Weekly Pharmacy Updates
provided by Paula Straub, RPh, Precision Healthcare Delivery
Medication Adherence Tip of the Week-Encourage your patients to use only one pharmacy. This way the pharmacy can help manage refills and check for drug interactions. Many pharmacies now can help your patients align refill dates so that they can pick up medications at the same time each month.
Pharmacy Update- Generic Releases
Aripiprazole Orally disintegrating tablet 10mg, 15mg
Generic now available
Generic now available
Generic now available
Generic now available
Medication Adherence Tip of the Week- Medication adherence is key to improving patients' confidence to manage their illness, improving clinical outcomes, and lowering utilization. Asking the right questions can make a real difference in your practice.
Here is some advice for discussion:
1. Be aware of the tendency to use medical jargon. Instead of saying, “This will treat your hypertension,” say, “Let's try this for your high blood pressure.”
2. Don't judge. Instead of saying, “Why aren't you taking your metformin?” say, “I'm curious to know what happens when you take your metformin.”
3. Be aware of costs. Most patients are hesitant to say they can't afford a medication, so ask the patient to get back to you if the copayment or cost is too high.
4. Look for underlying conditions. For example, patients who are depressed rarely take their medications, so consider treating the depression first.
5. Be clear about the benefit of the medicine. For example, you might say, “If you take your diabetes medicines and control your blood sugar, you may not need to have your eyeglass prescription changed as often.”
Pharmacy Update- A series of articles in the Journal Dermatologic Clinics reviewed prescribing patterns on acute and long-term acne treatments to identify trends. The study authors from Rutgers University of Medicine have acknowledged that acne is an inflammatory, not infectious condition which has led to a call for reduction in antibiotic use. This has caused for a re-evaluation of the highly efficacious combination topical therapy. The study points out that, in patients using topical and oral antibiotics:
- An increase of bacteria in the back of the throat and tonsils compared with nonusers was three times more likely
- Long-term use of antibiotics in acne treatment is associated with an increase in upper respiratory infections and skin bacteria; and
- Glucose levels are affected by long-term antibiotic therapy.
Overuse of antibiotics can also promote the growth of resistant bacteria thus making treatment more challenging. To address these problems, there has been renewed interest in using benzoyl peroxide. The study authors also suggest that, in severe acne, early intervention with retinoid isotretinoin is effective without antibiotics. The researchers do expect the use of antibiotics to continue at some level. But antibiotics should be used as a supplement with benzoyl peroxide or a topical retinoid for moderate-to-severe cases of inflammatory acne. Studies have shown that these combination treatment regimens are fast and effective and help to reduce the development of resistant strains of bacteria that causes acne, but the CDC recommends that antibiotics be used for a maximum of six months.
Medication Adherence Tip of the Week- The Give and Take of Medication Adherence
50% of patients do not take their medicines as prescribed. What can we as providers do about this? Anyone taking less than 80% of prescribed medicines would be considered non-adherent. Sometime patients will be adherent to several medications and not adherent to one or two of them. It’s not an “all-or-none” issue. As providers you shouldn’t expect perfection. But you need to recognize that medication adherence can sometimes be a tough thing to discover. Some patients are stating that they’re honest about their medication-taking behavior; however, as providers we need to recognize that there’s a “white-coat adherence.” Patients may be adherent a week before they come to your office so they can say, “yes I am taking my medication as prescribed.” Look for clues for non-adherence. Patients may have suboptimal critical outcomes, such as uncontrolled A1C, blood pressure or lipid profiles. Other clues could be those patients that are “frequent flyers” when it comes to hospital admissions or readmissions, or patients that miss their appointments and follow-ups. Patients with psychological stressors, anxiety disorders, a history of depression and even low health literacy are clues for further investigation.
Pharmacy Update-Safety of long-term use of PPIs
- Proton pump inhibitors (PPIs), which are used for treatment of gastroesophageal reflux disease (GERD) and for prevention of upper gastrointestinal adverse effects caused by NSAIDs and aspirin, are one of the most commonly prescribed classes of drugs in the US. Al PPIs are similarly effective and are generally well tolerated, but their long-term use as been associated with a number of safety concerns. These concerns are related to the suppression of gastric acid secretion namely: Clostridium difficile infection
- Pneumonia, Osteoporotic fractures and Rebound acid hypersecretion. PPIs have revolutionized the management of acid-related diseases. There is strong evidence supporting their superior efficacy and overall safety profile. Unfortunately, this has also led to their overuse and inappropriate use. When used appropriately, the overall benefits significantly outweigh the potential risks in most patients. Almost half of all patients taking a PPI do not have a clear indication. Nearly all adverse effects associated with PPIs occur among patients who receive long-term therapy. Through effective counseling providers can ensure that PPI use is associated with appropriate indications utilizing the lowest effective dose for the shortest duration possible.
Medication Adherence Tip of the Week-It is important to provide communication and trust when discussing medication adherence with your patients. Allow your patients to speak freely. Time is of the essence, but research shows that most patients will talk no longer than 2 minutes when given the opportunity. Use plain language when speaking with patients. Say, “Did you take all of your pills?” instead of using the word “adherence.” Ask for patients’ input when discussing recommendations and making decisions. Remind patients to contact your office with any questions.
Pharmacy Update-The FDA has approved an expanded indication for Lyrica (pregabalin) oral capsules and oral solution for adjunctive therapy for the treatment of partial-onset seizures in patients 1 month and older. Lyrica was previously approved for this indication in patients 4 years and older. Lyrica is also indicated for management of postherpetic neuralgia, fibromyalgia, neuropathic pain associated with diabetic peripheral neuropathy, and neuropathic pain associated with spinal cord injury.
Medication Adherence Tip of the Week-Prescribing generic medications can improve compliance. Multiple studies have shown that cost is an important factor leading to lower adherence. A more affordable generic medication that is taken regularly is more effective than a brand name medication that is not. Recommend use of mail order if cost is an issue because your patients can save money on copays.
Pharmacy Update-The FDA has approved AstraZeneca’s Qternmet XR (dapagliflozin/saxagliptin/metformin hydrochloride) extended-release oral tablets as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus.