iForumRx.org

Smoking remains a habit for many people, even among those who are motivated to quit. Historically, most smoking cessation interventions have targeted individuals who are ready to quit smoking in the next 30 days, overlooking those who are not yet ready to quit.  Perhaps an abstinence game, Take a Break , can move people in pre-contemplation and contemplation toward quitting. Guest Authors:  Anna R...

It is well established that overuse of short-acting beta-agonists (SABA) increases the risk of poor asthma control, exacerbations, and increased mortality.  Several studies have combined a beta-agonist with an inhaled corticosteroid (ICS). The combination provides symptom relief and decreases the risk of poor outcomes.  The days of using albuterol monotherapy should be coming to an end; two drugs...

Health professionals must deal with a lot of uncertainty in their work, such as weighing the risks and benefits of various treatment options, determining whether a patient’s symptoms are an adverse effect of medication therapy, or deciding if adding a new drug to the formulary will be cost-effective. A lower tolerance of uncertainty increases the risk of burnout and other stress-related harms. A n...

The 2022 AHA/ACC/HFSA Heart Failure Guidelines is a much-needed update and consolidates previously published recommendations. In the written commentary we describe the top ten things every clinician should know about the 2022 AHA/ACC/HFSA Heart Failure Guidelines.  This podcast episode highlights some of the key recommendations from the guidelines and addresses some of the practical implications....

When was the last time your patients or loved ones were screened for cognitive changes and dementia? Patients and caregivers both fear and accept cognitive decline as part of the aging process, but often delay screening. However, early detection of cognitive impairment can assist healthcare teams to make proactive interventions to slow cognitive decline and promote healthy aging.   Guest Authors:...

Unsurprisingly, medication burden increases as we age. At each clinic visit, we consider starting new medications, but it’s still relatively uncommon to critically evaluate medications that could be deprescribed . How can we change the culture to embrace deprescribing as an integral part of patient care?  The OPTIMIZE study was a provider- and patient-level educational intervention that attempted...

Most practitioners won’t hesitate to start drug therapy in an adult patient with chronically elevated blood pressure (BP) … except, perhaps, if the patient is pregnant. In this vulnerable population, we frequently take a “wait-and-see” approach and withhold therapy unless the BP elevations become severe. But is this the right decision? Guest Authors:  Timothy D. Gladwell, PharmD, BCPS, BCACP and S...

Nonalcoholic steatohepatitis (NASH) is quickly emerging as one of the most common reasons for both liver cirrhosis and liver transplant in the United States – soon predicted to overtake hepatitis C virus as the predominant etiology.  Currently, there are no FDA-approved medications to treat these disorders.  Hopefully, that will soon change. Guest Author: Scott Malinowski, PharmD Music by Good Tal...

Pain and hypertension are two of the most prevalent conditions worldwide. Acetaminophen is often considered the “go-to” and the “safe” over-the-counter analgesic for patients with hypertension because it is not commonly believed to increase blood pressure or cardiovascular events. But is that assumption grounded in evidence? Guest Authors: Lizzie Baumeister, PharmD and Austin Morgan, PharmD, BCACP...

This episode is a collaboration between the ACCP Ambulatory Care Practice and Research Network (PRN) ... and iForumRx.org. Wondering if a continuous glucose monitor (CGM) is right for your patient?  Worried about workflow, prior authorization, billing, and payment?  Our expert panelists explain how they manage patients in their practices and how they bill for their services. Guests:  Jennifer Truj...

Physical activity is critical to preventing and treating diabetes and reduces cardiovascular disease (CVD) and mortality.  Although moderate-to-high intensity aerobic exercise of any type is likely beneficial, cycling is particularly attractive because it is a low-impact exercise (e.g. easier on the joints) and can potentially be used as a transportation method. Guest Author:  Kristin Lutek, Pharm...

Many older adults do not receive recommended screening exams or treatments and frequently take multiple medications that place them at high risk of adverse effects and drug-drug interactions. Pharmacists performing an Annual Wellness Visit (AWV) provides an opportunity to conduct a comprehensive medication review to identify and correct medication-related problems as well as close care gaps. Guest...

This episode is a collaboration between the ACCP Ambulatory Care Practice and Research Network (PRN) ... and iForumRx.org. Do you experience FOMO (aka fear of missing out) when it comes to the primary literature?  How can you keep on top of the never-ending stream of new evidence that's published (and presented) every day!  Of course, iForumRx is one way to keep abreast of the latest evidence ......

The thrombotic antiphospholipid syndrome (TAPS) is associated with atypical thromboembolic events and/or recurrent pregnancy loss. Patients with TAPS are at very high risk of recurrent thrombotic events and require indefinite therapy.  Warfarin therapy is very challenging to manage in this patient population and requires frequent monitoring.  Thus a direct oral anticoagulant would be a welcomed al...

Sacubitril/valsartan is considered part of the backbone of guideline-recommended therapies for the management of patients with heart failure. In 2021, sacubitril/valsartan became the preferred treatment over an ACEi or ARB in patients with heart failure with reduced ejection fraction (HFrEF) because it reduces the risk of cardiovascular death and hospitalization for heart failure in nearly all adu...

Unfortunately, many patients with CAD do not receive the influenza vaccine every year.  And many patients being discharged from hospital after an acute coronary event don't receive it either. The IAMI (Influenza Vaccination After Myocardial Infarction) study was the first, large, randomized, double-blind, placebo-controlled, multi-center trial to investigate whether influenza vaccination could red...

Two novel oral antiviral agents were granted emergency use authorization (EUA) by the U.S. Food and Drug Administration (FDA) for the treatment of mild to moderate COVID-19 in late December 2021. Although it is named after Thor’s hammer, Mjölnir, molnupiravir was given a last place (4th line) recommendation by the National Institutes of Health (NIH) COVID-19 Treatment Guideline Panel.  What gives?...

Published in Diabetes Care every January, the Standards of Medical Care in Diabetes by the American Diabetes Association (ADA) provides recommendations for the care of patients with diabetes.  And every year clinicians eagerly read, discuss, and apply them in their practices.  In this episode, we discuss some of the highlights. Guest Author: Jennifer N. Clements, PharmD, BCPS, BCACP, CDCES, BC-ADM...

Is my patient’s forgetfulness due to dementia or diphenhydramine? In older adults, adverse drug events (ADEs) can often be misinterpreted and lead to the initiation of new medications, which carry their own risks of ADEs … that can be misinterpreted as a new problem … leading to even more medications being prescribed.  In this episode, our guests critically examine a study that identified a new pr...

Thiazide diuretics have been in clinical use for more than 60 years. Small studies published in the 1950s/60s reported that chlorothiazide had less diuretic and antihypertensive effect in patients with lower glomerular filtration rates which led to the belief that thiazides are ineffective in advanced CKD.  The Chlorthalidone in Chronic Kidney Disease (CLICK) Trial challenges this dogma. Guest Aut...

Traditionally, hypertension management involves a stepwise approach where agents are titrated and added. Thus, achieving optimal BP control requires close follow-up, time, and resources.  Outside of these logistics, providers are prone to clinical inertia (aka fail to advance therapy when they should) and sometimes “push back” from patients who experience the burdens of treatment and follow-up. Pe...

Despite prevention efforts, about 1 in 3 patients diagnosed with diabetes have comorbid CKD. Half of these individuals have moderate to severe disease. Unlike patients with type 1 diabetes where it develops after many years after the diagnosis, CKD is commonly present at diagnosis in patients with type 2 diabetes. While many interventions are available to prevent the progression of CKD, more are n...

More than half of women in the United States aged 15 to 49 years use a form of contraception. However, many women discontinue use during the first 12 months. Reasons for discontinuation include inconvenience, method failure, adverse effects, and cost. But another potential factor that is not as well-studied is the sexual acceptability of the contraceptive method. Guest Authors:  Katherine Harte, P...

Although guideline-directed medical therapy substantially improves morbidity and mortality in patients with heart failure with reduced ejection fraction (HFrEF), treatments that clearly improve outcomes in those with HF and an EF >40% remain elusive. Unfortunately, the incidence and prevalence of HF are expected to substantially increase in the coming decades.  More evidence and effective treatmen...

Continuous glucose monitors (CGMs) are now commonplace, and every clinician should know the basics about who can benefit from CGM use and how to address common questions and problems.  Authors:  Brianna Patacini, PharmD, BCACP, CDCES and Dawn Fuke, PharmD, BCPS Special Guest: Jennifer Trujillo, PharmD, BCPS, CDCES, BC-ADM Music by Good Talk