Claude Skills by dromlakhani

If CGM fails or is removed, revert the insulin pump to manual mode provided basic criteria for pump use in hospital are still met. Trigger phrase: "CGM failed, should we switch pump to manual mode?"

Verify that insulin pump supplies (provided by patient or family) will be available throughout the hospitalization to support continued pump use. Triggered by questions such as "Do we have sufficient pump supplies for the hospital stay?"

Transition insulin pump to scheduled subcutaneous basal bolus insulin when anticipated hospital length of stay exceeds 1 to 2 days and pump expertise is unavailable. Triggers include: "Patient expected to stay >2 days, should we switch pump to scheduled insulin?"

This skill suggests using real-time continuous glucose monitoring (CGM) and algorithm-driven insulin pumps (ADIPs) rather than multiple daily injections (MDIs) with self-monitoring of blood glucose (SMBG) three or more times daily for adults and children with type 1 diabetes (T1D). Trigger phrases include "Should I use RT-CGM+ADIP or MDI+SMBG for this T1D patient?" or "Is intensive pump therapy indicated for this patient?"

Evaluates cardiovascular risk factors in persons receiving hormone therapy by obtaining fasting lipid profiles and diabetes screening. Triggered when a patient is on gender-affirming hormone therapy and due for routine cardiovascular risk assessment.

This skill determines whether an adolescent or adult patient meets DSM-5 criteria for gender dysphoria (gender incongruence) by evaluating the presence of at least two of six specified criteria over a minimum 6-month duration, accompanied by clinically significant distress or impairment. It is triggered when a clinician queries whether the patient's reported symptoms align with gender dysphoria, such as persistent incongruence between experienced/expressed gender and designated gender.

Determines if patient meets ICD-10 criteria for transsexualism. Triggered when a clinician uses ICD-10 for diagnostic purposes in gender identity assessment.

Assists clinicians in determining whether to proceed with social transition for prepubertal youth experiencing gender dysphoria or gender incongruence. Triggers include prepubertal youth with GD/gender incongruence and discussions about initiating social transition.

Calculates initial and escalating dose for pubertal induction hormone therapy based on patient weight or body surface area. Triggers include patient eligible for sex hormone treatment, ready to start hormones.

Determines if adolescent meets criteria for GnRH agonist treatment to suppress pubertal development. Triggers include adolescent requesting to suppress puberty, adolescent with gender dysphoria seeking pubertal blockade, or clinician noting Tanner G2/B2 with request for hormone suppression.

Determines if an adolescent meets criteria for initiating sex hormone treatment for gender dysphoria/gender incongruence. Triggered when an adolescent requests sex hormones or presents for gender-affirming hormone therapy evaluation.

Determines whether an adult patient meets eligibility criteria for initiating gender-affirming hormone therapy. Triggered when an adult patient requests gender-affirming hormones or presents for evaluation of hormone therapy eligibility.

Determines whether a patient meets the minimum age requirement (≥18 years or legal age of majority) for genital surgery that includes gonadectomy and/or hysterectomy. Trigger phrase: patient requests gonadectomy or hysterectomy as part of gender-affirming genital surgery.

Determines whether bone mineral density (BMD) measurement is indicated when patients have osteoporosis risk factors or have discontinued sex hormone therapy following gonadectomy. Clinical triggers include documented osteoporosis risk factors (e.g., low body weight, glucocorticoid use, prior fracture) or cessation of sex hormone therapy after surgical gonadectomy.

Determines if patient meets criteria for genital gender-affirming surgery affecting fertility. Triggers include patient on hormones, considering surgery.

Determines if current hormone levels are within target range for affirmed gender (e.g., testosterone 400-700 ng/dL for transgender males, estradiol 100-200 pg/mL for transgender females). Triggers include patient on hormone therapy and time for level check.

Determines if a patient has completed ≥1 year of consistent and compliant hormone therapy for genital surgery approval. Triggers include patient requesting genital surgery and being on hormone therapy.

This skill recommends against initiating puberty blocking or gender-affirming hormone treatment in prepubertal children diagnosed with gender dysphoria or gender incongruence. Clinical triggers include a young child presenting with GD/gender incongruence and caregivers or clinicians considering hormone intervention.

Guides timing of breast surgery for transgender males based on physical and mental health status. Triggers include transgender male considering breast surgery or requesting mastectomy.

Assesses whether hysterectomy and oophorectomy are medically necessary as part of gender-affirming surgery for transgender patients. Triggered when a patient is planning gender-affirming surgery and clinicians need to determine if total hysterectomy and oophorectomy should be included.

Assesses Tanner stage to determine if physical changes of puberty have begun (stage G2/B2 or higher) for considering pubertal suppression. Triggered when a clinician evaluates pubertal development in an adolescent patient.

Applies standard breast-screening guidelines for transgender females who have been assessed as having no known increased risk of breast cancer. Trigger phrases include transgender female and assessed as no increased breast cancer risk.

This skill guides individualized prostate cancer screening for transgender females receiving estrogen therapy based on personal risk. Trigger phrase: transgender female receiving estrogens.

Provides a monitoring schedule for patients receiving GnRH agonist therapy for pubertal suppression. Trigger phrases include 'patient undergoing GnRH agonist therapy' or 'initiating pubertal suppression'.

Provides schedule for monitoring during sex hormone induction. Trigger: patient initiating gender-affirming hormone therapy (GAHT).

Provides monitoring schedule for transgender females on estrogen therapy, including clinical evaluation, hormone levels, prolactin, electrolytes, BMD, and cancer screening. Triggered when a transgender female is receiving estrogen therapy for gender affirmation.

Provides monitoring schedule for transgender males on testosterone therapy, detailing timing of clinical visits, laboratory tests, and assessment for virilization and adverse reactions. It is triggered when a clinician manages a transgender male patient on gender‑affirming hormone therapy and needs to schedule appropriate follow‑up.

This skill determines whether testicular volume should be used as the primary or sole indicator of sexual development in male childhood cancer survivors who have received gonadotoxic treatments such as alkylating agents or testicular radiotherapy. Triggers include clinician questions like “Can I use testicular volume to assess puberty in this male survivor after chemotherapy?” or “Is testis size reliable for sexual maturity evaluation post‑radiation?”

This skill indicates the need for periodic prolactin monitoring in transgender females undergoing estrogen therapy. Clinical triggers include a transgender female patient receiving estrogen treatment.

This skill guides clinicians to inform and counsel individuals seeking gender-affirming medical treatment about fertility preservation options before initiating puberty suppression in adolescents or before starting hormonal therapy in adolescents and adults. It is triggered when a patient is eligible for pubertal suppression or sex hormone treatment and is about to begin such therapy.

Decide whether commonly-excluded patients (eating disorders, elderly ≥75, upper GI disease) can actually receive a GLP-1 receptor agonist. Use when a clinician asks "can I give semaglutide to a patient with binge eating disorder / anorexia / bulimia", "is liraglutide safe in an 80-year-old", "GLP-1 with GERD or chronic gastritis", "GLP-1 in sarcopenic elderly", or anytime a patient is being ruled out for GLP-1 therapy based on a perceived contraindication. Grounded in Gorgojo-Martínez 2023 §6...

Apply the four published expert-consensus clinical scenarios to manage GI adverse events in complex GLP-1 receptor agonist patients — persistent nausea mid-titration, GERD/heartburn after up-titration, elderly with sarcopenia risk, and insulin-treated elderly with CKD plus diarrhoea. Use when a clinician describes a patient resembling one of these archetypes, or asks "how to manage GLP-1 in an elderly patient with CKD", "patient on liraglutide developed reflux", "sarcopenia worry on semagluti...

Decide how to modify GLP-1 receptor agonist dose-escalation when GI adverse events appear during titration — extend, hold, step-back, set sub-maximal maintenance, or switch agent — using CTCAE grading of nausea and the "start low, go slow" flexible-titration framework. Use when a clinician asks what to do if nausea, vomiting, diarrhoea, or constipation appears while up-titrating semaglutide (2.4 mg or 7.2 mg, SC or oral), liraglutide, dulaglutide, tirzepatide, retatrutide, survodutide, CagriS...

Counsel a patient before starting a GLP-1 receptor agonist (semaglutide, liraglutide, dulaglutide, exenatide, lixisenatide, oral semaglutide) on how to prevent GI adverse events — nausea, vomiting, diarrhoea, constipation. Use when a clinician asks for patient-education material, a GLP-1 starter handout, pre-initiation counselling, or "what should I tell my patient before starting Ozempic/Wegovy/Rybelsus/Victoza/Saxenda/Trulicity." Produces a structured patient-facing brief grounded in the Go...

Select the right rescue medication for GI adverse events caused by a GLP-1 receptor agonist — antiemetics for nausea/vomiting, antidiarrhoeals for diarrhoea, stool softeners for constipation, plus drug-interaction adjustments. Use when a clinician asks "which antiemetic on semaglutide", "domperidone vs metoclopramide for GLP-1 nausea", "loperamide for liraglutide diarrhoea", or asks for pharmacological rescue when diet/lifestyle alone has failed. Grounded in Gorgojo-Martínez 2023 §4.3 and Fig...

Provide symptom-specific dietary and lifestyle advice for a patient on a GLP-1 receptor agonist who has developed nausea, vomiting, diarrhoea, or constipation. Use when a clinician asks "what to advise for nausea/vomiting/diarrhoea/constipation on semaglutide/liraglutide/tirzepatide", or any GLP-1 patient with a specific GI symptom needs targeted non-pharmacological advice. Outputs a focused do/avoid list per symptom, grounded in the Gorgojo-Martínez 2023 consensus (Figure 2).

Reduce the dose of basal insulin or sulfonylurea when starting or escalating a GLP-1 receptor agonist (Mounjaro/tirzepatide or Wegovy/Ozempic/semaglutide) to avoid hypoglycemia. Use when a clinician asks "how much to reduce insulin when starting Ozempic", "sulfonylurea dose reduction on tirzepatide", "hypoglycemia risk adding GLP-1 to insulin", or needs concrete reduction percentages before co-prescribing. Grounded in Mounjaro and Wegovy Canadian Product Monographs plus SURPASS-5 protocol.

Look up drug-specific nausea and vomiting rates across the full generation of GLP-1-based obesity agents — semaglutide 2.4 mg, semaglutide 7.2 mg, CagriSema, tirzepatide, retatrutide, survodutide, oral semaglutide 25/50 mg, and orforglipron — to counsel patients before initiation or to decide which agent to switch to when tolerability is the deciding factor. Use when a clinician asks "how much nausea should I expect on Wegovy vs Zepbound", "retatrutide vs semaglutide tolerability", "CagriSema...

Counsel patients on oral hormonal contraceptive interaction with tirzepatide (Mounjaro) — requirement for non-oral contraception or added barrier method for 4 weeks after initiation and 4 weeks after each dose escalation. Use when a clinician asks "does Mounjaro affect the pill", "tirzepatide and oral contraceptive", "contraception counselling on GLP-1", or when a woman of childbearing potential is starting or escalating Mounjaro. Grounded in the Mounjaro Canadian Product Monograph (April 202...

Assess and monitor pancreatobiliary risk (acute pancreatitis, cholelithiasis, cholecystitis, lipase/amylase elevations) in patients on GLP-1 receptor agonists. Use when a clinician asks about gallstone risk on semaglutide/liraglutide/tirzepatide, "GLP-1 and pancreatitis", lipase elevation interpretation, prophylactic ursodeoxycholic acid, or whether to start a GLP-1 in a patient with prior pancreatitis or gallbladder disease. Grounded in Gorgojo-Martínez 2023 §5.

Guide perioperative decisions for patients on GLP-1 receptor agonists (semaglutide, tirzepatide, liraglutide, dulaglutide) undergoing general anesthesia, deep sedation, or endoscopy — whether to hold, how long, and how to weigh aspiration risk from delayed gastric emptying. Use when a clinician asks "hold Ozempic/Wegovy/Mounjaro before surgery", "GLP-1 before endoscopy", "anesthesia aspiration risk tirzepatide", or needs a pre-procedure decision for a patient on a long-acting GLP-1 RA. Ground...

Bedside prescribing reference for Mounjaro (tirzepatide) — indications, dose escalation, missed-dose rule, KwikPen vs prefilled pen differences, contraindications, warnings, storage, and monitoring. Use when a clinician asks how to start tirzepatide, how to titrate Mounjaro, how to handle a missed weekly dose, Mounjaro storage, Mounjaro contraindications, Mounjaro pregnancy/MTC warnings, or needs a quick Mounjaro monograph lookup. Grounded in the Canadian Product Monograph (Eli Lilly Canada, ...

Match an adult obese patient to the best-fit evidence anchor for Noveltreat (semaglutide 2.4 mg) using the 7 Sun Pharma monograph obesity profiles — medically-supervised weight loss, obese + uncontrolled T2DM, obese + CVD / HFpEF risk, obese + knee osteoarthritis, obese + MASH, obese + prediabetes, and obese + PCOS. Use when a clinician describes a candidate for semaglutide 2.4 mg and wants the matching STEP / SELECT / STEP-HFpEF / ESSENCE / STEP 9 / STEP 10 trial with key numbers, clinical c...

Bedside prescribing reference for Noveltreat (Sun Pharma semaglutide 0.25/0.5/1/1.7/2.4 mg pre-filled pen) for chronic weight management — adult indication criteria, 5-step dose escalation, missed-dose rule, contraindications, warnings, drug interactions, and red-flag stop signals. Use when a clinician asks how to start Noveltreat, how to titrate semaglutide 2.4 mg, Noveltreat missed dose, Noveltreat contraindications, Noveltreat drug interactions, or when a patient on Noveltreat needs a mono...

Storage, handling, and disposal of the Noveltreat pre-filled semaglutide injection pen (0.25 / 0.5 / 1 / 2.4 mg, Sun Pharma) — fridge rules, 28-day out-of-fridge limit, single-use, pen-lock mechanism, light and freeze precautions, biomedical-waste disposal. Use when a clinician, pharmacist, or patient asks how to store Noveltreat, whether the pen can be kept outside the fridge, how long Noveltreat is stable at room temperature, how to dispose of a used Noveltreat pen, or what to do with an ac...

Check whether an adolescent aged 12 to under 18 years qualifies for Wegovy (semaglutide 2.4 mg) using BMI age-sex 95th-percentile cutoff, weight above 60 kg threshold, and secondary-obesity exclusion. Use when a clinician asks "is my teenager eligible for Wegovy", "Wegovy in adolescents", "pediatric semaglutide 2.4 mg indication", or needs to screen a 12 to 17 year-old with obesity before initiation. Grounded in the Wegovy Canadian Product Monograph (Novo Nordisk, March 2024).

Bedside prescribing reference for Wegovy (semaglutide 2.4 mg) — adult and pediatric indications, 16-week dose-escalation schedule, missed-dose rule, 12-week continuation rule, contraindications, warnings, and monitoring. Use when a clinician asks how to start Wegovy, how to titrate semaglutide 2.4 mg, Wegovy pediatric indication, missed Wegovy dose, Wegovy contraindications, or when a patient on Wegovy needs a monograph-level clinical decision. Grounded in the Canadian Product Monograph (Novo...

In women who have started estrogen replacement, suggests evaluating AED levels and adjusting AED doses as required. Triggers include: woman on estrogen replacement requiring AED management.

This skill guides the workup of females with oligomenorrhea or amenorrhea to evaluate for central hypogonadism by measuring serum estradiol, FSH, and LH while excluding pregnancy, hyperprolactinemia, hyperandrogenism, and thyroid disease. Use when evaluating a female with menstrual irregularities suggesting hypogonadism (e.g., oligomenorrhea/amenorrhea with low estrogen and inappropriately low or normal gonadotropins).

This skill guides ordering initial labs (serum testosterone, FSH, and LH) to evaluate suspected central hypogonadism in adult males. Use when a male presents with low libido, fatigue, decreased energy, or other signs suggestive of gonadal deficiency.