The Rx Consultant
 

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Learn what's new with top-selling drugs and common health conditions, & get a quick review. Articles provide context and background in addition to the core information you will use every day.

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2  Hours of CE for Pharmacists Nurse Practitioners & Pharmacy Technicians.

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  • This issue will bring you up to date on the impact of nonadherence on chronic conditions and strategies for increasing compliance.

    Key Takeaways:
    • Medication nonadherence contributes to poor clinical outcomes (including higher hospitalization and death rates) and increases healthcare costs.
    • Risk factors/red flags for medication non-adherence include depression, cognitive impairment, missed office visits, poor patient/provider relationship, and lack of response to medication.
    • Strategies to improve adherence should address multiple dimensions and be tailored to the individual patient.

    Of the 3.8 billion prescriptions dispensed in the US each year, half are not taken as prescribed. Medication nonadherence is a global healthcare problem that is increasingly recognized as a leading cause of rising health care costs and poor health outcomes (eg, disease progression). One to two-thirds of medication related hospital admissions in the US result from nonadherence. In addition, as many as 25% of nursing home admissions may be due to medication nonadherence. Avoidable healthcare costs attributed to nonadherence range from $100 billion to $300 billion each year.

    The World Health Organization (WHO) has acknowledged that “increasing the effectiveness of adherence interventions may have a far greater impact on the health of the population than any improvement in specific medication treatment.” In response to the problem, the Agency for Healthcare Research and Quality (AHRQ), the National Council on Patient Information and Education, and the WHO have issued a call for strategies to improve medication adherence. Furthermore, the Centers for Medicare and Medicaid Services (CMS) continues to acknowledge the importance of adherence consultation with patients. Adherence rates for diabetes, hypertension, and cholesterol (statin) medications are triple weighted measures for the 5-star rating system CMS uses to grade the quality of prescription drug plans. This issue explores the problem of nonadherence, includin its economic and clinical impact on chronic conditions, provides the tools you need to identify and measure nonadherence, and outlines strategies you can use to improve medication adherence...

  • Depression (major depressive disorder, or MDD) was the leading cause of disability worldwide in 2017. In 2015, 7-10% of adults and 10-12% of adolescents in the US suffered from MDD. Alarmingly, suicide completion rates in the US increased 24% from 1999 to 2014.5 In 2015, suicide was the second leading cause of death in 15-34 year olds and the third leading cause of death in 10-14 year olds. Depression is also a known contributor to the illness and death associated with chronic pain and diseases such as dementia, diabetes, and cerebrovascular and heart disease. Depression should be treated along with chronic medical problems to achieve the best outcome for all conditions.

    Both the Agency for Healthcare Research and Quality (AHRQ) and the National Institute for Mental Health (NIMH) recommend psychotherapy and antidepressants as effective treatments for depression. Adding certain antipsychotics to antidepressant therapy may boost the response to antidepressants. There is increasing evidence that exercise, a healthy diet, and certain supplements (eg, omega-3, vitamin D, folate, SAM-e) also decrease depressive symptoms. Electroconvulsive therapy (ECT) and other types of brain stimulation are FDA-approved and recommended for treatment-resistant depression. Ketamine is being investigated for treatment-refractory depression, and is currently being used (off-label) for some treatment-refractory cases...

  • Fluoroquinolones are broad-spectrum antibiotics that have been used to treat infections of varying types and severity since the 1980s. They are well-tolerated by most patients; however, a growing body of evidence has linked fluoroquinolone use to rare but disabling, and potentially permanent, side effects involving tendons, peripheral nerves, and the central nervous system (CNS). Cardiac, gastrointestinal (GI), metabolic (glucose), and ocular side effects, as well as allergic reactions, have also been reported. In May 2016, the FDA determined that the risks of fluoroquinolone use for certain uncomplicated infections are generally greater than the benefits when other treatment options are available.

    Subsequently, the labels of all systemic (oral and injectable) fluoroquinolones were updated with strengthened warnings, including a revised boxed warning. The revisions include "limitation of use" statements advising that, in the treatment of acute bacterial sinusitis, acute bacterial exacerbation of chronic bronchitis, and uncomplicated urinary tract infections (UTIs), fluoroquinolones should be reserved for patients who have no other options.

    This issue reviews uncommon but serious side effects of systemic fluoroquinolones. Dosing considerations, use in children and during pregnancy, and potential drug interactions are also discussed...

  • Osteoarthritis (OA) – also called degenerative joint disease – is the most common chronic joint condition, affecting about 27 million Americans. The resulting pain, stiffness, and swelling can affect mobility, productivity, and quality of life.

    While no treatment has been shown to slow the progression of joint damage, a combination of non-drug interventions and drug therapy can be used to manage symptoms and improve mobility. Resistance exercise, weight loss, and psychosocial interventions are among the non-drug interventions recommended for osteoarthritis patients. Recommended drug therapies include acetaminophen, oral and topical nonsteroidal antiinflammatory drugs (NSAIDs), tramadol, and intra-articular corticosteroid injections. The American College of Rheumatology (ACR) provides recommendations for the management of hand, knee, and hip OA.3 The American Academy of Orthopaedic Surgeons (AAOS) provides somewhat different recommendations for the management of knee and hip OA. Drug therapy recommendations are summarized in the Appendix.

    This issue will focus on oral medications and complementary therapies commonly used for the treatment of OA – particularly OA of the knee, hip, and hand – based on ACR and AAOS guidelines,3-5 as well as other evidence-based literature.

  • The American Diabetes Association (ADA) updates their practice guidelines every year, incorporating new data that can have a significant impact on patient health, care, and outcomes. Each January for the past 26 years, the ADA has published these guidelines as the Standards of Medical Care in Diabetes, referred to simply as the “Standards of Care.” This publication is the go-to reference guide for many healthcare professionals who care for people with diabetes. It provides practitioners, patients, researchers, and payers with the components of diabetes care, general treatment goals, and tools to evaluate the quality of care.

    While healthcare providers may focus on managing glucose, blood pressure, and lipid goals in patients with diabetes, the cornerstone of therapy is Diabetes Self-Management Education and Support (DSME/S), which engages the patient in active collaboration with the healthcare team Self-management is an ongoing, lifelong process that does not stop after each healthcare visit...

  • The past few years have seen a number of legislative and regulatory changes at the federal level; both with the Food and Drug Administration (FDA) and the Drug Enforcement Administration (DEA). This article will address key changes impacting pharmacy practice in the areas of compounding, drug supply chain security, biosimilars, and the regulation of controlled substances in order to prevent diversion and abuse.

    The passage of the Drug Quality and Security Act of 2013 (DQSA) updates the Federal Food, Drug, and Cosmetic Act (FDCA) in the areas of human drug compounding and drug supply chain security.1 Previously, compounding was mostly regulated by individual states under section 503A of the FDCA. In the years to come, the FDA will continue to clarify regulations surrounding compounding and drug supply chain security.

    The FDA has developed policy regarding biological medications, particularly around nearly identical biological products (biosimilars) and their therapeutic substitution. A new online publication called the “Purple Book” lists biological products, and specifies those that are biosimilar and/or interchangeable....

    2.0 Hours Pharmacy Law CE - 0.20 CEU. Target Audience: pharmacists, nurses, nurse practitioners, advanced practice nurses and pharmacy technicians.

 
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