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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Preventing Weight Gain - Recommending Behavior Change in Young Adults

July 15, 2016

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. 

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What’s the story, H. pylori? New regimens in the toolbox?

June 17, 2016

The list of regimens for Helicobacter pylori eradication is longer than ever.  In recent years, American and European guidelines have recommended clarithromycin-based triple therapy or bismuth-containing quadruple therapy for primary treatment of H. pylori infection. However, increasing resistance to these regimens has forced us to consider alternative treatments, including but not limited to: the addition of probiotics, use of sequential regimens, and the inclusion of levofloxacin in the antibiotic cocktail. With all these choices, the clinician is left wondering what the best option is.

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PATHWAY-2: Does the road lead to spironolactone for resistant hypertension?

June 3, 2016

Resistant hypertension (RH) is frequently encountered in primary care practice and often presents a significant clinical challenge because limited evidence-based guidance exists. RH is a major cause of cardiovascular disease and death, and has been associated with a 50% increased risk of myocardial infarction, stroke, congestive heart failure, and chronic kidney disease when compared to patients without RH. The American Heart Association defines RH as uncontrolled BP despite maximal treatment with a three-drug regimen, ideally including a diuretic. The exact prevalence of RH is unknown, but large randomized controlled trials suggest it affects one in five patients with elevated BP.  Previous research findings suggest chlorthalidone, spironolactone, and eplerenone are all effective add-on therapies when BP remains uncontrolled with typical first line agents.  The Pathway-2 study provides the first direct comparative evaluation of three different four-drug antihypertensive regimens.

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