iForumRx.org

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 potent...

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...

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 no...

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...

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...

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...

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. Gues...

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, Ph...

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 associate...

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 op...

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 w...

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 G...

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, Phar...

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 oft...

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...

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 l...

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, Ph...

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...

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 advanc...

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 hear...