In this episode, we will review the beta-blocker drug class. We discuss their pharmacology, pharmacokinetic/pharmacodynamic parameters, evidence-based use, efficacy, and safety considerations.

Key Concepts

1. Various beta-blockers are divided into four main subtypes: non-selective, B1-selective, beta-blockers with alpha 1 antagonistic activity, and beta-blockers with intrinsic sympathomimetic activity (ISA). These subtypes govern their place in therapy, efficacy, and adverse effects.
2. With regards to dosing, “start low and go slow”. The antihypertensive effect is dose-specific, but heart failure therapy requires a GDMT dosing approach to initiate and reach a certain target dose. Do not initiate as a new agent in acutely decompensated heart failure and definitely do not abruptly stop the therapy -- a taper over 1-2 weeks is required.
3. Beta blockers are not first-line antihypertensives; however, they should be used in patients with compelling indications, such as systolic heart failure and post-MI. Other uses include angina, atrial fibrillation, migraine, tremors, and more.
4. Beta blockers are associated with a number of adverse effects including bradycardia, bronchoconstriction, weight gain, dyslipidemia, hyperkalemia, and masking of hypoglycemia. More severe adverse effects include heart block, exacerbation of heart failure, and morbidity/mortality from acute withdrawal.

In this episode, we discuss pharmaceutical industry career paths with Dr. Anastasiya Koshkina, a graduate of the RFUMS College of Pharmacy and Associate Director and Clinical Scientist at The Janssen Pharmaceutical Companies of Johnson & Johnson.

Key Concepts

1. When preparing for the fellowship application process, do your homework on the sector(s) you plan to apply for. It is crucial that you have a cohesive and logical story for why you are applying and what makes you a good fit for the position.
2. Strong clinical knowledge is important in the pharmaceutical industry even though there are no traditional direct patient care interactions.
3. Postgraduate pharmaceutical fellowship programs are looking for applicants with strong academics (high GPA), leadership experience in extracurricular, and research experiences.
4. Pharmacy fellowship programs are specific to a sector of a pharmaceutical company (e.g. medical affairs, regulatory affairs, research and development, etc.).. Unlike with pharmacy residencies, fellowships may or may not have rotations; if rotations exist, they are usually many months in length.
5. The team (the people you will be working with) are an essential component of a position. It is much better to work with a team that is supportive and committed to your professional development than to have a seemingly perfect job but be part of a team that is not supportive. The people are everything!

In episode 57, we had in depth discussion of safety issues, general use and recommendations for PPI therapy. In this episode, we briefly review PPI safety concerns and focus on strategies to deprescribe proton pump inhibitors.

Key Concepts

1. PPIs are approved as acid-reducing therapies to treat various conditions related to decreased gastric pH, however, undocumented use of PPI has increased over the years.
2. For indicated conditions, PPI should be used at lowest dose for shortest duration possible.
3. When used for longer than intended duration, PPIs may cause long-term issues such as hypomagnesemia, low vitamin B12 levels, low iron levels, anemia, C. difficile-associated diarrhea (CDAD), chronic kidney disease (CKD), and hypergastrinemia causing rebound acid hypersecretion.
4. Options for limiting PPI use are: abrupt discontinuation, dose reduction, on-demand dosing, slow deprescribing, or switching to alternate therapy. Abrupt discontinuation leads to rebound hypersecretion due to high gastrin levels.
5. There is lack of substantial evidence for what deprescribing strategy is better, but decreasing from multiple times a day to single daily dose, reducing the single daily dose, and switching to every other day are all appropriate strategies.

References

• Farrell B, Pottie K, Thompson W, et al. Deprescribing proton pump inhibitors. Evidence-based clinical practice guideline. Can Fam Physician. 2017 May; 63(5): 354–364.
• https://deprescribing.org/resources/deprescribing-guidelines-algorithms/ - Specific recommendations for deprescribing certain medications or medication classes

In this episode, we announce the debut of the HelixTalk Drug Superlative Awards -- awards given to medications on the market that are outstanding or notorious. In announcing these completely fictitious awards, we review key clinical pearls and pitfalls that every clinician should be aware of with these medications.

Key Concepts

1. Drug most likely to be remembered for COVID-19 ineffectiveness rather than its actual FDA indication: hydroxychloroquine
2. Commonly used but worst hypertensives on the market: it’s a tie! Atenolol and hydrochlorothiazide.
3. Most confusing dosage forms: valproic acid, valproate sodium, and divalproex -- it’s all the same thing!
4. Most innovative prodrug: valacyclovir
5. Hottest inactive ingredient: it’s a tie! Sulfobutylether-beta-cyclodextrin (SBECD), an excipient in remdesivir, and polyethylene glycol (PEG), an excipient in mRNA vaccines.

In this episode, we will discuss basic pharmacology and use of naloxone, available formulations, evidence for its effectiveness, and naloxone-related pharmacy management and regulations.

Key Concepts

1. Naloxone, available in various formulations, is a quick-acting opioid reversal agent approved for use in opioid overdose cases.
2. Naloxone access laws are in place in the majority of the states allowing patients and caregivers to obtain the medication as well as administer naloxone.
3. These access laws allow pharmacists to dispense naloxone to patients without individual prescriptions under prescriptive authority, standing/protocol orders, or collaborative agreements. Registration, training, education, and reporting requirements may vary per individual state.
4. Despite such access laws, overall prescribing of naloxone per high-dose opioid prescriptions remain low. Not many studies are available, but some suggest these laws help reduce opioid overdose deaths and emergency department visits. Implementation and education about such laws need to be improved.

References

• Prescription Drug Abuse Policy System. Naloxone Overdose Prevention Laws. http://pdaps.org/datasets/laws-regulating-administration-of-naloxone-1501695139
• Naloxone finder. https://www.getnaloxonenow.org/#getnaloxone
• Illinois Department of Public Health. Naloxone. https://www.dph.illinois.gov/naloxone
• Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/medication-assisted-treatment/medications-counseling-related-conditions/naloxone
• A Way Out. https://www.opioidinitiative.org/awayout

In this episode, we chat with Morgan Anderson, PharmD, BCIDP and alumna of RFUMS, about Enterococcal infections including patterns of antimicrobial resistance and recommended treatment options.

In this episode, we will briefly review the clotting cascade and warfarin's mechanism of action, and then discuss warfarin pharmacogenetics implications and what clinical recommendations and tools are available in order to calculate warfarin dose.

In this episode, we discuss the FDA·s Emergency Use Authorization (EUA) process and review the resources available to healthcare providers when an EUA for a drug therapy is approved.

In this episode, we interview the niece of Dr. Rosalind Franklin, the namesake of our university, who is also named Rosalind Franklin. As part of the university’s centennial celebration of Dr. Franklin, we discuss her amazing life and scientific achievements and reflect on how her story can be applied to our own lives.

In this episode, we discuss how to excel in your next journal club presentation or discussion while avoiding the all-too-common pitfalls for this unique format.