Pressing Update: Aprocitentan for the Treatment of Hypertension.

OBJECTIVE: This article reviews the published data including the pharmacology, efficacy, and safety of aprocitentan, a novel endothelin receptor antagonist developed to treat hypertension in conjunction with additional agents. DATA SOURCES: A literature search was conducted from drug discovery until May 2024 through PubMed, MEDLINE, and National Institutes of Health Clinical Trials Registry utilizing the following search terms: Tryvio, aprocitentan, hypertension, resistant hypertension, endothelin receptor antagonist, and ACT-132577. STUDY SELECTION AND DATA EXTRACTION: All relevant English-language studies, or studies that could be appropriately translated into English, containing the pharmacology, pharmacokinetics, safety, and efficacy of aprocitentan, were selected for review. DATA SYNTHESIS: In the setting of resistant hypertension, aprocitentan has shown significant reductions in blood pressure in both medical office and 24-hour ambulatory settings at 4 weeks with a sustained effect at 40 weeks. Studies evaluating cardiovascular risk reduction have not been conducted at this time. Fluid retention and edema were the most frequent adverse events reported in clinical studies with aprocitentan. As a class, endothelin receptor antagonists may cause fetal harm; aprocitentan should be used with caution to avoid embryo-fetal toxicity. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE IN COMPARISON TO EXISTING DRUGS: Owing to the existent barriers for the treatment of resistant hypertension, aprocitentan presents itself as an effective option when added to traditional antihypertensives. This single-strength, once-daily regimen may serve as an appealing option to both patients and prescribers. CONCLUSION: Aprocitentan is a safe and effective medication for the treatment of hypertension when added to other pharmacological therapies.

A pilot study surveying the impact of pharmacist-led counseling on naloxone dispensing.

OBJECTIVE: The purpose of this study was to evaluate the impact of pharmacist counseling on patients purchasing naloxone and to highlight reasons for naloxone purchase refusal. DESIGN: A multisite study that was conducted from September 15, 2022, to January 11, 2023. SETTING: Independent community pharmacies. PATIENTS/PARTICIPANTS: Fifty patients met inclusion criteria. Data collected included demographics, preintervention knowledge assessment, post-intervention naloxone purchase, and reasons for naloxone refusal. OUTCOME MEASURES: The primary outcome was naloxone purchase after pharmacist education intervention. The secondary outcome was reasons for naloxone purchase refusal. RESULTS: The primary outcome showed that 60 percent of patients purchased naloxone after pharmacist intervention. As a secondary outcome, the number of patients who refused to purchase naloxone was 20 percent, with the majority of patients expressing that naloxone was not necessary as a reason for refusal. CONCLUSION: More studies are needed in order to conclude the impact of pharmacist education on the increasing purchase of naloxone.

Using a virtual simulation platform for dispensing pediatric prescriptions in a community-based pharmaceutical skills course.

BACKGROUND AND PURPOSE: Safe and accurate dispensing of medications is an essential skill. Pharmacy schools must provide students with the knowledge and practice to enhance special population dispensing skills. The objective of this study is to describe a community pharmacy pediatric simulation completed by first-year pharmacy students and to review student perceptions on confidence and knowledge learned after a MyDispense (Monash University) simulation. EDUCATIONAL ACTIVITY AND SETTING: First-year Pharmaceutical Skills students participated in a MyDispense simulation to identify errors and omissions of prescription orders with a focus on pediatrics. Although students had limited therapeutic knowledge, the activity emphasized federal and Florida law requirements. Retrieval and direct application of these principles along with new experiences in identifying medication errors afforded students to learn in a low-stake, controlled environment. FINDINGS: Of the 64 students enrolled in the Pharmaceutical Skills I course, 57 completed the pre-simulation survey and 56 students completed the post-simulation survey (87.5% response rate). Increased confidence and knowledge were found for most questions. The pre-simulation survey had students most frequently answer neutral followed by disagree or strongly disagree for ability to complete the listed task. The post-simulation survey responses shifted with many students responding with agree or strongly agree for the listed task and found MyDispense to be a helpful simulation tool. SUMMARY: Exposing pharmacy students to pediatric virtual simulations early in the curriculum may increase confidence and knowledge. Future pediatric simulation coursework would benefit longitudinally to further build confidence and enhance retention of knowledge.

Pharmacist-driven continuous glucose monitoring in community and ambulatory care pharmacy practice: A scoping review.

BACKGROUND: Continuous glucose monitoring (CGM) devices improve clinical outcomes and facilitate achieving patient-specific goals. However, opportunities and barriers to implementation of pharmacist-driven CGM services are not well-described. OBJECTIVES: This scoping review was conducted to identify opportunities and barriers to implementing pharmacist-driven CGM services in the community and ambulatory care setting. Clinical outcomes resulting from pharmacist-driven CGM were also explored. METHODS: A health librarian searched Ovid MEDLINE, Cochrane CENTRAL, Embase, Web of Science, Scopus, International Pharmaceutical Abstracts using keywords and subject headings from inception through December 2, 2022 to identify studies describing pharmacist or pharmacy-based CGM programs. No publication type, date limits, language restrictions, or other filters were applied. The database search was supplemented by a search of Google Scholar and a citation search of preselected gold standard articles. RESULTS: The scoping review initially identified 942 citations of which 249 passed abstract screening and 11 were included in the review. Among studies, the most common design was retrospective, populations varied, control groups were not consistently used, follow-up was primarily short, and sample sizes were small. One study evaluated pharmacist-driven CGM in a community pharmacy setting. Ten studies took place in the ambulatory care setting. Barriers to initiating pharmacist-driven CGM as a clinical service include educational, logistical, workflow, and financial incentive. Beneficial outcomes from pharmacist-driven CGM include improved quality of life, increased empowerment, and improved glycemic control. CONCLUSION: There is lack of strong evidence to support pharmacist-driven CGM in the community pharmacy setting. However, small studies suggest pharmacist-driven CGM is feasible and beneficial in the ambulatory care setting. Further exploration of how educational, logistical, workflow, and financial barriers can be overcome is warranted, given potential for improved clinical outcomes.

Impact of Overbasalization on Clinical Outcomes in Patients With Type 2 Diabetes: A Post Hoc Analysis of a Large Randomized Controlled Trial.

The American Diabetes Association's Standards of Medical Care in Diabetes emphasize the need for awareness regarding overbasalization (basal insulin doses >0.5 units/kg/day without bolus insulin) in the treatment of type 2 diabetes. However, outcomes data on the impact of overbasalization are limited. This post hoc analysis of a large randomized controlled trial suggests that an insulin therapy regimen involving overbasalization compared with a basal-bolus insulin regimen that avoids overbasalization is less effective at lowering A1C and may be associated with increased cardiovascular risk. Clinicians should consider alternative approaches to glycemic control before increasing basal insulin doses to >0.5 units/kg/day.

Improvement in Clinical Outcomes and Access to Care With Pharmacist-Led Chronic Care Management Services at a Rural Family Medicine Clinic.

Background: Chronic care management (CCM) can significantly impact the management of chronic diseases in rural patient populations. To date, few practice models have addressed its impact on clinical outcomes and access to care in rural practice settings. Objective: Implement a sustainable pharmacist-led CCM practice model while tracking clinical outcomes and healthcare access at a rural, medically underserved family medicine clinic. Methods: This study retrospectively examined data from the clinic's CCM program from October 2020 through May 2021 and included total clinical encounters at three- and 6-months intervals, as well as changes in clinical outcomes like A1c and systolic blood pressure (SBP) at three- and 6-months intervals. Results: Over an 8-month period, 46 patients were enrolled in pharmacist-led CCM services. Those with a CCM encounter or office visit within 3 months of enrollment showed a mean A1c reduction of 1.07% after 3 months (95% CI -1.70 to -.44, P = .0016), while those with an encounter or office visit within 6 months of enrollment displayed a mean A1c reduction of 1.64% after 6 months (95% CI -2.35 to -.92, P < .001). There was a 73.8% increase in total clinical encounters in the 6 months after CCM enrollment compared to the 6 months preceding it, signifying increased access to care. Conclusion: Patients with CCM encounters or office visits within the first 3-6 months experienced statistically significant reductions in A1c. Moreover, total clinical encounters markedly increased in the 6 months after enrollment, allowing for more frequent engagement between ambulatory pharmacists and traditionally challenging rural patients.

System intervention in community pharmacy setting: Leading to better patient care through reducing harm associated with coprescribing benzodiazepines and opioids.

OBJECTIVE: The opioid epidemic is frequently discussed including the staggering numbers involved with coprescribing opioids and benzodiazepines associated with death. Community pharmacists, with the help of a system intervention, have a unique opportunity to help reduce the coprescribing of benzodiazepines and opioids and reduce the associated risk of death. DESIGN: A single center retrospective chart review was conducted after a system intervention was placed, as a quality improvement project, from November 2019 to May 2020. SETTING: Independent community pharmacy. PATIENTS/PARTICIPANTS: Data included demographics, dosing of each medication pre- and post-intervention, and naloxone status. Main outcome(s) measures: The primary outcome evaluated was reduction in dose/discontinuation of these prescriptions. The secondary outcome evaluated was the number of naloxone prescriptions ordered per protocol and picked up. RESULTS: The primary outcome did not show statistical difference; however, the secondary outcomes showed statistical significance. CONCLUSION: In conclusion, community pharmacists, with the help of evolving technologies, can reduce harm associated with the coprescribing of benzodiazepines and opioids.