iForumRx.org

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 ca...

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. ...

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 Aut...

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....

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 t...

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 dia...

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 Shauntá Chamberlin, PharmD, BCPS Produced by...

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 p...

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?    Gues...

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:...

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...

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...

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: Shil...

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 202...

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...

Currently, there are no known safe, effective, and inexpensive ways that can prevent or reduce the risk of developing autoimmune diseases. Any strategy that could reduce the chances of developing an autoimmune disorder would be welcomed by practitioners and patients alike.  Perhaps vitamin D and omega 3 fatty acid supplementation can get the job done. Guest Authors: Rileigh Provenza, PharmD and Ni...

Obesity is a chronic, progressive, multi-factorial, neurobehavioral disease characterized by excessive adipose tissue.  Here are some things every clinician should know about treating overweight and obesity but be sure to read the written commentary posted on iForumRx.org Guest Authors:  Jennifer N. Clements, PharmD, BCPS, BCACP, CDCES, BC-ADM and Seena L. Haines, PharmD., BCACP, NBC-HWC, CHWC Mus...

Hyperkalemia is a common electrolyte disorder in patients with CKD that can be exacerbated by renin-angiotensin-aldosterone system (RAAS) inhibitors. While hyperkalemia poses potential risks to patients with CKD, the potentially negative impact of discontinuing RAAS inhibitor therapy on long-term renal and cardiovascular outcomes in CKD patients is unclear. Guest Author: Michelle A. Fravel, PharmD...

Reason for Visit: JS was referred by her PCP to the ambulatory care pharmacist for contraceptive counseling. Chief Complaint: “I think I’m leaning more towards the pill, but I’m really open to anything. It’s also itchy again down there, probably another yeast infection.” Guest Author:  Elizabeth Salisbury, PharmD Expert Panelists:  Ashley Meredith, PharmD, MPH, BCACP; Rebecca Stone, PharmD, BCACP,...

What is the secret to staying up to date with clinical updates, tips for flourishing in your practice and life, and inspirational stories about pharmacist entrepreneurs…all at the click of a button? No, it is not magic. It is a podcast! Guest Authors: Elizabeth Yett, PharmD, BCACP, TTS and Elizabeth Hearn, PharmD, BCACP Music by Good Talk

Would you be willing to pay three times more for a brand-name levothyroxine product than a generic equivalent? Clinical practice guidelines recommend against switching between products. As a result, levothyroxine has higher brand-name product dispensing rates than other medications, costing patients and the healthcare system much more money. Guest Authors:  Connie Liang, PharmD and Kathleen Pincus...

The landmark REDUCE-IT trial demonstrated that icosapent ethyl (IPE) 4 g daily significantly reduced cardiovascular events in high-risk patients when added to statin therapy, but is a fancy fish oil supplement really worth our coin? Guest Authors:  Joseph Nardolillo, PharmD, BCACP and Vivian Cheng, PharmD, BCPS, BCACP Music by Good Talk