iForumRx.org

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 Cantrell, PharmD, BCPS

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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

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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 not be as effective?

Guest Authors: Taylor M. Benavides, PharmD, BCPS and Elizabeth B. Hearn, PharmD, BCACP

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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 play a critical and positive role in the lives of people with COPD by encouraging lifestyle changes, administering vaccines to immunize against respiratory illnesses, ensuring proper inhaler technique, and assisting with medication access.

Panelists:  Melissa Lipari, PharmD, BCACP; Thomas Levi Lancaster, PharmD, BCACP, BC-ADM; and Rachel Basinger, PharmD, BCACP, CTTS, DipACLM

Produced by  Rebecca Khaimova, PharmD, BCACP, CDCES and Anna K Love, PharmD, BCACP

Music by lemonmusicstudio from Pixabay

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 Authors:  Benjamin King, PharmD, BCACP, Amber Lilly, PharmD, and Jordan Cloonan, PharmD

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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 Nigro, PharmD, BCACP, CDCES

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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

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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.

Guest Authors: Mary Eva McClure, PharmD and Tavajay Campbell, PharmD, BCACP, CDCES

Guest Expert:  Michael Brodeur, PharmD, BCGP

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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, PharmD, BCACP

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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 associated with early implementation of SDOH screening in primary care.

Guest Author: Sharmon P. Osae, PharmD, BCACP, CDCES

Music by: Good Talk