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Are You REAL-ly Paying Attention? The Importance of Attention Controls

Critically-evaluating the literature is essential to engage in evidence-based practice. A key component of assessing studies involves determining whether the comparator groups are appropriate. Most pharmacists are familiar with the use of placebos for evaluating drug treatments, but how many of us have considered the comparator groups in behavioral interventions? For these situations, employing attention placebo controls (APC) is important. Guest Authors: Elizabeth A. Cook, PharmD, BCACP,...


Is it Time to “Step Up” Rescue Treatment for Asthma to Prevent Exacerbations?

We’ve been managing asthma, for the most part, the same way for quite some time now … short-acting beta agonist (SABA) for quick relief, inhaled corticosteroids (ICS) as first-line maintenance treatment, step up if needed, step down if possible … plus self-management education and a written asthma action plan. Despite many treatment options, numerous adults, adolescents, and children still suffer from asthma exacerbations, leading to reduced quality of life, missed work and school, higher...


Stop the Shots: Edoxaban vs Dalteparin in Cancer-Associated VTE treatment

For the treatment of cancer-associated VTE, LMWHs are recommended over warfarin (Grade 2B) and DOACs (all Grade 2C). Warfarin therapy in cancer-associated VTE is often made more difficult by wildly fluctuating international normalized ratios, procedure-related interruptions, as well as numerous drug-drug and drug-food interactions. While DOACs have been widely used in the treatment of VTE, there is very little data supporting their use in patients with active cancer until now with the...


Hypertension – Time for Patients to Control the Wheel

Traditionally, the management of hypertension requires routine blood pressure checks by a health professional to adjust medications. Could self-monitoring lead to better outcomes? Would a greater percentage of patients achieve their goal blood pressure (BP)? Self-monitoring may be an efficient method to improve blood pressure control; however, results from published reports are inconsistent. The authors of the TASMINH4 study sought to compare the effectiveness of three different approaches...


Cutting Down HIV Treatment to a 2-Drug Regimen

While multi-drug combination therapies for HIV has resulted in longer lifespans, simplified medication regimens are needed to reduce pill-burden in an aging population with HIV. Two-drug regimens are potentially attractive because they may minimize drug exposure; reduce risks for adverse effects, drug-drug interactions, and long-term toxicities; and potentially increase patient adherence. The SWORD-1 and SWORD-2 trials evaluated the efficacy and safety of a two-drug regimen to maintain...


Strategies for Managing Hypertension: Is the Paradigm Shifting?

Forty-five percent of all adults in the United States have high blood pressure — that’s more than 100 million people! Of those treated with pharmacotherapy, more than half are not achieving their blood pressure goals. Thus, millions of Americans are receiving suboptimal care. A recently published systematic review and meta-analysis examined various implementation strategies to improve BP control in patients with high blood pressure. Which implementation strategies work best? Guest Author:...


Don’t Kid Yourself: Broad- versus Narrow-Spectrum Antibiotics in Children

Overuse of broad-spectrum antibiotics can lead to antimicrobial resistance, increased cost, and higher prevalence of adverse drug reactions. Nearly 2 million infections and 23,000 deaths are caused by bacteria that are antibiotic-resistant each year in the United States costing the healthcare system an estimated 20 billion dollars. Moreover, adverse reactions to antibiotics are the most common reason for pediatric patients to visit the emergency department. Narrow-spectrum antimicrobials...


Treating Opioid Use Disorder - X:BOT Offers a Pragmatic Approach

Opioid-use disorder (OUD), a risk factor and major contributor to opioid-related deaths, is often underdiagnosed and undertreated. Currently there are three FDA-approved pharmacologic treatments for OUD maintenance therapy: methadone, buprenorphine (with or without naloxone), and naltrexone. Despite definitive evidence that methadone and buprenorphine products are effective in the treatment of OUD, there are still considerable accessibility and availability barriers that patients face when...


Can We KEEP Perimenopausal Women Sexually Satisfied?

Female sexual dysfunction (FSD) effects women of all ages but is common among perimenopausal / postmenopausal women and may be related to a reduction in circulating estrogen. Oral estrogens increase sex hormone-binding globulin (SHBG) which lowers available free testosterone and thus may negatively impact sexual function.Transdermal estrogens are typically preferred because they lack a high first-pass effect and are not associated with risk of thromboembolic events. However, additional...


Therapy for Early-Stage COPD: What is the GOLDen Regimen?

Nearly 16 million adults in the United States have chronic obstructive pulmonary disease (COPD) but this is probably a woeful underestimate as many adults are asymptomatic in early stages. Screening is only recommended if patients exhibit symptoms and have risk factors. However, the most rapid decline in lung function occurs during GOLD stage 1. As COPD progresses, mortality, morbidity, and the economic burden increase very significantly. These facts suggest a need to detect and treat...


Inflammatory Statements about Cardiovascular Risk Reduction: The CANTOS Trial

We’ve all seen and used the American College of Cardiology 10-year atherosclerotic cardiovascular disease (ASCVD) risk calculator. There are several modifiable risk factors such as blood pressure, cholesterol, and smoking status that, if addressed, can lower ASCVD risk. But are there other modifiable risk factors that we are failing to account for and might be able to address? New evidence suggests systemic inflammation may be one. Guest Authors: Ian Hatlee, Pharm.D and Scott Pearson,...


Top Ten Things Every Clinician Should Know About the 2017 Hypertension Guidelines

We interview Eric MacLaughlin, Joseph Saseen, and Kristin Rieser about the ACC/AHA Guidelines for the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure in Adults released in November 2017. Dr. MacLaughin, a member of the Guideline Writing Committee, gives a insiders view of the guidelines development process and explains the rationale for lower blood pressure goals. Drs. Saseen and Rieser talk about some of the practical considerations that we all must consider as we...


Where is the COMPASS Taking Us? Rivaroxaban, Aspirin, or Both for Stable CVD ?

Since the introduction of direct oral anticoagulants (DOACs) less than a decade ago, use of this class has expanded beyond the prevention and treatment of venous thromboembolism and stroke prevention in the setting of atrial fibrillation. The potential role of DOACs in the secondary prevention of coronary artery disease (CAD) has been of considerable interest. In the setting of CAD, warfarin has resulted in significant more major bleeding when given either alone or in combination with...


Azithromycin to Prevent Asthma Exacerbations: What AMAZES Us and What Doesn’t

Despite good adherence to high-dose inhaled corticosteroids (ICS) and concomitant long-acting beta agonists (LABA), millions of people with asthma continue to experience exacerbations. What more can patients and clinicians do to reduce the risk of exacerbations? Does the routine use of antibiotics reduce the frequency of exacerbations? This is the question the recently published AMAZES study attempted to answer.


Painstaking Efforts to Improve Opioid Stewardship

Drug overdose is now the leading cause of death among Americans under the age of 50. In 2016, the United States (U.S.) Centers for Disease Control and Prevention (CDC) released a seminal guideline for primary care clinicians regarding opioid prescribing. These guidelines are now being implemented by clinicians, insurers, and healthcare institutions. The Transforming Opioid Prescribing in Primary Care (TOPCARE) study sought to assess the impact of a multicomponent care management...


Validating HERDOO2 - When is it Safe to Stop Therapy After an Unprovoked VTE?

According to the 2016 CHEST VTE Guidelines, at least 3 months of therapy is recommended for an unprovoked DVT or PE (Grade 1B).Thereafter, the clinician is expected to weigh the risks and benefits to determine if extended therapy is appropriate. Balancing the risk of mortality from recurrent VTE versus major bleeding has been challenging. A validated clinical decision tool is sorely needed! Until recently, no risk assessment tool has been validated and therefore none have been widely...


Testing the Limits on Blood Glucose Monitoring: Can We Safely Cut Back?

Is self-monitoring of blood glucose (SMBG) cost-effective? SMBG is often recommended to help guide treatment decisions. Consumer-oriented advertising often promotes frequent SMBG as means to achieve better glycemic control but current clinical practice guidelines do not provide specific recommendations regarding the frequency of blood glucose monitoring. The lack of conclusive evidence supporting the clinical benefits of routine SMBG combined with the rising costs of healthcare has led...


Wrapping up Knee Pain: Cabbage Leaf Wraps for Osteoarthritis of the Knee

Cabbage leaf wraps (CLWs) … the newest health craze trending on social media? A culinary masterpiece? Or an effective complementary treatment for osteoarthritis (OA) relief? A recently published study attempted to answer the latter question. Guest Author: Emily Prohaska, PharmD, BCACP, BCGP Music by Good Talk


All for One and FOURIER for All!

Although statins have a proven benefit and are widely used, ASCVD continues to be the leading cause of death in the US. In 2015, two proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, alirocumab (Praluent®) and evolocumab (Repatha®), were approved to treat elevated cholesterol when added to maximally-tolerated statin therapy in patients with familial hypercholesterolemia or history of ASCVD. However, the lack of long-term CV outcomes data, high cost, and uncertainty...


Vitamin D to Prevent Respiratory Tract Infections: Is the Evidence Dazzling or Disappointing?

Observational studies and systematic reviews have shown an association between low vitamin D concentrations and acute respiratory tract infections (ARTIs). An association is one thing, but can vitamin D supplementation reduce the risk of ARTIs? That’s what a recent systematic review and meta-analysis attempted to determine. Guest Author: Amanda Schartel, Pharm.D., BCACP Theme music by Good Talk