iForumRx.org

Heartburn Headache: Cumulative PPI Use and Dementia Risk

Omeprazole ranks among the top 10 most prescribed medications in the United States, and many patients take proton pump inhibitors (PPIs) for years. Widespread PPI use persists despite data about potential serious adverse effects.  Some worry that PPI use increases the risk of dementia.  Are those worries supported by data?

Guest Authors:  Molly M. Corder, PharmD, BCPS, BCACP and Ryan S. Ades, PharmD, BCPS

Music by Good Talk

Complex Patient Case 2 - Managing Adverse Effects

Reason for Visit: The patient is here today for hypotension and diabetes follow-up. The primary care physician has consulted the clinical pharmacist regarding hypotension.

Chief Complaint: “I feel dizzy when I stand up and feel like my heart is racing. I have never passed out, but it feels like I might, and I usually have to sit back down."

Guest Authors:  Kellie Ball, PharmD and Johnathon Proctor, PharmD

Expert Panelists:  Morgan Weaver Godfrey, PharmD, BCPS and Richard J. Silvia, PharmD, BCPP

Educating Patients and Prescribers About Deprescribing to Reduce Medication Burden May Not Be Enough

Unsurprisingly, medication burden increases as we age. At each clinic visit, we consider starting new medications, but it’s still relatively uncommon to critically evaluate medications that could be deprescribed. How can we change the culture to embrace deprescribing as an integral part of patient care?  The OPTIMIZE study was a provider- and patient-level educational intervention that attempted to increase deprescribing.

Guest Authors:  Kashelle Lockman, PharmD, MA and Sarah Greiner, PharmD

Music by Good Talk

On the Look Out for Prescribing Cascades

Is my patient’s forgetfulness due to dementia or diphenhydramine? In older adults, adverse drug events (ADEs) can often be misinterpreted and lead to the initiation of new medications, which carry their own risks of ADEs … that can be misinterpreted as a new problem … leading to even more medications being prescribed.  In this episode, our guests critically examine a study that identified a new prescribing cascade:  gabapentinoid -> diuretics.

Guest Authors: Veronica Arceri, PharmD and Mallory Telese, BA, PharmD, BCACP 

Music by Good Talk

Is the Grass Really Greener? Cognitive Function After Discontinuation of Cannabis

Cannabis use is a hot topic among patients and in healthcare circles. Cannabis is used by an estimated 20% of multiple sclerosis (MS) patients to ameliorate symptoms such as spasticity, pain, and insomnia. Unfortunately, both MS and regular cannabis use can negatively impact cognition. Determining whether cognitive impairment can be reversed upon discontinuation of cannabis can help to distinguish its beneficial and harmful effects in patients with MS. It might also provide insights regarding the reversibility of cognitive impairment when cannabis is used for recreational purposes.

Guest Authors:  Lindsey Trotter, PharmD; Sean Smithgall, PharmD, BCACP; and Nicole Slater, PharmD, BCACP

Music by Good Talk

Age is Just a Number: Discontinue Statins with Care

More than 14 million Americans age 75 years and older face a dilemma. They are at high risk for atherosclerotic cardiovascular disease (ASCVD). On the other hand, older adults are more susceptible to adverse effects associated with statins. Many adults, often in their 60s or early 70s, decide to initiate statin therapy for the primary prevention of ASCVD. However, at some point in a patient’s life, the potential benefits may no longer be so clear … or the risks and costs increase. Unfortunately, there is little information on the potential consequences of stopping statin in patients who are tolerating statins.

Guest Authors:  Maricar Conson, PharmD and W. Cheng Yuet, PharmD, BCACP

Music by Good Talk

D-PRESCRIBE Study: As Age Goes Up, The Medication Must Go Down!

The D-PRESCRIBE study provides compelling evidence that a focused, systematic medication review conducted by community-based pharmacists coupled with patient education and written recommendations to prescribers results in a significant reduction in the use of potentially inappropriate medications.  In this episode, Christine Dimaculangan reviews the methods and results of the D-PRESCRIBE study and our expert panelists discuss its implications and implementation.

Guests: Christine Dimaculangan, PharmD.; Nicole Brandt, PharmD, MBA, BCPP, BCGP; and Emily Prohaska, PharmD, BCACP, BCGP

Music by Good Talk