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Secondary Stroke Prevention in A-Fib: Do DOACs PROSPER in High-Risk Patients?

Several guidelines now recommend direct oral anticoagulants (DOACs) as the preferred anticoagulants for patients with non-valvular atrial fibrillation (a-fib). However, the landmark clinical trials focused largely on the primary prevention of stroke.  Moreover, real-world data using DOACs for secondary prevention is lacking. Many have argued that warfarin might be a better choice in these high-risk patients because it requires routine monitoring and increases the patient’s contact with the healthcare system. Does the choice of anticoagulant make a difference in preventing recurrent stroke?

Guest Authors: Blaire White, PharmD; Amber Cizmic, PharmD, BCACP; and Tish Smith, PharmD, BCACP

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Under Pressure: Does Directly Observing Medication Administration Lower Blood Pressure?

Treatment-resistant hypertension, the need for 4 or more medications to achieve goal blood pressure (BP), occurs in nearly 1 in 5 patients.¹ But is it truly treatment-resistant? Nonadherence is often regarded as the primary cause in many patients.  But how can we distinguish between other causes of hypertension that should prompt additional diagnostic testing or treatment intensification? A recent study suggests there is a simple solution: watch them take their pills.

Guest Authors: Meagan Brown, PharmD, BCACP and Raven Jackson, PharmD

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Will Oral Semaglutide PIONEER the Way to Lower Cardiovascular Risk?

Until recently, glucagon-like-peptide-1 (GLP-1) receptor agonists were only available as injectable products. Some clinicians and patients are reluctant to use injectable agents because they require additional patient education and can be intimidating.  If a GLP-1 receptor agonist were available in an oral dose form, it would be welcomed treatment option. But would the cardiovascular safety and benefits of oral GLP-1 receptor agonists be better, similar, or worse than their injectable siblings?

Guest Authors:  Sally Earl, PharmD, BCPS and Megan Supple, PharmD, BCACP

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Using CRP in COPD to Guide Treatment Decisions During Exacerbations

Patients frequently present to outpatient clinics and community pharmacies with acute exacerbations of chronic obstructive pulmonary disease and clinicians have an important decision to make. Should they prescribe antibiotics? Patients may seek antibiotics as a quick fix to their symptoms, but many AECOPD are not caused by bacterial infection. Prescribing unnecessary antibiotics exposes patients to adverse effects and can increase antimicrobial resistance.  But not prescribing antibiotics could delay recovery if the exacerbation is of bacterial origin … or worse, result in an avoidable hospitalization and death. Could a simple, bedside test empower patients and prescribers to use antimicrobials more selectively?

Guest Author:  Brittany Schmidt, PharmD, BCACP

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Addressing the Adherence Problem: Do Med Sync Programs Really Work?

The “silent killer” that impacts every ambulatory care practice is medication non-adherence.  Today, medication non-adherence is estimated to cause 125,000 preventable deaths every year and costs all of us $300 billion. It is no surprise that pharmacists have an important roll to play tackling this critical issue. Many pharmacies have now implemented medication synchronization or med sync programs to proactively address medication adherence.  While some have called med sync a “golden ticket,” research is clearly needed.

Guest Authors: Michael Kachmarsky, PharmD, BCACP and Daniel Longyhore, PharmD, MS, BCACP

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The Importance of a Healthy Mind in Patients with an Unhealthy Heart

Patients who have had acute coronary syndromes (ACS) are more likely to suffer from major depression than the general population with rates of clinically relevant symptoms of depression as high as 45%. Unfortunately, even if patients are routinely screened for depression with a PHQ-2 and PHQ-9 in primary care settings, appropriate treatments are often not initiated. Depression causes psychological stress which activates the sympathetic nervous system which leads to increased cortisol levels, inflammation, and platelet activation that can contribute to atherosclerosis and accelerate plaque formation. Thus, untreated depression may worsen cardiac outcomes.

Guest Authors: Hansita B. Patel, PharmD and Abigail L. Hulsizer, PharmD

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Addressing the Concerns and Needs of Transgender Persons

The transgender/gender nonconforming (TGNC) community faces a variety of challenges including access to healthcare, societal stigma, and discrimination. As a profession, pharmacy is well-positioned to reduce and address the barriers to care faced by TGNC individuals and to provide them with positive experiences within the healthcare system. However, formal instruction about this patient population’s social and medical needs is lacking in most pharmacy school curricula.

Guest Authors: Justin Bachman, PharmD and Abby Frye, PharmD, BCACP

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The Power of Pharmacist-to-Pharmacist Handoffs During Transitions of Care

Hospital readmissions are often medication-related and potentially preventable. Pharmacists can play a vital role in improving medication outcomes during transitions of care (TOC). Although numerous TOC practice models have been described, it remains unclear what practices will promote optimal continuity of care. A recently published study in the Journal of the American Pharmacists Association (JAPhA) examined the impact of pharmacist-to-pharmacist handoffs using electronic communications to reduce hospital readmissions in high-risk patients.

Guest Authors: Jessica Wooster, PharmD, BCACP and Laressa Bethishou, PharmD, BCPS

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

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

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Making the GRADE: It’s time to AGREE on better CPGs

Staying abreast of the constant changes to clinical practice guidelines (CPGs) and determining their quality is difficult.  The general consensus in the medical community is that CPGs reduce inappropriate care and improve treatment quality and patient safety. However, concerns have been raised about the reliability, quality, and validity of CPGs. A recently published systematic review critically appraised the quality of published CPGs for the treatment of chronic diseases in primary care.

Guest Authors:  Frank Yu, Pharm.D. and Takova Wallace-Gay, Pharm.D., BCACP

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