🗞 Rapid Fire: Guideline Summaries
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You’ll find some of the newest guidelines relevant to Primary Care below, along with a few key takeaways from each one of them.
Some of these guidelines are dense – but don’t worry, over at Pathway, they’re all neatly summarized and broken down into digestible chunks to make them easier to understand.
🤕 Migraine - from the American College of Physicians (ACP 2025), the American Academy of Family Physicians (AAFP 2024), and the United States Department of Veterans Affairs (VA/DoD 2024), among others: - Offer aspirin/acetaminophen/caffeine for the short-term treatment of migraine. (A)
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Offer eletriptan, frovatriptan, rizatriptan, sumatriptan (PO or SC), sumatriptan/naproxen, or zolmitriptan (PO or intranasal) for the short-term treatment of migraine. (A)
- Consider offering metoclopramide in combination with aspirin for nausea and vomiting caused by acute migraine. (B)
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Consider offering physical therapy for the management of migraine headaches. (C)
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Consider initiating monotherapy with a β-blocker (metoprolol or propranolol), valproate, venlafaxine, or amitriptyline for the prevention of episodic migraine in nonpregnant adults in outpatient settings. (C)
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Consider offering monotherapy with a CGRP antagonist (atogepant or rimegepant) or a CGRP antibody (eptinezumab, erenumab, fremanezumab, or galcanezumab) for the prevention of episodic migraine in nonpregnant adults in outpatient settings not tolerating or inadequately responding to a trial or trials of a β-blocker (metoprolol or propranolol), valproate, venlafaxine, or amitriptyline. (C)
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Migraine medications and Dosing
🌲 Lichen Sclerosus - from the British Association for Sexual Health and HIV (BASHH 2025), the European Dermatology Forum (EDF 2024), and the European Academy of Dermatology and Venereology (EADV 2022), among others: - Evaluate for autoimmune diseases, particularly thyroid dysfunction (thyroid autoantibodies and TSH), if clinically indicated, as these conditions can commonly coexist with lichen sclerosus (LS). (B)
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Offer ultra-potent topical corticosteroids, such as clobetasol propionate, as first-line therapy for LS. (A)
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Consider offering mometasone furoate if there is intolerance to clobetasol propionate. (B)
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Consider offering topical calcineurin inhibitors, such as tacrolimus 0.1% or pimecrolimus 1%, for the treatment of LS only when other treatments are not suitable. (C)
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Do not use topical testosterone, dihydrotestosterone, estrogen, or progesterone in female patients with genital LS. Consider offering topical vaginal estrogen in case of additional genitourinary syndrome. (D)
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Consider offering oral retinoids for severe hyperkeratotic disease. (C)
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Consider offering UVA1 phototherapy for extra-genital disease, recognizing the difficulty in delivering it to genital skin. (C)
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Obtain regular follow-up examinations in patients with LS initially every 1-6 months until the disease has stabilized, and annually thereafter. (A)
🥲 Vulvodynia - from the British Association for Sexual Health and HIV (BASHH 2025) and the European Academy of Dermatology and Venereology (EADV 2022): -
Consider offering topical local anesthetics, such as 5% lidocaine ointment or 1-2% lidocaine gel, daily for provoked vulvodynia. Counsel patients about possible irritation. Advise applying lidocaine for dyspareunia 15-20 minutes before intercourse and wash off just before. (B)
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Consider offering amitriptyline for provoked vulvodynia, titrating gradually from 10 mg up to 75 mg daily based on patient response and side effects. (C)
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Consider offering gabapentin or pregabalin if patients are unresponsive or unable to tolerate the side effects of other treatments. (C)
- Consider offering botulinum toxin injection in patients with unprovoked or provoked (especially if associated with vaginismus) vulvodynia. (C)
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Obtain multidisciplinary long-term follow-up every 3 months until improvement. (B)
🫘 Autosomal Dominant Polycystic Kidney Disease - from the Kidney Disease: Improving Global Outcomes Foundation (KDIGO 2025), the European Association for the Study of the Liver (EASL 2022), and the United Kingdom Kidney Association (UKKA/BAPN 2019), among others:
- Obtain abdominal imaging by ultrasound for screening patients at risk of ADPKD, in the context of the family history, kidney function, and comorbidities. (B)
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Consider obtaining follow-up MRI, CT imaging, and/or genetic testing to clarify the diagnosis and further characterize the disease. (E)
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Avoid obtaining routine screening of vascular abnormalities of non-intracranial large arteries in patients with ADPKD and no familial history of vascular aneurysms or dissections. (D)
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Obtain screening for aortic aneurysms in patients with ADPKD and their first-degree relatives with a family history of aortic root or thoracic aortic aneurysms. (E)
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Obtain regular BP monitoring, preferably with home BP measurements, in patients with ADPKD and high BP. (E)
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Initiate tolvaptan in adult patients with ADPKD with an eGFR ≥ 25 mL/min/1.73 m² who are at risk for rapidly progressive disease. (B)
- Do not use SGLT-2 inhibitors to slow eGFR decline in patients with ADPKD. (D)
🦴 Osteoporosis in Men - from the U.S. Preventive Services Task Force (USPSTF 2025), the American College of Physicians (ACP 2024), and the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO 2024), among others:
- Use the FRAX tool for the assessment of fracture risk and as the basis for setting intervention age-dependent thresholds in male patients with osteoporosis. (A)
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Consider obtaining bone mineral density testing in male patients with any of the following:
- 50-64 years with a previous osteoporosis-related fracture or ≥ 2 clinical risk factors
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≥ 65 years with 1 clinical risk factor for fracture
- ≥ 70 years. (C)
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Use a female reference database for the densitometric diagnosis of osteoporosis in males. (A)
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Obtain serum total testosterone measurement as part of the pretreatment assessment of male patients with osteoporosis. (B)
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Consider initiating pharmacotherapy in all male patients with a history of fragility fracture. (B)
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Initiate oral bisphosphonates (alendronate or risedronate) as first-line therapy in patients at a high risk of fracture. (A)
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Initiate zoledronate as second-line therapy in patients at a high risk of fracture. (A)
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Consider initiating denosumab as second-line pharmacotherapy to reduce the risk of fractures in male patients with primary osteoporosis having contraindications to or experiencing adverse effects from bisphosphonates. (C)
- Consider initiating abaloparatide as first-line therapy in patients with osteoporosis at a very high risk of osteoporotic fracture. (C)
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Common osteoporosis medicines wish dosing and important facts Acknowledgments: - Editorial Team: Jeremy Swisher, MD, Cole Phillips, MD, Khudhur Moh, MD, Hovhannes Karapetyan, MD
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