Evidence against e-cigarettes for smoking cessation.

Electronic cigarettes (e-cigarettes) have been touted as a safer alternative to cigarettes and even as a smoking cessation aid. The health risks associated with smoking are well known, and smoking cessation has been studied extensively with options including behavioral therapy and pharmacotherapy (nicotine replacement therapy [NRT], varenicline, and bupropion). Several studies analyzed the effects of e-cigarettes as a smoking cessation aid. When used for smoking cessation, those who successfully abstain from cigarette smoking have a higher rate of continuation on e-cigarettes than NRT or pharmacotherapy. Other risks of e-cigarettes are highlighted including e-cigarette or vaping product use-associated lung injury. There is no approved pharmacotherapy for e-cigarette cessation. Two of the analyzed studies demonstrated the use of varenicline as a potential pharmacotherapy for e-cigarette cessation. The proposed benefits of e-cigarettes as a smoking cessation aid should be weighed against their probable detrimental effects. E-cigarette use should be discouraged as a whole and notably, as a smoking cessation aid.

Opioid-Related Disorders Among Pregnant Women with Sickle Cell Disease and Adverse Pregnancy Outcomes.

OBJECTIVE: Opioid use during pregnancy has increased in recent years, parallel with the opioid epidemic in the general population. Opioids are commonly used as an analgesic for pain crisis, a hallmark symptom of sickle cell disease (SCD). With the amplified frequency and severity of SCD pain crisis during pregnancy, the use of opioids may increase concurrently. The aim of this study was to examine trends in opioid-related disorders (ORDs) among pregnant women with and without SCD, as well as assess the risk for preterm labor, maternal sepsis, and poor fetal growth among patients with SCD and ORD. METHODS: We conducted a retrospective analysis of inpatient pregnancy- and childbirth-related hospital discharge data from the 2002-2014 National (Nationwide) Inpatient Sample database. The primary outcome was the risk of ORD in pregnant women with SCD and its impact on threatened preterm labor, fetal growth, and maternal sepsis. RESULTS: Among the >57 million pregnancy-related hospitalizations examined, 9.6 per 10,000 had SCD. ORD in mothers with SCD was four times as prevalent as in those without SCD (2% vs 0.5%). A significant rise in ORD occurred throughout the study period and was associated with an increased risk of maternal sepsis, threatened preterm labor, and poor fetal growth. CONCLUSIONS: Pregnant women with SCD have a fourfold increased risk of ORD compared with their non-SCD counterparts. The current opioid epidemic continues to worsen in both groups, warranting a tailored and effective public health response to reduce the resulting adverse pregnancy outcomes.

Effect of home-based asthma medication therapy management program on pediatric African Americans with uncontrolled asthma.

OBJECTIVES: To determine the impact of a pharmacist home-based and telephonic medication therapy management (MTM) program for African American children enrolled in a state Medicaid plan with asthma exacerbations. Caregivers' knowledge of asthma is described. DESIGN: This study was a quasi-experimental, pre-post prospective study with 2 phases: a pre-phase followed by a 12-month intervention post-phase in which each patient served as their own control. Pharmacists were sent to the patients' homes to provide MTM at weeks 1, 24, and 48 while pharmacy students provided telephonic outreach at weeks 4, 8, 12, and 36. SETTING: A local Medicaid managed care organization. PARTICIPANTS: Pediatric African American patients (4-17 years old) with uncontrolled asthma. MAIN OUTCOME MEASURES: Outcomes included emergency department (ED) visits, change in pharmacist assessment of asthma control, change in asthma knowledge test, change in Asthma Control Test, and change in medication adherence score. RESULTS: Overall, 366 pediatric patients (4-17 years old) were enrolled in this program over a 1-year period. Among the patients who were enrolled in the program, there were 122 asthma-related ED visits in the year preceding enrollment compared to 57 ED visits after their first home-based visit (P < 0.001). Although only 102 patients completed the study, more patients were assessed by the pharmacists as having well-controlled asthma at the final visit (76.8%) than at baseline (58.7%). Based on the Asthma Control Test, more patients reported uncontrolled asthma at baseline (47.5%) than at the final visit (39%). There was a statistically significant increase in the Asthma Knowledge Test (P < 0.05) and the Medication Adherence Assessment (P = 0.035) among patients compared with baseline. CONCLUSION: Rates of asthma exacerbations requiring an ED visit were substantially lower in the year after the initial pharmacist visit compared with the year preceding enrollment in the medication therapy management program.

Provision of Medication Therapy Management by Pharmacists to Patients With Type-2 Diabetes Mellitus in a Federally Qualified Health Center.

BACKGROUND: Type-2 diabetes mellitus is a complex condition for which pharmacists are well suited to improve patient outcomes by delivering medication therapy management (MTM) services. When diabetes is well controlled, patients can avoid its long-term complications, such as cardiovascular and renal diseases. This article describes an MTM pilot program that was implemented at a federally qualified health center (FQHC). METHODS: This program was implemented at three clinics involving patients with uncontrolled diabetes, defined as hemoglobin A1c (HbA1c) greater than 8%. The primary endpoint assessed was HbA1c. Secondary endpoints included knowledge scores, medication adherence, and patient satisfaction. Outcomes were compared with a group of patients from the same clinics who did not receive MTM. RESULTS: Fifty-seven patients met the established criteria and were enrolled in the six-month program. Thirty-seven patients completed the program and had an average 15% reduction in HbA1c (P < 0.05). Their average knowledge scores and medication adherence scores also increased from baseline. CONCLUSION: MTM provided by pharmacists as part of a health care team at an FQHC led to significant reductions in HbA1c.

Empagliflozin (Jardiance): A Novel SGLT2 Inhibitor for the Treatment of Type-2 Diabetes.

Empagliflozin (Jardiance): a novel SGLT2 inhibitor for the treatment of type-2 diabetes.

Polycystic ovary syndrome: a review of treatment options with a focus on pharmacological approaches.

Oral contraceptives, antidiabetes drugs, and statins are some of the therapies used to address the symptoms of this complex hormonal condition. Weight loss and surgery may also be beneficial as non-drug options.

An International Web-based Preceptor Development Program for Nigerian Pharmacists, A Pilot Study.

OBJECTIVE: To implement an international web-based program for preceptor development in Nigeria and assess its impact on Nigerian pharmacists' knowledge and attitudes toward effective precepting skills. METHODS: A web-based preceptor development program was developed and offered to the participants of the 1-year special Doctor of Pharmacy (PharmD) conversion program. This preceptor development program included recorded webinars on key identified topics to support the participants' preparation to precept PharmD students, including practice site development, evaluating and providing feedback to students, and interprofessional collaboration. In addition, surveys were administered before and after participation to assess the knowledge and attitudes toward effective precepting skills. Multiple-choice and short-answer questions were used to assess knowledge. Attitudes were ranked on a 4-point Likert scale. RESULTS: The program was completed by 94 participants from over 20 Nigerian states. From the pre to postsurveys, the participants demonstrated a significant improvement in their knowledge of effective precepting skills. In addition, although most respondents initially agreed with survey questions gauging views about preceptor roles and responsibilities, the perceptions improved. CONCLUSION: An international web-based preceptor development program was successfully delivered to pharmacy educators across Nigeria and improved their knowledge and attitudes toward effective precepting. Expanding this program to include pharmacists throughout Nigeria as a continuing education resource can aid in preparing pharmacy educators in the nation to precept students in the new PharmD curricula and support international initiatives to promote pharmacy education and practice.

Building Community-Engaged Multidisciplinary Partnerships to Improve Medication Management in Elderly Patients With Multiple Chronic Conditions.

PURPOSE: Many studies in preventing adverse drug events have been researcher-driven, yet few have engaged patients in the development of a project. This project aims to engage minority elderly patients with multiple chronic conditions in the development of research questions and strategies to improve medication safety. METHODS: Elderly patients (≥65 years old) who were prescribed 7 or more chronic medications were recruited through a university-based aging resource network in a historically African American community in Houston, Texas. Patients and a caregiver participated in a multidisciplinary workgroup comprised of a physician, pharmacists, a nurse, health educators, and a social worker. Patients were engaged by utilizing the 4 patient-centered outcomes research engagement principles. The workgroup created a strategic plan, completed an environmental scan, identified research problems, and reviewed current evidence-based approaches in the literature. Workgroup findings were presented to a broader audience within a community town hall setting, and input was collected from a community-wide survey. RESULTS: From April 2018 to July 2018, 3 patients and 1 caregiver participated in 5 multidisciplinary workgroup meetings. A total of 74 seniors attended the town hall meeting, and 69 completed the surveys. The most common drug-related problems among survey participants were doubts about drug advertisements (79%) and drug interactions (70%). Most participants (88%) were more comfortable in receiving face-to-face counseling compared to an app or virtual visits. Findings aided in developing 3 grant proposals. CONCLUSIONS: This narrative provides a roadmap for conducting multidisciplinary, patient-centered participatory research to refine research strategies in minimizing drug-related problems.

Academic Detailing Has a Positive Effect on Prescribing and Decreasing Prescription Drug Costs: A Health Plan's Perspective.

BACKGROUND: When initiated by a health plan, academic detailing can be used to change prescribing practices, which can lead to increased safety and savings. OBJECTIVE: To evaluate the impact of academic detailing on prescribing and prescription drug costs of cefixime to a health plan. METHODS: A prospective intervention study was carried out that evaluated the prescribing practices and prescription drug costs of cefixime. A total of 11 prescribers were detailed by 1 pharmacist between August 2014 and March 2015. Two of the 11 prescribers did not respond to the academic detailing and were not followed up. The physicians' prescribing habits and prescription costs were compared before and after detailing to evaluate the effectiveness of the intervention. Data were collected for approximately 5 months before and after the intervention. Each prescriber served as his or her own control. RESULTS: Overall, an approximate 36% reduction in the number of cefixime prescriptions written and an approximate 20% decrease in prescription costs was seen with academic detailing compared with the year before the intervention. In 9 of 11 (82%) prescribers, intervention with academic detailing was successful and resulted in fewer prescriptions for cefixime during the study period. CONCLUSION: Academic detailing had a positive impact on prescribing, by decreasing the number of cefixime prescriptions and lowering the drug costs to the health plan.

Dapagliflozin: A Sodium Glucose Cotransporter 2 Inhibitor for the Treatment of Diabetes Mellitus.

OBJECTIVE: To review clinical evidence for the efficacy, safety, and tolerability of dapagliflozin (Farxiga-AstraZeneca), a sodium glucose cotransporter 2 inhibitor, as monotherapy or in combination with other hypoglycemic agents for the treatment of type 2 diabetes. DATA SOURCES: Literature was identified through a systematic MEDLINE search of clinical trial results for dapagliflozin. DATA SYNTHESIS: Multiple controlled clinical trials have established the efficacy, safety, and tolerability of dapagliflozin as monotherapy or in combination with other therapies for type 2 diabetes. Dapagliflozin is approved by Food and Drug Administration as monotherapy or as an add-on to other glucose lowering agents including insulin for the treatment of type 2 diabetes. CONCLUSION: Dapagliflozin is effective for the treatment of type 2 diabetes.

Albiglutide: A once-weekly glucagon-like peptide-1 receptor agonist for type 2 diabetes mellitus.

PURPOSE: The pharmacology, pharmacokinetics, efficacy, safety, dosage and administration, and place in therapy of the glucagon-like peptide-1 (GLP-1) receptor agonist albiglutide are reviewed. SUMMARY: Albiglutide (Tanzeum, GlaxoSmithKline) is an injectable GLP-1 agonist approved in 2014 for use as an adjunct to diet modification and exercise to improve glycemic control in adults with type 2 diabetes. Albiglutide augments glucose-dependent insulin secretion and slows gastric emptying; it has an elimination half-life of approximately five days, allowing for once-weekly administration. Clinical trials demonstrated mean absolute reductions in glycosylated hemoglobin (HbA1c) values of 0.78-1.55% after 16 weeks of adjunctive therapy with albiglutide. Specific recommendations on albiglutide use have been issued by the American Association of Clinical Endocrinologists (AACE) and the American Diabetes Association (ADA). Studies show that the potential for hypoglycemic episodes with albiglutide use is low. In clinical trials, the most frequently reported adverse events were nausea and diarrhea. The use of albiglutide is contraindicated in patients with a history of pancreatitis and patients with a personal or family history of thyroid cancer. CONCLUSION: Albiglutide has been shown to be effective for the management of type 2 diabetes in adults and is recommended (by ADA) as second-line therapy when used in combination with metformin and (by AACE) as first-line monotherapy in patients with an HbA1c concentration of ≤7.5% at treatment initiation. In clinical trials, albiglutide was generally well tolerated by patients, with adverse effects comparable to those seen with other GLP-1 agonists.

Alogliptin: A new dipeptidyl peptidase-4 inhibitor for the management of type 2 diabetes mellitus.

PURPOSE: The pharmacology, pharmacodynamics, pharmacokinetics, safety, efficacy, and place in therapy of alogliptin and its combinations for managing type 2 diabetes mellitus are reviewed. SUMMARY: Alogliptin is a selective, orally bioavailable inhibitor of the enzymatic activity of dipeptidyl peptidase-4 (DPP-4). It works by slowing the inactivation of the incretin hormones, thereby increasing their concentrations in the bloodstream and reducing fasting and postprandial glucose concentrations in a glucose-dependent manner in patients with type 2 diabetes mellitus. Alogliptin has a moderate degree of absorption, estimated to exceed 75%, and its absorption is not affected by food. No drug interactions are known to be associated with alogliptin monotherapy. It is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. The clinical efficacy and safety of alogliptin have been demonstrated in several clinical trials, reducing patients' glycosylated hemoglobin level by 0.4-1.0% in 26 weeks. Alogliptin does not require any dosage adjustment when coadministered with ketoconazole, fluconazole, gemfibrozil, warfarin, metformin, glyburide, and pioglitazone. Alogliptin selectively binds to and inhibits DPP-4 in vitro at concentrations approximating therapeutic exposures. The most common adverse events associated with alogliptin are nasopharyngitis, headache, and upper respiratory tract infection. As with the other DPP-4 inhibitors, use of alogliptin may be associated with the development of pancreatitis during therapy. CONCLUSION: Alogliptin, a selective DPP-4 inhibitor, does not differ greatly from the other DPP-4 inhibitors currently available. It can be used as monotherapy or in combination with metformin for the management of type 2 diabetes.

From a to z: medication cost-management strategies for disproportionate share hospitals.

BACKGROUND: Harris County Hospital District, Houston, TX, is a publicly funded hospital system that provides care to residents of Harris County with a need-based payment system. The Harris County Hospital District pharmacy department, with a drug budget of more than $75 million in fiscal year 2010, utilizes a closed formulary system that is managed by the Formulary Management and Pharmacoeconomics Service, along with the medical staff. This service is comprised of clinical pharmacists whose goal is to provide a comprehensive, safe, and cost-effective formulary. OBJECTIVE: To describe the unique formulary management process at a county hospital system and what makes this process cost-effective, which may benefit pharmacy departments in institutions serving an indigent patient population. SUMMARY: The Harris County Hospital District drug formulary is overseen by the Pharmacy & Therapeutics committee, which is supported by 5 therapeutic subcommittees, including antimicrobials, cardiovascular, general formulary, central nervous system, and oncology. The Pharmacy & Therapeutics Committee consists of a medical staff committee that is supported by clinical pharmacists, who serve as the facilitators of these 5 subcommittees. Their responsibilities include the provision of drug information for formulary decisions, providing parameters to govern the use of certain medications, communicating changes to the formulary, conducting class reviews and medication utilization evaluations, coordinating annual pharmaceutical bids, reviewing and writing medication use policies and procedures, facilitating the use of cost-effective medications, and monitoring the use of medications in the hospital system. CONCLUSION: The processes incorporated by Harris County Hospital District in its formulary management are cost-effective and may be beneficial to other pharmacy departments, especially those institutions that serve an indigent patient population and are interested in cost-effective management strategies.

Clevidipine: a new intravenous option for the management of acute hypertension.

PURPOSE: The pharmacology, pharmacokinetics, efficacy, safety, dosage and administration, and place in therapy of clevidipine are reviewed. SUMMARY: Clevidipine is a new lipophilic, short-acting, third-generation dihydropyridine calcium channel blocker (CCB) approved for use in the management of acute hypertension when oral agents are not feasible. It exerts its hemodynamic effects through selective arterial vasodilation without effects on the venous circulation. Clevidipine has a half-life of approximately two minutes after i.v. administration, resulting in very rapid onset and offset of antihypertensive action. Unlike many current i.v. antihypertensive agents that are metabolized by the kidneys or liver, clevidipine is metabolized in the blood and tissues and does not accumulate in the body. Clevidipine does not appear to inhibit or induce cytochrome P-450 isoenzymes. Several Phase III clinical trials have reported the clinical efficacy and safety of clevidipine in patients with severe hypertension and in cardiac surgical patients with perioperative hypertension. The most frequent adverse events reported in clinical trials of clevidipine were headache, nausea, and vomiting. Risk of rebound hypertension, especially in patients not transitioned from clevidipine to oral antihypertensive therapy after prolonged infusions, should be monitored for at least eight hours after the drug is discontinued. CONCLUSION: Clevidipine, a novel third-generation dihydropyridine CCB, has demonstrated efficacy and safety in patients with acute hypertension and preoperative, perioperative, and postoperative hypertension. While its short duration of action and short half-life are appropriate for use in acute settings, more information on its safety is needed to assess its appropriate use in therapy.