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D-PRESCRIBE Study: As Age Goes Up, The Medication Must Go Down!

The D-PRESCRIBE study provides compelling evidence that a focused, systematic medication review conducted by community-based pharmacists coupled with patient education and written recommendations to prescribers results in a significant reduction in the use of potentially inappropriate medications. In this episode, Christine Dimaculangan reviews the methods and results of the D-PRESCRIBE study and our expert panelists discuss its implications and implementation. Guests: Christine...


Keeping Intensive Blood Pressure Goals in MIND: Does it Impact Cognitive Decline?

Intensive blood pressure (BP) control reduces the risk of cardiovascular events and mortality, but the verdict isn't in yet on the benefits of intensive control to prevent the development of dementia. Previous studies have shown an inconsistent relationship between blood pressure control and cognitive decline. SPRINT-MIND, using data from SPRINT, was designed to evaluate the effects of intensive BP control on cognitive outcomes including probable dementia and mild cognitive...


Is a Team-Based Approach in Primary Care Worth It?

A team-based approach to patient care is well established in acute care settings, but not as widely adopted in primary care settings. Working within a team could have a positive impact on the efficiency of visits, quality of care, workload, job satisfaction, and patient satisfaction. Previous studies in acute-care hospital settings reveal positive outcomes, but there have been mixed results in primary care settings. Are the extra time, effort, and money necessary to change to a collaborative...


Cardiovascular Risk with Elevated Triglycerides - Does Icosapent Ethyl REDUCE-IT?

Although hypertriglyceridemia has consistently been associated with increased CV events, medications that lower triglycerides have failed to reel in a significant reduction in major CV events when combined with statin therapy. Could purified fish oil derivatives be the answer? Or just another red herring? The Reduction of CV Events with Icosapent-Ethyl Intervention Trial (REDUCE-IT) sought to clarify the utility of icosapent ethyl, a highly purified EPA derivative. Guest Authors: Melissa...


Another Case of Newer Isn’t Always Better! Gabapentin vs. Pregabalin for Chronic Sciatica

Sciatica is a form of neuropathic pain which can be particularly frustrating for patients and difficult to manage. With a lack of evidence to guide treatment and opioid use becoming increasingly under the microscope, data supporting the use of alternative pain regimens are needed. Gabapentin and pregablin are GABA analogs often used to treat sciatic pain, but is one superior to the other? Pregabalin is newer and available as a branded product only, but is it more effective than generically...


Fall Risk and Benzos – Is Trazodone Really the Knight in Shining Armor?

Older adults are often tormented by insomnia, pain, and other comorbidities that impact their quality of life. Medication therapy is often sought to treat and manage these diseases, but healthcare providers often overlook the risks of prescribing medications to patients who are older, frail, and at high risk for falls. Trazodone is increasingly prescribed for insomnia instead of benzodiazepines presumably because it is considered to be safer and it does not appear on either the Beers or...


Top Ten Things Every Clinician Should Know About the 2018 Cholesterol Guidelines

The American Heart Association / American College of Cardiology (AHA/ACC) Task Force recently published the 2018 Guideline on the Management of Blood Cholesterol. The guidelines writing committee had representation from 12 organizations, including the National Lipid Association, American Diabetes Association, and the American Pharmacists Association — all of whom endorsed the guidelines. The previous guidelines (published in 2013) were intended to answer some specific clinical questions and...


Another Attempt to ARRIVE at an Answer Using Aspirin for Primary Prevention

Daily low-dose aspirin has long been considered a “wonder drug” for its cardioprotective effects, particularly in patients with pre-existing cardiovascular and cerebrovascular disease; however, despite decades of research, the use of aspirin to prevent a first event is less certain. In 2014, the Food and Drug Administration (FDA) responded to a citizen petition requesting the labeled indications for low dose aspirin be updated to include primary prevention. The FDA concluded that the...


Does a “One-Size-Fits-All” Aspirin Dosing Approach Still Hold WEIGHT?

Personalized medicine is at the forefront of health care today, focusing on how best to tailor the treatment approach to each person. But should we be thinking about personalizing the approach for prevention as well? The one-dose-fits-all approach has been used in nearly all aspirin studies. What is poorly understood is the influence of body weight. Perhaps the reason why aspirin has resulted in only modest benefits in clinical trials might be related to under (and over) dosing based on...


Aspirin for Primary Prevention of CV Events in Diabetes - Is the Evidence ASCENDing?

Aspirin is no doubt beneficial in patients with overt vascular disease for the secondary prevention of myocardial infarction, stroke, or cardiovascular death. However, evidence supporting use of aspirin for primary prevention in patients who have not had a cardiovascular event is far less compelling. The clinical uncertainty of aspirin use for the primary prevention of CV events in patients with diabetes is reflected in the different recommendations in current guidelines. The investigators...


LDL Limbo: How Low is Too Low?

There has been significant debate regarding the safety of achieving very low LDL-C levels, including a potential negative impact on cognitive function. The current ACC/AHA guidelines (circa 2013) suggest decreasing the statin dose in patients with two consecutive LDL-C levels below 40 mg/dL based on expert opinion. The lack of evidence has been a major challenge for clinicians and it is unclear whether medication doses should be reduced in high-risk patients who may benefit from very low...


Top Ten Things Every Clinician Should Know About the 2018 Antithrombotic Therapy Atrial Fibrillation Guidelines

The American College of Chest Physicians (ACCP) recently updated their guideline recommendations for the use of antithrombotics for the prevention of stroke in patients with atrial fibrillation (aka the Chest Guidelines). Find out what's new, who shouldn't receive treatment based on the CHADS-VASc score, and why the guideline panel recommends calculating a patient's SAME-TTR score. Guest Author: Dylan Lindsay, PharmD Music by Good Talk


Maybe Old is Gold? Newer Insulins Might Not Be Better – Just More Expensive

Fredrick Banting, the Canadian scientist who discovered insulin in 1921 and sold the patent for just $1 to the University of Toronto and made it available to pharmaceutical companies royalty-free, would be disappointed to know that the high cost of insulin is now a major barrier to treatment. The average price of insulin has nearly tripled, from $4.34/ml in 2002 to $12.92/ml in 2013. Insulin’s high cost affects everyone: (1) uninsured patients, (2) insured patients with high co-payments and...


Using Controllers PRN for Mild Persistent Asthma – An Oxymoron?

Two recent studies challenge our current approach to managing patients with mild persistent asthma. When patients with asthma are prescribed inhaled corticosteroids (ICSs), we instruct them to use the medication daily. In patients with persistent asthma, guidelines recommend maintenance therapy, with either an ICS or a combination ICS/long-acting beta-agonist (LABA), plus a short-acting beta-agonist (SABA) as needed for rescue treatment. The Symbicort Given as Needed in Mild Asthma (SYGMA) 1...


The ZOE Trials – The Herpes Zoster Recombinant Subunit Vaccine — It’s Time to Upgrade!

We now have two vaccinations to protect against herpes zoster — a live-attenuated vaccine (Zostavax) and the new recombinant subunit vaccine (Shingrix). While the live-attenuated vaccine has been available for more than a decade and a CDC-recommended vaccine in older adults, only one in three eligible patients have received it. Based on the results of two recently published studies, the new recombinant subunit vaccine appears to provide substantially improved efficacy and duration. Guest...


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 viral...