iForumRx.org
Up in Flames: Antiplatelet Therapy in Patients with Stable Ischemic Heart Disease Receiving Anticoagulation for A-fib

Up in Flames: Antiplatelet Therapy in Patients with Stable Ischemic Heart Disease Receiving Anticoagulation for A-fib

January 3, 2020

Antiplatelet therapy is a mainstay treatment for the prevention of recurrent cardiovascular events in patients with stable coronary artery disease (CAD). Anticoagulation therapy is the cornerstone of therapy for most patients with atrial fibrillation (AF). AF and CAD are frequent comorbid conditions, occurring in 20-30% of patients with stable CAD. Unfortunately, combining antiplatelet and anticoagulation therapy increases the risk of major bleeding over 50% compared to anticoagulation alone. Recent real-world observational data suggest that direct oral anticoagulation (DOACs) therapy can reduce cardiovascular event rates. This begs the question: In patients with stable CAD and AF, is combination therapy necessary or is anticoagulation monotherapy sufficient?  The AFIRE study attempted to address this important clinical question.

Guest Authors: Alina Kukin, PharmD and Zachary R. Noel, PharmD, BCCP

Music by Good Talk

Are Older Adults with Heart Failure Self-Care Aware?

Are Older Adults with Heart Failure Self-Care Aware?

December 6, 2019

Heart failure (HF) affects at least 5.7 million people in the United States alone and requires a strict self-care regimen to avoid hospitalizations. Patients with HF have high readmission rates, high medical costs, and many experience a poor quality of life. But what if patients with HF do not understand or are not capable of carrying out the recommended HF “self-care regimen”? Subjective questionnaires are often used to assess HF symptoms and self-care behaviors but may not accurately depict a patient’s functional capabilities. The FRAIL-HF study attempted to objectively evaluate patients’ ability to perform HF self-care tasks and correlate self-care ability with readmissions rates and one-year mortality.

Guest Authors: Holly Porras, PharmD and Emily Prohaska, PharmD, BCACP, BCGP

Music by Good Talk

Improving Access to Naloxone - Yes, Pharmacists (Nar)CAN!

Improving Access to Naloxone - Yes, Pharmacists (Nar)CAN!

August 2, 2019

The opioid overdose epidemic, primarily driven by potent synthetic opioids, has rapidly intensified in recent years.  Overdose education and naloxone distribution (OEND) efforts appear to have a positive impact on opioid-overdose mortality. As many states continue to expand naloxone access through various legislation efforts, it’s important to identify which laws have the greatest impact on reducing fatal opioid overdoses. 

Guest Authors:  Scott Coon, PharmD, BCPS, BCACP and Matthew Thomas, PharmD

Music by Good Talk

Keeping Intensive Blood Pressure Goals in MIND: Does it Impact Cognitive Decline?

Keeping Intensive Blood Pressure Goals in MIND: Does it Impact Cognitive Decline?

April 12, 2019

Intensive blood pressure (BP) control reduces the risk of cardiovascular events and mortality, but the verdict isn't in yet on the benefits of intensive control to prevent the development of dementia. Previous studies have shown an inconsistent relationship between blood pressure control and cognitive decline. SPRINT-MIND, using data from SPRINT, was designed to evaluate the effects of intensive BP control on cognitive outcomes including probable dementia and mild cognitive impairment.

Guest Authors:  Michelle Balli, PharmD, BCACP and Amy Robertson, PharmD, BCACP

Music by Good Talk

Don’t Kid Yourself: Broad- versus Narrow-Spectrum Antibiotics in Children

Don’t Kid Yourself: Broad- versus Narrow-Spectrum Antibiotics in Children

April 27, 2018

Overuse of broad-spectrum antibiotics can lead to antimicrobial resistance, increased cost, and higher prevalence of adverse drug reactions. Nearly 2 million infections and 23,000 deaths are caused by bacteria that are antibiotic-resistant each year in the United States costing the healthcare system an estimated 20 billion dollars. Moreover, adverse reactions to antibiotics are the most common reason for pediatric patients to visit the emergency department.  Narrow-spectrum antimicrobials are generally preferred, but there are instances where broader coverage is recommended.  A recent study attempts to “clean up” the debate by examining the benefits and risks of using narrow- versus broad-spectrum antibiotics in children with acute respiratory tract infections.

Guest Authors:  Amber Giles, PharmD, MPH, BCPS, AAHIVP  and Paige Hughes, PharmD

Music by Good Talk

Where is the COMPASS Taking Us? Rivaroxaban, Aspirin, or Both for Stable CVD ?

Where is the COMPASS Taking Us? Rivaroxaban, Aspirin, or Both for Stable CVD ?

December 8, 2017

Since the introduction of direct oral anticoagulants (DOACs) less than a decade ago, use of this class has expanded beyond the prevention and treatment of venous thromboembolism and stroke prevention in the setting of atrial fibrillation. The potential role of DOACs in the secondary prevention of coronary artery disease (CAD) has been of considerable interest. In the setting of CAD, warfarin has resulted in significant more major bleeding when given either alone or in combination with antiplatelet agents when compared to aspirin alone.  Therefore, clinicians have been reluctant to embrace the combination of an anticoagulant plus an antiplatelet agent. However, could DOACs have a role in stable CAD? The COMPASS trial aimed to find an answer.

Guest Authors:  Candyce Bryant, Pharm.D., Joy Hoffman, Pharm.D., and M. Shawn McFarland, Pharm.D.

Music by Good Talk

Opioid Safety and Overdose Prevention

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.