Hypertension – Time for Patients to Control the Wheel

June 15, 2018

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 to BP monitoring.

Guest Authors:  Vicky Shah, PharmD, BCPS and Daniel Longyhore, MS, PharmD, BCPS

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Cutting Down HIV Treatment to a 2-Drug Regimen

May 24, 2018

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 suppression in HIV infected patients.

Guest Authors Tinh An (April) Nguyen, PharmD and Jihae Lim, PharmD

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Strategies for Managing Hypertension: Is the Paradigm Shifting?

May 10, 2018

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: Lauren G Pamulapati, PharmD

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

April 27, 2018

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 are generally preferred, but there are instances where broader coverage is recommended.  A recent study attempts to “clean up” the debate by examining the benefits and risks of using narrow- versus broad-spectrum antibiotics in children with acute respiratory tract infections.

Guest Authors:  Amber Giles, PharmD, MPH, BCPS, AAHIVP  and Paige Hughes, PharmD

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Using Sotagliflozin In Tandem with Insulin: Weighing the Benefits in Type 1 Diabetes

April 13, 2018

Patients with type 1 diabetes often have sub-optimal glycemic control.  The gold standard of treatment is basal-bolus insulin or continuous subcutaneous insulin infusion via an insulin pump.  However, only a third of patients with type 1 diabetes achieve the American Diabetes Association A1C goal <7%.  There has been particular interest in using SGLT-2 inhibitors in patients with type 1 diabetes due to their ability to decrease body weight and blood pressure as well as improve glycemic control and perhaps cardiovascular outcomes. InTandem3 was a phase III, multicenter, randomized, double-blind, placebo-controlled trial evaluating the safety and efficacy of sotagliflozin, a novel dual SGLT 1 and 2 inhibitor, in patients with Type 1 diabetes. 

Guest Author:  Diana Isaacs, Pharm.D., BCPS, BD-ADM, CDE

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

March 30, 2018

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 seeking Medication Assisted Treatment (MAT). The EXtended-release naltrexone vs Buprenorphine/naloxone for Opioid Treatment (X:BOT) trial compared the efficacy and safety of XR-NTX and BUP-NX to induce and maintain a patient with OUD on MAT as well as reducing opioid overdoses, relapses, and cravings.

Guest Author:  Jordan L. Wulz, PharmD, MPH, BC-ADM, CHC

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Can We KEEP Perimenopausal Women Sexually Satisfied?

March 16, 2018

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 research – directly comparing oral and transdermal preparations – was needed.  An ancillary study of the Kronos Early Estrogen Prevention Study (KEEPS) did just that - examined the impact of oral and transdermal estrogens on sexual functioning.

Guest Authors:  Stefanie C. Nigro, PharmD, BCACP and Christine Dimanculangan, Pharm.D.

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Know When to Hold ‘Em - Know When to Fold ‘Em. Deprescribing in BPH.

March 2, 2018

A recently published study explores the possible benefits to discontinuing an alpha-1 blocker after receiving combination therapy with a 5-alpha reductase inhibitor for the treatment of benign prostatic hyperplasia (BPH).  In more symptomatic patients, or patients with confirmed, enlarged prostates, it is recommended to use both medication classes (alpha-1 blocker and 5-alpha reductase inhibitor) to minimize symptoms by relaxing the prostatic smooth muscle and reducing the size of the prostate – producing a potentially synergistic effect.  This study found that withdrawal of alpha 1-blockers after a year of combination therapy did not worsen urinary symptoms, QOL, and voiding or storage function.  This provides evidence that combination therapy may not be needed indefinitely for all patients.

Guest Authors:  Erica Crannage, PharmD and Stephanie Crist, PharmD

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ARCH Study: Is Romosozumab better than Alendronate for the Fracture-Prone?

February 16, 2018

It’s been 20 years since alendronate was approved to treat osteoporosis.  Although effective, bisphosphonates aren’t ideal. Romosozumab is an investigational monoclonal antibody that increases bone formation and decreases bone resorption. Is romosozumab a potentially better alternative to bisphosphonate therapy?  That’s what the ARCH study attempted to answer.

Guest Authors:  Yanqun Evonne Lee, MClinPharm and Joyce Yu-Chia Lee, PharmD

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SPRINTing towards lower BP goals : A re-analysis of the ACCORD-BP trial

February 2, 2018

The new 2017 ACC/AHA guidelines recommend a BP goal of <130/80 mmHg for everyone – including patients with diabetes. The 2018 ADA guidelines also recommend a goal of <130/80 mmHg, but only in patients at high risk of cardiovascular disease and only when it can be achieved without undue treatment burden. This change in recommendations is largely driven by results of the Systolic Blood Pressure Intervention Trial (SPRINT), which demonstrated a 25% reduction in the primary composite outcome of CV events with intensive BP control (SBP target <120 mmHg). However, extrapolating these findings to patients with T2DM has been challenging as patients with diabetes were excluded from SPRINT. A recent re-analysis of the ACCORD-BP study shed some new light.

Guest Authors: Kevin Cowart, Pharm.D. and Karen Sando, Pharm.D.

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