LDL Limbo: How Low is Too Low?

October 26, 2018

There has been significant debate regarding the safety of achieving very low LDL-C levels, including a potential negative impact on cognitive function. The current ACC/AHA guidelines (circa 2013) suggest decreasing the statin dose in patients with two consecutive LDL-C levels below 40 mg/dL based on expert opinion. The lack of evidence has been a major challenge for clinicians and it is unclear whether medication doses should be reduced in high-risk patients who may benefit from very low LDL-C levels.  A recently published meta-analysis sought to address this clinical dilemma.

Podcast Case: Very Low LDL Case

Guest Authors:  Apryl Anderson, PharmD and Dave Dixon, PharmD, BCPS, BCACP, CLS, CDE

Music by Good Talk

 

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Top Ten Things Every Clinician Should Know About the 2018 Antithrombotic Therapy Atrial Fibrillation Guidelines

October 12, 2018

The American College of Chest Physicians (ACCP) recently updated their guideline recommendations for the use of antithrombotics for the prevention of stroke in patients with atrial fibrillation (aka the Chest Guidelines).  Find out what's new, who shouldn't receive treatment based on the CHA2DS2-VASc score, and why the guideline panel recommends calculating a patient's SAME-TTR score.

Guest Author:  Dylan Lindsay, PharmD

Music by Good Talk

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Maybe Old is Gold? Newer Insulins Might Not Be Better – Just More Expensive

September 21, 2018

Fredrick Banting, the Canadian scientist who discovered insulin in 1921 and sold the patent for just $1 to the University of Toronto and made it available to pharmaceutical companies royalty-free, would be disappointed to know that the high cost of insulin is now a major barrier to treatment. The average price of insulin has nearly tripled, from $4.34/ml in 2002 to $12.92/ml in 2013. Insulin’s high cost affects everyone: (1) uninsured patients, (2) insured patients with high co-payments and deductibles, (3) Medicare beneficiaries with coverage gaps and fixed income, and (4) everyone else paying higher premiums to offset the insurers’ expenditures. Are the newer insulins really worth the extra cost?  A new study by investigators at Kaiser Permanente Northern California suggests that most patients can safely use NPH insulin instead of more expensive insulin analogs.

Download the podcast patient case:  NPH vs Insulin Analogs

Guest Authors:  Jaini Patel, PharmD, BCACP and Regina Arellano, PharmD, BCPS

Music by Good Talk

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Using Controllers PRN for Mild Persistent Asthma – An Oxymoron?

September 7, 2018

Two recent studies challenge our current approach to managing patients with mild persistent asthma. When patients with asthma are prescribed inhaled corticosteroids (ICSs), we instruct them to use the medication daily. In patients with persistent asthma, guidelines recommend maintenance therapy, with either an ICS or a combination ICS/long-acting beta-agonist (LABA), plus a short-acting beta-agonist (SABA) as needed for rescue treatment.  The Symbicort Given as Needed in Mild Asthma (SYGMA) 1 and SYGMA 2 trials challenge the traditional approach comparing combination ICS/LABA (budesonide-formoterol) as needed to traditional ICS maintenance with SABA rescue therapy.

Guest Author:  Brittany Schmidt, PharmD, BCACP

Music by Good Talk

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The ZOE Trials – The Herpes Zoster Recombinant Subunit Vaccine — It’s Time to Upgrade!

August 26, 2018

We now have two vaccinations to protect against herpes zoster — a live-attenuated vaccine (Zostavax) and the new recombinant subunit vaccine (Shingrix). While the live-attenuated vaccine has been available for more than a decade and a CDC-recommended vaccine in older adults, only one in three eligible patients have received it.  Based on the results of two recently published studies, the new recombinant subunit vaccine appears to provide substantially improved efficacy and duration.

Guest Author:  Katherine Montag Schafer, PharmD, BCACP

Music by Good Talk

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Are You REAL-ly Paying Attention? The Importance of Attention Controls

August 3, 2018

Critically-evaluating the literature is essential to engage in evidence-based practice.  A key component of assessing studies involves determining whether the comparator groups are appropriate.  Most pharmacists are familiar with the use of placebos for evaluating drug treatments, but how many of us have considered the comparator groups in behavioral interventions?  For these situations, employing attention placebo controls (APC) is important.

Guest Authors:  Elizabeth A. Cook, PharmD, BCACP, CDE, AE-C and Rachel A. Sharpton, PharmD, BCACP

Music by Good Talk

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Is it Time to “Step Up” Rescue Treatment for Asthma to Prevent Exacerbations?

July 13, 2018

We’ve been managing asthma, for the most part, the same way for quite some time now … short-acting beta agonist (SABA) for quick relief, inhaled corticosteroids (ICS) as first-line maintenance treatment, step up if needed, step down if possible … plus self-management education and a written asthma action plan.  Despite many treatment options, numerous adults, adolescents, and children still suffer from asthma exacerbations, leading to reduced quality of life, missed work and school, higher costs, and increased asthma-related morbidity and mortality. Exacerbations can be triggered by acute respiratory infections, exposure to allergens and other environmental conditions, and poor medication use behaviors. Regardless of cause, finding ways to reduce or prevent exacerbations should be a priority.

Guest Author:  Kristen A. Pate, Pharm.D., BCACP

Music by Good Talk

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Stop the Shots: Edoxaban vs Dalteparin in Cancer-Associated VTE Treatment

June 29, 2018

For the treatment of cancer-associated VTE, LMWHs are recommended over warfarin (Grade 2B) and DOACs (all Grade 2C).  Warfarin therapy in cancer-associated VTE is often made more difficult by wildly fluctuating international normalized ratios, procedure-related interruptions, as well as numerous drug-drug and drug-food interactions.  While DOACs have been widely used in the treatment of VTE, there is very little data supporting their use in patients with active cancer until now with the publication of the Hokusai VTE Cancer study.

Guest Authors:  Elizabeth Scheffel, PharmD and Christa George, PharmD, BCPS, BCACP, CDE

Music by Good Talk

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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

Music by Good Talk

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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

Music by Good Talk

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