INNOVATIONS in pharmacy

Angiotensin-Neprilysin Inhibitor Therapy: A Retrospective Chart Study

2024-10-29T10:42:02-05:00

Background: Guideline-directed medical therapy in patients with systolic heart failure (HF) has demonstrated improvement in morbidity and mortality rates. The FDA approved sacubitril/valsartan in 2015 to reduce the risk of cardiovascular death and hospitalization for HF. Objective: The purpose of this study was to evaluate the change in loop diuretic dose and the clinical outcomes of angiotensin receptor-neprilysin inhibitor (ARNI) therapy within a 90-day follow-up period.

Methods: A retrospective chart review of 110 HF patients on concomitant ARNI and loop diuretic therapy at New York University Langone Health was conducted. The primary endpoint was a change in loop diuretic dose. Six secondary endpoints, including dose conversion from ACEi or ARB to ARNI therapy, were assessed.

Results: Of the 110 HF patients, 72 did not receive diuretic dose adjustments, yet 40 (55.56%) experienced laboratory-dependent dehydration. Fifty-six percent of patients experienced an improvement in systolic blood pressure, and 52 percent experienced a decrease in diastolic blood pressure. Sixty percent of patients experienced an improvement in EF, with a median increase of 10.00% over a 90-day follow-up. A significant negative correlation between patients’ age and absolute change in EF was identified (r= -0.28; p < 0.05), indicating that the increase in EF was stronger for younger patients. Eighteen hospitalizations occurred within a 90-day follow-up, with only 4 patients being admitted for heart failure exacerbation.

Conclusion and Relevance: This study examines the real-world effects of ARNI therapy in patients with systolic heart failure. Optimization of HF medications, including ARNI therapy, remains an important factor for achieving the maximum benefits in heart failure management. ARNI therapy requires careful monitoring to ensure effective diuresis in symptomatic heart failure patients while avoiding adverse events. Future studies should address diuretic dose adjustment in conjunction with the administration of ARNI and sodium-glucose cotransporter-2 inhibitors.

Call for Papers - Advancing Astropharmacy and Sports Pharmacy

2025-01-22T02:36:46-06:00

Ashley Anderson R.Ph., IOC-Drugs in Sport, (sportspharmacists@gmail.com)

Ashley Anderson, B.S.Pharm, MBA, International Olympic Committee-Drugs in Sport Certificate is a clinical pharmacist at an acute care hospital, working in general practice and also specializes in Clincal Sports Pharmacy. Ms. Anderson received her pharmacy degree from Butler University and completed studies in herbal medicine in Zhejiang China during and after pharmacy school. From 2006 until 2021, Ms. Anderson worked for the US Anti-Doping Agency, answering calls on the Drug Reference Line, creating drug information materials for elite athletes and the public, and leading the ingredient management for the search engine called Global DRO. Ms. Anderson has been a thought leader in Sports Pharmacy Integrity and is the founder of the International Sports Pharmacists Network, creator of the University of Southern California Sports Pharmacy curriculum, and was the lead content contributor and editor for the FIP global report on Sports Pharmacy.

Ahmer Raza R.Ph., (ahmerraza313@yahoo.com)

Ahmer Raza, Pharm.D., MPharm., is a Ph.D. student in Clinical Pharmacy, actively contributing to the I-CARE4OLD project—an EU-funded initiative. His research focuses on developing an innovative decision-support AI tool for personalized care aimed at optimizing treatments, enhancing the quality of life for individuals with chronic complex conditions, improving the overall quality of care, and reducing societal healthcare costs. In addition to his work in clinical pharmacy, Ahmer is passionately advancing the concept of Astropharmacy in collaboration with experts from the University of Minnesota, exploring the unique challenges and opportunities of pharmaceutical care in space exploration. He is dedicated to pushing the boundaries of pharmacy science by bridging clinical innovations with futuristic domains like Astropharmacy, while also advocating for the establishment of specialized Space Pharmacy Council and research frameworks to support these emerging fields.

Shireen Aziz R.Ph., (shireenaziz1994@yahoo.com)

Shireen Aziz, Pharm.D., MS Pharmacology, is a Ph.D. student in Clinical Pharmacy actively contributing to the I-CARE4OLD project. Her research interest are on pharmacokinetic and pharmacodynamic (PKPD) changes in space, drug stability under space conditions, and the effects of the space environment on human physiopharmacology. In addition to her clinical pharmacy research, Shireen is actively working on advancing the concept of Astropharmacy, exploring innovative pharmaceutical solutions for long-duration space missions and extraterrestrial environments. Her work aims to bridge the gap between terrestrial pharmacology and space medicine, contributing to the development of specialized guidelines and frameworks for pharmaceutical care in space exploration. With a vision for groundbreaking advancements, she collaborates with international experts to establish Astropharmacy as a transformative field in pharmacy and space research.

Misbah Noreen R.Ph., (misbahshah101@gmail.com)

Misbah Noreen is a pharmacist with a strong foundation in Biomedicine. Her research interests focus on understanding PKPD changes in extreme environments, such as space, and exploring how these changes influence drug efficacy and safety. She is actively working on addressing the challenges of medication stability in space and investigating the physiological effects of the space environment on drug metabolism and action. Misbah is also contributing to the advancement of the emerging field of Astropharmacy, collaborating with global experts to explore innovative pharmaceutical practices and regulatory frameworks for space missions. With her strong interdisciplinary approach, she is passionate about bridging gaps between clinical pharmacy and novel frontiers like space medicine. She aims to contribute to the global pharmacy profession by shaping innovative pharmaceutical practices that can adapt to diverse and challenging environments.

Evaluating the Effect on Total Daily Insulin Dose in Adult Patients with Type 1 Diabetes Managed with Metformin and/or GLP-1 or GLP-1/GIP Receptor Agonists

2024-11-14T09:07:39-06:00

Purpose:

There are few studies that have assessed the utility of metformin and glucagon-like peptide-1 receptor agonists (GLP-1 RA) in type 1 diabetes (T1D), specifically looking at glucose control indices. These studies have largely evaluated the impact of agents not routinely used. Limited data exist on the use of the dual glucagon-like peptide-1/glucose-dependent insulinotropic polypeptide receptor agonist (GLP-1/GIP RA) in T1D. The objective of this study was to evaluate the effect of this growing practice in utilizing these common non-insulin therapies in T1D.

Methods:

This single-center, retrospective cohort study evaluated adult patients with T1D who received standard insulin therapy plus the following non-insulin therapies for at least 3 months: metformin; GLP-1 RA or GLP-1/GIP RA; or metformin and a GLP-1 RA or GLP-1/GIP RA (combination group). Data points were collected on starting dates of the first and second (if applicable) non-insulin agents, and the first office visit of at least 3 months on maximum tolerated doses. The primary endpoint was change in total daily insulin dose (TDD). Secondary and safety endpoints were evaluated in A1c, weight, and hypoglycemia.

Results:

A total of 110 of 366 patients met inclusion criteria. Changes in average insulin TDD were +4.06, -5.9 and -6.9 units for the metformin, GLP-1RA or GLP-1/GIP RA, and combination groups respectively (P =0.013). TDD after non-insulin therapy addition decreased in all patients on average 3.54 units (P =0.02). All groups saw significant decrease in A1c by 0.62%, weight by 3.8kg, and hypoglycemia was seen in 76% of patients.

Conclusions:

Non-insulin therapies added to standard insulin therapy in T1D resulted in decreased insulin requirement, increased glycemic control, and decreased body weight. While statistically significant, it remains unclear if the decreased insulin requirement is clinically significant. Further prospective studies are warranted to validate these findings.

Implementation and Evaluation of a Long-Term Care at Home (Home LTC) Service in a Rural Community Pharmacy Setting

2024-12-05T10:09:50-06:00

Background: The majority of older Americans are expected to need some level of institutional long term care. Community pharmacies are positioned to delay this need by supporting medication management. There are potential mechanisms for pharmacists to deliver long term care at home (Home LTC) services and bill insurers for services that may delay the transition to a higher level of care.

Objectives: This project aims to evaluate the implementation of a community pharmacy delivered Home LTC service in a rural community. The objectives were to: 1) describe implementation and challenges of pharmacy-provided HOME LTC services, 2) attempt billing for Home LTC services, 3) describe pharmacist clinical interventions including drug therapy problems (DTPs) and 4) measure patient/caregiver satisfaction with the service.

Methods: This was a pilot evaluation of a community pharmacist delivered intervention. Patient eligibility requirements include taking 6+ medications, having 3+ chronic conditions, and having 2+ limitations in activities of daily living (ADLs). All participants received a comprehensive medication review. Pharmacy staff prepared medications in monthly adherence packaging and delivery was offered. Home visits were performed by the pharmacist as needed. A post study survey assessed satisfaction and invited suggestions for improvement. Patient characteristics, DTPs, interventions, reimbursement attempts and amounts, and survey responses were documented, and analyzed descriptively.

Results: Fourteen patients were enrolled in the study - 3 living in a group home and 7 were already receiving adherence packaging. All 14 patients received at least 1 clinical intervention, and 4 home visits were conducted. Seven patients (50%) completed the satisfaction survey and reported universally high satisfaction with the service elements.

Conclusion: Overall, implementing a HOME LTC service was successful, however, the pharmacy failed to be reimbursed for service elements, including adherence packaging. Patients were satisfied with the service. Bridging the reimbursement gap is critical to sustainably provide patients with this desired service.

Influenza Vaccination Rates, Perceptions, and Vaccine Hesitancy in K-12 Teachers and Staff

2024-08-15T19:29:04-05:00

BACKGROUND: Vaccination misinformation can contribute to vaccine hesitancy and decreased vaccination. Previous immunization events at various K-12 schools carried out by Idaho State University L.S. Skaggs College of Pharmacy have noticed a small turn out of teachers and staff getting immunized during these events. Given the prominent role that teachers/staff serve in communities, we surveyed K-12 teachers and staff to determine their perceptions, knowledge, and reasons surrounding vaccine hesitancy. Our survey focused on the influenza vaccine, but also inquired about vaccine knowledge in general.

METHODS: A Qualtrics survey was distributed online throughout the West Ada School District, located in southwestern Idaho. Demographics, receipt of vaccine, influenza vaccination motivation, knowledge and reasons for hesitancy were collected. Surveys were distributed July 2020 and analyzed using descriptive statistics. Response differences between those who most recently received their influenza vaccine and those who did not were also compared using chi-square or Mann-Whitney U tests when appropriate.

RESULTS: A total of 503 surveys were completed, with all respondents college educated and teaching throughout the K-12 curriculum. A majority of respondents (n=409;81%) received a yearly influenza vaccination. Reasons for vaccination included: avoidance of flu, reduction of spread, and prevention of complications. Reasons against vaccination included: lack of efficacy, side effects, and numerous “other” responses. When comparing general influenza vaccine knowledge between those who received their influenza vaccine vs. those that did not, those who had been vaccinated displayed responses that more closely coincided with scientific data.

CONCLUSIONS: The majority of surveyed K-12 teachers/staff received their influenza vaccine during the 2019-2020 season. However, ~20% of teachers/staff are still hesitant due to misinformation regarding vaccinations. Resources and partnerships between health organizations and school districts may increase vaccine acceptance.