The Rx Consultant
 

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

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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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  • First FDA-Approved Cannabinoid
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  • Improved Diabetes Control with Text Message Support
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  • Common Medications May Be Contributing to Depression
    The use of medications with depression as a side effect may be contributing to the growing probl... Read More
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  • 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...

  • 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...

  • This issue will bring you up to date on the recent guidelines for the management of hypertension in adults.

    Key Takeaways:
    • Two guidelines, two definitions of hypertension: The 2017 ACC/AHA guideline defines stage 1 hypertension as a BP of 130/80 mmHg or above. In contrast, the hypertension guideline from the 8th Joint National Committee (JNC 8) defines hypertension as BP of 140/90 mmHg or above - an ongoing controversy.
    • Think preventive: ACC/AHA recommends lifestyle changes for patients with "elevated" BP and those with stage 1 hypertension who have a 10-year cardiovascular risk less than 10%.
    • First Line Treatments: Both JNC 8 and ACC/AHA recommend thiazide-type diuretics (TTDs), angiotensin converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), and calcium channel blockers (CCBs) as first line drug options.

    Hypertension is a leading cause of cardiovascular disease, stroke, heart failure, and kidney disease. According to a recent update from the CDC National Center for Health Statistics, nearly 30% of adults in the US have hypertension. The rate of hypertension is similar among women (28%) and men (30%). It is more common among US non-hispanic black adults than any other ethnicity. Within age groups, the incidence ranges from 7.5% among adults 18-39 years old to 63% in those age 60 and older. Of concern is that hypertension control has not been improving. In 2015-2016, only 48% of adults with hypertension had achieved control which, at the time, was considered blood pressure less than 140/90 mmHg.

    Recently, the American College of Cardiology (ACC) and the American Heart Association (AHA) released an updated guideline for the prevention, detection, evaluation and management of hypertension.2 The 2017 ACC/AHA guideline was developed and approved in collaboration with 9 other professional groups, including the American Pharmacists Association (APhA). A multidisciplinary, team-based approach to hypertension management is strongly recommended (including the patient, primary provider, and other professionals such as cardiologists, nurses, physician assistants, pharmacists, and dietitians)...

  • 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...


  • 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...

  • For more than 50 years, vitamin K antagonists such as warfarin were the only oral anticoagulation option for patients with blood clotting disorders. Dabigatran (Pradaxa®), an oral direct thrombin (factor IIa) inhibitor, finally broke onto the scene with FDA approval in October 2010 as the first of the next generation of oral anticoagulants.Since that time, 3 additional oral anticoagulants have been approved in the US. Rivaroxaban (Xarelto®), apixaban (Eliquis®), and the very recently approved edoxaban (SavaysaTM) are oral direct factor Xa inhibitors that share the convenient attributes of dabigatran: fixed dosing, no routine coagulation monitoring (eg, INR testing), and no known dietary interactions – to name just a few...
 
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