Claude Skills by dromlakhani

The guideline recommends using biochemical follow-up as a more objective indicator of relapse than symptoms in patients with increased bone turnover after treatment for Paget’s disease. Trigger phrases include monitoring for disease recurrence after bisphosphonate therapy, evaluating rising bone turnover markers, and assessing asymptomatic patients.

This skill suggests treatment with a bisphosphonate in patients with Paget's disease who also have symptomatic congestive heart failure. Triggers include the presence of Paget's disease alongside signs or symptoms of congestive heart failure such as dyspnea, orthopnea, or elevated jugular venous pressure.

Pretreat with a potent bisphosphonate before surgery for pagetic bone neoplasm to reduce bleeding from adjacent pagetic bone. Triggers include suspicion of osteosarcoma or giant cell tumor in pagetic bone prompting orthopedic surgical referral.

This skill recommends immediate administration of a potent intravenous bisphosphonate with neurosurgical consultation for patients presenting with paraplegia or progressive spinal stenosis attributable to spinal Paget's disease. Clinical triggers include new-onset paraplegia, worsening lower‑extremity weakness, or spinal stenosis symptoms in a patient with established spinal Paget's disease.

This skill suggests administering a bisphosphonate before elective total joint replacement to reduce intraoperative hemorrhaging and postoperative loosening of the prosthesis in patients with severe osteoarthritis adjacent to Paget's disease bone. Trigger phrases include preoperative planning for joint replacement in a patient with Paget's disease affecting the adjacent bone.

Recommends administering a potent bisphosphonate prior to elective osteotomy for severe lower‑extremity bowing in Paget’s disease that causes impaired ambulation or severe joint pain. Triggered when planning surgical correction of a lower‑extremity deformity in a patient diagnosed with Paget’s disease.

Recommends treatment with a bisphosphonate for most patients with active Paget's disease who are at risk of future complications. Triggers include active Paget's disease with risk of fracture, deformity, or neurologic symptoms.

Recommends measuring a specific bone formation or resorption marker in patients with Paget's disease who have abnormal liver or biliary tract function to assess treatment response or disease evolution. Triggered when liver function tests (e.g., ALT, AST, ALP, bilirubin) are abnormal in a patient with known Paget's disease.

This skill outlines using short-term changes in bone resorption markers (e.g., serum CTx or urine NTx) before and shortly after bisphosphonate therapy to predict an adequate therapeutic response. It is triggered when there is urgency to control severe symptoms or when Paget’s disease is highly active, prompting rapid efficacy assessment.

Suggests treatment with a potent bisphosphonate to prevent worsening of a hearing deficit in patients with Paget's disease involving the temporal bone. Triggers include detected or suspected hearing loss thought to be related to Paget's disease.

Recommends obtaining serum total alkaline phosphatase or a more specific bone formation marker for initial biochemical evaluation after radiological confirmation of Paget’s disease. Triggered after imaging establishes diagnosis to set baseline bone turnover.

Uses the least significant change (LSC) derived from analytical and biological variation to determine whether two sequential bone turnover marker measurements reflect a true biological difference. Triggers include when monitoring biomarker trends to assess treatment response or disease progression in Paget’s disease.

Assesses biochemical activity in untreated monostotic Paget's disease by measuring P1NP or BSAP and CTx or NTx when scintigraphy shows disease activity despite normal total alkaline phosphatase. Triggered when evaluating disease activity in patients with suspected or confirmed monostotic (single‑site) Paget's disease.

Recommends obtaining plain radiographs of the suspicious regions of the skeleton in patients with suspected Paget's disease. Clinical triggers include unexplained bone pain, elevated alkaline phosphatase, or clinical suspicion based on presentation.

This skill suggests performing a radionuclide bone scan to determine the extent of Paget's disease and identify asymptomatic sites after diagnosis. It is triggered when Paget's disease is diagnosed and a baseline extent assessment is needed.

Suggests reducing bone turnover below the midpoint of the reference range for the chosen monitoring bone turnover marker to maximize the duration of remission. Triggered when aiming to sustain long-term remission after treatment and the marker exceeds the midpoint.

This skill outlines when to obtain a repeat radiograph approximately one year after radiological diagnosis of osteolytic lesions in Paget's disease to assess lesion improvement or worsening. Consider repeat imaging if biochemical markers of bone turnover remain elevated or bone pain persists despite therapy.

This skill determines the appropriate retreatment interval for bisphosphonate therapy in Paget's disease based on drug-specific remission duration. It is triggered when planning long-term management after an initial bisphosphonate course, considering retreatment for zoledronate (seldom within 5 years), alendronate (maybe 2–6 years), or risedronate (maybe 1–5 years).

Suggests a single 5‑mg intravenous dose of zoledronate as the treatment of choice in patients with active Paget’s disease who have no contraindication to IV zoledronate. Triggered when initiating pharmacologic therapy for Paget’s disease and confirming absence of renal impairment or other contraindications.

Recommends vertebral fracture assessment (baseline spinal x-ray or DXA) to identify unsuspected vertebral fractures in men over-replaced with glucocorticoids and at fracture risk. Use when evaluating a male hypopituitarism patient on glucocorticoids with fracture risk factors such as age >50, prior fracture, or low BMD.

Recommends ACE inhibitors, ARBs, or calcium channel blockers as first-line hypertension therapy rather than β‑adrenergic blockers in obese patients with type 2 diabetes. Triggers include when a clinician asks, 'What antihypertensive should I start for this obese patient with T2DM to avoid weight gain?' or 'Should I avoid β‑blockers in this patient with diabetes and hypertension?'

Recommends adding a glucose‑lowering agent that promotes weight loss (GLP‑1 agonist or SGLT‑2 inhibitor) to metformin for overweight or obese patients with type 2 diabetes. Triggered when a clinician asks which drug to add to metformin for weight loss in an obese T2DM patient or whether to prefer a GLP‑1 agonist over insulin for its weight‑loss benefit.

Advises against using medications approved for other indications solely for weight loss, except in research contexts or by providers with weight‑management expertise managing well‑informed patients. Common triggers include questions such as 'Is it appropriate to prescribe topiramate off‑label for weight loss in this patient?' or 'Should I avoid off‑label bupropion for obesity treatment outside a research setting?'.

Recommends using non‑sympathomimetic agents (lorcaserin, orlistat) for pharmacological weight loss in patients with cardiovascular disease. Triggers include clinician questions such as “What weight‑loss medication is safest for this patient with coronary artery disease?” or “Should I avoid phentermine in a patient with prior stroke seeking obesity treatment?”.

Recommends against using sympathomimetic agents (phentermine, diethylpropion) in patients with uncontrolled hypertension or a history of heart disease. Triggers include clinician questions such as “Is it safe to prescribe phentermine for this patient with uncontrolled hypertension?” or “Should I avoid sympathomimetics in a patient with prior MI seeking weight‑loss medication?”.

Determines if a patient is a candidate for bariatric surgery using BMI thresholds: BMI ≥35 kg/m2 with comorbidity or BMI ≥40 kg/m2 regardless of comorbidities. Triggers include when a clinician asks, 'Is this patient eligible for bariatric surgery given their BMI and comorbidities?' or 'Should I refer a patient with BMI 38 and sleep apnea for surgical evaluation?'.

The skill evaluates all patients with acromegaly for hypertension, diabetes mellitus, cardiovascular disease, osteoarthritis, and sleep apnea at initial assessment. It is triggered by a new diagnosis of acromegaly or when a patient presents for baseline endocrine workup.

This skill recommends longitudinal monitoring and rigorous management of identified comorbidities—such as hypertension, diabetes mellitus, cardiovascular disease, osteoarthritis, and sleep apnea—in patients with acromegaly. Apply throughout follow‑up when comorbidities are present to mitigate morbidity and mortality risk.

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Guides dose escalation for obesity pharmacotherapy based on efficacy and tolerability while staying within approved upper dose limits. Triggers include clinician questions like "How should I titrate naltrexone/bupropion if the starting dose is tolerated?" or "What is the maximum liraglutide dose I can use?"

This skill guides clinicians to assess whether a patient has achieved ≥5% weight loss at 3 months while on a weight‑loss medication and to determine continuation versus discontinuation based on efficacy and safety. It is triggered when a clinician asks, 'Has this patient lost enough weight at 3 months to continue lorcaserin?' or 'Should I stop phentermine/topiramate because the patient lost only 3% of body weight?'.

Advises assessing efficacy and safety at least monthly for the first 3 months, then at least every 3 months for all patients prescribed weight‑loss medications. Triggers include clinician questions such as “How often should I check progress after starting orlistat?” or “What is the follow‑up schedule for a patient on liraglutide?”.

Recommends selecting antihistamines with reduced central nervous system activity (less sedation) to minimize weight‑gain risk. Triggers include clinician questions such as “Which antihistamine is least likely to cause weight gain for this patient with allergies?” or “Should I prefer a non‑sedating antihistamine over diphenhydramine for this obese patient?"

Recommends that diet, exercise, and behavioral modification be included in all obesity management approaches for patients with a BMI of 25 kg/m2 or higher. Triggered when clinicians ask, 'What foundational non-pharmacologic therapy should I start for this overweight patient?' or 'Should I initiate lifestyle changes for a patient with BMI 26?'.

Recommends regular monitoring of weight and waist circumference in patients receiving antiretroviral therapy due to unavoidable weight gain, redistribution, and associated cardiovascular risk. Triggered when a clinician asks, 'How often should I check weight and waist in this patient on ART?' or 'What parameters should I track to detect ART‑related weight changes?'

Determines if a patient is a candidate for pharmacotherapy based on BMI thresholds: BMI ≥27 kg/m2 with at least one obesity-related comorbidity or BMI ≥30 kg/m2 regardless of comorbidities. Triggered when a clinician asks, “Does this patient qualify for weight‑loss medication based on BMI and comorbidities?” or “Should I consider pharmacotherapy for a patient with BMI 28 and hypertension?”.

Recommends using NSAIDs or DMARDs instead of glucocorticoids for chronic inflammatory disease (e.g., rheumatoid arthritis) to limit weight gain. Triggered when clinicians ask, “What anti‑inflammatory should I choose for this RA patient to avoid weight gain?” or “Should I avoid steroids in this obese patient with RA?”

This skill guides clinicians in sharing decision‑making when selecting an antiepileptic drug (AED) by providing quantitative estimates of each drug’s expected weight effect. It is triggered when a clinician asks how to discuss weight‑change risks when choosing an AED or what information to provide on weight effects of specific agents such as valproate versus lamotrigine.

Recommends a shared decision‑making process that provides patients with quantitative estimates of the expected weight effect of antidepressants to inform drug choice, also considering expected treatment length. Triggers include clinician questions such as ‘How should I discuss weight‑change risks with this patient starting an antidepressant?’ or ‘What tool can I use to show expected weight impact of sertraline vs bupropion?’.

Recommends using weight‑neutral antipsychotic alternatives when possible and employing shared decision‑making that provides quantitative estimates of expected weight effect to guide drug choice. Triggered when a clinician asks, “How do I involve this patient in choosing an antipsychotic with minimal weight gain?” or “What resources show weight‑change projections for risperidone vs aripiprazole?”.

This skill suggests using approved weight‑loss medication over no pharmacological therapy to ameliorate comorbidities and improve physical activity in adults with BMI ≥30 kg/m² or BMI ≥27 kg/m² with at least one comorbid condition. It is triggered when a clinician asks, for example, 'Should I add medication to help maintain weight loss in this patient with BMI 31 and diabetes?' or 'Is pharmacotherapy appropriate for long‑term weight control in a patient with BMI 28 and hypertension?'.

Recommends weight‑losing and weight‑neutral medications as first‑ and second‑line agents for managing overweight/obese patients with type 2 diabetes. Triggers include when a clinician asks, 'Which diabetes medications will not worsen weight in this obese patient?' or 'Should I avoid sulfonylureas in this patient with T2DM and obesity due to weight gain risk?'

Step-by-step meal planning for a patient with obesity — from diet recall to calorie prescription to macronutrient targets. Use when a clinician asks "how do I plan a diet for my obese patient", "what calorie target for weight loss", "how many calories should I prescribe", "meal plan for obesity", "diet plan for overweight patient", or needs to build an individualised dietary prescription at the clinic.

Interprets ALT levels to screen for NAFLD in pediatric patients with obesity. Triggered when evaluating overweight/obese youth (BMI ≥85th percentile) and considering liver enzyme testing.

Assesses contraindications for bariatric surgery in adolescents, recommending against the procedure in pre‑adolescent children, pregnant or breast‑feeding teens, and those who have not mastered healthy dietary and activity habits or have unresolved substance use, eating disorder, or untreated psychiatric disorder. Clinical triggers include Tanner stage <4, positive pregnancy test, lactation, ongoing substance abuse, active eating disorder, or untreated psychiatric comorbidity.

Assesses eligibility for bariatric surgery in adolescents with obesity. Trigger phrases include Tanner 4-5 pubertal development, BMI ≥40 kg/m2 or BMI ≥35 kg/m2 with significant comorbidities, failed lifestyle modification, and need for psychological stability.

Determines if a child ≥2 years is overweight, obese, or extremely obese using BMI percentile and extreme obesity thresholds. Triggers include BMI ≥85th percentile (overweight), ≥95th percentile (obese), or ≥120% of the 95th percentile or ≥35 kg/m2 (extremely obese).

The skill calculates, plots, and reviews a child's BMI percentile at least once per year during well-child or sick-child visits. It triggers when a pediatric patient presents for routine health supervision or acute care, prompting BMI assessment and longitudinal tracking.

This skill interprets blood pressure using age-, sex-, and height-specific percentile norms to screen for prehypertension and hypertension in pediatric patients. Trigger phrases include BP ≥90th to <95th percentile = prehypertension and BP ≥95th percentile = stage 1 hypertension (with age‑specific adjustments).

This skill recommends evaluating children and adolescents with a BMI at or above the 85th percentile for age and sex for potential obesity-related comorbidities. Clinical triggers include overweight or obese classification by BMI percentile.