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

About 12% of the US population has some form of thyroid disease, and more than half of them are unaware of their condition. Hypothyroidism is the most common thyroid condition. It affects about 2% of women and 0.1-0.2% of men; however, in adults over 60 years old, 6% of women and 2.5% of men have the condition.

Hypothyroidism is a chronic disease that requires lifelong treatment; fortunately, it can be easily managed with thyroid hormone replacement medication. The recommended treatment is levothyroxine, which was the most frequently prescribed drug in the US in 2019. Other thyroid hormone replacement medications are available in various products and strengths, which can be cause of confusion for healthcare providers and patients. Choosing the correct product and dose requires a full understanding of the disease and the treatments. Healthcare providers should be able to provide evidence-based recommendations, taking into consideration a patient's age, concurrent medical conditions, and other medications. This issue will review the pathophysiology and clinical features of hypothyroidism, as well as drug therapy considerations. Treatment strategies for older adults, children, and pregnant women are summarized. Subclinical hypothyroidism is also discussed.

There has been an increase in prescription medications, mainly stimulants, for the treatment of attention deficit hyperactivity disorder (ADHD) along with an explosion of new formulations. A 2016 CDC report estimates that about 9% of children 2 to 17 years of age (6.1 million) have been diagnosed with ADHD. Among the children with ADHD, 6 out of 10 were taking ADHD medication. The lifetime prevalence of ADHD has been estimated to be as high as 8.1%. In 2015, 4% of privately insured women ages 15 to 44 filled an ADHD prescription, most often for a stimulant such as mixed amphetamine salts or methylphenidate – a 344% increase compared to 2003.3 In 2016, the CDC reported that 3 out of 4 preschoolers diagnosed with ADHD were prescribed stimulants, despite a recommendation for behavior therapy alone for that age group.

This issue is the first of a 2-part review of ADHD. Part 1 focuses on stimulant and nonstimulant treatments for ADHD, including the advantages of certain formulations and delivery methods, common and serious adverse effects, and possible longterm effects. Part 2 is available online at rxconsultant.com and summarizes diagnosis and clinical presentation in all age groups (including adults), non-drug and behavioral interventions, clinically significant drug interactions with stimulants and nonstimulants, and the comorbid conditions that often accompany ADHD.

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...