SenioRx Care Perspective

Transcription

1 CT-ASCP's SenioRx Care Perspective Inside: UCONN Student Chapter Update Page 2 New Choices for an Old Problem: Pages 3-5 Urinary Incontinence Medications in Overactive Bladder Notes n Votes August 2015 Page 6 Fall 2015 Volume II No. 3 SAVE THE DATES CT-ASCP Fall CE Webinar Paradigm Shifts: LTC and ACOs Speaker: Paul Listro Wednesday, October 21, pm (EST) Schwarting Senior Symposium 2016 Thursday, April 7, 2016 Aqua Turf Club, Plantsville, CT More details to follow Please help spread the word by forwarding to those you think may be interested. Connecticut Chapter of

2 ylan Girardi, Student Chapter Historian UCONN Chapter of ASCP Fall 2015 The fall semester has begun and UCONN ASCP is coming out of the gate running. In the first week we were able to strum up new interest in the organization amongst the incoming P1 class at the Get to know your Organization Ice Cream Social. This semester our biweekly meetings will continue to be held on Tuesdays between 4-5pm in the School of Pharmacy. Our chapter s executive board has changed dramatically this year with only one seasoned member remaining, it is comprised of: President - Amanda Mertz (P3), Vice President Christopher Vollono (P3), Treasurer Matt Merola (P3), Secretary Casie Holveck (P2), PSG Representative Oliver Kim P2, and Historian Dylan Girardi (P3). Even though the semester has just begun, we already have many events in the works including a few that are right around the corner. September The pharmacy career fair was a big success. We helped promote consultant pharmacy with members from the CT ASCP chapter. Immediately after the fair we also hosted a panel comprised of four active long-term care pharmacists who discussed and answered questions that students had about Consultant Pharmacy practice. To conclude the evening, CT ASCP held a chapter meeting in the school of pharmacy. These events were extraordinarily educational for the new members who are new to the concept of long-term care and ASCP as a whole. Our chapter is also participating in the Walk To End Alzheimer s that is taking place in Hartford on September 20, This year we are collaborating with the UCONN chapter of CPNP in order to increase the size of our team and the amount of funds we raise. If anyone is interested in helping support the Alzheimer s Association, we highly encourage you to visit their website at act.alz.org to find a walk happening near you or make a donation. October The countdown to the ASCP Annual Meeting has begun! This year we will be sending students to the local meeting in Boston as well as the national conference in Las Vegas! The conference is sure to be a hit this year with all of the amazing CE programs on the bill. We are also excited to attend the Halloween Masquerade Ball. Be sure to keep an eye out for our crowd pleasing costumes! November and Beyond Once again our chapter will be holding a What Not To Wear event for all Pharmacy and Pre-Pharmacy students in order to help them avoid making common fashion faux pas when interviewing. Student models will take to the stage in order to demonstrate what is both appropriate and inappropriate in a professional clinical setting. New events for our chapter include working with Hartford Hospital long term care affiliates Jefferson House and Hebrew Home. Our members are excited to help support the Music and Memory program that Hebrew Home has been running since last fall by collecting old ipods across campus. These devices will be used to enhance life by creating custom playlists for dementia patients who have a hard time socializing. For more Information about M&M programs visit their website at Finally, we are working on partnering with our colleagues at the URI chapter to organize a Zoom conference with consultant pharmacists and a few guest lecturers. More details to follow -- stay posted! As always, if there are any opportunities to shadow at various sites, participate in brown bag events, or volunteer for events that would allow our student chapter to further our continuing education in consultant pharmacy, including being part of our guest lecture series, we would greatly appreciate it. Please contact our chapter President, Amanda Mertz, at ascp.uconn@gmail.com if interested. Above: Consultant pharmacist panelists, Bob Tendler, Andrea Leschak, Anna Sampieri, and Mike Gemma presenting on Long-Term Care and Consultant Pharmacy at the University of Connecticut.

3 veractive Bladder uren Manganiello, PGY-2 Resident, Geriatrics VA Connecticut Healthcare System Urinary incontinence is a widespread medical condition that affects many elderly adults worldwide. Advanced age is a risk factor with incontinence estimated to occur in up to 30% of community-dwelling elderly adults and up to 50% of nursing home residents. 1 Non-pharmacologic interventions are often considered the gold-standard for treatment of many types of incontinence, however the frequency of pharmacotherapy use has been rising with the emergence of new antimuscarinic agents on the market. Antimuscarinic agents are currently the mainstay of pharmacotherapy for overactive bladder and urge urinary incontinence. Antimuscarinic medications work as competitive antagonists of acetylcholine at muscarinic receptors which allow for a relaxation of the bladder smooth muscle. In turn, this mechanism allows for suppression of premature detrusor muscle contractions which decreases urgency, frequency, and incontinent episodes in those with overactive bladder. was the first antimuscarinic agent to be used in clinical practice for the treatment of overactive bladder and is used for comparison in clinical trials. Despite demonstrating efficacy in reducing incontinence episodes, immediate-release formulations of oxybutynin have a limitation to use given risk of bothersome anticholinergic adverse effects including xerostomia, constipation, and confusion. Immediate-release formulations have an active metabolite, N-desethyloxybutynin (DEO), which is generated during first-pass metabolism and has been associated with a high incidence of adverse effects. extended-release products have been shown to have a decreased rate of adverse effects which may be due to bypassing first-pass metabolism and decreased DEO formulation. Transdermal and topical oxybutynin products allow for bypass of first-pass metabolism and a more tolerable adverse effect profile (although both carry a risk of application site reaction). 1 Alternative antimuscarinic agents have been developed to improve tolerability and decrease adverse effects while maintaining efficacy in reducing urgency and incontinence episodes. Overall, these agents have been shown to improve quality of life in patients with overactive bladder and are considered equally effective based on statistical superiority over placebo and/or active controls. Tolterodine is a competitive antimuscarinic agent available both in immediate and extended release forms which has also been associated with decreased discontinuation rates due to adverse effects when compared to oxybutynin. However, given its extensive CYP3A4 and 2D6 metabolism tolterodine has the potential to have a multitude of drug interactions. Fesoterodine is a pro-drug which has an active metabolite of tolterodine and requires dose adjustments given renal impairment or use with CYP3A4 inhibitors. Solifenacin and darifenacin were originally thought to be uroselective antimuscarinic agents, however, the available data does not indicate that these medications have reduced anticholinergic adverse effects. Solifenacin has dose reductions recommended when used with CYP3A4 inhibitors. Trospium is a second-generation antimuscarinic agent which does not readily cross the blood-brain barrier as it is hydrophilic. Therefore, trospium is hypothesized to have less CNS adverse effects. Overall, the newer anticholinergic agents have been shown to be efficacious in treating symptoms of overactive bladder and choice of agent should remain patient-specific. 2 In 2012, mirabegron gained FDA-approval for use in overactive bladder with a promising novel mechanism of action. Mirabegron is a B3 adrenergic agonist which allows for greater bladder relaxation during filling. This medication may offer an alternative treatment option for patients who are unable to tolerate an anticholinergic medication and/or who have cognitive impairment. The most common adverse effect with mirabegron is increased blood pressure and patients should use with caution in conjunction with CYP2D6 substrates and/or inhibitors. 3 Novel agents present a new opportunity for pharmacists to use knowledge of drug interactions, patient co-morbidities, and financial information to assist in the most appropriate medication choice for patients with overactive bladder. Pharmacists can continue to make patient-specific recommendations and provide education to health care team members along the way. As more data emerges, pharmacists can continue to lead conversations regarding use of antimuscarinic agents in the future.

4 uren Manganiello, PGY-2 Resident, Geriatrics VA Connecticut Healthcare System Summary Chart: Agents Utilized in Treatment of Overactive Bladder Medication (Generic) Darifenacin ER Fesoterodine ER immediaterelease extendedrelease 3% transdermal gel pump transdermal 10% packet 3.9mg transdermal patch Brand Name Enablex Toviaz Ditropan Ditropan L Starting Dose 7.5mg PO once 4mg PO once 5mg two or three times PO 5 to 10mg PO once Gelnique Apply 3 pumps (84mg) Oxytrol (OTC) OR if packets: Apply 1 packet Apply 1 patch twice per week Solifenacin VESIcare 5mg PO once Maximum Dose 15mg PO once 8mg PO once 5mg four times 30mg PO once Same as starting dose Same as starting dose 10mg PO once Comments -Dry mouth (20-35%) and constipation (14-21%) are most common AE s - CYP3A4 interactions (will require dose adjustment) -Reduced dose in moderate hepatic impairment, not recommended in severe impairment -Dry mouth (18-35%) and constipation (4-6%) are most common AE s - CYP3A4 interactions (will require dose adjustment) -Reduced dose in severe renal impairment -Not recommended in severe hepatic impairment -Dry mouth (71%) and constipation (15%) are common -Dizziness (17%) and somnolence (14.6%) can occur -Compliance may be difficult with multiple times/day dosing -Short duration may be helpful if only needed at certain times of the day -Although dry mouth (29%) and constipation (7%) are common, less likely than IR formulation -Better compliance with once dosing -Associated with low rates of dry mouth (9%) and constipation (3%) -Apply to clean, dry, intact skin on abdomen, thighs, or upper arms/shoulders -Keep area dry for at least 1 hour after application -Do not use same site more than once in 7 days -Application site reaction may occur including irritation and dermatitis (up to 14%) -Available without a prescription (OTC) in US for women -Associated with low rates of dry mouth (10%) and constipation (3%) -Apply under clothing to abdomen, hip, or buttock -Do not use same site more than once in 7 days -Application site pruritus (14 to 17%); local erythema - Dry mouth (11 to 28%) and constipation (5 to 13%) are common - Reduce dose for severe renal impairment or moderate hepatic impairment - Not recommended for severe hepatic impairment - CYP3A4 interactions (will need dose adjustment) -Modestly prolongs QTc interval; caution with other QTc prolonging drugs and in patients with congenital prolonged QT

5 uren Manganiello, PGY-2 Resident, Geriatrics VA Connecticut Healthcare System Medication (Generic) Tolterodine immediate release Tolterodine extended release Trospium immediate release Trospium extendedrelease Brand Name Detrol Detrol LA Sanctura Sanctura R Summary Chart: Agents Utilized in Treatment of Overactive Bladder Starting Dose 1mg twice 2mg once 20mg once 60mg once Mirabegron Myrbetriq 25mg once Maximum Dose 2mg twice 4mg once 20mg twice Same as starting dose 50mg once Comments - Dry mouth (23-35%) and constipation (6-7%) are common -Reduced dose for renal and/or hepatic impairment, not recommended for severe renal or hepatic impairment -Metabolized in liver by CYPs 3A4 and 2D6 Modestly prolongs QTc interval; caution with other QTc prolonging drugs and in patients with congenital prolonged QT -Take on empty stomach or 1 hour before meal -May have lowest risk of CNS adverse effects -Reduce dose for renal impairment, not recommended for severe renal impairment -Not metabolized by CYP = low risk of interactions -Avoid alcohol consumption within 2 hours of using extended -release preparation -Associated with less anticholinergic effects given novel mechanism of action -May exacerbate hypertension -Dose adjustment recommended in severe renal impairment and moderate hepatic impairment; not recommended in severe hepatic impairment References: 1. Cook K, Sobeski L. Urinary incontinence in older adults. Pharmacotherapy Self-Assessment Program: Special Populations. 2013; Rovner ES, Wyman J, Lam S. Chapter 68. Urinary Incontinence. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey L. eds. Pharmacotherapy: A Pathophysiologic Approach, 9e. New York, NY: McGraw-Hill; accesspharmacy.mhmedical.com/content.aspx?bookid=689&sectionid= Accessed August 17, Mirabegron. DRUGDE Micromedex 2.0. Truven Health Analytics, Inc. Greenwood Village, CO. Available at: micromedexsolutions.com CT-ASCP would like to send our congratulations to Amy Huie-Li for receiving her Fellowship into the American Society of Consultant Pharmacists (FASCP), Erica Estes from the University of Rhode Island on election to Region 1 Board of Directors, and Emalee Collins and Habib Doumit for obtaining CGP certification!

6 Kristina Niehoff, Pharm.D., BCPS, CT-ASCP Secretary / Treasurer ONSOR RECOGNITION onsorship: Jen Pyron (Novo Nordisk) VIEW OF PAST MINUTES e 6/1/15 minutes were reviewed and approved (BP, KN). APTER NEWS gislative: CMS is not paying for copays dual eligible Part D ticipants. ICD-10 codes should be used starting October 1, 2015 aws: M. Gemma will follow up with Jen Sharkey about bylaw isions. l Recruitment Events: CT Student Pharmacists: The Board is planning on moving forward with a booth at the UConn School of Pharmacy s Career Fair on September 16 th from 1-4pm. Following the Career Fair from 4-5pm, the board would like to have a have panel discussion to educate students about job opportunities for pharmacists in long term and post-acute care. M. Gemma will follow up with Jill Fitzgerald about having a table and finding a room for the post-career fair event. The board will plan on hosting a similar event at the University of Saint Josephs in the spring. CT Pharmacists and Student Pharmacists: The board discussed having a kickoff event in October for students and pharmacists throughout Connecticut at a central location. l Continuing Education The fall continuing education is being planned by B. Pelletier. The CE credit will be a law credit about ACOs and will possibly be in a Webinar format. B. Pelletier is currently looking for a speaker. te and Federal Employees: In an effort to include all state and federal employees in our CT ASCP meetings, the board voted in favor of paying for dinner at the monthly meetings for Board of Director members or committee members. Any other state or federal employee that wants to come to the meeting, must be pre-approved by the board in order for the chapter to sponsor that individuals dinner. A board of directors member will pay for the dinners and then be reimbursed by the chapter. B. Pelletier gave the first motion and A. Leschak gave the second motion. The board voted unanimously. S16: The potential schedule was distributed for discussion. The board discussed Al Power as a potential speak for SSS16. His speaking fee is $5,000 plus travel. B. Pelletier will negotiate for lowest possible rate. The committee members will be sent a disclosure form to fill out and return. Education: Brian Pelletier, Andrea Leschak Volunteer Committee: Kim Daley, Amy Huie-Li, Lauren Manganiello, Anna Sampieri Vendors: Dave Cooper Passport: Amy Huie-Li Other committee members: Bob Tendler, Beth Esstman, Kevin Chamberlin ONN/USJ NEWS onn has a new Dean of the pharmacy school. J. Fitzgerald will be nding the AACP Leadership Fellows Program. R. Eyler had a baby. USJ has a new Assistant Dean and classes start on August 17 th. This l be the first year that USJ has representation at the National Kappa Psi ference. MEMBER NAME & TITLE July August Septembe Mike Gemma President / Legislative Committee Kevin Chamberlin Immediate Past President Brian Pelletier President Elect Kristina Niehoff Secretary / Treasurer Kim Daley Board / Communication Committee Anna Torda, Board / Communication Committee Rachel Eyler Board Andrea Leschak Board / SS Committee Karen Rubenfeld Board Anna Sampieri Board Meeting adjourned at 7:40pm. Next Meeting: 9/14/15 at 5:30pm at TBD (sponsored by Actavis) Respectfully submitted, Kristina Niehoff, PharmD, BCPS CT-ASCP Secretary/Treasurer Guests: Mark Wrabel, Amy Huie-Li, Bob Tendler, Kevin Chamberlin, Roma Patel, Thuy Trang Bui, Lauren Manganiello, Beth Esstman, Macayla Landi, Melissa Striglio, Amanda Sihabout, Gresa Ajeti Editorial Board Amy Huie-Li, PharmD, CGP, FASCP Anna Torda, PharmD Kim Daley, PharmD Kevin Chamberlin, PharmD Brian Pelletier, PharmD, CGP Kristina Niehoff, PharmD, BCPS Jennifer Kloze, PharmD, BCPS