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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

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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

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A CLEAN Sweep: Getting Rid of the Medication Cost Barrier

Medication adherence plays a very significant role in achieving positive patient health outcomes and when medication regimens are not followed, patients often fail to reach optimal disease control. This is especially concerning in ambulatory care settings where chronic disease states are most often treated. One of the potential barriers to optimal medication use is cost.

Guest Authors:  Emily Eddy, PharmD, BCACP, BC-ADM; Brittany Long, PharmD, BCACP; and Lindsey Petters, PharmD, BCPS

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Should Bedtime be Med-Time for Hypertension?

Few medications are specifically dosed at night to optimize outcomes. However, antihypertensive medications may soon belong on our patients’ nightstands. It is common practice for patients to take all antihypertensive medications in the morning, but perhaps daytime dosing doesn’t maximize cardiovascular risk reduction? The potential benefits of chronotherapy and its impact on BP and CV outcomes have been investigated since the 1980s. However, current practice guidelines do not explicitly recommend dosing antihypertensive medications at bedtime.

Guest Authors:  Vivian Cheng, PharmD, BCPS and Joseph Saseen, PharmD, BCPS, BCACP

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Let’s COLCOT to the Chase: Colchicine for Secondary Prevention of CV Events

Millions of Americans will have a myocardial infarction in their lifetime and 20% will have a recurrent fatal or non-fatal coronary heart disease event. Several modifiable risk factors, including elevated blood pressure, cholesterol, and glucose as well as tobacco use, can and should be addressed to reduce the risk of recurrent cardiovascular events. Systemic inflammation has also been associated with poor CV outcomes. Is systemic inflammation a modifiable CV risk factor? And if so, should an anti-inflammatory agent be added to the recommend post-MI drug cocktail to reduce the risk of morbidity and mortality?  That's the question that the COLCOT Study attempted to answer.

Guest Authors:  Jessica Wearden, PharmD and Augustus (Rob) Hough, PharmD, BCPS, BCCP

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Don’t Let Numbers Fool You: Levothyroxine Isn’t a Cure-all

Patients with subclinical hypothyroidism often complain of symptoms commonly seen in patients with overt hypothyroidism: cold insensitivity, dry skin, fatigue, constipation, muscle cramps, poor memory, slowed thinking, and depression. Indeed, up to a quarter of people with normal TSH levels report up to two of these symptoms, pointing to the non-specific nature of these symptoms. How then should a clinician decide which patients might benefit from thyroid replacement therapy?

Guest Authors:  Mallory Kuchis, PharmD and Michael P. Kane, PharmD, BCPS, BCACP

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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

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A Cause for a PAUSE: Evaluating a Standardized Perioperative DOAC Management Protocol

One in six patients with atrial fibrillation (AF), or an estimated six million patients worldwide, will require perioperative anticoagulant management this year.  Ambulatory care pharmacists commonly face the scenario where a patient taking a direct oral anticoagulant (DOAC) for AF requires an elective surgery or procedure. Best practices for periprocedural management of DOACs are unclear and current guidelines differ in their recommended approaches. Having a simple, systematic periprocedural DOAC management protocol would be helpful. But would a straightforward protocol that is easily understood by clinicians and patients be safe and effective? The PAUSE study investigators attempt to establish the standard of care.

Guest Authors:  Maggie Faraj, PharmD and Candice Garwood, PharmD, BCPS, BCACP

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Who CARES? Getting to the Heart of Allopurinol and Febuxostat CV Outcomes

Should we target uric acid levels when working to reduce cardiovascular risk? Cardiovascular (CV) disease remains the leading cause of death with many contributing risk factors, including hyperuricemia. Evidence suggests an elevation in uric acid levels is associated with and can lead to worse outcomes for individuals with CV disease and heart failure.  The Cardiovascular Safety of Febuxostat and Allopurinol in Patients with Gout and Cardiovascular Morbidities (CARES) trial was conducted to evaluate whether febuxostat was noninferior to allopurinol with regard to CV events in patients with gout and CV disease.

Guest Authors:  Sophia Dietrich, PharmD and Michael W. Nagy, PharmD, BCACP

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

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

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