iForumRx.org
Can VOYAGER Put PAD Patients Back on Their Feet?

Can VOYAGER Put PAD Patients Back on Their Feet?

August 28, 2020

Peripheral artery disease (PAD) impacts 8.5 million Americans age 40 years or older, often leading to acute limb ischemia, amputation, hospitalization, revascularization, major adverse cardiac events (MACE), and death. In addition to being at very high risk of MACE, more than 10% of PAD patients who had revascularization surgery are hospitalized for major adverse limb events, including acute limb ischemia leading to amputation. Could combination therapy, an antithrombotic regimen comprised of a direct oral anticoagulant and an antiplatelet agent, help prevent limb ischemia and cardiovascular (CV) events in these high-risk patients?

Guest Authors:  Navya Varshney, PharmD, BCPS and Rachel Lowe, PharmD, BCPS

Music by Good Talk

Will Bempedoic Acid provide SERENITY for Patients with Statin Intolerance?

Will Bempedoic Acid provide SERENITY for Patients with Statin Intolerance?

August 14, 2020

Current guidelines recommend statins for primary and secondary prevention of atherosclerotic cardiovascular disease (ASCVD) due to their well-established therapeutics benefits.  Unfortunately, many patients are unable to tolerate statins due to statin-associated muscle symptoms (SAMS), most commonly manifested as myalgias. Patients who are unable to tolerate a statin can be challenging to treat. Even if the patient is willing to try a lower dose or a different statin, the patient’s low-density lipoprotein cholesterol (LDL-C) may still be above the recommended threshold.  This puts patients unable to tolerate statins at increased risk of ASCVD or of a recurrent cardiovascular event. Is bempedoic acid a useful therapeutic option in patients with SAMS?

Guest Authors:  Kara Gurries, PharmD, BCACP and Janeen Ibarreta, PharmD

Music by Good Talk

No Provider Status, No Problem: CCM as a Revenue Source in Community Pharmacy

No Provider Status, No Problem: CCM as a Revenue Source in Community Pharmacy

July 31, 2020

Hypertension is poorly managed in the United States with only 25% of patients achieving optimal blood pressure (BP) control (BP less than 130/80 mmHg).  To achieve optimal control, patients require close follow-up and BP-lowering medication regimens need to be titrated and periodically adjusted. Community pharmacists are in a unique position to manage patients who have poorly controlled hypertension. However, significant barriers exist to implementing hypertension management services by community pharmacists including a lack of reimbursement. Is chronic care management (CCM) a viable payment model to support these services?

Guest Authors:  Kimberly Zitko, PharmD, BCACP, BCGP and Brittany Schmidt, PharmD, BCACP

Music by Good Talk

Powerful Placebos and Notorious Nocebos: Implications for Ambulatory Care

Powerful Placebos and Notorious Nocebos: Implications for Ambulatory Care

July 17, 2020

Imagine you have recommended statin therapy to a patient with diabetes. A few weeks later, the patient experiences leg pain and stops it. Was this patient’s leg pain caused by the statin? Or was it a nocebo effect? Muscle symptoms in placebo-controlled trials of statin therapy range from 3-5%, while rates in real-world observational studies are between 15-20%. Ambulatory care pharmacists have an important role in recognizing and managing placebo and nocebo effects. Understanding the placebo effect allows clinicians to harness the power of placebos. Reframing risks during patient education may decrease nocebo effects.

Guest Authors:  Sara Wettergreen, PharmD, BCACP and Joseph Nardolillo, PharmD

Music by Good Talk

An Incli-ng of Benefit? Efficacy and Safety of Inclisiran for Elevated LDL

An Incli-ng of Benefit? Efficacy and Safety of Inclisiran for Elevated LDL

July 6, 2020

Lipid management continues to be an essential component in the prevention and treatment of atherosclerotic cardiovascular disease (ASCVD).  For the past decade, clinical practice guidelines have gone back and forth about optimal treatment goals but guidelines all agree that statins should be used as the preferred initial therapy. However, there is still a lack of clarity about the optimal add-on therapies. The newest LDL-lowering therapy is inclisiran, a small interfering RNA (siRNA) that targets the PCSK9 pathway.

Guest Authors:  Joshua O. Holmes, PharmD, MS and Amanda Schartel, PharmD, BCACP

Music by Good Talk

Will Riva Be Defeated By It’s (Long-Standing) Nemesis, Apixa?

Will Riva Be Defeated By It’s (Long-Standing) Nemesis, Apixa?

June 19, 2020

Do we finally have enough evidence to establish a preferred direct-acting oral anticoagulant (DOAC) for stroke prevention in patients with atrial fibrillation? The use of DOACs for a-fib has rapidly increased due to their ease of use and favorable safety profile. The AHA/ACC/HRS and CHEST guidelines now recommend DOACs over warfarin for stroke prevention in a-fib, but do not state a preference for one DOAC over another. Factor Xa inhibitors, specifically apixaban and rivaroxaban, are the most commonly prescribed DOACs suggesting they are preferred by clinicians in real-world practice but is one better than the other?

Guest Authors: Amy D. Robertson, PharmD, BCACP and Michelle Balli, PharmD, BCACP

Music by Good Talk

Should Bedtime be Med-Time for Hypertension?

Should Bedtime be Med-Time for Hypertension?

March 27, 2020

Few medications are specifically dosed at night to optimize outcomes. However, antihypertensive medications may soon belong on our patients’ nightstands. It is common practice for patients to take all antihypertensive medications in the morning, but perhaps daytime dosing doesn’t maximize cardiovascular risk reduction? The potential benefits of chronotherapy and its impact on BP and CV outcomes have been investigated since the 1980s. However, current practice guidelines do not explicitly recommend dosing antihypertensive medications at bedtime.

Guest Authors:  Vivian Cheng, PharmD, BCPS and Joseph Saseen, PharmD, BCPS, BCACP

Music by Good Talk

Let’s COLCOT to the Chase: Colchicine for Secondary Prevention of CV Events

Let’s COLCOT to the Chase: Colchicine for Secondary Prevention of CV Events

March 13, 2020

Millions of Americans will have a myocardial infarction in their lifetime and 20% will have a recurrent fatal or non-fatal coronary heart disease event. Several modifiable risk factors, including elevated blood pressure, cholesterol, and glucose as well as tobacco use, can and should be addressed to reduce the risk of recurrent cardiovascular events. Systemic inflammation has also been associated with poor CV outcomes. Is systemic inflammation a modifiable CV risk factor? And if so, should an anti-inflammatory agent be added to the recommend post-MI drug cocktail to reduce the risk of morbidity and mortality?  That's the question that the COLCOT Study attempted to answer.

Guest Authors:  Jessica Wearden, PharmD and Augustus (Rob) Hough, PharmD, BCPS, BCCP

Music by Good Talk

Age is Just a Number: Discontinue Statins with Care

Age is Just a Number: Discontinue Statins with Care

February 14, 2020

More than 14 million Americans age 75 years and older face a dilemma. They are at high risk for atherosclerotic cardiovascular disease (ASCVD). On the other hand, older adults are more susceptible to adverse effects associated with statins. Many adults, often in their 60s or early 70s, decide to initiate statin therapy for the primary prevention of ASCVD. However, at some point in a patient’s life, the potential benefits may no longer be so clear … or the risks and costs increase. Unfortunately, there is little information on the potential consequences of stopping statin in patients who are tolerating statins.

Guest Authors:  Maricar Conson, PharmD and W. Cheng Yuet, PharmD, BCACP

Music by Good Talk

A Cause for a PAUSE: Evaluating a Standardized Perioperative DOAC Management Protocol

A Cause for a PAUSE: Evaluating a Standardized Perioperative DOAC Management Protocol

January 31, 2020

One in six patients with atrial fibrillation (AF), or an estimated six million patients worldwide, will require perioperative anticoagulant management this year.  Ambulatory care pharmacists commonly face the scenario where a patient taking a direct oral anticoagulant (DOAC) for AF requires an elective surgery or procedure. Best practices for periprocedural management of DOACs are unclear and current guidelines differ in their recommended approaches. Having a simple, systematic periprocedural DOAC management protocol would be helpful. But would a straightforward protocol that is easily understood by clinicians and patients be safe and effective? The PAUSE study investigators attempt to establish the standard of care.

Guest Authors:  Maggie Faraj, PharmD and Candice Garwood, PharmD, BCPS, BCACP

Music by Good Talk

Play this podcast on Podbean App