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SGLT2i plus MRAs for Heart Failure: A Sweet or Sour Combination?

We now have “diabetes medications” to treat heart failure with reduced ejection practice (HFrEF). Many clinicians have not yet used a sodium-glucose transporter 2 inhibitor (SGLT2i) for the treatment of HF and are (rightfully) concerned about potential drug-drug interactions, particularly when using an SGTL2i with a mineralocorticoid (MRA). A recent secondary analysis using data from the EMPEROR-Reduced study may provide some reassurance.

Guest Authors:  B. Blake Miller, PharmD, BCPS and Jennifer Clements, PharmD, BCPS, BCACP, CDCES, BC-ADM

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Is As-Needed Nasal Corticosteroid Use Needed for Allergic Rhinitis Management?

Allergic rhinitis affects millions of children and adults. Indeed, it is the fifth most common chronic disease in the United States.  Although people do not die from allergic rhinitis, it sure can make you feel miserable, disturb sleep, and impair daily activities. Guidelines recommend the use of intranasal corticosteroids on a daily basis since the onset of action takes a few days. In reality, however, patients adjust their treatment according to the severity of their symptoms. As-needed corticosteroid use is effective for the treatment and prevention of asthma symptoms. Can we apply this same concept to allergic rhinitis? Could the as-needed use of intranasal corticosteroids achieve the same outcomes as daily use?

Guest Authors: Lalitha Sukumar, PharmD; Alyssa Gallipani, PharmD, BCACP; and Rahul Jacob, PharmD

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STEP-ping Up the Game for Weight Management

More than two-thirds of adults in the United States are overweight or obese — thus, obesity is, by far, the most common preventable health-related problem seen in practice today. Obesity is associated with several comorbidities, and weight reduction leads to positive outcomes in many diseases. Studies have shown that a weight loss of 10% improves cardiovascular risk and outcomes. Unfortunately, current pharmacological options for weight loss do not consistently achieve a 10% weight loss.  Can semaglutide deliver?

Guest Panelists: Teney Mathew, PharmD, Jason Zupec, PharmD, BCACP, and Amy Heck Sheehan, PharmD, BCPS

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Raised From The Grave: A Second Life for Sotagliflozin?

The prevalence of heart failure in patients with diabetes is four times higher than in the general population.  Likewise, chronic kidney disease (CKD) and diabetes are common morbidities. As new drug classes emerge in the management of diabetes and heart failure and CKD, it is important to thoroughly evaluate available literature and identify opportunities to reduce complications and costs. Sotagliflozin is a first-in-class dual SGLT-1 and 2 inhibitor approved in Europe.  Does it improve outcomes in patients with heart failure or CKD?

Guest Authors:  Maren Richards Brinton, PharmD and Jonathan C. Hughes, PharmD, BCPS, BCACP

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Tiny (n-of-1) Trials to Overcome Statin-Associated Muscle Pain

In blinded clinical trials the percentage of patients who experience muscle symptoms while taking a statin is typically in the 3-5% range.  In practice, the percentage of patients who report muscle symptoms is 10-25%.  This disparity between what has been observed in blinded trials and what patients experience when treated with a statin is due, in part, to the nocebo effect — a belief that a medication may cause harm.  How many lives could be saved if we routinely used tiny randomized, controlled, blinded trials to determine when statin therapy can be safely continued?

Guest Panelists: Elizabeth Hearn, PharmD; Stuart T Haines PharmD, BCPS, BCACP; and Kathryn (Katie) Kiser, PharmD, BCACP

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Top Ten Things Every Clinician Should Know About Infographics

An infographic is an “informational graphic” that integrates design with data in order to visually communicate information in a clear, concise, and comprehensive manner. The use of these visual tactics can be powerful tools to enhance engagement, increase comprehension, and long-term retention of information.  Our guests explain how to create a successful infographic that can amplify the key educational messages to your targeted audience.  Be sure to download the Infographic about creating Infographics on the iForumRx website!

Guest Authors:  Ashley Barlow, PharmD and Brooke Barlow, PharmD

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Mind Over Migraine: Can Mindfulness Improve Outcomes?

Nearly 12% of the population suffers from migraine headaches — which not only negatively impacts patients, but causes a major “headache” for the healthcare system, costing billions for treatment, evaluation, and lost productivity costs in the United States alone. Two-thirds of patients discontinue prophylactic or abortive migraine therapies due to ineffectiveness or adverse effects. Can mindfulness exercises help migraine sufferers find their “Zen”?

Guest Authors:  Denver Shipman, PharmD, BCPP and Elizabeth Cook, PharmD, AE-C, BCACP, CDCES

Guest Panelist: Rebecca Castner, PharmD, BCACP, AAHIVP

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Is Home Blood Pressure Monitoring a “Home Run” for Blood Pressure Management?

Nearly 67 million people, which equates to 3 out of every 4 people, living with high blood pressure in the US remain uncontrolled, despite the clear and compelling benefits of achieving good control. Remote monitoring and self-management of BP may enable us to broadly achieve optimal BP control in most patients. Increased use of telehealth technology improves access to care, but the effects on the cost and quality of care, particularly in the context of hypertension management, have not been clearly established.

Guest Authors: Mary Taylor, PharmD and Megan Supple, PharmD, BCACP, CPP

Guest Panelist:  Joseph Saseen, PharmD, BCPS, BCACP, CLS

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Increasing the Patient-Clinician Connection: the “Presence 5 Practices”

Amidst scientific and technological advancements and an increasing focus on administrative tasks and metrics, meaningful connections with patients are falling by the wayside. Mindlessly using technology can be distracting and lower patient perceptions of their quality of care. How can the busy practitioner increase “presence” with patients while still meeting clinical and administrative demands?

Guest Authors: Emily Prohaska, PharmD, BCACP, BCGP and Nick Schulte, PharmD, BCPS

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FAST Take: Update on Febuxostat Cardiovascular Safety

We know gout is among the many comorbidities that increase the risk of cardiovascular disease (CVD). In 2018, the cardiovascular safety of febuxostat and allopurinol in patients with gout and cardiovascular morbidities (CARES) trial concluded that febuxostat was non-inferior to allopurinol. BUT, two of the secondary endpoints were very concerning. Febuxostat was inferior to allopurinol in terms of cardiovascular death and all-cause mortality. Many clinicians were left wondering whether febuxostat was cardiotoxic …. or conversely, perhaps allopurinol was cardioprotective. Will another cardiovascular outcome trial provide greater clarity to guide clinical practice?

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

Guest Panelist: Dawn Fuke, PharmD, BCPS

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