The Omnicare HealthLine
|
|
- Gervase Jones
- 6 years ago
- Views:
Transcription
1 The Omnicare HealthLine Inside This Issue 1-3 Focus on the 2017 ADA Diabetes Guidelines 4 Dosing Considerations for Newer Oral Anticoagulants 5 Clinical Capsule: Adverse Effects of Select Antidiabetic Medications in Older Persons 5 Regulatory Recap 6 New Drug Eucrisa 6 New Generic Medications 7 HealthLine Quiz February 2017 Focus on the 2017 ADA Diabetes Guidelines for Older Persons - by Allen Lefkovitz Type 2 diabetes mellitus (DM2) is estimated to affect 29.1 million Americans and is currently the seventh leading cause of death. It is estimated that 25.9% of older adults (65 years and older), representing 11.8 million individuals, have DM2, which means that 40.5% of all cases of DM2 involve older adults. Each year, the American Diabetes Association (ADA) releases guidance to patients and healthcare professionals with the components of diabetes care, general treatment goals, and tools to evaluate the quality of care. Entitled The Standards of Medical Care in Diabetes, hereafter referred to as the 2017 Standards, this annual report is available free at: The number of recommendations specific to older adults increased from 12 to 14 in Also, the strength of supportive evidence improved from expert consensus or clinical experience (Grade E) to supportive evidence from poorly controlled or uncontrolled studies (Grade C) for 5 of these recommendations (where grade A evidence is the strongest and grade E evidence is the weakest). This article provides an overview of selected recommendations (new and ongoing) from the 2017 Standards that impact the care of older adults with DM2. Glycemic Targets and Hypoglycemia Hypoglycemia should be avoided in older adults with diabetes. It should be assessed and managed by adjusting glycemic targets and pharmacologic interventions. (Grade B) Management of diabetes in the longterm care (LTC) setting (i.e., nursing homes and skilled nursing facilities) is unique. - American Diabetes Association (2017) Antidiabetics are the 3rd most common drug class and insulin is the 2nd most likely drug to result in an emergency department visit due to an adverse drug event. The most recent estimate is that approximately 282,000 emergency room visits occur each year due to hypoglycemia. A noteworthy change in the 2017 Standards involves the revised definition and classification of hypoglycemia as outlined in the table below. Classification Glycemic Criteria Description Glucose Alert Level 70 mg/dl Sufficiently low for treatment with fastacting carbohydrate and dose adjustment of glucose-lowering therapy Clinically Significant Hypoglycemia < 54 mg/dl Sufficiently low to indicate serious, clinically important hypoglycemia Severe Hypoglycemia No specific value Hypoglycemia associated with severe cognitive impairment requiring external assistance for recovery Within their Choosing Wisely document, the American Geriatrics Society s (AGS) recommendation is to Avoid using medications other than metformin to achieve hemoglobin A1c < 7.5% in most older adults. In their explanation of this recommendation, the AGS goes on to say Reasonable glycemic targets would be % in healthy older The Omnicare HealthLine Page 1 of 7
2 The Omnicare HealthLine 2 adults with long life expectancy, % in those with moderate comorbidity and a life expectancy < 10 years, and % in those with multiple morbidities and shorter life expectancy. Glycemic goals for some older adults might reasonably be relaxed using individual criteria, but hyperglycemia leading to symptoms or risk of acute hyperglycemic complications should be avoided in all patients. (Grade C) Patients with diabetes residing in long-term care facilities need careful assessment to establish glycemic goals and to make appropriate choices of glucose lowering agents based on their clinical and functional status. (Grade E) Overall, relaxed goals are suitable for many elderly patients. The graphic below is intended to assist in individualizing glycemic goals for elderly diabetics. An awareness of factors such as an individual s risk of hypoglycemia, life expectancy, and how long they have been diabetic, can impact dramatically the establishment of glycemic goals, such as the A1c. However, as recommended by the ADA, if an older adult is cognitively and functionally intact and if they have a significant life expectancy, they may receive diabetes care with goals similar to those developed for younger adults. More Stringent A1c 7% Less Stringent Risk of hypogycemia and other drug adverse events Low High How long have they been diabetic? Newly diagnosed Long-standing Life expectancy Long Short Relevant comobidities Absent Few/mild Severe Established vascular complications Absent Few/mild Severe Adapted from ADA Standards of medical care in diabetes Diabetes Care 2017; 40(1):S53 For more information on the risk of hypoglycemia with common drugs for DM2, please refer to the Clinical Capsule on page 5. Considerations in Treatment of DM2 Although the focus of this article is not the pharmacological treatment of diabetes, two new recommendations in the 2017 Standards are worth mentioning. The first new recommendation is actually included twice in the 2017 Standards: within the Prevention or Delay of DM2 section and the Pharmacologic Approaches to Glycemic Treatment section. This duplication may be understood by remembering that metformin is the preferred initial pharmacologic agent for DM2. Long-term use of metformin may be associated with biochemical vitamin B12 deficiency, and periodic measurement of vitamin B12 levels should be considered in metformin-treated patients, especially in those with anemia or peripheral neuropathy. (Grade B) The second new recommendation was based upon two larger clinical trials involving oral Jardiance (empagliflozin) or injectable Victoza (liraglutide). As indicated in the 2017 Standards Ongoing studies are investigating the cardiovascular benefits of other agents in these drug classes. In patients with long-standing suboptimally controlled type 2 diabetes and established atherosclerotic cardiovascular disease, empagliflozin or liraglutide should be considered as they have been shown to reduce cardiovascular and all-cause mortality when added to standard care. (Grade B) The Omnicare HealthLine Page 2 of 7
3 The Omnicare HealthLine 3 Although not a new recommendation, the 2017 Standards emphasize education for long-term care facility staff. Consider diabetes education for the staff of long-term care facilities to improve the management of older adults with diabetes. (Grade E) Areas of management that should be included in this recommended education are not clearly delineated in the 2017 Standards, but should likely include: How to detect symptoms of DM2 Policies and procedures for preventing hypoglycemia Policies and procedures for managing hypoglycemia Timely reporting of out of range blood glucose values detected during routine monitoring or symptoms that may indicate a hyperglycemic crisis Nutritional considerations (e.g., individual diets, how to report decreased intake) How to provide preventive and routine eye, foot, and oral care Comorbid Conditions Associated with DM2 In addition to recommending an overall assessment of medical, mental, functional, and social geriatric domains, since 2015 the Standards have specifically recommended depression screening, and in the 2017 Standards the ADA newly recommends a routine assessment for cognitive impairment. Annual screening for early detection of mild cognitive impairment or dementia is indicated for adults 65 years of age or older. (Grade B) Older adults ( 65 years of age) with diabetes should be considered a high priority population for depression screening and treatment. (Grade B) In addition to mental health-related recommendations, the 2017 Standards continue to address cardiovascular health by including 2 recommendation that focus on enhancing cardiovascular health. Treatment of hypertension to individualized target levels is indicated in most older adults. (Grade C) Treatment of other cardiovascular risk factors should be individualized in older adults considering the time frame of benefit. Lipid-lowering therapy and aspirin therapy may benefit those with life expectancies at least equal to the time frame of primary prevention or secondary intervention trials. (Grade E) The reason for individually addressing hypertension at a higher grade of evidence is because There is strong evidence from clinical trials of the value of treating hypertension in older adults. However, blood pressure targets, like glycemic control targets, have been relaxed to minimize the risk of hypotension, which can result in orthostasis and falls. End of Life Considerations for Individuals with DM2 Palliative care and end of life recommendations, which are particularly pertinent in the long-term care environment, remain the same. Overall comfort, prevention of distressing symptoms, and preservation of quality of life and dignity are primary goals for diabetes management at the end of life. (Grade E) When palliative care is needed in older adults with diabetes, strict blood pressure control may not be necessary, and withdrawal of therapy may be appropriate. Similarly, the intensity of lipid management can be relaxed, and withdrawal of lipid-lowering therapy may be appropriate. (Grade E) The Omnicare HealthLine Page 3 of 7
4 The Omnicare HealthLine 4 Medication Safety by Yamini Shah Dosing Considerations for Newer Oral Anticoagulants A number of new or novel oral anticoagulants have been approved by the Food and Drug Administration (FDA) since These include: Pradaxa (dabigatran), Xarelto (rivaroxaban), Eliquis (apixaban), and most recently, Savaysa (edoxaban). In December 2016, Steinberg et al. published results of an analysis that included more than 5,000 adults treated with one of the three newer oral anticoagulants for stroke prevention in nonvalvular atrial fibrillation. Almost 1 of 8 patients treated with Pradaxa (dabigatran), Xarelto (rivaroxaban), or Eliquis (apixaban) received doses other than those recommended in the FDA-approved labels (or off-label doses). Approximately, 9% of patients received a dose lower than that recommended by the FDA-approved labeling (e.g., underdosed) and 3% received a dose higher than the FDA-approved labeling (e.g., overdosed). Relative to those patients whose doses were consistent with the FDA-approved label, patients who received off-label doses were significantly older in age (median 79 and 80 years of age vs. 70 years of age, respectively; p < ). In the study by Steinberg et al., underdosing was associated with an increased risk of cardiovascular hospitalization. Receiving doses higher than those recommended in the FDA-approved labeling was associated with nearly double the rate of increased all-cause mortality. Among patients taking: Pradaxa (dabigatran), those with an estimated creatinine clearance (CrCl) of 30 ml/minute to 50 ml/minute had the highest rates of off-label dosages: 23% were underdosed (recommended dosage is 150 mg twice a day*). Xarelto (rivaroxaban), those with a CrCl of 15 ml/minute to 50 ml/minute had the highest rates of off-label dosages: 34% were overdosed (recommended dosage is 15 mg once daily*). Eliquis (apixaban) with 2 or more of the following (age 80 years, body weight 60 kg, or serum creatinine 1.5 mg/dl): 21% were overdosed (recommended dosage is 2.5 mg twice daily*) *FDA recommended dosing is for stroke prevention in nonvalvular atrial fibrillation. Dosing for other indications and CrCl may vary. The reasons for prescribing of lower than recommended doses may be related to concerns about adverse events, particularly bleeding. Prescribing doses higher than those recommended by the FDA may represent lack of awareness of approved dosing recommendations, lack of awareness of dosing variation based on indication and renal function (and in some cases, age and weight), unnoticed drug interactions, or variability in calculating creatinine clearance. The American Geriatrics Society s Beers Criteria provides additional recommendations for the reduction in dose or avoidance of anticoagulants due to an increased risk of bleeding in patients 65 years of age with renal impairment and/or clinical trial exclusion criteria. Avoid Pradaxa (dabigatran), Xarelto (rivaroxaban), or Savaysa (edoxaban) if CrCl < 30 ml/minute. Avoid Eliquis (apixaban) if CrCl < 25 ml/minute. Reduce dose of Xarelto (rivaroxaban) and Savaysa (edoxaban) if CrCl is 30 ml/minute to 50 ml/minute. The Beers Criteria also suggest using Pradaxa (dabigatran) with caution in patients 75 years of age due to an increased risk of gastrointestinal bleeding compared with certain other oral anticoagulants. Other renal, age, and weight dosing considerations for Savaysa (edoxaban) based on the FDA-approved labeling are: Avoid Savaysa (edoxaban) if CrCl > 95 ml/minute for nonvalvular atrial fibrillation because of decreased efficacy (e.g., increased risk of ischemic stroke compared to warfarin at the highest dose studied); use another anticoagulant. Reduce Savaysa (edoxaban) dose if body weight 60 kg for treatment of deep vein thrombosis and pulmonary embolism. The Omnicare HealthLine Page 4 of 7
5 The Omnicare HealthLine 5 The Clinical Capsule by Kori Hauersperger Adverse Effects of Select Antidiabetic Medications in Older Persons Medication Sulfonylureas (e.g., glyburide) Biguanides (i.e., metformin) DPP-4 Inhibitors (e.g., Tradjenta, Januvia) SGLT2 Inhibitors (e.g., Invokana) Insulin Risk of hypoglycemia, other adverse effects Moderate to high risk of hypoglycemia; Not recommended in older adults Decreased renal/hepatic function, inconsistent food intake and insulin use increase risk for hypoglycemia Low risk of hypoglycemia; Recommended as first line therapy in older adults Frail patients at risk for GI distress/weight loss; titrate slowly and monitor weight. Avoid in CrCl < 30 ml/min Low risk of hypoglycemia; Recommended as second line or add-on therapy Frail patients may be at risk for GI distress but less than metformin. No renal dose adjustment required for linagliptin Low risk of hypoglycemia; Not recommended in older adults Risk of dehydration, weight loss, and genitourinary tract infections. Monitor for hypotension and dizziness High risk of hypoglycemia Begin with basal, avoiding prandial coverage if possible due to increased complexity and hypoglycemia risk GI = gastrointestinal; CrCl = creatinine clearance; DPP = dipeptidyl peptidase; SGLT2 = sodium-glucose contransporter 2 Standards of Medical Care in Diabetes 2017 available at care.diabetesjournals.org. Drug information available at Regulatory Recap: CMS Adverse Event Trigger Tool: Toxicity Related to Angiotensin-Converting Enzyme Inhibitors - by Carrie Allen Angiotensin-converting enzyme inhibitors (ACEI) are used frequently in the long-term care setting (e.g., lisinopril). The CMS Adverse Event Trigger Tool focuses on 3 ACEI associated adverse drug events (ADE): hyperkalemia, angioedema, and acute kidney failure. The table* below lists selected risk factors, signs and symptoms, and specific documentation related to this issue. Risk Factors for ADE with ACEI Signs and Symptoms Documentation Congestive heart failure Impaired renal function Dehydration Hypersensitivity to ACEI Concurrent use with: Diuretics NSAIDs Anticoagulants Cyclosporine Potassium supplements Elevated potassium levels Fatigue, weakness, or nausea Dizziness, syncope Headaches Slow, weak, or irregular pulse Abnormal heart rhythm Angioedema Swelling of soft tissues Shortness of breath, wheezing Persistent non-productive cough Acute Kidney Failure Elevated BUN/creatinine and/or reduced/absent urine output Swelling of feet/legs Nausea/vomiting, anorexia Flank pain Is there evidence of a system to ensure: changes in condition are identified and assessed promptly, including an assessment of medications? serum potassium, BUN, and creatinine levels are drawn routinely? lab results are appropriately communicated to the physician including when panic values are obtained? For residents with risk factors for drug toxicity, does the care plan reflect interdisciplinary monitoring for signs/ symptoms of adverse drug reactions? * This table is not all-inclusive; refer to the CMS Adverse Event Trigger Tool and relevant clinical references for more information. Multiple risk factors increase the risk of an ADE occurring. The Omnicare HealthLine Page 5 of 7
6 The Omnicare HealthLine 6 NEW Drug by Dave Pregizer Eucrisa Ointment Brand Name (Generic Name) How Supplied Therapeutic Class Approved Indication Usual Dosing Select Drug Interactions Most Common Side Effects Miscellaneous Website Eucrisa [you-kris-a] (crisaborole) [kris-a-bor-ole] 2% crisaborole in 60 gm and 100 gm laminate tubes Phosphodiesterase-4 inhibitor Topical treatment of mild to moderate atopic dermatitis in patients 2 years of age & older Apply a thin layer twice daily to affected areas None expected Application site pain For external use only and not for ophthalmic, oral, or intravaginal use NEW Generic Medications Generic Name Brand Name Date Generic Available Dexmethylphenidate 25 mg and 35 mg Extended-Release Capsule Focalin XR Capsule ER 1/5/17 Rasagiline 0.5 mg and 1 mg Tablet Azilect Tablet 1/4/17 Aprepitant 40 mg, 80 mg and 125 mg Capsule Emend Capsule 12/27/16 Ergotamine / Caffeine 1 mg / 100 mg Tablet Cafergot Tablet 12/27/16 Oseltamivir 30 mg, 45 mg, 75 mg Capsule Tamiflu Capsule 12/12/16 Ezetimibe 10 mg Tablet Zetia Tablet 12/12/16 The Omnicare HealthLine Page 6 of 7
7 The Omnicare HealthLine 7 HealthLine Quiz - by Steve Law 1. Which statement about diabetes in Older Persons is FALSE? a. Diabetes Type 2 (DM2) is the 7th leading cause of death b. Clinically significant hypoglycemia is defined as a glucose level less than 54 mg/dl c. Insulin is the second most likely drug to result in an emergency department visit due to an adverse drug event d. Victoza should not be used in diabetics with established atherosclerotic cardiovascular disease 2. Long-term use of metformin may be associated with a biochemical vitamin B-6 deficiency: a. True b. False 3. Which statement is FALSE concerning comorbid conditions associated with DM2 in older adults (age 65 years or older)? a. Annual screening for early detection of mild cognitive impairment or dementia is indicated b. Older adults should be screened for depression c. The blood pressure goal for most older adults is to be below 120/80 mmhg d. All older adults should be assessed to determine their need to be on a statin and asprin 4. Xarelto (rivaroxaban) generally should be avoided in older adults with a CrCl less than 30 ml/minute: a. True b. False 5. Which medication has the highest risk of hypoglycemia in the elderly? a. Metformin b. Glyburide c. Januvia d. Invokana 6. An adverse effect to monitor for with an ACE Inhibitor is hypokalemia? a. True b. False 7. Which is TRUE about the new medication Eucrisa (crisaborole)? a. It is a cream indicated for the topical treatment of mild to moderate atopic dermatitis b. It is a phosphodiesterase-2 inhibitor c. Application site pain is the most common side effect d. Usual dosing is to apply a thin layer three times a day to affected areas *Please note, the HealthLine Quiz is designed to help readers retain information that is relevant to their care setting. It is not an approved source of continuing education credits for healthcare professionals. Editorial Board Allen L. Lefkovitz, PharmD, BCGP, FASCP Senior Editor Carrie Allen, PharmD, BCGP, BCPS, BCPP, CCHP Assistant Editor Kori Hauersperger, PharmD, BCGP Steve Law, PharmD, BCGP Terry O Shea, PharmD, BCGP David Pregizer, RPh Yamini Shah, PharmD Barbara J. Zarowitz, PharmD, FCCP, BCPS, FCCM, BCGP, FASCP Contributing Authors for This Issue Allen L. Lefkovitz, PharmD, BCGP, FASCP Director - Clinical Pharmacy Education and Drug Data, CVS Health Yamini Shah, PharmD Clinical Pharmacist, Clinical Development, CVS/caremark Kori Hauersperger, PharmD, BCGP OSC 2 OR Clinical and Drug Information Analyst, CVS Health Carrie Allen, PharmD, BCGP, BCPS, BCPP, CCHP Clinical Pharmacist, CVS Health David Pregizer, RPh Consultant Pharmacist, HCR-Manorcare Steve Law, PharmD, BCGP Clinical Services Manager for Indiana; Omnicare Pharmacies in Indiana Answers to the HealthLine Quiz: 1) D 2) B 3) C 4) A 5) B 6) B 7) C The Omnicare HealthLine Page 7 of 7
HealthLine. Focus on Heart Failure Part 2: Treatment Considerations
December 2017 THE OMNICARE HealthLine Focus on Heart Failure Part 2: Treatment Considerations Several studies have demonstrated that a lack of using guideline-directed therapy is associated with increased
More informationThe Omnicare HealthLine
The Omnicare HealthLine Inside This Issue 1-3 Updated Focus on Adverse Drug Events 4 Methotrexate Safety Reminders 5 Clinical Capsule: Drug Interactions with Oral Quinolones 5 Regulatory Recap 6 New Drug
More informationMedical Policy An independent licensee of the Blue Cross Blue Shield Association
Oral Anticoagulants Page 1 of 7 Medical Policy An independent licensee of the Blue Cross Blue Shield Association Title: Oral Anticoagulant - Bevyxxa (betrixaban), Eliquis (apixaban), Pradaxa (dabigatran),
More informationDrug Class Monograph
Drug Class Monograph Class: Sodium-Glucose Co-Transporter 2 (SGLT-2) Inhibitors Drugs: Farxiga (dapagliflozin), Invokamet (canagliflozin/metformin), Invokana (canagliflozin), Jardiance (empagliflozin),
More informationSodium-Glucose Co-Transporter 2 (SGLT-2) Inhibitors Drug Class Prior Authorization Protocol
Sodium-Glucose Co-Transporter 2 (SGLT-2) Inhibitors Drug Class Prior Authorization Protocol Line of Business: Medicaid P&T Approval Date: February 21, 2018 Effective Date: April 1, 2018 This policy has
More informationType 2 Diabetes: Where Do We Start with Treatment? DIABETES EDUCATION. Diabetes Mellitus: Complications and Co-Morbid Conditions
Diabetes Mellitus: Complications and Co-Morbid Conditions ADA Guidelines for Glycemic Control: 2016 Retinopathy Between 2005-2008, 28.5% of patients with diabetes 40 years and older diagnosed with diabetic
More informationThe Omnicare HealthLine
The Omnicare HealthLine Inside This Issue 1-3 Focus on COPD Exacerbation: Part 1 4 Boxed Warning for Opioids and Benzodiazepines 5 Clinical Capsule: COPD Beyond Bronchodilators 5 Regulatory Recap 6 New
More informationThe Many Faces of T2DM in Long-term Care Facilities
The Many Faces of T2DM in Long-term Care Facilities Question #1 Which of the following is a risk factor for increased hypoglycemia in older patients that may suggest the need to relax hyperglycemia treatment
More informationDiabetes and the Elderly: Medication Considerations When Determining Benefits and Risks
Diabetes and the Elderly: Medication Considerations When Determining Benefits and Risks Gretchen M. Ray, PharmD, PhC, BCACP, CDE Associate Professor UNM College of Pharmacy September 7 th, 2018 DISCLOSURES
More informationSAVAYSA (edoxaban tosylate) oral tablet
SAVAYSA (edoxaban tosylate) oral tablet Coverage for services, procedures, medical devices and drugs are dependent upon benefit eligibility as outlined in the member's specific benefit plan. This Pharmacy
More informationThe Omnicare HealthLine
The Omnicare HealthLine Inside This Issue 1-3 Focus on Seizure Disorder in Older Adults: Part 1 4 Entresto is Contraindicated with ACE Inhibitors 4 Increased Risk of Bladder Cancer with Pioglitazone- Containing
More informationWhat s New in Diabetes Medications. Jena Torpin, PharmD
What s New in Diabetes Medications Jena Torpin, PharmD 1 Objectives Discuss new medications in the management of diabetes Understand the mechanism of the medications discussed Understand the side effects
More informationCardiovascular Benefits of Two Classes of Antihyperglycemic Medications
Cardiovascular Benefits of Two Classes of Antihyperglycemic Medications Nathan Woolever, Pharm.D., Resident Pharmacist Pharmacy Grand Rounds November 6 th, 2018 Franciscan Healthcare La Crosse, WI 2017
More informationDrug Use Criteria: Direct Oral Anticoagulants
Texas Vendor Drug Program Drug Use Criteria: Oral Anticoagulants Publication History 1. Developed March 2017. 2. Revised February 2018. Notes: Information on indications for use or diagnosis is assumed
More informationAnticoagulation Task Force
Anticoagulation Task Force Newest Recommendations Donald Zabriskie, BPharm, MBA, RPh Pharmacy Patient Care Services Cleveland Clinic- Fairview Hospital THE DRUGS THE PERFECT ANTICOAGULANT Oral administration
More informationDiabetes Mellitus II CPG
1 Diabetes Mellitus II CPG Candidates for Screening Integrated Complex Care Patients: Check Yearly Prediabetes: Check Yearly No Diabetes Mellitus (DM) Risk Factors: Check at Age 45, Repeat Every 3 Years
More informationOral Anticoagulation Drug Class Prior Authorization Protocol
Oral Anticoagulation Drug Class Prior Authorization Protocol Line of Business: Medicaid P & T Approval Date: February 21, 2018 Effective Date: April 1, 2018 This policy has been developed through review
More informationOral and Injectable Non-insulin Antihyperglycemic Agents
Appendix 5: Diabetes Education and Medical Management in Adults with Diabetes Oral and Injectable Non-insulin s This directive will be implemented by RPhs, RNs or RDs who have been deemed authorized implementers.
More informationHot Topics: Transitions of Care
Our quarterly newsletter is a great way to stay up-to-date on emerging clinical information, medication safety issues, and Larkin s Hospital medication policies and procedures. Hot Topics: Transitions
More informationAnticoagulation Therapy in LTC
Anticoagulation Therapy in LTC By: Cynthia Leung, RPh, BScPhm, PharmD. Clinical Consultant Pharmacist MediSystem Pharmacy Jun 11, 2013 Agenda Stroke and Bleeding Risk Assessment Review of Oral Anticoagulation
More informationTreating the elderly patients with type 2 diabetes mellitus
Treating the elderly patients with type 2 diabetes mellitus Niki Katsiki MSc, PhD, MD, FRSPH IASO/EASO Scope Member EASD Diabetes & Cardiovascular Disease Group Member Member of the Executive Board of
More informationUW MEDICINE PATIENT EDUCATION. Treating Blood Clots. What is a blood clot? DRAFT
UW MEDICINE PATIENT EDUCATION Treating Blood Clots About deep vein thrombosis (DVT) and pulmonary embolism (PE) and how they are treated This handout explains blood clots, their symptoms, and how they
More informationNEWSLETTER DUE CARE PROGRAM. WINTER 2014 Summer 2015 COMMONLY ASKED QUESTION:
DUE CARE PROGRAM NEWSLETTER WINTER 2014 Summer 2015 Lisa Sather, RPh DUR Coordinator Mountain-Pacific Quality Health 3404 Cooney Drive Helena, MT 59602 406-457-5818 The DUE CARE PROGRAM, administered by
More informationAmerican Diabetes Association 2018 Guidelines Important Notable Points
American Diabetes Association 2018 Guidelines Important Notable Points The Standards of Medical Care in Diabetes-2018 by ADA include the most current evidencebased recommendations for diagnosing and treating
More informationDiabetes Oral Agents Pharmacology. University of Hawai i Hilo Pre-Nursing Program NURS 203 General Pharmacology Danita Narciso Pharm D
Diabetes Oral Agents Pharmacology University of Hawai i Hilo Pre-Nursing Program NURS 203 General Pharmacology Danita Narciso Pharm D 1 Learning Objectives Understand the role of the utilization of free
More informationJennifer Loh, MD, FACE Chief of Endocrinology KP Hawaii AAMD of Medical Education, KP Hawaii
Individualized Diabetes Treatment for the Elderly Jennifer Loh, MD, FACE Chief of Endocrinology KP Hawaii AAMD of Medical Education, KP Hawaii Extremely Relevant Baby Boomers are aging! ¼ of people age
More informationDrug Class Review Newer Diabetes Medications and Combinations
Drug Class Review Newer Diabetes Medications and Combinations Final Update 2 Report July 2016 The purpose reports is to make available information regarding the comparative clinical effectiveness and harms
More informationGlobal Anticoagulants Market: Size, Trends & Forecasts ( ) April 2017
Global Anticoagulants Market: Size, Trends & Forecasts (2017-2021) April 2017 Global Anticoagulants Market Scope of the Report The report entitled Global Anticoagulants Market: Size, Trends & Forecasts
More informationDipeptidyl-Peptidase 4 (DPP-4) Inhibitors Drug Class Prior Authorization Protocol
Dipeptidyl-Peptidase 4 (DPP-4) Inhibitors Drug Class Prior Authorization Protocol Line of Business: Medicaid P&T Approval Date: February 21, 2018 Effective Date: April 1, 2018 This policy has been developed
More informationTreatment with Rivaroxaban Xarelto
Treatment with Rivaroxaban Xarelto Anticoagulation Clinic This handout explains the medicine rivaroxaban, a drug that helps prevent blood clots. What is rivaroxaban? Rivaroxaban (brand name Xarelto) is
More informationCollaborative Practice Agreement
Collaborative Practice Agreement [community pharmacy name] [address] [phone number] [physician practice] [address] [phone number] Effective: [date] Expiration: [date] 1 Table of Contents 1.0 Introduction...4
More informationDrug Class Review Newer Oral Anticoagulant Drugs
Drug Class Review Newer Oral Anticoagulant Drugs Final Original Report May 2016 The purpose of reports is to make available information regarding the comparative clinical effectiveness and harms of different
More informationApixaban for Atrial Fibrillation in Patients with End-Stage Renal Disease on Dialysis
Apixaban for Atrial Fibrillation in Patients with End-Stage Renal Disease on Dialysis Caitlin Reedholm, PharmD PGY1 Pharmacy Resident St. David s South Austin Medical Center November 2, 2018 Abbreviations
More informationTREATMENTS FOR TYPE 2 DIABETES. Susan Henry Diabetes Specialist Nurse
TREATMENTS FOR TYPE 2 DIABETES Susan Henry Diabetes Specialist Nurse How can we improve outcomes in Type 2 diabetes? Earlier diagnosis Better patient education Stress central role of lifestyle management
More informationKaty Trinkley PharmD, BCACP Tiffany Goldberg Pharm D Candidate Katie Heist MD
Katy Trinkley PharmD, BCACP Tiffany Goldberg Pharm D Candidate Katie Heist MD Metformin: Only oral diabetes medication with proven benefits on cardiovascular morbidity and mortality Inexpensive medication
More informationSpecial thanks to the EJC Foundation for their support of Sanford Center Geriatric Specialty Clinic
Special thanks to the EJC Foundation for their support of Sanford Center Geriatric Specialty Clinic Sanford Center for Aging 775-784-4744 med.unr.edu/aging Diabetes Management Series: From Selfmanagement
More informationCOMMON DRUG RELATED PROBLEMS SEEN IN PACE AND MECHANISMS TO MITIGATE RISK
COMMON DRUG RELATED PROBLEMS SEEN IN PACE AND MECHANISMS TO MITIGATE RISK Robert L Alesiani, PharmD, CGP Chief Pharmacotherapy Officer CareKinesis, Inc. (a Tabula Rasa Healthcare Company) 2 3 4 5 Pharmacogenomics
More informationManagement of DM in Older Adults: It s not all about sugar! Who needs treatment for DM? Peggy Odegard, Pharm.D., BCPS, CDE
Management of DM in Older Adults: It s not all about sugar! Peggy Odegard, Pharm.D., BCPS, CDE Who needs treatment for DM? 87 year old, frail male with moderately severe dementia living in NH with persistent
More informationSouthern Trust Anticoagulant Team
CLINICAL GUIDELINES ID TAG Title: Author: Speciality / Division: Directorate: Anticoagulation- Primary Care Guidance for reviewing patients on DOACs Southern Trust Anticoagulant Team Haematology Acute
More informationTrends and Variation in Oral Anticoagulant Choice in Patients with Atrial Fibrillation,
Trends and Variation in Oral Anticoagulant Choice in Patients with Atrial Fibrillation, 2010-2017 Junya Zhu, PhD Department of Health Policy and Management January 23, 2018 Acknowledgments Co-Authors G.
More informationAntiplatelets and Anticoagulants. Helen Leung, PharmD PGY1 Pharmacy Resident Memorial Hermann-Texas Medical Center
Antiplatelets and Anticoagulants Helen Leung, PharmD PGY1 Pharmacy Resident Memorial Hermann-Texas Medical Center Mechanism 2 http://www.medicinehack.com/2011/07/virchows-triad.html Mechanism 3 http://drtedwilliams.net/kb/index.php?pagename=coagulation%20cascade
More informationDrug Class Monograph
Drug Class Monograph Class: Oral Anticoagulants Drug: Coumadin (warfarin), Eliquis (apixaban), Pradaxa (dabigatran), Savaysa (edoxaban), arelto (rivaroxaban) Formulary Medications: Eliquis (apixaban),
More informationFARXIGA (dapagliflozin) Jardiance (empagliflozin) tablets. Synjardy (empagliflozin and metformin hydrochloride) tablets. GLUCOPHAGE* (metformin)
Type 2 Medications Drug Class How It Works Brand and Generic Names Manufacturers Usual Starting Dose The kidneys filter sugar and either absorb it back into your body for energy or remove it through your
More informationpat hways Key therapeutic topic Published: 26 February 2016 nice.org.uk/guidance/ktt16
pat hways Anticoagulants, including non-vitamin K antagonist oral anticoagulants (NOACs) Key therapeutic topic Published: 26 February 2016 nice.org.uk/guidance/ktt16 Options for local implementation NICE
More informationTreatment with Apixaban Eliquis
Treatment with Apixaban Eliquis Anticoagulation Clinic 416-530-6000 ext 3477 This handout explains the medicine rivaroxaban, a drug that helps prevent blood clots. What is apixaban? Apixaban (brand name
More informationCARDIAC REHABILITATION PROGRAMME:- MEDICATION
CARDIAC REHABILITATION PROGRAMME:- MEDICATION AIM OF THIS SESSION Understand the reasons for taking your medications, Discuss the common side effects associated with these medications - knowing when to
More informationThe Death of Sulfonylureas? A Review of New Diabetes Medications
The Death of Sulfonylureas? A Review of New Diabetes Medications Kelly Hoenig, Pharm.D., BCPS Cedar Rapids Family Medicine Residency 2/4/17 Objectives Review GLP-1 Agonists, DPP-IV Inhibitors and SGLT-2
More informationAn assessment of the appropriate use of medicines in older patients with impaired kidney function, in a general practice setting
University of Wollongong Research Online Faculty of Science, Medicine and Health - Papers Faculty of Science, Medicine and Health 015 An assessment of the appropriate use of medicines in older patients
More informationUse of Anticoagulants in Geriatrics: Current Evidence and Special Considerations
Use of Anticoagulants in Geriatrics: Current Evidence and Special Considerations Aryn You, PharmD Assistant Professor, Pharmacy Practice The Daniel K. Inouye College of Pharmacy Aida Wen, MD Associate
More informationHeart Failure Clinician Guide JANUARY 2018
Kaiser Permanente National CLINICAL PRACTICE GUIDELINES Heart Failure Clinician Guide JANUARY 2018 Introduction This evidence-based guideline summary is based on the 2018 National Heart Failure Guideline.
More informationThe Omnicare HealthLine
The Omnicare HealthLine Inside This Issue 1-4 Focus on Seasonal Influenza 2016-2017 5 The Vaccine Adverse Event Reporting System 6 Clinical Capsule: Antipsychotic Therapy for Parkinson s Psychosis 6 Regulatory
More informationDiabetes and New Meds for Cardiovascular Risk Reduction. F. Dwight Chrisman, MD, FACC. Disclosures: BI Boehringer Ingelheim speaker
Diabetes and New Meds for Cardiovascular Risk Reduction F. Dwight Chrisman, MD, FACC Disclosures: BI Boehringer Ingelheim speaker 1 Prevalence of DM DM state specific prevalence 2006 4%-6% 6-8% 8-10% 10-12%
More informationReviewing Diabetes Guidelines. Newsletter compiled by Danny Jaek, Pharm.D. Candidate
Reviewing Diabetes Guidelines Newsletter compiled by Danny Jaek, Pharm.D. Candidate AL AS KA N AT IV E DI AB ET ES TE A M Volume 6, Issue 1 Spring 2011 Dia bet es Dis pat ch There are nearly 24 million
More informationThe P&T Committee Lisinopril (Qbrelis )
Situation Background Assessment The P&T Committee Lisinopril (Qbrelis ) Qbrelis, 1 mg/ml lisinopril oral solution, has recently become an FDA- approved formulation. Current practice at UK Chandler Medical
More informationWhat s new with DOACs? Defining place in therapy for edoxaban &
What s new with DOACs? Defining place in therapy for edoxaban & Use of DOACs in cardioversion Caitlin M. Gibson, PharmD, BCPS Assistant Professor, Department of Pharmacotherapy University of North Texas
More informationDiabetes Management in New Brunswick Nursing Homes
Diabetes Management in New Brunswick Nursing Homes Prepared by Dr. Angela McGibbon March, 2016 As the population ages and with the rising incidence of diabetes, there are increasing numbers of people with
More informationSGLT2 Inhibitors
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 Subject: SGLT2 Inhibitors Page: 1 of 7 Last Review Date: June 22, 2018 SGLT2 Inhibitors Description Invokana
More informationNEW/NOVEL ORAL ANTICOAGULANTS (NOACS): COMPARISON AND FREQUENTLY ASKED QUESTIONS
NEW/NOVEL ORAL ANTICOAGULANTS (NOACS): COMPARISON AND FREQUENTLY ASKED QUESTIONS OBJECTIVES: To provide a comparison of the new/novel oral anticoagulants (NOACs) currently available in Canada. To address
More informationAspirin versus pradaxa
Search Search Aspirin versus pradaxa 14-12-2012 Dabigatran (Pradaxa): Good news on safety but caution still warranted. the risk of bleeding versus the risk. (Aspirin and other inhibitors of. 15-12-2008
More informationHealthLine. Bacteremia. Pneumonia 400,000 hospitalizations annually
October 2017 THE OMNICARE HealthLine Focus on Pneumococcal Vaccines - by Allen Lefkovitz Streptococcus pneumoniae (aka pneumococcus) can cause serious and sometimes life-threatening infections. As outlined
More informationMultiple Factors Should Be Considered When Setting a Glycemic Goal
Multiple Facts Should Be Considered When Setting a Glycemic Goal Patient attitude and expected treatment effts Risks potentially associated with hypoglycemia, other adverse events Disease duration Me stringent
More informationPreventing Stroke in Patients with Atrial Fibrillation: USING THE EVIDENCE
Preventing Stroke in Patients with Atrial Fibrillation: USING THE EVIDENCE What Is Atrial Fibrillation? Atrial fibrillation also called AFib or AF is the most common abnormal heart rhythm, affecting an
More informationDrug Class Review Monograph GPI Class 27 Anti-diabetics
Drug Class Review Monograph GPI Class 27 Anti-diabetics Review Time Frame: 11/2015 04/2017 Previous Class Review: 02/2016 Background: Antidiabetic drug classes include: Alpha-glucosidase inhibitors- slow
More informationUpdate on Oral Anticoagulants. Dr. Miten R. Patel Cancer Specialists of North Florida Cell
Update on Oral Anticoagulants Dr. Miten R. Patel Cancer Specialists of North Florida Cell 904-451-9820 Email miten.patel@csnf.us Overview Highlights of the 4 new approved oral anticoagulants Results from
More informationCASUISTIEK: DOACS. Kop 1/02/2018. Voet 1 INLEIDING INLEIDING. Klassieke OAC. DOACs CORRECT DOSING. Prof. Stephane Steurbaut, PharmD, PhD
INLEIDING CASUISTIEK: DOACS Prof. Stephane Steurbaut, PharmD, PhD Klinische Universitaire Farmacie Ziekenhuizen - Transmurale 27-1-2018 Zorg 2 2 INLEIDING Klassieke OAC DOACs COECT DOSING Indication VTE
More informationDrug Class Monograph
Class: Dipeptidyl-Peptidase 4 (DPP-4) Inhibitors Drug Class Monograph Drugs: alogliptin, Januvia (sitagliptin), Janumet (sitagliptin/metformin), Janumet XR (sitagliptin/metformin), Jentadueto (linagliptin/metformin),
More informationUpdate on Therapies for Type 2 Diabetes: Angela D. Mazza, DO July 31, 2015
Update on Therapies for Type 2 Diabetes: 2015 Angela D. Mazza, DO July 31, 2015 Objectives To present the newer available therapies for the management of T2D To discuss the advantages and disadvantages
More informationOral Pharmacologic Treatment of Type 2 Diabetes Mellitus
Oral Pharmacologic Treatment of Type 2 Diabetes Mellitus You should be offering psychosocial care to all patients with diabetes, says the ADA. Here are the specific recommendations. Summary Recommendation
More informationMEDICAL ASSISTANCE HANDBOOK PRIOR AUTHORIZATION OF PHARMACEUTICAL SERVICES. A. Prescriptions That Require Prior Authorization
MEDICAL ASSISTANCE HBOOK PRI AUTHIZATION OF PHARMACEUTICAL SERVICES I. Requirements for Prior Authorization of Anticoagulants A. Prescriptions That Require Prior Authorization Prescriptions for Anticoagulants
More informationHeart Failure Clinician Guide JANUARY 2016
Kaiser Permanente National CLINICAL PRACTICE GUIDELINES Heart Failure Clinician Guide JANUARY 2016 Introduction This evidence-based guideline summary is based on the 2016 National Heart Failure Guideline.
More informationJoshua Settle, PharmD Clinical Pharmacist Baptist Medical Center South ALSHP Fall Meeting September 30, 2016
Joshua Settle, PharmD Clinical Pharmacist Baptist Medical Center South jjsettle@baptistfirst.org ALSHP Fall Meeting September 30, 2016 Objectives Describe the current information concerning newly approved
More informationSGLT2 Inhibitors
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 Subject: SGLT2 Inhibitors Page: 1 of 7 Last Review Date: November 30, 2018 SGLT2 Inhibitors Description
More informationHERTFORDSHIRE MEDICINES MANAGEMENT COMMITTEE (HMMC) DABIGATRAN RECOMMENDED What it is Indications Date decision last revised
Name: generic (trade) Dabigatran etexilate (Pradaxa ) HERTFORDSHIRE MEDICINES MANAGEMENT COMMITTEE (HMMC) DABIGATRAN RECOMMENDED What it is Indications Date decision last revised Direct thrombin inhibitor
More informationMetformin Hydrochloride
Metformin Hydrochloride 500 mg, 850 mg, 500 mg LA and 750 mg LA Tablet Description Informet is a preparation of metformin hydrochloride that belongs to a biguanide class of oral antidiabetic drugs. Metformin
More informationClinical Policy: Dabigatran (Pradaxa) Reference Number: CP.PMN.49 Effective Date: Last Review Date: 05.18
Clinical Policy: (Pradaxa) Reference Number: CP.PMN.49 Effective Date: 05.01.12 Last Review Date: 05.18 Line of Business: Medicaid Revision Log See Important Reminder at the end of this policy for important
More informationUpdates in Anticoagulation for Atrial Fibrillation and Venous Thromboembolism
Disclosures Updates in Anticoagulation for Atrial Fibrillation and Venous Thromboembolism No financial conflicts of interest Member of the ABIM Focused- Practice in Hospital Medicine Self Examination Process
More informationGlucophage XR is contra-indicated during breast-feeding.
Name GLUCOPHAGE XR 1000 mg Prolonged release tablets Active ingredient Metformin hydrochloride Composition Each Glucophage XR 1000 mg prolonged release tablet contains as active ingredient 1000 mg metformin
More informationGLYXAMBI (empagliflozin-linagliptin) oral tablet
GLYXAMBI (empagliflozin-linagliptin) oral tablet Coverage for services, procedures, medical devices and drugs are dependent upon benefit eligibility as outlined in the member's specific benefit plan. This
More informationAmerican Diabetes Association Standards of Medical Care in Diabetes 2018: Latest Updates
American Diabetes Association Standards of Medical Care in Diabetes 2018: Latest Updates Juan Pablo Frias, MD President and CEO, National Research Institute, Los Angeles, CA Clinical Faculty, University
More informationAppendix C Factors to consider when choosing between anticoagulant options and FAQs
Appendix C Factors to consider when choosing between anticoagulant options and FAQs Choice of anticoagulant for non-valvular* atrial fibrillation: Clinical decision aid Patients should already be screened
More informationIt Happens Even in Type 2! When to Start Thinking Seriously About Hypoglycemia
It Happens Even in Type 2! When to Start Thinking Seriously About Hypoglycemia Jacqueline LaManna, PhD, ANP BC, BC ADM, CDE Holly Divine, PharmD, BCACP, CGP, CDE, FAPhA Disclosures Dr. Jacqueline LaManna
More informationSAFE study A-fib ED Anticoagulation Package
SAFE study A-fib ED Anticoagulation Package In this package you will find documents to help you make decision making easy for the Anticoagulation of New AFib patients being discharged from the ED: 1. Anticoagulation
More informationLimitations of Use: Glumetza is not used for the treatment of type 1 diabetes or ketoacidosis (1).
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.30.20 Subject: Glumetza Page: 1 of 5 Last Review Date: March 18, 2016 Glumetza Description Glumetza (extended-release
More informationDept of Diabetes Main Desk
Dept of Diabetes Main Desk 01202 448060 Glucose management in Type 2 Diabetes in Adults The natural history of type 2 diabetes is for HbA1c to deteriorate with time. A stepwise approach to treatment is
More informationAnticoagulatie en de oudere patiënt: Terughoudenheid gerechtvaardigd of niet?
Anticoagulatie en de oudere patiënt: Terughoudenheid gerechtvaardigd of niet? 16/06/2018 apr. Julie Hias Satellite symposium supported by the Alliance BMS/Pfizer 432BE18PR03459/ 180570 (Date of Preparation:
More informationMedications for Treating Stroke
Medications for Treating Stroke Subject Expert Sonny Kupniewski, PharmD, BCPS Swedish Medical Center Englewood, CO 2 Objectives Medications used to prevent stroke Prevention of strokes in patients with
More informationGeri-PARDY! (2015 Beers Criteria) Pharmacology Edition
Geri-PARDY! Pharmacology Edition (2015 Beers Criteria) Aurelio Muyot, MD, AGSF, FACP Assistant Professor College of Osteopathic Medicine Touro University Nevada Objectives Review the 2015 Beers Criteria
More informationA DECISION AID FOR AFIB STROKE PREVENTION FOR PATIENTS WITH ATRIAL FIBRILLATION
A DECISION AID FOR AFIB STROKE PREVENTION FOR PATIENTS WITH ATRIAL FIBRILLATION For Patients with HIGH RISK You have atrial fibrillation, also known as AFib, which means you have an irregular heart beat.
More informationSide Effects of: GLP-1 agonists DPP-4 inhibitors SGLT-2 inhibitors. Bryce Fukunaga PharmD April 25, 2018
Side Effects of: GLP-1 agonists DPP-4 inhibitors SGLT-2 inhibitors Bryce Fukunaga PharmD April 25, 2018 Objectives For each drug class: Identify the overall place in therapy Explain the mechanism of action
More informationHealthLine. Focus on Heart Failure, Part 1: Classifications and Causes
November 2017 THE OMNICARE HealthLine Focus on Heart Failure, Part 1: Classifications and Causes he American Heart Association defines heart failure (HF) as a chronic, progressive condition in which the
More informationMEDICAL ASSISTANCE BULLETIN
ISSUE DATE July 5, 2016 SUBJECT EFFECTIVE DATE July 11, 2016 MEDICAL ASSISTANCE BULLETIN NUMBER *See below BY Prior Authorization of Anticoagulants - Pharmacy Services Leesa M. Allen, Deputy Secretary
More informationAnticoagulation in Atrial Fibrillation Patient information
Anticoagulation in Atrial Fibrillation Patient information Introduction This leaflet will help you understand your new medicine. Your new medicine is commonly known as a blood thinner because that is what
More informationSGLT2 Inhibitors
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.30.19 Subject: SGLT2 Inhibitors Page: 1 of 6 Last Review Date: September 15, 2016 SGLT2 Inhibitors Description
More informationComparison of novel oral anticoagulants (NOACs)
Comparison of novel oral anticoagulants (NOACs) For guidance for full information refer to individual SPCs available at www.medicines.org.uk Licensed indications for NOACs Prevention of stroke and systemic
More informationGLP-1 (glucagon-like peptide-1) Agonists (Byetta, Bydureon, Tanzeum, Trulicity, Victoza ) Step Therapy and Quantity Limit Criteria Program Summary
OBJECTIVE The intent of the GLP-1 (glucagon-like peptide-1) s (Byetta/exenatide, Bydureon/ exenatide extended-release, Tanzeum/albiglutide, Trulicity/dulaglutide, and Victoza/liraglutide) Step Therapy
More informationMedicines for stroke prevention in atrial fibrillation. Choosing the right one for you
Medicines for stroke prevention in atrial fibrillation Choosing the right one for you Atrial fibrillation (AF) is a condition that affects the heart, causing it to beat irregularly and too fast. When this
More informationHave participants measure their blood pressure daily at a standard time for two weeks. Obtain BP values from participant (fax, call, , mail).
Blood Pressure Management and Control Protocol BP Management: A) BP goal: Achieve blood pressure values less than 130/80mmHg. B) Process: Have participants measure their blood pressure daily at a standard
More informationAtrial Fibrillation Implementation challenges. Lesley Edgar Ross Maconachie
Atrial Fibrillation Implementation challenges Lesley Edgar Ross Maconachie Atrial Fibrillation Most common heart rhythm disturbance Rapid and irregular electrical signals Reduced efficiency of blood flow
More informationDrug Class Monograph
Drug Class Monograph Class: Dipeptidyl-Peptidase 4 (DPP-4) Inhibitors Drugs: alogliptin, alogliptin/metformin, Januvia (sitagliptin), Janumet (sitagliptin/metformin), Janumet XR (sitagliptin/metformin),
More informationDOAC the story so far... Dr GM Benson Director NI Haemophilia and Thrombosis Centre BHSCT
DOAC the story so far... Dr GM Benson Director NI Haemophilia and Thrombosis Centre BHSCT A rose by any other name.. Recommendation on the nomenclature for oral anticoagulants: communication from the SSC
More information