iForumRx.org

Implementing Comprehensive Medication Management – Ingredients for Success

Pharmacists providing effective comprehensive medication management (CMM) services in interprofessional care settings can contribute to improved patient outcomes. Core components of a successful practice include a clearly articulated philosophy of practice, a systematically implemented process of care, and an effective practice management system.  Although much has been written about the first two components, less is known about what is required to create an effective practice management system.

Guest Authors:  Elizabeth Cook, PharmD, BCACP, AE-C, CDE and Leslie Walters, PharmD, BCACP

Music by Good Talk

Can VOYAGER Put PAD Patients Back on Their Feet?

Peripheral artery disease (PAD) impacts 8.5 million Americans age 40 years or older, often leading to acute limb ischemia, amputation, hospitalization, revascularization, major adverse cardiac events (MACE), and death. In addition to being at very high risk of MACE, more than 10% of PAD patients who had revascularization surgery are hospitalized for major adverse limb events, including acute limb ischemia leading to amputation. Could combination therapy, an antithrombotic regimen comprised of a direct oral anticoagulant and an antiplatelet agent, help prevent limb ischemia and cardiovascular (CV) events in these high-risk patients?

Guest Authors:  Navya Varshney, PharmD, BCPS and Rachel Lowe, PharmD, BCPS

Music by Good Talk

Will Bempedoic Acid provide SERENITY for Patients with Statin Intolerance?

Current guidelines recommend statins for primary and secondary prevention of atherosclerotic cardiovascular disease (ASCVD) due to their well-established therapeutics benefits.  Unfortunately, many patients are unable to tolerate statins due to statin-associated muscle symptoms (SAMS), most commonly manifested as myalgias. Patients who are unable to tolerate a statin can be challenging to treat. Even if the patient is willing to try a lower dose or a different statin, the patient’s low-density lipoprotein cholesterol (LDL-C) may still be above the recommended threshold.  This puts patients unable to tolerate statins at increased risk of ASCVD or of a recurrent cardiovascular event. Is bempedoic acid a useful therapeutic option in patients with SAMS?

Guest Authors:  Kara Gurries, PharmD, BCACP and Janeen Ibarreta, PharmD

Music by Good Talk

No Provider Status, No Problem: CCM as a Revenue Source in Community Pharmacy

Hypertension is poorly managed in the United States with only 25% of patients achieving optimal blood pressure (BP) control (BP less than 130/80 mmHg).  To achieve optimal control, patients require close follow-up and BP-lowering medication regimens need to be titrated and periodically adjusted. Community pharmacists are in a unique position to manage patients who have poorly controlled hypertension. However, significant barriers exist to implementing hypertension management services by community pharmacists including a lack of reimbursement. Is chronic care management (CCM) a viable payment model to support these services?

Guest Authors:  Kimberly Zitko, PharmD, BCACP, BCGP and Brittany Schmidt, PharmD, BCACP

Music by Good Talk

Powerful Placebos and Notorious Nocebos: Implications for Ambulatory Care

Imagine you have recommended statin therapy to a patient with diabetes. A few weeks later, the patient experiences leg pain and stops it. Was this patient’s leg pain caused by the statin? Or was it a nocebo effect? Muscle symptoms in placebo-controlled trials of statin therapy range from 3-5%, while rates in real-world observational studies are between 15-20%. Ambulatory care pharmacists have an important role in recognizing and managing placebo and nocebo effects. Understanding the placebo effect allows clinicians to harness the power of placebos. Reframing risks during patient education may decrease nocebo effects.

Guest Authors:  Sara Wettergreen, PharmD, BCACP and Joseph Nardolillo, PharmD

Music by Good Talk

An Incli-ng of Benefit? Efficacy and Safety of Inclisiran for Elevated LDL

Lipid management continues to be an essential component in the prevention and treatment of atherosclerotic cardiovascular disease (ASCVD).  For the past decade, clinical practice guidelines have gone back and forth about optimal treatment goals but guidelines all agree that statins should be used as the preferred initial therapy. However, there is still a lack of clarity about the optimal add-on therapies. The newest LDL-lowering therapy is inclisiran, a small interfering RNA (siRNA) that targets the PCSK9 pathway.

Guest Authors:  Joshua O. Holmes, PharmD, MS and Amanda Schartel, PharmD, BCACP

Music by Good Talk

Will Riva Be Defeated By It’s (Long-Standing) Nemesis, Apixa?

Do we finally have enough evidence to establish a preferred direct-acting oral anticoagulant (DOAC) for stroke prevention in patients with atrial fibrillation? The use of DOACs for a-fib has rapidly increased due to their ease of use and favorable safety profile. The AHA/ACC/HRS and CHEST guidelines now recommend DOACs over warfarin for stroke prevention in a-fib, but do not state a preference for one DOAC over another. Factor Xa inhibitors, specifically apixaban and rivaroxaban, are the most commonly prescribed DOACs suggesting they are preferred by clinicians in real-world practice but is one better than the other?

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

Music by Good Talk

Should Penicillin Allergy Skin Testing be a Thing of the PAST?

Many, many, many patients report they have penicillin (PCN) allergy. But while nearly 10% report being allergic to PCN, fewer than 1% have a true allergy. And this hampers antimicrobial stewardship efforts because clinicians are often forced to turn to agents with a broader spectrum, that are more expensive, and more likely to cause adverse effects including the development of resistance. However, determining whether a patient has a true PCN allergy is time-consuming and expensive. Historically, patients were sent to an allergist for PCN allergy skin testing (PAST) followed by oral provocation challenge (OPC). What if patients could skip past the skin test and receive a direct OPC instead? Direct OPC may not only increase patient willingness to be tested but also the feasibility of offering testing in primary care (and perhaps community pharmacy) settings.

Guest Authors:  Frank A Fanizza, PharmD, BCACP and Emily S Prohaska, PharmD, BCACP, BCGCP

Music by Good Talk

Does Long-Term Proton Pump Inhibitor Use Pump Up Your Risk of Adverse Effects?

Many studies have linked proton pump inhibitor (PPI) use to several adverse effects including Clostridium difficile-associated diarrhea, community-acquired pneumonia, bone fractures, and nutritional deficiencies. Other reports have linked PPI use with chronic kidney disease, cognitive decline, myocardial infarction (MI), stroke, and even death. Many patients take PPIs chronically and may be concerned about the risk of these side effects. This poses a challenge for healthcare providers as safety data has been primarily based on retrospective and observational studies. A recently pre-planned analysis using data from the prospective COMPASS study sheds some reassuring light.

Guest Authors:  Hindu Rao, PharmD and Jelena Lewis, PharmD, BCACP, APh

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