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Recommends checking and managing vitamin D according to Endocrine Society guidelines to avoid hypocalcemia in patients receiving bisphosphonates or denosumab for hypercalcemia of malignancy. Use when a clinician notes risk factors for hypocalcemia (e.g., low 25‑OH vitamin D, renal insufficiency) and asks about baseline labs before antiresorptive start.

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Recommends mineralocorticoid receptor antagonists for all primary aldosteronism patients to prevent target organ damage, irrespective of blood pressure control or serum potassium levels. Triggered when a clinician encounters a PA patient with well‑controlled BP and normal K and wonders, 'Do I still need to treat with MRA?' or considers stopping therapy.

日本語の概要は準備中です。原文の説明を表示しています。

Suggests monitoring DHEA replacement in women with primary adrenal insufficiency (PAI) by measuring morning serum DHEAS levels before the daily dose, targeting the mid‑normal range. Consider when evaluating low libido, depressive symptoms, or low energy despite optimized glucocorticoid and mineralocorticoid replacement.

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Suggests a trial of dehydroepiandrosterone (DHEA) replacement in women with primary adrenal insufficiency (PAI) who report low libido, depressive symptoms, and/or low energy levels despite otherwise optimized glucocorticoid and mineralocorticoid replacement. Consider when a woman with PAI presents with persistent low libido, depressive symptoms, and/or low energy levels after glucocorticoid and mineralocorticoid doses have been titrated to clinical targets.

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Calculates the lowest effective glucocorticoid dose (dexamethasone or prednisone) to normalize blood pressure and serum potassium in glucocorticoid-remediable aldosteronism (GRA/FH-I) by titrating to biochemical and clinical targets. Indicated when initiating medical treatment for confirmed GRA, triggered by findings such as early-onset hypertension, family history of stroke before age 40, spontaneous hypokalemia, or suppressed plasma renin activity with elevated aldosterone.

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Recommends spironolactone as first-line mineralocorticoid receptor antagonist for initial medical therapy of primary aldosteronism due to low cost and widespread availability. Use when a clinician queries which MRA to start for a patient with PA requiring medical therapy.

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Clinicians educate adrenal insufficiency patients taking nondexamethasone glucocorticoids who initiate enzyme-inducing antiepileptic drugs about early signs of adrenal insufficiency. Trigger when an AI patient on nondexamethasone GC starts an enzyme-inducing AED such as phenytoin, carbamazepine, or oxcarbazepine.

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Recommends measuring serum cortisol levels at 8–9 AM as the first-line test for diagnosing central adrenal insufficiency. Use when starting diagnostic workup for suspected adrenal insufficiency; triggers include suspected adrenal insufficiency requiring initial cortisol testing.

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In patients with adrenal insufficiency receiving dexamethasone replacement, the guideline suggests increasing the dexamethasone dose when enzyme-inducing antiepileptic drugs are co-administered. Trigger phrases include "AI patient on dexamethasone starts enzyme-inducing antiepileptic drug" or "AI patient on dexamethasone requiring enzyme-inducing AED".

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Work a primary-prevention patient through the 2026 ACC/AHA multisociety dyslipidaemia guideline CPR framework — Calculate (10-year and 30-year PREVENT-ASCVD), Classify (low / borderline / intermediate / high), Personalize (demographic, clinical, biomarker, and reproductive risk enhancers), and Reclassify (coronary artery calcium scoring where appropriate). Use when a clinician asks how to assess ASCVD risk for primary prevention, who needs a statin, borderline risk patient what to do, intermediate risk should I start a statin, risk enhancers to look for, premature family history of ASCVD how does it change risk, pregnancy-related risk factors, PCOS and cardiovascular risk. Grounded in the 2026 ACC/AHA multisociety dyslipidaemia guideline.

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Complete bedside prescribing reference for Mirago (mirabegron, beta-3 adrenoceptor agonist) for overactive bladder — covering contraindications, safety screening, drug interactions, dose selection in special populations, titration, and administration. Use when a clinician asks how to start mirabegron, what dose to use in renal or hepatic impairment, is mirabegron safe in this patient, mirabegron drug interactions, or Mirago for OAB.

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Bedside prescribing reference for Bemdec (bempedoic acid / NEXLETOL) — indication check, dose, statin co-prescribing safety caps, monitoring plan, warnings for hyperuricemia and tendon rupture, and special population guidance. Use when a clinician asks "can I start bempedoic acid", "Bemdec indication", "is bempedoic acid safe with my statin", "patient on Nexletol has joint pain or high uric acid", "bempedoic acid in CKD or liver disease or pregnancy", or any prescribing or monitoring question about bempedoic acid.

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Recommends adjusting glucocorticoid doses on the day of surgery based on illness severity and magnitude of surgical stress. Triggers when managing a patient requiring surgery needing perioperative glucocorticoid management, such as "patient on HC for central AI undergoing major abdominal surgery" or "patient with hypopituitarism scheduled for minor procedure".

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Select the right pharmacologic agent for a child aged 12+ with obesity using the CMAJ 2025 guideline — choosing between GLP-1 receptor agonists, metformin, or orlistat with monitoring guidance. Trigger when a clinician asks which medication to use for pediatric obesity, whether to start semaglutide or metformin in a child, or how to manage obesity pharmacologically in adolescents.

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Diagnose monogenic and syndromic obesity in children and adolescents using a structured step-by-step algorithm. Use this skill whenever a clinician suspects a genetic cause of obesity, asks about leptin deficiency, MC4R mutation, POMC deficiency, PCSK1 deficiency, leptin receptor deficiency, Bardet-Biedl syndrome, Prader-Willi syndrome, Alström syndrome, or any case of early-onset severe obesity with hyperphagia. Also trigger for questions about targeted pharmacotherapy including setmelanotide or metreleptin, or when to order a genomic obesity panel. Cross-references the NHS Genomic Test Finder skill to surface the relevant R-code once a diagnosis is reached.

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Select the right treatment tier for a child with obesity — behavioural, pharmacologic, or surgical — using the CMAJ 2025 pediatric obesity guideline. Trigger when a clinician asks what to do for a child with obesity, which intervention to start, whether to escalate treatment, or when to consider medication or surgery for pediatric obesity.

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Write technical documentation that matches the measured profile of professionally-written docs. Carries the craft rules derived from 114k words of pre-2022 documentation (SQLite, PostgreSQL, Python, Django, Rust, Go, Pro Git, nginx), the per-Diátaxis-type numeric targets, and the copywriting register for page leads. Use when drafting or rewriting any documentation prose, or when a page is factually right but reads as machine-written.

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Bring documentation prose down to a high-school reading level without losing precision. Runs after the content is written and before humanizer. Targets grade 9 on four measures — sentence length, vocabulary, clause load and jargon density — and carries the rewriting moves that actually shift them.

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Read-only view of the execution roadmap. Lists every epic with its per-status tallies, nests the still-open rows beneath their epic, collapses wholly-finished epics into one rollup line, and closes by naming the next planned task in file order. Four verbs — `list` (the reader's view), `tasks` and `epics` (filterable row and epic queries), `next` (the first planned task). Invoke any time to see what is left to build. Not a workflow phase; never writes; never starts or commits work.

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Prepare amux for a new release. Updates version numbers, docs, getting-started, release notes, and blog post. Does NOT run the release script.

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Use when the user describes a problem, decision or stuck situation but names no method: "how should I approach this?", "help me think this through", "we can't decide", "where do I start?". Picks the best-fit thinking method and runs it. Skip for plain execution tasks or when a method is named.

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Use for systems thinking, or when a change may ripple beyond its target: "what are the side effects?", "why does this keep coming back?", "how do these teams or services affect each other?". Maps loops, delays and leverage points. Skip for single-step fixes.

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Shape an article as a journey of beats, choose-your-own-adventure style. The user picks a starting beat from the raw material, you write only that beat, then offer options for where to pivot next, beat by beat, until the article reaches a natural end. Use when the user has raw material and wants to assemble it as a narrative rather than an argument.

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Use when starting feature work that needs isolation from current workspace or before executing implementation plans - ensures an isolated workspace exists via native tools or git worktree fallback

日本語の概要は準備中です。原文の説明を表示しています。