Keeping health professionals current with useful, quick updates on drugs & therapy - with CE for pharmacists, pharmacy technicians and nurse practitioner.

This issue highlights the use of continuous glucose monitoring (CGM) systems, sodium glucose transport protein-2 (SGLT2) inhibitors, newer insulin formulations, and the expert guideline recommendations focused on individualization of therapy.

In 2017, the Centers for Disease Control reported that over 30 million people in the US (~10% of the population) have diabetes, including 7.2 million who are undiagnosed. The total estimated cost of diagnosed diabetes in the US was $327 billion in 2017.2 Individuals with diabetes incur average annual medical expenses of about $16,750 – more than twice the expense for people without diabetes.

Over the last decade, the options for managing diabetes have grown dramatically – including new medication classes (eg, glucagon- like peptide-1 agonists, sodium-glucose transport protein-2 inhibitors), new insulin analogs (eg, insulin degludec, biosimilar insulins), and new technologies to help patients monitor their diabetes (eg, continuous glucose monitoring).

Clinical practice guidelines have increased the emphasis on individualizing treatment options and goals to meet the needs of each patient. Patients have more say in the management of their diabetes and overall health. It is essential that healthcare providers help patients navigate the vast pool of information available at their fingertips. Diabetes patients can easily get confused by the often-conflicting information or misinformation available on television and the internet, and from friends and family members. Community providers need a good, working knowledge of patient-specific diabetes management, including current treatments and technologies...

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...

New Drugs 2017: In 2017, 46 new medicines were approved by the FDA – the highest number of approvals in 21 years. Scott Gottlieb, who was sworn in as FDA Commissioner in May 2017, has made use of policy changes put into effect during recent years to accelerate the approval process. This issue of The Rx Consultant focuses on new drugs that may be important additions (including a number of “firsts”) in their therapeutic areas: venous thromboembolism prophylaxis, atopic dermatitis, hepatitis C infection, psoriasis, HER2-positive breast cancer, Parkinson disease, Huntington disease, tardive dyskinesia, and bacterial vaginosis.

Two new glaucoma medications are summarized in the online appendix. Dosing, drug interactions, and pronunciation guides are shown in Table 1. Brief descriptions of 14 additional new drugs are included in Table 2...

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.