While narcotic analgesics remain a mainstay for the treatment of acute and chronic pain, urgent care visits and deaths from opioid overdoses have skyrocketed. Our panelists are Dr. Lucas Hill from the University of Texas at Austin and Jeffrey Bratberg from the University of Rhode Island. Dr. Hill practices in a primary care setting and maintains the iForumRx Opioid Safety and Overdose Prevention Resource Page. Dr. Bratberg helped develop, implement, and expand the Collaborative Pharmacy Practice for Naloxone Partnership in Rhode Island. Drs. Hill and Bratberg describe how healthprofessionals - particularly ambulatory care pharmacists - can take action to improve the safe use of opioids and prevent overdoses.
A recent paper published in Diabetes Care proposing a new classification system for diabetes challenges our existing paradigm and has significant implications for our treatment approach for diabetes.
We're all aware that there is an obesity epidemic and its linked to dozens of health problems. But nothing we've done so far — public awareness campaigns, changes in school lunch programs, and approving new drugs for weight loss — has halted this epidemic. The prevalence of obesity continues to climb in young adults and most of us keep packing on the pounds as we get older! Thus preventing weight gain in young adults is critically important to long-term outcomes. The recent results of the Study of Novel Approaches to Weight Gain Prevention (SNAP) provides evidence to guide recommendations for behavioral change.
For over two decades LMWHs have been routinely used to provide therapeutic coverage in patients who must temporarily stop warfarin. Current guidelines suggest using injectable anticoagulants during warfarin interruption (aka bridging) in patients with atrial fibrillation based on patients’ risk of arterial thrombosis. Using the CHADS2 score to assess risk, the guidelines recommend (grade 2C) bridge therapy if the CHADS2 score is 5 or higher and not bridging if the CHADS2 score is 2 or lower. But what about patients with a CHADS2 score of 3 or 4?
Basal, prandial, NPH, ultra-long, inhaled, 70/30, 75/25, 50/50, U-100, U-200, U-300, and U-500 insulin … the list of options for patients with diabetes requiring insulin continues to expand. Current guidelines for glycemic management of patients with type 2 diabetes provide specific recommendations for the initiation of insulin therapy, but not insulin intensification. The recently published LanScape study provides a foundation for making evidence-based clinical decisions.
The debate over the intensity of blood pressure (BP) lowering for patients with hypertension has been going on for decades. Additional fuel to the fire was recently added with the early halt and publication of the Systolic Blood Pressure Intervention Trial (SPRINT). So “how low should you go” for patients with high BP? Do lower BP goals reduce CV outcomes and death, particularly in patients at high risk? Do they cause greater adverse effects? Or perhaps even worsen CV outcomes? These questions were examined in SPRINT.
The recommended treatment duration for a first episode of unprovoked venous thromboembolism (VTE) is, at a minimum, 3 months with extended anticoagulation favored for those who are not at high risk for bleeding. However, the optimal duration of anticoagulation therapy remains unknown.
The Prolonged Anticoagulation Treatment for a First Episode of Idiopathic Pulmonary Embolism (PADIS-PE) study examines this question but, most importantly, provides insights about patient outcomes after anticoagulation treatment is discontinued
Many clinicians are questioning the role pharmacists play in anticoagulation therapy management as direct oral anticoagulants (DOACs) increasingly replace warfarin for a variety of indications. A recent study examined medication adherence and therapy management practices at Veterans Health Administration (VHA) patient care sites. Although this study does not have all the answers, it does reveal the importance of patient selection and ongoing patient monitoring – potentially key roles for pharmacists.
To treat acute asthma exacerbations in children, how about a single dose of dexamethasone and your done! Sounds simple, easy, and convenient. But is it too good to be true?