iForumRx.org

Electronic cigarettes (e-cigarettes; also known as e-cigs, electronic nicotine delivery systems, vapes, mods, pods, and vape pens) have surged in popularity since their market introduction in 2007. Some view e-cigarettes as a less harmful alternative to traditional cigarettes and a potential harm reduction strategy. Others worry about their addictive potential and see them as a setback in our quest for a tobacco-free society. Guest Authors: Elizabeth S. Yett, PharmD, BCACP, CTTS and Kirk E. Evoy, PharmD, BCACP, BC-ADM, CTTS Music by Good Talk

Asthma and chronic obstructive pulmonary disease (COPD) are underdiagnosed due to the underuse of spirometry, underreporting of symptoms, and economic barriers.  Is there an effective way to capture undiagnosed but symptomatic patients and route them for appropriately managing their respiratory symptoms?  That's what the UCAP study attempted to answer. Guest Authors:  Michelle Balli, PharmD, BCACP and Michelle Hernandez, PharmD Music by Good Talk

Despite advances in the management of acute myocardial infarction (MI), up to 38% of patients will experience signs of heart failure (HF) and many have a reduced left ventricular ejection fraction (LVEF). Sodium-glucose cotransporter 2 (SGLT2) inhibitors have well-documented cardiovascular benefits. However, data are limited regarding their use after an acute MI. Guest Authors: Amy Hu, PharmD and Kathleen Pincus, PharmD, BCPS, BCACP, CDCES Music by Good Talk

One of the most debilitating aspects of dementia is the behavioral and psychological symptoms of dementia (BPSD) that impact nearly 90% of patients. These symptoms significantly diminish the quality of life and functional abilities of those affected. To combat the most severe of these symptoms, antipsychotic medications are often prescribed, but not without possibly harmful consequences. A new study sheds additional light on these detrimental consequences. Guest Authors:  Melissa C. Palmer, PharmD, BCPS, BCPP and Jessa Marie Koch, PharmD, APh, BCPP Music by Good Talk

It is still difficult for patients to quit despite their best efforts. Of the nearly 70% of current smokers who want to quit smoking, only about 7.5% succeed.  Unfortunately, there is a lack of evidence to inform subsequent treatment strategies if the initial quit attempt is unsuccessful. Guest Authors:  Elizabeth Yett, PharmD, BCACP, TTS and Katherine Montag Schafer, PharmD, BCACP, CDCES Music by Good Talk

Reason for Visit: The patient is a 76-year-old Hispanic referred to the ambulatory care pharmacist for dyslipidemia management.  The patient has a remote history of an MI (15 years ago) but states he is unable to take statins. Guest Authors: Mayela Warner, PharmD and Maricar Conson, PharmD, BCPS Expert Panelists: Sara Wettergreen, PharmD, BCACP, BC-ADM and Tomasz Jurga, PharmD, BCPS, BCACP, BCCP, CDCES Music by Good Talk

Sodium-glucose cotransporter-2 (SGLT-2) inhibitors are one of the established treatments used to slow the progression of CKD and improve outcomes.  Could perhaps the glucagon-like peptide 1 (GLP-1) receptor agonists provide similar, additive, or different benefits in patients with CKD?  Guest Author: John Swegle, PharmD, BCPS, BCACP  Music by Good Talk

Over the last several decades, the popularity of cannabis (aka marijuana, weed) has increased significantly, and the recognition of medical benefits is evolving. Cannabis is often celebrated in popular culture as a relaxation-promoting, pain-relieving, harmless substance, and its use among young adults and pregnant women is increasing steadily.  A recently published ancillary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b) aimed to characterize the association between maternal cannabis use and adverse pregnancy outcomes. Guest Author: Courtney Cameron, PharmD, BCACP Special Guest: Leah Sera, PharmD, MA, BCPS Music by Good Talk

This episode is a collaboration between the ACCP Ambulatory Care Practice and Research Network (PRN) ... and iForumRx.org. We speak with three panelists who describe the use of remote patient monitoring within their cardiology practices.  From measuring weight, blood pressure, heart rate, blood glucose, and even pulmonary artery pressure, the use of remote patient monitoring devices has the potential to revolutionize patient care by making more data available "real-time" and engaging patients more in their care.  Nonetheless, there are significant barriers too.  Panelists:  Christine Cadiz PharmD, BCPS; Rachel Klosko, PharmD, BCCP, and Aimon Miranda, PharmD, BCPS Produced by  Rebecca Khaimova, PharmD, BCACP, CDCES and Anna K Love, PharmD, BCACP Music by lemonmusicstudio from Pixabay

It is now uncommon to see warfarin therapy initiated for stroke prevention. However, quality patient care is never a “one-size-fits-all” approach.  New evidence from the FRAIL-AF trial suggests that some of our most vulnerable older adults might be better off maintained on a vitamin K antagonist rather than (automatically) switched to a direct oral anticoagulation (DOAC).   Guest Author:  Matthew Cantrell, PharmD, BCPS Music by Good Talk

Reason for Visit:  Patient presents today for routine follow-up in the heart failure clinic to optimize his medications. Guest Authors: Jushua W. Skaggs, PharmD, and Jessica Wooster Thomas, PharmD, BCACP Expert Panelists: Kristin Watson, PharmD, MS, BCCP and Robert DiDomenico, PharmD Music by Good Talk

Direct oral anticoagulants (DOACs) are the standard of care for stroke prevention in most patients with nonvalvular atrial fibrillation (NVAF). Data on the safety and efficacy of DOACS in patients with obesity are limited and, at times, contradictory.  What would you recommend for a patient with a BMI>40: warfarin, which requires periodic monitoring and dose adjustments, or a DOAC, which may not be as effective? Guest Authors: Taylor M. Benavides, PharmD, BCPS and Elizabeth B. Hearn, PharmD, BCACP Music by Good Talk

This episode is a collaboration between the ACCP Ambulatory Care Practice and Research Network (PRN) ... and iForumRx.org. The treatment of COPD has evolved significant over the past few years.  The GOLD classification system was recently changed with a greater focus on exacerbations, and the role of inhaled corticosteroids (ICS) is limited to those with evidence of inflammation.  Pharmacists can play a critical and positive role in the lives of people with COPD by encouraging lifestyle changes, administering vaccines to immunize against respiratory illnesses, ensuring proper inhaler technique, and assisting with medication access. Panelists:  Melissa Lipari, PharmD, BCACP; Thomas Levi Lancaster, PharmD, BCACP, BC-ADM; and Rachel Basinger, PharmD, BCACP, CTTS, DipACLM Produced by  Rebecca Khaimova, PharmD, BCACP, CDCES and Anna K Love, PharmD, BCACP Music by lemonmusicstudio from Pixabay

Patients with diabetes mellitus are at increased risk of dementia; therefore, knowledge about medications and their possible impact on the development of dementia is critical. Historically, metformin has been the most frequently prescribed medication for type 2 diabetes. Does metformin impact the risk of dementia? Should providers be hesitant to prescribe … or discontinue metformin therapy? Guest Authors:  Benjamin King, PharmD, BCACP, Amber Lilly, PharmD, and Jordan Cloonan, PharmD Music by Good Talk

Reason for Visit:  Referred by her community pharmacist to see a medical professional after frequent reports of low blood glucose readings. This is her first visit to this family medicine office — her previous PCP retired over a year ago. Guest Authors: Katherine A Owen, PharmD, and Allison Zeurn, PharmD, BCACP Expert Panelists: Jennifer N. Clements, PharmD, BCPS, BCACP, CDCES, BC-ADM and Stefanie Nigro, PharmD, BCACP, CDCES Music by Good Talk

Pharmacogenomics (PGx) is a rapidly evolving field of precision medicine that studies how genetic variability influences drug response. PGx testing can improve patient care through personalized medication adjustments for a variety of conditions, including pain, mental health, cardiology, and oncology. Guest Authors: Lauren Jackson, PharmD, MPH and Jacob Marler, PharmD, BCCCP Music by Good Talk

While driving autonomy plays a crucial role in supporting mobility, social connections, and access to healthcare, older adults face elevated risks on the road. Rigorously collected data would equip us to educate patients about potential dangers, help us engage in collaborative discussions with patients and providers about deprescribing, and improve road safety for this vulnerable demographic. Guest Authors: Mary Eva McClure, PharmD and Tavajay Campbell, PharmD, BCACP, CDCES Guest Expert:  Michael Brodeur, PharmD, BCGP Music by Good Talk

Emerging data suggests we may have been overzealous with systemic corticosteroid prescribing and that allowing patients to self-manage their exacerbations with steroid rescue therapy may be harmful. However, we can now identify a subgroup of COPD patients who might benefit from systemic corticosteroids to treat their exacerbation. Guest Authors:  Hope Shrader Sherman, PharmD and Maricar Conson, PharmD, BCACP Music by Good Talk

Identifying and addressing the social determinants of health (SDOH) influences health outcomes and can positively impact health equity in our society.  While health systems in the US are screening for SDOH more often, information on how to improve screening efficiency and effectiveness is lacking. A recently published study was designed to determine what patient and clinician factors are associated with early implementation of SDOH screening in primary care. Guest Author: Sharmon P. Osae, PharmD, BCACP, CDCES Music by: Good Talk

This episode is a collaboration between the ACCP Ambulatory Care Practice and Research Network (PRN) ... and iForumRx.org. Mental illness is very common - 1 in 5 adults in the United States will have a mental illness during their lifetime.  Every ambulatory care (and community) pharmacist should be confident in their ability to recognize mental health challenges and how to use medications in an optimal manner to treat them.  This is a FOLLOW-UP conversation from the ACCP Annual Meeting program entitled Ambulatory Care PRN Focus Session — Breaking Down Depression and Anxiety Management for the Ambulatory Care Pharmacist. Expert Panelists:  Richard Silvia, PharmD, BCPP and Jordan Baye, PharmD, BCPS Music by lemonmusicstudio from Pixabay

Reason for Visit:  Referred by primary care provider to pharmacy services for education and management; diabetes not responding to oral therapy. Guest Authors: Jillian Cerullo, PharmD and Michelle Gauvin, PharmD, BCACP, BCGP, CDCES Expert Panelists: Jennifer Trujillo, PharmD, BCPS, CDCES, BC-ADM and Joshua Neumiller, PharmD, CDCES Music by Good Talk

Weight extremes, a body-mass index (BMI) either very underweight or obese, are associated with increased all-cause mortality.  Mortality attributable to obesity is caused by many secondary conditions like metabolic disorders and cardiovascular (CV) disease. Enter the glucagon-like peptide-1 (GLP-1) receptor agonists—initially approved in the treatment of type 2 diabetes— which induce significant weight loss regardless of diabetes status.  But can a weight loss drug decrease CV mortality? Guest Authors:  Gregory Castelli, PharmD, BCPS, BC-ADM, CDCES and Drake Meaney, PharmD, BCPS Music by Good Talk

Pharmacists are the most accessible health professionals and can play a vital role in screening and managing hypertension.  But would an expanded scope of practice that enabled pharmacists to prescribe and manage antihypertensive therapies be cost-effective? Guest Authors: Stefania Cian, PharmD and Candice Garwood, PharmD, FCCP, BCPS, BCACP  Special Guest: Dave Dixon, PharmD, BCACP, CLS Music by Good Talk

Omeprazole ranks among the top 10 most prescribed medications in the United States, and many patients take proton pump inhibitors (PPIs) for years. Widespread PPI use persists despite data about potential serious adverse effects.  Some worry that PPI use increases the risk of dementia.  Are those worries supported by data? Guest Authors:  Molly M. Corder, PharmD, BCPS, BCACP and Ryan S. Ades, PharmD, BCPS Music by Good Talk

Most clinical settings now use oscillometric BP devices to measure patients' BP, and over half of people with hypertension (HTN) use a home BP monitor.   Can we trust these BP readings if an inappropriate cuff size was used? How will this impact the way we assess BP control? Guest Authors:  Vincent Lam, PharmD and Kathleen Pincus, PharmD, BCPS, BCACP, CDCES Music by Good Talk

Over 75% of heart failure with preserved ejection fraction (HFpEF) patients have a comorbid diagnosis of obesity. Obesity is an independent risk factor for the development of HFpEF and contributes to disease progression. Obese patients with HFpEF have greater symptom burden, reduced functional capacity, and impaired quality of life when compared to those without obesity.  We know that patients often struggle to adhere to lifestyle modifications long enough to see meaningful weight loss, but the benefits of GLP-1 agonists for patients with HFpEF who are obese are not yet clear. Guest Authors: Alicia M. Nordberg-Payne, PharmD; Rebecca Munger, PharmD, BCACP; Jason Zupec, PharmD, BCACP Music by Good Talk

As people living with HIV age, the risk of cardiovascular disease becomes the greatest threat to their health and quality of life. Not only does inflammation from HIV infection contribute to atherosclerotic cardiovascular disease (ASCVD), but dyslipidemia from the antivirals commonly used to treat HIV further enhances that risk. But does statin therapy reduce ASCVD risk in patients living with HIV?  That's the question that the REPRIEVE study attempted to answer. Guest Authors:  Laura Lerner, PharmD and Joseph Nardolillo, PharmD, BCACP Music by Guest Talk

Respiratory syncytial virus (RSV) is a common respiratory virus that typically causes mild cold-like symptoms but can potentially cause severe illness in children and older adults. Every year, thousands of older adults and infants are hospitalized due to RSV, and 10,000 or more die.  In 2023, two vaccines (Abrysvo and Arexvy) and a monoclonal antibody (Beyfortus) became available to help prevent lower respiratory tract disease (LRTD) associated with RSV. 

Reason for Visit: JT was referred by his PCP to the ambulatory care pharmacist for hypertension management. Chief complaint: “My medication is making my mouth dry. I want to stop it.” Guest Authors: Sabrina Silviera, PharmD and Megan Scalia, PharmD, BCACP Expert Panelists: Eric MacLaughlin, PharmD, BCPS and Joseph Saseen, PharmD, BCPS, BCACP, CLS Music by Good Talk

Can supplements marketed for cardiovascular health be used in place of statin therapy? Health professionals have long been wary of nutraceuticals and dietary supplements due to the lack of safety and efficacy regulations. The SPORT trial attempts to provide robust data, to practitioners and patients, on how common supplements perform compared to statin therapy.  Guest Authors: Kaitlyn Phillips, PharmD, Lindsey Pitt, PharmD, and Anna Love, PharmD, BCACP Music by Good Talk

Do pharmacists providing remote care using telehealth technologies to patients who self-monitor their blood pressure perform as well as physicians and care managers providing care face-to-face? Is BP control better (or worse)? What about patient satisfaction?  The Hyperlink 3 study provides more evidence the telehealth is safe and effective ... and patients prefer it. Guest Authors: Elizabeth Yett, PharmD, BCACP, TTS, and Jessica Wooster, PharmD, BCACP Music by Good Talk

Less than 1 in 4 patients with hypertension in the United States have achieved their blood pressure (BP) goal, according to the CDC. Many clinicians only think of changing medications if a patient is having an intolerance to the current regimen. However, individual patients might respond differently to each of the four major anti-hypertensive medication classes and, if we could determine in advance which class(es) would lower the blood pressure the most, we could minimize the number of medications eventually needed to attain control. Guest Author:  Anthony Ishak, PharmD, BCPS Music by Good Talk

Approximately 1 in 6 adults in the United States report some trouble with their hearing. Despite the prevalence and implications of hearing loss, hearing aid use is strikingly low due to cost and accessibility. In late 2022, the FDA finalized regulations for over-the-counter hearing aids to be sold without medical evaluation or the services of a hearing professional. But will self-fitting OTC hearing aids be as effective as audiologist-fitted prescription hearing aids? Guest Authors:  Lucas A. Berenbrock, PharmD, MS, BCACP and Elaine Mormer, PhD, CCC-A Music by Good Talk

More than 46 million people in the US met diagnostic criteria for a substance use disorder (SUD) in 2021. These numbers are staggering and suggest that SUD is more common than diabetes in the United States.  However, only 6% received treatment.  Expanding the care delivery model is essential to improving treatment access and enhancing physical, mental, and social/societal outcomes.  Pharmacists can play a key role. Guest Authors: Melissa C. Palmer, PharmD, BCPS, BCPP and Amanda Stahnke, PharmD, BCACP Music by Good Talk

Did you know that iForumRx has resource pages related to a wide range of therapeutic areas, patient populations, and practice management issues?  Each resource page provides a succinct annotated list of key clinical trials, clinical practice guidelines, and websites.  A content expert manages each resource page, and the materials are regularly updated to reflect the latest evidence and guidance.  Our newest resource page — Gender Affirming Care — was released in August 2023.  Guest Authors:  Alex Mills, PharmD, BCACP, AAHIVP and Jordan Rowe, PharmD, BCACP, BC-ADM Music by Good Talk

Thiazide diuretics are a first-line treatment for patients with high blood pressure (BP), either as monotherapy or, more often, in combination with other first-line agents, but which one should clinicians use? Chlorthalidone was used in several landmark clinical trials and has a favorable pharmacokinetic profile.  But hydrochlorothiazide is the most commonly used (and cheapest) thiazide. Guest Authors: Brian T Terrell, PharmD, BCACP and Eric J MacLaughlin, PharmD, BCPS Music by Good Talk

This episode is a collaboration between the ACCP Ambulatory Care Practice and Research Network (PRN) ... and iForumRx.org. The treatment of dyslipidemia has gotten a lot more complex in recent years as we now have several non-statins that can substantially lower LDL cholesterol and reduce cardiovascular event rates - including PCSK9 monoclonal antibodies, ezetimibe, bempedoic acid, and inclisiran. When and how should we be using these agents? Panelists:  David Dixon, PharmD, BCACP, CDCES, CLS; Kathryn Litten, PharmD, BCACP; and Tomasz Jurga, PharmD, BCPS, BCACP, BCCP, CDCES Produced by Jonathan Hughes, PharmD, BCPS, BCACP and Anna Love, PharmD, BCACP Music by lemonmusicstudio from Pixabay

There has been a long-standing debate about the optimal approach to statin use, including whether we should initiate therapy using a “fixed-dose”, high-potency statin, or whether we should “start low and go slow” by titrating the dose to a specific LDL-C target. The LODESTAR study was designed to determine if treating LDL-C to a target level produces similar cardiovascular outcomes when compared to a fixed-dose approach. Guest Authors: Dawn Fuke, PharmD, BCPS and Catherine Behret, PharmD, BCACP Music by Good Talk

Type 2 diabetes (type 2 DM) is a progressive disease caused by a variety of pathophysiologic defects. However, even with substantial advances in treatment, glycemic control remains elusive, and most patients require combination therapy.  The Glycemia Reduction Approaches in Type 2 Diabetes: A Comparative Effectiveness (GRADE) study sought to investigate the glucose-lowering efficacy of several diabetes medications in combination with metformin. Guest Authors:  Katelyn Currier, PharmD and Jennifer Trujillo, PharmD, BCPS, CDCES, BC-ADM Music by Good Talk  

This episode is a collaboration between the ACCP Ambulatory Care Practice and Research Network (PRN) ... and iForumRx.org. Population health pharmacists play a critical role in delivering high-quality, cost-effective care to populations at the most risk for adverse outcomes. Panelists:  Ryan Wargo, PharmD, BCACP; Rochelle Rubin, PharmD, BCPS, CDCES; and Shauta Chamberlin, PharmD, BCPS Produced by Jonathan Hughes, PharmD, BCPS, BCACP and Anna Love, PharmD, BCACP Music by lemonmusicstudio from Pixabay

The Kidney Disease: Improving Global Outcomes (KDIGO) guidelines were recently updated with a focus on kidney health in patients with diabetes.  The updated guidelines include recommendations on screening, prevention, and treatment of chronic kidney disease (CKD), including the use of SGLT2 inhibitors, finerenone, and ACE inhibitors or ARBs.  The written commentary posted on the iForumRx website provides a succinct summary of the Top Ten Things Every Clinician Should Know. Guest Authors:  Kara Olstad, PharmD; Gurminder Sanghera, BSc, PharmD; and Darren Grabe, PharmD Music by Good Talk

If we've learned anything from the COVID-19 pandemic, it's that delivering healthcare to patients at a distance is possible. Telehealth can help increase access to care for patients in medically underserved communities and for those who have transportation, cost, and time barriers.  But one question has not been adequately answered—is telehealth an effective method to deliver primary care?    Guest Authors:  Keaton Thomas, PharmD and Haley M. Klassing, PharmD,  Music by Good Talk

Several studies have shown the benefits of involving pharmacists in the primary care setting.  And there are some recommendations regarding an appropriate physician-patient panel size per pharmacist.  But what's the ideal ambulatory care pharmacist-patient panel size? Guest Authors: Benjamin King, PharmD, BCACP, Jubilee Winar, PharmD, and Jasmin Ortiz, PharmD Music by Good Talk

There are a variety of non-statin lipid-lowering medications with proven cardiovascular benefits; however, most of the evidence supporting their use has been as an adjunct with a statin. Bempedoic acid offers a novel mechanism of action to treat hypercholesterolemia. But is there a CLEAR role for bempedoic acid in the treatment and prevention of ASCVD in statin-intolerant patients? Guest Authors: Sarah B. Edwards, PharmD and Briana Williams, PharmD, BCPS, BCACP Special Guest: Joseph Saseen, PharmD, BCPS, BCACP Music by Good Talk

One in five people in the U.S. report suffering from anxiety in the past year, and one in three will experience an anxiety disorder in their lifetime, but 40% of patients go untreated. Perhaps patients are disinterested (or distrust) in traditional pharmacotherapy ... or perhaps it is due to a lack of availability of services (like cognitive behavioral therapy – CBT). Many patients (and clinicians) are interested in exploring and using alternative treatment approaches, but are they effective? Guest Authors:  Cindy King, PharmD, BCACP and Chris Paxos, PharmD, BCPP, BCPS, BCGP Music by Good Talk *MBSR = Mindfulness-base Stress Reduction

The cost of diabetes in the United States has nearly doubled over the past decade in part due to rising prices and the cost of newer medications used to manage the disease.  With new, improved, but costly alternatives available, it's going to be challenging for ambulatory care practitioners to evaluate if the potential benefits of using these newer medication classes as first-line therapy (instead of metformin) outweigh their big price tag. Guest Authors:  Amanda Smith, PharmD and Nicole Slater, PharmD, BCACP Music by Good Talk

Several medication classes can be used to treat diabetic peripheral neuropathic pain (DPNP); however, many patients have a suboptimal response or experience dose-limiting side effects. Treatment guidelines suggest several first-line options but, in the absence of compelling evidence, offer no direction as to which agent to try first or if we should consider combination therapy. Guest Authors: Shilpa Klocke, PharmD, BCPS and Nicole Hahn, PharmD, BCACP Music by Good Talk

You've probably encountered many patients who have experienced muscle symptoms after starting a statin.  Statin-associated muscle symptoms (SAMS) contribute to treatment discontinuation and significantly increase cardiovascular (CV) adverse events and mortality. What strategies do you recommend to increase statin tolerance?  Guest Author:  Rick Hess, PharmD, CDCES, BCACP Music by Good Talk

This episode is a collaboration between the ACCP Ambulatory Care Practice and Research Network (PRN) ... and iForumRx.org. Measuring blood pressure (BP) and managing hypertension are among the essential roles that pharmacists play in ambulatory care and community-based practice environments.  This program is a question-and-answer session as a follow-up to the Ambulatory Care PRN program at the 2022 ACCP Global Conference on Clinical Pharmacy.  The panelists answer YOUR questions about the role of manual vs. automated BP readings, using self-monitored BP readings to make clinical decisions, 24-hour ambulatory care BP monitoring, and bedtime administration of antihypertensive agents. Guests:  Andrew Hwang, PharmD, BCPS; Dr. Anthony Ishak, PharmD, BCPS, and Dr. Lalita Prasad-Reddy, PharmD, BCPS, BCACP Produced by Jonathan Hughes, PharmD, BCPS, BCACP and Anna Love, PharmD, BCACP Music by lemonmusicstudio from Pixabay

Patient for pharmacists' patient care services remains a challenge.  While provider status at the federal level has not yet been realized, there has been a steady growth of payers and programs covering services provided by pharmacists in recent years. Guest Author: E. Michael Murphy, PharmD, MBA Music by Good Talk

Reason for Visit: The patient is here today for hypotension and diabetes follow-up. The primary care physician has consulted the clinical pharmacist regarding hypotension. Chief Complaint: “I feel dizzy when I stand up and feel like my heart is racing. I have never passed out, but it feels like I might, and I usually have to sit back down." Guest Authors:  Kellie Ball, PharmD and Johnathon Proctor, PharmD Expert Panelists:  Morgan Weaver Godfrey, PharmD, BCPS and Richard J. Silvia, PharmD, BCPP