iForumRx.org

If Your Heart’s Not into It, Do You Really Need to Take Your Meds?

Dilated cardiomyopathy is the leading cause of sudden cardiac death and heart failure (HF) and the chief indication for cardiac transplantation. However, approximately 40% of patients see a significant improvement in left ventricular ejection fraction and reduction in the left ventricle size over time with pharmacologic treatment. As deprescribing becomes an increasingly important part of our clinical practice, we need more data about how deprescribing impacts outcomes, particularly in chronic diseases such as heart failure.  The recently published TRED-HF is attempted to address this important question: Is the burden of lifelong therapy with medications necessary or worth it in patients with "recovered" dilated cardiomyopathy?

Guest Author:  Jennifer Pruskowski, PharmD, BCPS, BCGP, CPE

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Should We Hold Our Breath for Vitamin D in COPD?

Chronic obstructive pulmonary disease (COPD) exacerbations contribute to mortality, disease progression, worsening quality of life, and increased health care costs. Respiratory tract infections are a common cause of COPD exacerbations.  While prophylactic antibiotics may play a role, vitamin D supplementation is an attractive option by stimulating innate and adaptive immune responses. Although severe vitamin D deficiency (25(OH)D <10 ng/mL) has been associated with more frequent exacerbations and hospitalizations in patients with COPD, it is unclear if supplementation actually reduces exacerbation frequency. A recent meta-analysis provides some data regarding the potential benefits of vitamin D supplement to prevent COPD exacerbations.

Guest Authors:  Jennifer Clements, PharmD, BCPS, BCACP and Lisa Gibbs, PharmD

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Breaking Up is Hard to Do: Are E-Cigarettes the Solution Tobacco Cessation?

While there are several proven smoking cessation medications available over-the-counter and by prescription, e-cigarettes are being increasingly used for smoking cessation despite the lack of data or official FDA approval for this indication. To appropriately advise our patients, it is important to understand the safety and efficacy of e-cigarette use as a potential smoking cessation aid.

Guest Authors: Diane Kim, PharmD and Amanda Schartel, PharmD, BCACP

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Need a VITALity Boost? Rethink Vitamin D and Fish Oil Supplements

Vitamin D and fish oil (aka omega-3 fatty acids) were the most widely used vitamin and nutritional supplement in 2011-2012.  Both have been commonly touted for their potential benefits in reducing cancer and cardiovascular disease. While vitamin D and omega-3 fatty acid supplements are wildly popular, the evidence supporting their health benefits is inconclusive and inconsistent. The VITAL study sought to determine whether vitamin D and/or marine omega-3 fatty acids can prevent cardiovascular disease (CVD) and cancer when used by the general population.

Guest Authors:  Anthony M Todd, PharmD; Sean E Smithgall, PharmD, BCACP; and Nicole A Slater, PharmD, BCACP

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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

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

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

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Is a Team-Based Approach in Primary Care Worth It?

A team-based approach to patient care is well established in acute care settings, but not as widely adopted in primary care settings.  Working within a team could have a positive impact on the efficiency of visits, quality of care, workload, job satisfaction, and patient satisfaction. Previous studies in acute-care hospital settings reveal positive outcomes, but there have been mixed results in primary care settings. Are the extra time, effort, and money necessary to change to a collaborative team-based approach worth it? Will it positively impact health care utilization, quality, and cost?

Guest Authors:  Lily Van, PharmD and Courtney Davis, PharmD, BCACP

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Cardiovascular Risk with Elevated Triglycerides - Does Icosapent Ethyl REDUCE-IT?

Although hypertriglyceridemia has consistently been associated with increased CV events, medications that lower triglycerides have failed to reel in a significant reduction in major CV events when combined with statin therapy. Could purified fish oil derivatives be the answer? Or just another red herring? The Reduction of CV Events with Icosapent-Ethyl Intervention Trial (REDUCE-IT) sought to clarify the utility of icosapent ethyl, a highly purified EPA derivative.

Guest Authors: Melissa Norton, PharmD and Elizabeth A. Cook, PharmD, AE-C, BCACP, CDE

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Another Case of Newer Isn’t Always Better! Gabapentin vs. Pregabalin for Chronic Sciatica

Sciatica is a form of neuropathic pain which can be particularly frustrating for patients and difficult to manage. With a lack of evidence to guide treatment and opioid use becoming increasingly under the microscope, data supporting the use of alternative pain regimens are needed. Gabapentin and pregablin are GABA analogs often used to treat sciatic pain, but is one superior to the other? Pregabalin is newer and available as a branded product only, but is it more effective than generically available gabapentin?  A recently published study attempts to answer this question.

Guest Authors:  Austin Morgan, PharmD and Frank Fanizza, PharmD

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Fall Risk and Benzos – Is Trazodone Really the Knight in Shining Armor?

Older adults are often tormented by insomnia, pain, and other comorbidities that impact their quality of life.  Medication therapy is often sought to treat and manage these diseases, but healthcare providers often overlook the risks of prescribing medications to patients who are older, frail, and at high risk for falls.  Trazodone is increasingly prescribed for insomnia instead of benzodiazepines presumably because it is considered to be safer and it does not appear on either the Beers or STOP/START lists.  But is trazodone really safer for patients than benzodiazepines?

Guest Authors:  Anthony M. Todd, PharmD and Nicole A Slater, PharmD, BCACP

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