The conversation before the next prescription HEART RESERVE | Fictional teaching cases 00:00:00.340 Before the next prescription, ask three questions. 00:00:03.110 What is this treatment helping? What is becoming harder? 00:00:06.170 And have reproductive plans changed? 00:00:08.470 Consider Elena. Her A1C is at goal, but she has had a myocardial infarction. 00:00:13.470 The treatment discussion must include cardiovascular benefit, not glucose alone. 00:00:17.790 At follow-up, weight loss looks encouraging. 00:00:20.570 Then she describes nausea, very small meals, and less energy. 00:00:24.930 That changes the visit. The prescriber and registered dietitian 00:00:28.800 nutritionist need to review symptoms, intake, hydration, and function before 00:00:33.530 the next dose decision. 00:00:35.070 Now consider Nora, who wants to try for pregnancy. 00:00:38.160 Verify the exact medicine and why she takes it. 00:00:41.570 For Wegovy used for weight reduction, the label specifies stopping at least 00:00:45.460 two months before a planned pregnancy. 00:00:48.130 Tirzepatide sold as Zepbound has a different counseling issue: oral 00:00:52.020 hormonal contraception. Discuss a non-oral method or an added 00:00:56.360 barrier method for four weeks after starting and after each dose increase. 00:01:00.670 These instructions are product specific. 00:01:03.420 For a patient with diabetes, stopping a GLP-1 medicine also requires a plan to 00:01:08.160 maintain glucose control before conception. 00:01:11.050 Endocrinology and the pregnancy-care team should coordinate the transition, 00:01:15.100 with nutrition support. Before the visit ends, put the plan into plain language. 00:01:20.020 What happens next? Who reviews it? 00:01:22.710 When will the patient hear from us? Ask her to explain the next step in her 00:01:26.430 own words. That is how a treatment decision becomes continuing care. Clinical sources: activity references 5–9. Full reference links appear in the learner manuscript.