Is there a Role for Fixed-Ratio Injectable Combinations in Type 2 Diabetes?

January 13, 2017

Pharmacotherapy for diabetes management has expanded in recent years with several new drug classes. Current guidelines recommend several options for patients who have not reached their goal A1c on metformin monotherapy including glucagon-like peptide-1 receptor agonists (GLP-1 RAs) or basal insulin. However, if basal insulin is chosen as the first add-on treatment with metformin, the post-prandial blood glucose (PPG) often will remain elevated.  A combination product that includes both a basal insulin plus a GLP-1 RA has the potential to addresses both fasting blood glucose and PPG … and perhaps has some other advantages over using either product alone.

Theme Music by Good Talk

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Bowel Cleansing Regimens – Pick Your Poison (Wisely)!

December 29, 2016

Colorectal cancer (CRC) is the second most common cause of cancer-related mortality in the United States. Screening is imperative because the early stages of CRC are often asymptomatic.Colonoscopy is an effective and widely employed screening option for CRC.  Suboptimal bowel preparation is a problem in more than 20% of colonoscopy procedures, which reduces adenoma detection rates (ADR). Day-before, split-dose, and same-day regimens are options for colon cleansing prior to a colonoscopy. Is one better than another in terms of tolerability and colorectal cancer detection?

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Preventing Pediatric Dosing Errors – Is It Time to Dump the Medicine Cup?

December 7, 2016

Children are often given liquid dosage forms for both prescription and over-the-counter medicines.  Several studies have shown that caregivers unintentionally put children at risk by inaccurately measuring the dose of liquid medications.  In 2015, the American Academy of Pediatrics (AAP) adopted a policy statement which recommends exclusively using milliliters for dosing instructions to prevent dosing errors.  Our guest today critically examines a recent study that examined labeling and dosing tools that may contribute to medication errors.

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Pharmacists Patient Care Process

December 1, 2016

Our guest, Dr. Melissa Somma McGivney, describes the Pharmacists Patient Care Process and explains why having a consistent philosophy of practice, a consistent process of care, and a sustainable practice management system are critical for success.

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Sweetening the Deal: Effects of SGLT-2 Inhibitors on Kidney Disease Progression

November 11, 2016

Approximately one in three patients with diabetes in the United States have chronic kidney disease (CKD).  The Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes (EMPA-REG OUTCOME) trial, published in 2015, demonstrated a reduction in cardiovascular and all-cause mortality in patients treated with empagliflozin. More recent data from the EMPA-REG OUTCOME trial suggests that empagliflozin may also confer significant renal protection. 

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Opioid Safety and Overdose Prevention

October 21, 2016

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.  

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Eleven Things Every Clinician Should Know About the “Egregious Eleven”

September 29, 2016

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.

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HIP-HIP-HOPE-3! Expanded role for statin therapy for primary prevention

September 15, 2016

The HOPE-3 trial sought to determine if blood pressure (BP) and cholesterol-lowering therapies are effective and safe as primary prevention strategies in intermediate risk patients. The American College of Cardiology and American Heart Association (ACC/AHA) guidelines support a risk-based approach to statin use but in intermediate risk patients the tradeoffs between benefit and risk were deemed “less clear.”  Do the results of HOPE-3 trial provide enough evidence to support routinely treating intermediate risk patients?

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Liraglutide: the new LEADER for second line therapy in diabetes management?

September 2, 2016

According to the current (2016) ADA guidelines, no agent is “the preferred” second line therapy after metformin monotherapy — instead the benefits, risks, cost, and convenience of each option should be considered and treatment should be individualized.  The liraglutide and cardiovascular outcomes in type 2 diabetes (LEADER) trial, which assessed the long-term cardiovascular effects of liraglutide, a GLP-1 receptor agonist, comes at an interesting time shortly after the publication of the empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes (EMPA-REG OUTCOME) trial.  Both studies found a cardiovascular benefit. How, then, will the results of these trials affect the algorithm for type 2 diabetes management and more importantly, clinical practice?

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The EAGLE has Landed! Reassuring the Safety and Efficacy of Drugs for Smoking Cessation in Mental Illness

August 16, 2016

Persons diagnosed with a psychiatric disorder consume nearly half of all cigarettes smoked in the United States!  Seven first-line therapies have shown to increase long-term abstinence rates, with bupropion sustained release (SR) doubling and varenicline tripling the odds of quitting. However, the FDA issued black box warnings in 2009 regarding increased neuropsychiatric events and suicidality with bupropion and varenicline use.  Thus many clinicians have been reluctant to prescribe these agents in persons with mental illness.  The EAGLES study compared the efficacy of non-nicotine therapies to nicotine replacement therapy in smokers with mental illness

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