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Cut It Out! Removing EHR Allergy Warnings to Improve Antimicrobial Stewardship

WARNING: Patient has a penicillin allergy! Do you want to continue with this cephalexin order?

Although these warnings are commonplace, immunologic cross-reactivity between penicillins and cephalosporins is uncommon. When B-lactams are indicated as first-line therapy for therapy, cephalosporins are often avoided if the patient has a penicillin allergy listed. Would the removal of EHR warnings about potential penicillin allergies when cephalosporins are ordered be helpful or harmful? 

Guest Authors:  Brian Wenger, PharmD and Nora Sharaya, PharmD, BCPS, BCACP, BC-ADM

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What’s the Right Dose of Aspirin in Patients with Heart Disease?

There is no consensus regarding the preferred dosage of aspirin in patients with atherosclerotic cardiovascular disease (ASCVD) and this has led to variability in prescribing patterns. This is likely due to the lack of head-to-head trials evaluating different aspirin doses and data weighing the clinical benefits and adverse effects experienced with aspirin. Until now?

Guest Authors: Ivy Nwogu, PharmD and Megan Supple, PharmD, BCACP, CPP

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Bursting the Steroid Bubble: Short-term Use Has Its Consequences

Short courses of corticosteroids, also known as “steroid bursts,” are frequently utilized in both pediatrics and adults; however, evidence supporting the safety of these bursts is lacking. Long-term use of oral corticosteroids is associated with a number of serious adverse effects.  New evidence suggests that a steroid burst is not risk-free.

Guest Authors:  Irene Ruiz, PharmD and Kristine A. Parbuoni, PharmD, BCPPS

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Guiding Antiplatelet Therapy: Is a Personalized Approach Worth It?

Variability in clopidogrel pharmacokinetics among patients has been appreciated for years and this results in inconsistent effects on platelet inhibition and poor outcomes. Multiple strategies to personalize antiplatelet therapy intended to balance the risks and benefits of therapy have been tested. A recent systematic review and meta-analysis attempts to answer the question: Is a personalized approach worth it?

Guest Authors:  Kiana R. Green, PharmD and Augustus (Rob) Hough, PharmD, BCPS, BCCP

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Psilocybin for Depression: Is it Worth the Trip?

Although there are numerous medications available to treat major depressive disorder, not all patients respond, and some experience intolerable side effects. Thus, we need to find and develop new treatment options. There has been considerable interest in psychedelic compounds that may have antidepressant activity. Recent research using psychedelics for mental health conditions has made news headlines, but most health professionals have only a vague awareness about psilocybin and its potential role.

Guest Authors:  Brittany L. Parmentier, PharmD, MPH, BCPS, BCPP and Andria F. Church, PharmD, BCPS, BCPP

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Up the Creek Without a Paddle? Look to Your Pharmacist to Bridge-It

Nearly half of all pregnancies are unintended and a high percentage of unwanted pregnancies lead to an abortion. Reducing the number of unintended pregnancies and increasing the use of effective birth control are two public health priorities. Could the implementation of pharmacist contraception prescribing combined with EC on the same day help “bridge the gap?”

Guest Authors:  Ashley H. Meredith, PharmD, MPH, BCACP, BCPS, CDCES and Veronica P. Vernon, PharmD, BCPS, BCACP, NCMP

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SGLT2i plus MRAs for Heart Failure: A Sweet or Sour Combination?

We now have “diabetes medications” to treat heart failure with reduced ejection practice (HFrEF). Many clinicians have not yet used a sodium-glucose transporter 2 inhibitor (SGLT2i) for the treatment of HF and are (rightfully) concerned about potential drug-drug interactions, particularly when using an SGTL2i with a mineralocorticoid (MRA). A recent secondary analysis using data from the EMPEROR-Reduced study may provide some reassurance.

Guest Authors:  B. Blake Miller, PharmD, BCPS and Jennifer Clements, PharmD, BCPS, BCACP, CDCES, BC-ADM

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Is As-Needed Nasal Corticosteroid Use Needed for Allergic Rhinitis Management?

Allergic rhinitis affects millions of children and adults. Indeed, it is the fifth most common chronic disease in the United States.  Although people do not die from allergic rhinitis, it sure can make you feel miserable, disturb sleep, and impair daily activities. Guidelines recommend the use of intranasal corticosteroids on a daily basis since the onset of action takes a few days. In reality, however, patients adjust their treatment according to the severity of their symptoms. As-needed corticosteroid use is effective for the treatment and prevention of asthma symptoms. Can we apply this same concept to allergic rhinitis? Could the as-needed use of intranasal corticosteroids achieve the same outcomes as daily use?

Guest Authors: Lalitha Sukumar, PharmD; Alyssa Gallipani, PharmD, BCACP; and Rahul Jacob, PharmD

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STEP-ping Up the Game for Weight Management

More than two-thirds of adults in the United States are overweight or obese — thus, obesity is, by far, the most common preventable health-related problem seen in practice today. Obesity is associated with several comorbidities, and weight reduction leads to positive outcomes in many diseases. Studies have shown that a weight loss of 10% improves cardiovascular risk and outcomes. Unfortunately, current pharmacological options for weight loss do not consistently achieve a 10% weight loss.  Can semaglutide deliver?

Guest Panelists: Teney Mathew, PharmD, Jason Zupec, PharmD, BCACP, and Amy Heck Sheehan, PharmD, BCPS

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Raised From The Grave: A Second Life for Sotagliflozin?

The prevalence of heart failure in patients with diabetes is four times higher than in the general population.  Likewise, chronic kidney disease (CKD) and diabetes are common morbidities. As new drug classes emerge in the management of diabetes and heart failure and CKD, it is important to thoroughly evaluate available literature and identify opportunities to reduce complications and costs. Sotagliflozin is a first-in-class dual SGLT-1 and 2 inhibitor approved in Europe.  Does it improve outcomes in patients with heart failure or CKD?

Guest Authors:  Maren Richards Brinton, PharmD and Jonathan C. Hughes, PharmD, BCPS, BCACP

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