagnostic and Therapeutic

27:06 | Pearl 5: Stenting in ERCP

Tags: CoreIM, Internal Medicine, Medical Education, Gallstones, Cholecystitis, Biliary Disease, ERCP, Biliary Imaging

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Throwback: Should you really fluid-restrict every patient with SIADH? When can IV fluids make hyponatremia better or worse? Are salt tabs actually doing enough? And what can urine studies tell you before you start treatment? Join us for a practical, physiology-driven approach to hyponatremia management, from fluids and solutes to loop diuretics and identifying the underlying cause. 

🔹Sponsor: Search “Amazon Pharmacy Nationwide Home Delivery" in your EHR to get home delivery (often same-day). Learn more here.

🔹Transcript and Shownotes

6:46 | Pearl 1: Key Principles

15:13 | Pearl 2: Fluids in hyponatremia

26: 03 | Pearl 3: Solutes in hyponatremia management

35:49 | Pearl 4: Lasix in hyponatremia management

40:05 | Pearl 5: Etiologies

Tags: CoreIM, Internal Medicine, Medical Education, SIADH, Fluid Restriction, Nephrology, Hospital Medicine, Urine Osmolality

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Why can lower-dose combinations be more effective and better tolerated than maximizing one medication? How to troubleshoot common challenges such as amlodipine edema, gout, electrolyte abnormalities, and the patient who says they cannot tolerate anything? Why ACT (ARBs, Calcium Channel Blockers, Thiazides) is the preferred first-line framework, and how to personalize medication choices based on comorbidities and side effects.

🔹Sponsor: Oakstone CME

Use the code "CORE25" for 25% off: https://www.coreimpodcast.com/MKSAP 

🔹Transcript and Shownotes

03:00 | Diagnosing Hypertension 

04:10 | When to Start Combination Therapy Instead of Monotherapy 

07:00 | Choosing First-Line Therapy Using the ACT Framework 

13:23 | Why ARBs Are Often Preferred Over ACE Inhibitors 

16:02 | Choosing the Right ARB: Candesartan vs Losartan 

18:39 | Comparing Potency & Duration Across First-Line Antihypertensives 

20:54 | Amlodipine Edema: Why It Happens and How to Fix It 

23:54 | Thiazides: Practical Tips, Electrolyte Problems & Class-Killer Side Effects 

29:33 | Managing Patients Who 'Can't Tolerate' Blood Pressure Medications 

Tags: Hypertension Management, High Blood Pressure, Primary Care, Internal Medicine, Core IM

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Learn from primary care docs what has been practiced and changed from the 2026 ACC/AHA Lipid Guidelines! Learn how the new CPR framework (Calculate, Personalize, Reclassify) and PREVENT risk calculator change statin decisions, why LDL targets are back, and when to use Lp(a), ApoB, and coronary artery calcium (CAC) testing. Discover updated risk-enhancing factors, expanded indications for non-statin therapies, and practical strategies to personalize lipid management for both primary and secondary

🔹Sponsor: Search “Amazon Pharmacy Nationwide Home Delivery" in your EHR to get home delivery (often same-day). Learn more here.

🔹Transcript and Shownotes:  

01:17 | Highlight #1 & #2: CPR and PREVENT Score

03:14 | Highlight #3: Updated ASCVD Risk Categories Using the PREVENT Score

05:30 | Highlight #4: LDL Targets Are Back

07:20 | Highlight #5: High-Risk Conditions That Bypass the PREVENT Score

08:41 | Highlight #6: Lp(a) Screening for Everyone

11:51 | Highlight #7: When to Use ApoB Testing

13:16 | Highlight #8: Reproductive Risk Factors

15:29 | Highlight #9: Using CAC to Guide Statin Therapy

19:09 | Highlight #10: Non-Statin Therapies

Tags: CoreIM, Internal Medicine, Medical Education, Cholesterol, Statins, LDL, ASCVD, Preventive Cardiology, LpA, ApoB, CAC, ACC2026, Cardiology, PrimaryCare 

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MASLD affects nearly one in three adults worldwide, yet many patients remain undiagnosed until advanced fibrosis or cirrhosis develops. So, which patients should clinicians actually be screening? When is a FIB-4 enough, and when should we move to elastography or hepatology referral? And are we finally entering an era where we can meaningfully treat MASH?

In this Beyond Journal Club episode, we unpack the evolving language of steatotic liver disease and take a close look at two major trials: MAESTRO-NASH studying resmetirom, the first FDA-approved liver-directed therapy for MASH, and ESSENCE, evaluating semaglutide in biopsy-confirmed disease.

Along the way, we explore what these biopsy-based histologic endpoints really mean, why placebo responses were surprisingly high, and whether improvements in steatohepatitis and fibrosis will ultimately translate into better clinical outcomes for patients.

This episode is for clinicians trying to understand where the field is headed, which patients deserve closer attention, and how metabolic liver disease is increasingly becoming part of everyday primary care and hospital medicine.

🔹Sponsor: Oakstone CME

Use the code "CORE25" for 25% off: https://www.coreimpodcast.com/MKSAP 

🔹Transcript and Shownotes:  

01:57 | Understanding MASLD as a Systemic Disease 

05:45 | MASLD vs MASH vs Met-ALD: Spectrum Steatotic Liver Disease 

08:55 | How to Screen for Fibrosis (FIB-4 & FibroScan) 

16:15 | Lifestyle Treatment & Weight Loss Targets 

19:00 | ESSENCE Trial: Semaglutide for MASH 

21:58 | MAESTRO-NASH Trial: Resmetirom 

27:27 | Future Treatments for MASH 

30:51 | Key Takeaways for Clinicians 

Tags: CoreIM, Internal Medicine, Medical Education, Hepatology, Fatty Liver Disease, Metabolic Dysfunction Associated Steatohepatitis, Nonalcoholic Fatty Liver Disease, Liver Fibrosis

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What blood pressure should we target in patients on hemodialysis? Why volume control remains the foundation of treatment? How blood pressure targets differ from the general population. Learn practical pearls on medication timing around dialysis, drug dialyzability, antihypertensive selection, and strategies to prevent intradialytic complications while optimizing long-term outcomes. 

🔹Sponsor: Search “Amazon Pharmacy Nationwide Home Delivery" in your EHR to get home delivery (often same-day). Learn more here. 

🔹Transcript and Shownotes:  

02: 19 | Pearl 1: Blood Pressure Targets 

09: 40 | Pearl 2: Timing Medications and Dialyzability 

15: 31 | Pearl 3 - Pharmacologic Management Nuances in Dialysis Patients 

22: 57 | Putting It All Together: The Medication Hierarchy 

Tags: CoreIM, Internal Medicine, Medical Education, Nephrology, ESRD, End-Stage Kidney Disease, Hypertension, Kidney Health, Dry Weight, Volume Overload

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Why is fluid management the most important part of dialysis care? This episode explores the fundamentals of hemodialysis, why ESKD patients have unique physiology, and how volume overload, not just hypertension, drives many complications. Learn practical pearls on dry weight, sodium restriction, diuretics, and the strategies that can reduce hospitalizations and improve patient outcomes. 

🔹Sponsor: Oakstone CME

Use the code "CORE25" for 25% off: https://www.coreimpodcast.com/MKSAP 

🔹Transcript and Shownotes:  

02:49 | Pearl 1: Foundations of Dialysis

09:21 | Pearl 2: Distinct Physiology

11:42 | Pearl 3: Why is fluid management so important?

19:43 | Pearl 4: Fluid Management Pro-tips

25:31 | Pearl 5: Diuretics in Patients with Residual Kidney Function

Tags: CoreIM, Internal Medicine, Medical Education, Nephrology, Dialysis, End-stage kidney disease, Hypertension, Kidney Health, Dry Weight, Volume Overload

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Can AI manage post-op atrial fibrillation or does medicine still require human judgment? Using post-op AFib as a case study, we explore where algorithms help, where evidence falls short, and why clinical context still matters. When evidence is incomplete, and every patient is different, can AI truly practice medicine or only assist the clinicians who do? This episode explores the space between algorithms, uncertainty, and human judgment in modern medical care. 

🔹Sponsor: Search “Amazon Pharmacy Nationwide Home Delivery" in your EHR to get home delivery (often same-day). Learn more here.

🔹Transcript and Shownotes:  

02:51 | Broad workup for reversible causes and other etiologies of AFib that may occur post-op

05:10 | Considerations for management of post-op atrial fibrillation

13:00 | Stroke risk in atrial fibrillation

20:49 | Outpatient management of atrial fibrillation 

25:54 | The role of AI in medical decision-making

Tags: CoreIM, Internal Medicine, Medical Education, Atrial Fibrillation, Cardiology, Open Evidence

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We start with a gripping story of seizures and use it as a jumping-off point to unpack practical pearls for in-flight emergencies. Along the way: what’s actually in the emergency medical kit, when planes divert, how ground medical support works, altitude physiology, legal protections, and how to stay calm when medicine suddenly happens at 35,000 feet. By the end, you may still sweat a little…but hopefully less than before.

🔹Sponsor: Oakstone CME

Use the code "CORE25" for 25% off: https://www.coreimpodcast.com/MKSAP 

🔹Transcript and Shownotes:  

04:40 | Emergency Medical Kit (EMK) Standard Contents

08:50 | Role of Ground-Based Medical Support & Flight Diversion Decision-Making

19:35 | Interpreting Hypoxia at Altitude

22:06 | In-Flight Liability

23:35 | Common Chief Concerns & Useful Additional Medications

24:53 | How to Be Resourceful in an Austere Environment

Tags: CoreIM, Internal Medicine, Medical Education, In-flight Care, Medical Emergencies, Clinical Reasoning, Seizure Management, Hypoxia, Airway Management, Cardiac Emergency, Syncope, Respiratory Distress

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