Sep 21, 2018

Download the podcast patient case:  NPH vs Insulin Analogs 


Fredrick Banting, the Canadian scientist who discovered insulin in 1921 and sold the patent for just $1 to the University of Toronto and made it available to pharmaceutical companies royalty-free, would be disappointed to know that the high cost...

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Sep 7, 2018

Two recent studies challenge our current approach to managing patients with mild persistent asthma. When patients with asthma are prescribed inhaled corticosteroids (ICSs), we instruct them to use the medication daily. The US and global guidelines for asthma management recommend escalating and deescalating asthma treatment based on the patient’s symptom frequency, risk for asthma exacerbations, and the impact of asthma symptoms on daily activities.1,2 Treatment should not only...

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Aug 26, 2018

We now have two vaccinations to protect against herpes zoster — a live-attenuated vaccine (Zostavax) and the new recombinant subunit vaccine (Shingrix). While the live-attenuated vaccine has been available for more than a decade and a CDC-recommended vaccine in older adults, only one in three eligible patients have received it.1 While several logistical barriers to vaccination exist,2 two main concerns have limited the use of the live-attenuated vaccine: 1) declining...

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Aug 3, 2018

Critically-evaluating the literature is essential to engage in evidence-based practice.  A key component of assessing studies involves determining whether the comparator groups are appropriate.  Most pharmacists are familiar with the use of placebos for evaluating drug treatments, but how many of us have considered the comparator groups in behavioral interventions?  For these situations, employing attention placebo controls (APC) is important in order to assure the comparator groups...

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Jul 14, 2018

We’ve been managing asthma, for the most part, the same way for quite some time now … short acting beta agonist (SABA) for quick relief, inhaled corticosteroids (ICS) as first line maintenance treatment, step up if needed, step down if possible … plus self-management education and a written asthma action plan.  Despite many treatment options, numerous adults, adolescents, and children still suffer from asthma exacerbations, leading to reduced quality of life, missed work and school, higher...

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Jun 29, 2018

At least 180 shots. That is minimum number of injections a cancer patient would face if diagnosed with cancer-associated venous thromboembolism (VTE). But oral treatment with a direct oral anticoagulant (DOAC) now may be an option. A recently published study demonstrated that oral edoxaban is non-inferior to the injectable low-molecular weight heparin (LMWH) agent dalteparin.1 The implications of this study could potentially increase cancer patients’ quality of life by eliminating...

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Jun 15, 2018

“Silent killer,” which would be an amazing slasher movie title, is often used to describe hypertension – a disease that causes irreparable harm to the body with few (if any) physical symptoms. But hypertension is a leading cause of morbidity and mortality impacting one billion — yes, that’s billion with a “b” — patients worldwide.1 Although numerous treatment options are available, the majority of patients with high blood pressure are not well controlled due to a variety of...

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May 24, 2018

An estimated 1.2 million people in the United States are currently living with the human immunodeficiency virus-1 (HIV-1).1 There are currently no cures or vaccines to prevent HIV but the availability of antiretroviral therapy (ART) has significantly decreased HIV-associated morbidity and mortality. Moreover, HIV has become a chronic, long-term condition in many parts of the world thanks to the availability of more than 20 approved anti-HIV drugs targeting different steps in the...

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May 10, 2018

Hypertension, considered a leading risk factor for cardiovascular morbidity and mortality, is poorly managed in our healthcare delivery system today.  Forty-five percent of all adults in the United States have high blood pressure — that’s over 100 million people!1,2  Of those treated with pharmacotherapy, more than half are not achieving their blood pressure (BP) goals.2 Thus, millions of Americans are receiving suboptimal care and this has significant consequences for...

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Apr 27, 2018

What do group A streptococcal pharyngitis, acute sinusitis, and acute otitis media have in common? These are all respiratory tract infections in kids that are very frequently treated with antibiotic; all too often – 50% of time – with broad-spectrum antibiotics.1 But should we be routinely prescribing broad-spectrum antibiotics for these common respiratory tract infections? Overuse of broad-spectrum antibiotics can lead to antimicrobial resistance, increased cost, and...

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Apr 13, 2018

Patients with type 1 diabetes often have sub-optimal glycemic control.  The gold standard of treatment is basal-bolus insulin or continuous subcutaneous insulin infusion via insulin pump.  However, only a third of patients with type 1 diabetes achieve the American Diabetes Association A1C goal <7%.1  While health professionals have been taught that most patients with type 1 diabetes are lean, obesity is increasingly common and mirrors the rate observed in the general population...

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Mar 30, 2018

Obligatory comment on the current opioid epidemic: it’s bad…and getting worse.1,2 This problem is not a new one but even with increasing national awareness of this issue, the troubling truth is that opioid overdose deaths continue to increase from year to year. Currently, we are seeing a continued shift from prescription opioids as the number one culprit of drug overdose deaths to illicit heroin and ultra-potent fentanyl/fentanyl analogues.3 While this topic has gained...

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Mar 16, 2018

If you turn on the television these days, you will likely see commercials encouraging men to talk to their doctors about ‘the little blue pill’. And while the sexual innuendoes can be a little humorous, the commercials themselves promote awareness and prompt men to talk about erectile dysfunction. But where are the commercials and conversations about female sexual dysfunction (FSD)? FSD is a complex sexual health disorder influenced by psychological, hormonal, environmental, and biologic...

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Mar 2, 2018

“You no longer need to take this medication” is music to a patient’s ears.  How often do clinicians have the opportunity to tell patients that stopping a medication is possible for a chronic condition?  A recently published study explores the possible benefits to discontinuing an alpha-1 blocker after receiving combination therapy with a 5-alpha reductase inhibitor for the treatment of benign prostatic hyperplasia (BPH).1


Although the etiology of BPH is unknown,...

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Feb 16, 2018

It’s been 20 years since alendronate was approved to treat osteoporosis.  Although effective, bisphosphonates aren’t ideal — they have been associated with osteonecrosis of the jaw and atypical femoral fracture.1,2  Rare events, to be sure, but troubling serious adverse events that weigh on the minds of many patients and clinicians. The 2016 AACE/ACE clinical practice guidelines for the diagnosis and treatment of postmenopausal osteoporosis recommend the use of bisphosphonates (...

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Feb 2, 2018

There is an old adage in the fashion industry that if you wait long enough, everything comes back into style. While that may not be true (yet) for Saturday Night Fever polyester suits, it certainly seems to apply to blood pressure (BP) goals in patients with type 2 diabetes mellitus (T2DM). The seventh report of the Joint National Committee (JNC-7)1 and American Diabetes Association (ADA) guidelines for many years recommended a BP goal of <130/80 mmHg for patients with...

Comments: 1
Jan 19, 2018

Nearly 16 million adults in the United States have chronic obstructive pulmonary disease (COPD) but this is probably a woeful underestimate as many adults are asymptomatic in early stages.1,2 The United States Preventative Services Task Force recommends against screening in asymptomatic adults due to a lack of evidence that regular screening improves morbidity, mortality, or quality of life. Screening is only recommended if patients exhibit symptoms and have risk factors.3...

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Jan 5, 2018

We’ve all seen and used the American College of Cardiology 10-year atherosclerotic cardiovascular disease (ASCVD) risk calculator. There are several modifiable risk factors such as blood pressure, cholesterol, and smoking status that, if addressed, can lower ASCVD risk. But are there other modifiable risk factors that we are failing to account for and address? New evidence suggests systemic inflammation may be one.


To date, lowering levels of atherogenic cholesterol (e.g.,...

Comments: 4
Dec 8, 2017

1. Blood pressure categorizes and terminology have changed…again. The new ACC/AHA/AAPA/ABC/ACPM/ACG/APhA/ASH/ASPC/NMA/PCNA (that's a mouthful!) guidelines for the prevention, detection, evaluation, and treatment of high blood pressure (BP) in adults now have four BP categories:

  1. normal BP is systolic <120mmHg and diastolic <80mmHg
  2. elevated BP is systolic 120 to 129mmHg and diastolic <80mmHg
  3. stage 1 hypertension is ...
Comments: 4
Dec 8, 2017

Since the introduction of direct oral anticoagulants (DOACs) less than a decade ago, use of this class has expanded beyond the prevention and treatment of venous thromboembolism and stroke prevention in the setting of atrial fibrillation. Specifically, the potential role of DOACs in the secondary prevention of coronary artery disease (CAD) has been of considerable interest. Both warfarin and rivaroxaban, in conjunction with antiplatelet agents, have previously been shown to reduce recurrent...

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Nov 26, 2017

Asthma costs the US health care system roughly 50 billion dollars annually.1 And patients with uncontrolled severe asthma (> 2 exacerbations per year) incur far more cost than patients with persistent asthma without exacerbations ($5174 vs $1775 in 2013).2 Despite good adherence with high-dose inhaled corticosteroids (ICS) and concomitant long-acting beta agonists (LABA), millions of people continue to experience exacerbations.3  What more can patients and...

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Nov 10, 2017

Drug overdose is now the leading cause of death among Americans under the age of 50.1 This crisis has been building since the late 1990s, in part the result of rampant prescribing of opioid analgesics.2 In 2016, the United States (U.S.) Centers for Disease Control and Prevention (CDC) released a seminal guideline for primary care clinicians regarding opioid prescribing.3 These guidelines are now being implemented by clinicians, insurers, and healthcare...

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Oct 13, 2017

While good glycemic control has been shown to prevent microvascular complications (e.g. retinopathy, nephropathy, neuropathy), only a few anti-diabetic agents have been shown to reduce macrovascular complications (e.g. cardiovascular events.1-5  Empagliflozin, a sodium glucose transporter-2 (SGLT2) inhibitor, not only reduced the risk of CV events but also all-cause mortality in the EMPA-REG OUTCOME study.4  (See iForumRx Commentary –...

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Sep 22, 2017

Have you ever been asked about when to stop anticoagulation therapy after an unprovoked venous thromboembolism (VTE)?  If so, then you know that this decision is controversial.  According to the 2016 CHEST VTE Guidelines, at least 3 months of therapy is recommended for an unprovoked DVT or PE (Grade 1B).Thereafter, the clinician is expected to weigh the risks and benefits to determine if extended therapy is appropriate.  For patients who are at low-to-moderate bleeding risk,...

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Sep 8, 2017

Is self-monitoring of blood glucose (SMBG) cost-effective? There is no question that achieving good glycemic control is one means to decrease diabetes-related complications.1 SMBG is often recommended to help guide treatment decisions.  Consumer-oriented advertising often promotes frequent SMBG as means to achieve better glycemic control but current clinical practice guidelines do not provide specific recommendations regarding the frequency of blood glucose monitoring.


Comments: 8