Antibiotic Stewardship: Improving Use In The Community

Antibiotic stewardship is the effort to improve antibiotic prescribing so that antibiotics are used correctly - and only when needed. It includes monitoring antibiotic prescribing; avoiding unnecessary use; minimizing underuse due to missed or delayed diagnoses; and, when an antibiotic is needed, ensuring selection of the appropriate drug, dose, route of administration, and duration of therapy. ...
The Rx Consultant

Breast Cancer

With breast cancer so often in the news, it is easy to forget that the diagnosis is an emotional and life-changing event for an individual patient. In the United States (US), an estimated 231,840 women and 2,350 men1 were diagnosed with invasive breast cancer in 2015. One in every 8 women in the US will be diagnosed with breast cancer during her lifetime. In contrast, a man’s lifetime risk is ...
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Cannabidiol (CBD)

The popularity of medical marijuana (also known as medical cannabis) continues to grow in the US. In 2018, over 3.5 million patients were registered to use medical cannabis; an increase from 2.6 million in March, 2016. As of January 2019, 33 states and Washington D.C., have laws legalizing medical marijuana. Ten states, Washington D.C., and Canada have legalized recreational marijuana.2-4 ...
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Cholesterol Management - Understanding the 2018 Guideline

Cardiovascular disease (CVD), which includes high blood pressure, stroke, heart failure, and coronary heart disease, is prevalent and costly. Coronary heart disease is the most common form, accounting for 43% of all deaths attributed to CVD. The underlying pathophysiology of CVD is atherosclerosis; hence the term atherosclerotic cardiovascular disease (ASCVD). Risk factor management and treatmen...
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Cholesterol Management: Understanding the 2018 Guideline - Prescribers Issue

Cardiovascular disease (CVD), which includes high blood pressure, stroke, heart failure, and coronary heart disease, is prevalent and costly. Coronary heart disease is the most common form, accounting for 43% of all deaths attributed to CVD.1 The underlying pathophysiology of CVD is atherosclerosis; hence the term atherosclerotic cardiovascular disease (ASCVD). Risk factor management and treatme...
The Rx Consultant for Prescribers

Chronic Insomnia

Insomnia is one of the most common medical complaints, generating over 5 million office visits per year in the US alone. Symptoms of insomnia occur in one-third to one-half of adults in the US, and are more prevalent among women and older adults. In patients with coexisting psychiatric illnesses, the incidence approaches 50% to 75%. About 1 in 10 adults has chronic insomnia – symptoms that occ...
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Dementia: Managing Neuropsychiatric Symptoms

Although cognitive disturbances such as memory and language impairment are the most recognized symptoms of dementia, the neuropsychiatric symptoms of dementia (NPSD) are often more concerning and can cause considerable disability and caregiver distress. The total annual cost of treatment for a patient with Alzheimer's disease (AD) who is living at home is estimated at $14,500. The direct managem...
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Depression: More Reasons & Options for Recovery

Depression (major depressive disorder, or MDD) was the leading cause of disability worldwide in 2017. In 2015, 7-10% of adults and 10-12% of adolescents in the US suffered from MDD. Alarmingly, suicide completion rates in the US increased 24% from 1999 to 2014.5 In 2015, suicide was the second leading cause of death in 15-34 year olds and the third leading cause of death in 10-14 year olds. Depr...
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Diabetes Update

The American Diabetes Association (ADA) updates their practice guidelines every year, incorporating new data that can have a significant impact on patient health, care, and outcomes. Each January for the past 26 years, the ADA has published these guidelines as the Standards of Medical Care in Diabetes, referred to simply as the “Standards of Care.” This publication is the go-to reference gui...
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Diabetes Update: The New Concentrated Insulin Products

In the US, approximately 22 million adults are living with diabetes; of these, 90–95% are classified as having type 2 diabetes (T2DM), a progressive disease in which beta cell function declines based on the duration of the disease and level of glycemic control. The American Diabetes Association (ADA) and the American Association of Clinical Endocrinologists (AACE) both recognize that achieving...
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Direct-Acting Oral Anticoagulants

This issue will review the evidence supporting DOACs and their place in therapy for: 1) atrial fibrillation (AF); 2) the acute treatment and long-term secondary prevention of deep vein thrombosis (DVT) and pulmonary embolism (PE); and 3) DVT and PE prevention after major orthopedic surgery and in medically ill patients. The differences among DOACs will be highlighted (eg, side effect profiles, d...
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Dry Eye Disease

Dry eye disease (DED) is a chronic, progressive, inflammatory disease of the ocular surface and lacrimal glands. The American Academy of Ophthalmology describes DED as inadequate moisture in the eyes due to changes in tear film consistency and the type of tears produced (leading to evaporative loss), with or without decreased tear production. The disease is also known as keratoconjunctivitis sic...
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Fluoroquinolones Warnings & Side Effects - What You Need to Know

This issue reviews uncommon but serious side effects of systemic fluoroquinolones. Dosing considerations, use in children and during pregnancy, and potential drug interactions are also discussed. Fluoroquinolones are broad-spectrum antibiotics that have been used to treat infections of varying types and severity since the 1980s. They are well-tolerated by most patients; however, a growing bod...
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Heartburn: Appropriate Use of OTC Medications

Heartburn is a burning sensation in the chest that may radiate toward the neck, throat, and occasionally, the back. It most often results from the reflux of gastric contents into the esophagus. Heartburn is among the most common gastrointestinal complaints, and is a common reason people seek medical care. The worldwide prevalence of reflux symptoms that occur at least once a week is estimated to...
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Hepatitis C Treatment: Gone Viral

Hepatitis C virus (HCV) remains a major public health concern. HCV, the most common blood borne infection in the US, is estimated to affect over 4 million Americans (about 1-2% of the population). Worldwide, over 170 million people are infected. Most Americans with HCV infection acquired it in the 1970s and 1980s, before the virus was identified. Although the rate of new infections declined betw...
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HIV Infection: An Update on Antiretroviral Therapy – Florida Board-Approved Edition

Florida Licensees: This issue, together with the Supplement (pages 13 - 19) meets the requirement of the Florida Board of Pharmacy for a CE course on HIV/AIDS. Thirty seven years after the first case of acquired immunodeficiency syndrome (AIDS) was reported, 36.7 million people world-wide are living with HIV. About 1.8 million new HIV infections and 1 million AIDS-related deaths were reported...
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Hormonal Contraceptives

There are 61 million women of childbearing age (15–44) in the US. About 43 million of these women are at risk of unintended pregnancy; they are sexually active and do not want to become pregnant. About two-thirds of them use a contraceptive method correctly and consistently. Oral contraceptives have been in use for over 50 years and are one of the most popular contraceptives; this method is us...
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Hypertension Update 2018

This issue will bring you up to date on the recent guidelines for the management of hypertension in adults. Key Takeaways: • Two guidelines, two definitions of hypertension: The 2017 ACC/AHA guideline defines stage 1 hypertension as a BP of 130/80 mmHg or above. In contrast, the hypertension guideline from the 8th Joint National Committee (JNC 8) defines hypertension as BP of 140/90 mmHg o...
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Immunization Update: A Focus on Medical Indications for Vaccines in Adults

The Healthy People 2020 report, published by the US Department of Health and Human Services, includes targets for reducing vaccine-preventable disease rates and increasing vaccination rates in all age groups. According to the report, for each birth cohort (group of individuals born in the same year), immunization with the routine childhood vaccination schedule prevents 14 million cases of diseas...
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Inflammatory Bowel Disease: A Focus On Biologics

The 2 main types of inflammatory bowel disease (IBD), Crohn’s disease (CD) and ulcerative colitis (UC), affect approximately 1.17 million people in the United States. The estimated prevalence of CD in North America is 26-199 cases per 100,000 people; for UC, it is 37-246 cases per 100,000 people. During the past 25 years, the rates of newly diagnosed UC and CD cases have increased. Reasons...
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Influenza Update

This issue provides key information on influenza vaccines and antiviral medications for the 2018-2019 flu season, including precautions, side effects, and use in special populations. Influenza (commonly referred to as “the flu”) is a contagious viral infection of the respiratory tract (eg, nose, throat, and lungs). Influenza viruses are primarily spread by respiratory transmission – thr...
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Managing Chronic Pain

Chronic pain management is a global health priority. Millions of adults (11%-19% of the US population) suffer daily from chronic, noncancer pain. A conservative estimate of the economic burden of pain in the US, including both healthcare costs and lost work productivity, is $560 - $635 billion annually. Most patients use a combination of non-drug approaches and medication to help alleviate pain....
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Managing Psoriasis

This issue will bring you up to date on the impact of Psoriasis and recent developments in drug therapy. Key Takeaways: • Psoriasis is recognized as an immunemediated, chronic, systemic inflammatory condition. • About 80% of patients with mild to moderate psoriasis can be managed well with topical medications. • Corticosteroids are the cornerstone of topical therapy. Psoriasis is t...
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Medical Marijuana

Marijuana has been used for thousands of years for medical conditions, as well as for recreational purposes. The terms “marijuana” and “cannabis” are used interchangeably; however, cannabis is the more contemporary clinical designation. The use of marijuana has increased recently among US adults (18 years and older), from 10% in 2002 to 13% in 2014. The rise in marijuana use coincides wi...
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Medication Adherence: A Critical Component of Healthcare

This issue will bring you up to date on the impact of nonadherence on chronic conditions and strategies for increasing compliance. Key Takeaways: • Medication nonadherence contributes to poor clinical outcomes (including higher hospitalization and death rates) and increases healthcare costs. • Risk factors/red flags for medication non-adherence include depression, cognitive impairment, ...
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New Considerations in Diabetes Management

This issue highlights the use of continuous glucose monitoring (CGM) systems, sodiumglucose 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 w...
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New Drugs 2017

In 2017, 46 new medicines were approved by the FDA – the highest number of approvals in 21 years. Scott Gottlieb, who was sworn in as FDA Commissioner in May 2017, has made use of policy changes put into effect during recent years to accelerate the approval process. This issue of The Rx Consultant focuses on new drugs that may be important additions (including a number of “firsts”) in ...
The Rx Consultant

New Drugs 2018

In 2018, the US Food and Drug Administration (FDA) approved 59 new drugs – the highest number in more than 10 years – including 19 first-in-class agents. Of the 59 new approvals, 73% received priority review. This issue of The Rx Consultant focuses on the new drugs that may be important additions (including a number of “firsts”) in their therapeutic areas: influenza infection, HIV-1 i...
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Oral Agents for the Treatment of Metastatic Non-Small Cell Lung Cancer

Lung cancer claims the lives of more people than any other cancer worldwide. In the US, lung cancer is the third most commonly diagnosed cancer. In 2018, there were approximately 234,030 new cases diagnosed and over 154,000 lung cancer related deaths. Lung cancers are histologically (microscopic tissue structure) defined as small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC), ac...
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Osteoarthritis Management

Osteoarthritis (OA) – also called degenerative joint disease – is the most common chronic joint condition, affecting about 27 million Americans. The resulting pain, stiffness, and swelling can affect mobility, productivity, and quality of life. While no treatment has been shown to slow the progression of joint damage, a combination of non-drug interventions and drug therapy can be used to...
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Pharmacy Law - A Focus on Opioid Prescriptions

From 1999 to 2017, more than 700,000 people died in the United States from a drug overdose. About 400,000 of these deaths involved both prescription and illicit opioids (eg, heroin); 218,000 deaths involved prescription opioids. In 2017 alone, there were more than 70,000 overdose deaths, with nearly 70% involving opioids. This was a 10% increase from 2016, when there were 63,632 overdose deaths ...
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Pharmacy Law: Determining the Legitimacy of Opioid Prescriptions

The pharmacists at XYZ Pharmacy are concerned. The pharmacy is in close proximity to a pain management clinic and patients from this clinic regularly present the pharmacists with prescriptions for MS Contin®, oxycodone, methadone, and other opioids in quantities as large as 1,000 tablets for a 1-month supply. Those prescriptions are usually accompanied with prescriptions for fentanyl oral lozen...
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Pharmacy Law: Regulatory Developments Affecting Pharmacy Practice

The past few years have seen a number of legislative and regulatory changes at the federal level; both with the Food and Drug Administration (FDA) and the Drug Enforcement Administration (DEA). This article will address key changes impacting pharmacy practice in the areas of compounding, drug supply chain security, biosimilars, and the regulation of controlled substances in order to prevent dive...
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Smoking Cessation For the Busy Clinician

More than 50 years after the landmark 1964 Surgeon General’s Report on the health consequences of smoking, an estimated 15% of adult Americans still smoke. Smoking remains the leading cause of preventable death in the United States – accounting for 480,000 deaths per year (1 of every 5). People who quit smoking greatly reduce their risk for tobacco-related diseases, including cancer, heart d...
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Update on Medication Errors and Adverse Drug Events-Florida Board-Approved Edition

Interest in medication errors was heightened by publication of the Institute of Medicine (IOM) report “To Err is Human,” which revealed the burden of medical errors and the impact on patients in the US. Following publication of the report in 2000, health care organizations bolstered efforts to reduce medical errors and the illness and death that result. Despite these efforts, a recent analys...
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