HelixTalk - Rosalind Franklin University's College of Pharmacy Podcast (general)

In this episode, we review new updates and key concepts from the 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. This guideline is newly published (April 2022) and is a full update of the 2013 guidelines and the 2017 focused update for heart failure.

Key Concepts

  1. Heart failure is classified as HFrEF (heart failure with reduced ejection fraction <= 40%), HFimpEF (with improved ejection fraction – was <=40% but is now > 40%), HFmrEF (ejection fraction 41% to 49% with increased LV filling pressures), and HFpEF (preserved ejection fraction >= 50% with increased LV filling pressures). Most drug therapy recommendations are similar for HFrEF, HFimpEF, and HFmrEF whereas HFpEF therapies are different.
  2. The 2022 AHA/ACC/HFSA heart failure guidelines now recommend SGLT2 inhibitors, such as dapagliflozin and empagliflozin, in patients with HFrEF, HFmrEF, and HFpEF.
  3. The 2022 AHA/ACC/HFSA heart failure guidelines continue to prefer ARNi, such as sacubitril/valsartan (Entresto), over ACE inhibitors and ARBs in patients with HFrEF. Based on the PARAGON-HF trial, ARNi is also recommended in those with HFpEF albeit with a weak recommendation.
  4. Avoiding excessive dietary sodium is reasonable to reduce congestive symptoms in patients with heart failure; however, guidelines do not recommend a specific maximum intake nor does data support clinical outcome benefit with dietary sodium restriction.

References

  • Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines [published online ahead of print, 2022 Apr 1]. Circulation. 2022;101161CIR0000000000001063. doi:10.1161/CIR.0000000000001063. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001063
  • Ezekowitz JA, Colin-Ramirez E, Ross H, et al. Reduction of dietary sodium to less than 100 mmol in heart failure (SODIUM-HF): an international, open-label, randomised, controlled trial. Lancet. 2022;399(10333):1391-1400. doi:10.1016/S0140-6736(22)00369-5
Direct download: 147_-_2022_hf_guidelines.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we discuss six newer antibiotics that target multidrug resistant gram negative bacteria with Dr. Christie Bertram, PharmD, BCIDP. We review common resistance mechanisms, particularly to carbapenems, and highlight the current role in therapy for the following antibiotics: ceftolozane/tazobactam (Zerbaxa®), ceftazidime/avibactam (Avycaz®), meropenem/vaborbactam (Vabomere®), imipenem/cilastatin/relebactam (Recarbrio®), cefiderocol (Fetroja®), and eravacycline (Xerava®).

Key Concepts

  1. Ceftolozane/tazobactam (Zerbaxa®) is primarily used for multidrug resistant Pseudomonas; it does not cover carbapenemase-producing organisms and (despite the tazobactam) needs metronidazole for intra-abdominal anaerobic coverage.
  2. Ceftazidime/avibactam (Avycaz®) is primarily used to cover CRE (Carbapenem-resistant Enterobacterales) but also has activity for many other gram negatives except Acinetobacter.
  3. Meropenem/vaborbactam (Vabomere®) has similar coverage to Avycaz® but may provide coverage for certain KPCs (Klebsiella pneumoniae carbapenemase). Vaborbactam does not restore activity for meropenem-resistant Pseudomonas.
  4. Imipenem/cilastatin/relebactam (Recarbrio®) has similar coverage to Avycaz® and Vabomere®; true niche in therapy is not yet well defined.
  5. Cefiderocol (Fetroja®) uses a unique mechanism to enter gram negative bacteria and has a broad spectrum of activity against carbapenemase-producing bacteria and many other multidrug resistant gram negatives. It has no gram positive activity.
  6. Eravacycline (Xerava®) is a tigecycline-like tetracycline with a broad spectrum of activity against carbapenemase-producing gram negative, gram positive, an anaerobic bacteria EXCEPT it lacks coverage for Pseudomonas.

References

  • Yusuf E, Bax HI, Verkaik NJ, van Westreenen M. An Update on Eight "New" Antibiotics against Multidrug-Resistant Gram-Negative Bacteria. J Clin Med. 2021;10(5):1068. Published 2021 Mar 4. doi:10.3390/jcm10051068
  • CDC Antibiotic Resistance Threats in the United States, 2019 report. https://www.cdc.gov/drugresistance/pdf/threats-report/2019-ar-threats-report-508.pdf
Direct download: 146_-_new_antibiotics.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we bring in two guests to discuss the impact of professional advocacy and resulting professional advancements in the state of Illinois. These guests were the front-line agents of advocacy which resulted in pharmacists' ability to prescribe hormonal contraceptives for patients in Illinois (HB 135). We take a deep dive into their efforts to make this change possible, how it will impact patient care, and its implications on possibilities for further advancement of the pharmacy profession all the while highlighting the importance of professional advocacy.

Direct download: 145_-_pharmacist_oral_contraception.mp3
Category:general -- posted at: 7:00am EDT

In this episode, we interview Dr. Danyelle Martin, a Medical Science Liaison (MSL) at Moderna, in order to learn more about the what, how, and future of mRNA-based therapeutics, and what impact it can have on healthcare and healthcare professionals in general.

Key Concepts

  1. Moderna has a “Research Engine” proprietary service that takes an mRNA idea from a web-based digital designer, to a digital ordering system, and finally to a production facility where mRNA constructs are synthesized and quality tested.
  2. Pharmaceutics play a big role in the formulation of mRNA particles. Lipid nanoparticles (LNPs) play an important role for stability and delivery of mRNA cargo. After LNPs and mRNA are co-formulated, the product is purified, filtered, frozen, and subjected to a series of good manufacturing practice (GMP) tests to ensure product quality.
  3. COVID-19 vaccines are a small glimpse into the potential future of mRNA-based therapeutics. Moderna’s pipeline includes mRNA vaccines for other viruses (including RSV, influenza, Zika and CMV) as well as therapeutics for non-viral diseases (including a personalized cancer vaccine and a VEGF-A mRNA molecule for myocardial ischemia).
Direct download: 144_-_moderna_mrna.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we review the diagnostic criteria and treatment strategy of hypothyroidism including the controversy surrounding brand versus generic levothyroxine and non-levothyroxine thyroid drugs.

Key Concepts

  1. The most common cause of hypothyroidism is autoimmune thyroiditis - the body attacks the thyroid gland cells. Typically in hypothyroidism, TSH levels will be high and thyroid hormone levels (T3 and T4) will be normal or low.
  2. Levothyroxine is the drug of choice to treat hypothyroidism. Doses should start low (to avoid cardiovascular side effects) and then be titrated up based on TSH levels.
  3. All other thyroid hormone formulations (including Thyroid USP, Armour Thyroid, liothyronine, etc.) are NOT recommended for use in hypothyroidism. These are not FDA approved medications and there is no data showing these products are more effective than levothyroxine.
  4. Generic formulations of levothyroxine are as effective and safe as brand-name Synthroid®. Although several levothyroxine formulations are AB compatible and can be interchanged by a pharmacist, patients should be maintained on the same formulation whenever possible.

References

  • Dong BJ, Hauck WW, Gambertoglio JG, et al. Bioequivalence of generic and brand-name levothyroxine products in the treatment of hypothyroidism. JAMA. 1997;277(15):1205-1213.
  • Rennie D. Thyroid storm. JAMA. 1997;277(15):1238-1243.
  • American Thyroid Association. https://www.thyroid.org/
Direct download: 143_-_hypothyroidism.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we will build up on our previous Weight loss Pharmacotherapy Episode, episode #13 to discuss updates in guidelines, prevention of obesity from comorbidity standpoint, and new treatment agents for weight-loss with a particular focus on Contrave (naltrexone/bupropion), Saxenda (liraglutide), and Wegovy (semaglutide).

Direct download: 142_-_obesity_meds.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we provide a concise overview of the diagnosis and treatment of hepatorenal syndrome-acute kidney injury (HRS-AKI) with a focus on the new HRS-1 definition (now called HRS-AKI), new data with terlipressin, and the AASLD 2021 guidelines.

Key Concepts

  1. At a basic level, HRS-AKI is caused by portal hypertension leading to systemic vasodilation and a prerenal state.  Our treatment focuses on increasing vascular volume (usually with albumin) and vasoconstriction to increase renal perfusion.
  2. The newest HRS-AKI definition borrows most of the AKI definitions from the KDIGO criteria for AKI.  HRS-AKI requires cirrhosis, ascites, AKI, and an exclusion of other etiologies of AKI.
  3. In AKI and HRS-AKI, concentrated (25%) albumin is given. A dose of 1 gm/kg/day (max 100 gm) for two days is used for AKI.  For HRS-AKI, a dose of 20-50 grams/day is recommended.
  4. The preferred vasoconstrictor in HRS-AKI is terlipressin; however, it is not available in the US. Norepinephrine (if in the ICU) is second-line.  If not in the ICU, midodrine and octreotide are recommended.  Therapy is continued until renal function recovers, if there is no improvement at 4 days, or if a full 14 days of therapy has been given.

References

  1. Biggins SW, Angeli P, Garcia-Tsao G, et al. Diagnosis, Evaluation, and Management of Ascites, Spontaneous Bacterial Peritonitis and Hepatorenal Syndrome: 2021 Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology. 2021;74(2):1014-1048. doi:10.1002/hep.31884
  2. European Association for the Study of the Liver. EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis. J Hepatol. 2018;69(2):406-460. doi:10.1016/j.jhep.2018.03.024
Direct download: 141_-_HRS.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we review the pharmacology, indications, adverse effects, and unique drug characteristics of the most common SSRIs on the market.

Key Concepts

  1. SSRIs (selective serotonin reuptake inhibitors) are the drug of choice for depression, anxiety, and a variety of other psychiatric indications.
  2. Fluoxetine (Prozac) and paroxetine (Paxil) inhibit CYP2D6, a metabolic pathway for several opioid analgesics, tamoxifen, and many other antidepressants.
  3. Adverse effects of SSRIs start immediately but the beneficial psychiatric effects take up to 1 to 2 months to occur. Patient counseling about the timing of adverse effects and efficacy are important!
  4. SSRIs should not be abruptly discontinued in patients taking the medication chronically. Withdrawal symptoms can include flu-like symptoms, changes in mood or sleep, and (rarely) even electric-like shocks. To discontinue, the SSRI dose should be tapered down over the period of several weeks.
Direct download: 140_-_ssri.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we discuss the recent accelerated approval of the new monoclonal antibody-based treatment agent, aducanumab (Aduhelm), by the FDA. We dive into the drug approval process, the efficacy and safety data, and the behind-the-scenes story of the FDA approval. Furthermore, we will present the controversy behind the approval and what it means for stakeholders.

Key Concepts

  1. Aducanumab (Aduhelm) is a monoclonal antibody proven to reduce beta amyloid plaques in patients with Alzheimer’s disease.
  2. Despite reducing plaques, aducanumab did NOT result in meaningful cognitive improvements in patients receiving the drugs versus placebo; additionally, the drug was associated with a potentially concerning adverse effect called ARIA-E (amyloid related imaging abnormalities-edema).
  3. Despite an advisory panel unanimously recommending AGAINST approval and a lack of clinical outcome improvement, the FDA did go on to approve the drug in patients with Alzheimer’s disease using an accelerated approval process.
  4. In the episode, we discuss the substantial ramifications of the FDA’s approval primarily in hurting its credibility in validating the safety and efficacy of other medications on the US market.
Direct download: 139_-_aducanumab.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we discuss the fascinating science of pharmaceutics with Dr. Kristen Ahlschwede and Dr. Rahul Deshmukh. We explore how dosage forms and excipients play an important role in how a drug product behaves in the human body with a particular focus on fentanyl patches, osmotic tablets (with laser-drilled holes), Depakote Sprinkles, and IV amiodarone.

Key Concepts

  1. Fentanyl patches were reformulated from a drug-in-a-reservoir system to an adhesive matrix system to prevent abuse and misuse. The new formulation prevents fentanyl from "leaking" out when cut.
  2. Osmotic tablet systems, such as Procardia XL, Glucotrol XL, and Concerta, use an "active" layer (containing drug) adjacent to a "push" layer that is osmotically active. When the push layer is exposed to water in the GI tract, it swells and pushes the active layer through a small laser-drilled precision hole.
  3. "Sprinkle" dosage forms typically involve small pellets inside a capsule, such as Depakote Sprinkles. The capsule itself does not delay or extend release; instead, the pellets themselves are involved in prolonging the absorption profile of the drug.
  4. Amiodarone IV is commercially available in two formulations -- the conventional formulation (Cordarone) contains benzyl alcohol and tween 80 to solubilize the drug but these excipients are associated with hypotension. A newer formulation (Nexterone) uses cyclodextrin as a solubilizing agent and is not associated with hypotension (although has a risk of nephrotoxicity, especially at higher cumulative doses).
Direct download: 138_-_pharmaceutics.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we reveal what goes on behind the scenes for drug pricing and pharmacy reimbursement with Dr. Benjamin Jolley. Our discussion covers important concepts like PBMs, DIR fees, MAC pricing, and even possible upcoming changes at the federal government.

Key Concepts

  1. Prescription drug reimbursement is a major factor in the decline of independent pharmacies nationwide. Complex reimbursement models, fees, and drug pricing structures are frequently not well understood by both patients and many healthcare providers.
  2. A pharmacy benefits manager (PBM) is a company hired by an insurance company to handle prescription drug coverage and reimbursement. Three PBMs control more than three-quarters of the entire US market and can often dictate the terms of a drug reimbursement contract with pharmacies.
  3. PBMs determine how much they will pay for the cost of a medication using either a benchmark (such as the average wholesale price minus some percentage) or a list of the maximum allowable cost (MAC) maintained by the PBM. Pharmacies are required to accept the PBM’s reimbursement amount regardless of the cost the pharmacy paid to acquire the drug from a wholesaler.
  4. DIR fees, clawbacks, and PBM rebate or discount agreements with manufacturers have resulted in lower reimbursements to pharmacies, higher drug prices for patients, and increased profits for PBMs.
Direct download: 137_-_pbm.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we discuss the recently published major updates in the 9th edition of the anticoagulation guidelines from CHEST. These new recommendations range from initiation of therapy, secondary prevention, and management of post-thrombotic syndrome.

Key Concepts

  1. Among patients with cancer-associated VTE, DOACs are preferred over low molecular weight heparins (LMWH) EXCEPT in patients with GI cancers. The preferred anticoagulant in those with GI cancers is either LMWH or apixaban.
  2. Among patients with antiphospholipid antibody syndrome, warfarin (INR goal 2-3) is preferred over DOAC therapy.
  3. In the extended phase of treatment (secondary prevention after 3 months of treatment), lower anticoagulant doses should be used (such as apixaban 2.5 mg BID or rivaroxaban 10 mg daily).
  4. In patients with a DVT, IVC filters should only be used when anticoagulation therapy is contraindicated. IVC filters reduce the risk of PE but do not alter the risk of DVT extension or future DVTs.
  5. Compression stockings are not recommended for prevention of post-thrombotic syndrome nor for recurrent DVT prevention.
Direct download: 136_-_chest_2021.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we debunk four medication myths that have persisted for decades: metronidazole and alcohol; statins and hepatotoxicity; cidal vs. static antibiotics; and "sulfa" allergies.

Key concepts

  1. Metronidazole does not interact with alcohol (ethanol) and does not cause a disulfiram-like reaction.
  2. Statins can cause transient increases in liver function tests; however, these increases are not associated with hepatotoxicity. Routine LFT monitoring is not recommended unless clinically indicated signs or symptoms of liver injury exist.
  3. The distinction of bactericidal versus bacteriostatic antibiotics is irrelevant. No evidence exists showing that having a bactericidal drug has superior efficacy to a bacteriostatic drug.
  4. A “sulfa” allergy nearly always means an allergy to Bactrim (sulfamethoxazole-trimethoprim). There are many non-antibiotic sulfonamide-containing medications that do not need to be avoided in patients with a sulfa allergy; however, patients with an allergy to any medication have an increased risk of an allergic reaction to other medication classes.
Direct download: 135_-_mythbusters.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we provide a concise review of the diagnostic criteria and general treatment approach to patients with hypertensive emergencies.

Key Concepts

  1. Hypertensive “urgency” is a misnomer - patients do not require immediate therapy and definitely should not receive IV therapy.
  2. In most cases, the goal blood pressure in hypertensive emergencies is to decrease by no more than 25% in the first hour, achieve a BP of 160/100 in hours 2-6, then over the next 24-48 hours lower to a more normal blood pressure goal.
  3. Labetalol is the preferred IV push antihypertensive UNLESS patients have acute heart failure, bradycardia, or possibly in patients with asthma/COPD.
  4. Nicardipine is one of the most commonly used IV infusions for hypertensive emergencies. Most other continuous infusions are reserved for special types of hypertensive emergencies (e.g. nitroglycerin for pulmonary edema or acute MI, esmolol for aortic dissection).
Direct download: 134_-_hypertensive_emergency.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we will explore depths of COVID 19 vaccine hesitancy - what it is, how to identify and address it, and some helpful resources.

Key Concepts

  1. When a patient seems hesitant to consider the COVID-19 vaccine, explore their hesitations further with a simple “why” or “tell more more” question.
  2. Understand the root of hesitancy and provide personalized responses using motivational interviewing. Key concepts of motivational interviewing include asking open-ending questions, asking the patient to share their concerns, reflective listening, acknowledging without judgement, and asking for permission to share information.
  3. The goal of a vaccine hesitancy conversation is not necessarily to have the patient receive the vaccine today; the goal is to move the patient one step closer to validated facts (combating misinformation) and consideration of receiving the vaccine.
Direct download: 133_-_vaccine_hesitancy.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we will explore the history of COVID vaccine development and have a heart-to-heart conversation with Dr. Archana Chatterjee regarding her role as a dean of the RFUMS Chicago Medical School, her career path, and her position and functions on the FDA’s Vaccines and Related Biological Products Advisory Committee (VRBPAC).

Direct download: 132_-_chatterjee.mp3
Category:general -- posted at: 6:00am EDT

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.
Direct download: 131_-_b-blockers.mp3
Category:general -- posted at: 6:00am EDT

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!
Direct download: 130_-_pharma-koshkina.mp3
Category:general -- posted at: 6:00am EDT

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

Direct download: 129_-_deprescribe_ppi.mp3
Category:general -- posted at: 6:00am EDT

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.
Direct download: 128_-_superlative_awards_2021.mp3
Category:general -- posted at: 6:00am EDT

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

Direct download: 127_-_naloxone.mp3
Category:general -- posted at: 6:00am EDT

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.

Direct download: 126_-_enterococcus.mp3
Category:general -- posted at: 6:00am EDT

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.

Direct download: 125_-_warfarin_pgx.mp3
Category:general -- posted at: 6:00am EDT

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.

Direct download: 124_-_EUA.mp3
Category:general -- posted at: 6:00am EDT

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.

Direct download: 123_-_rosalind_franklin100th.mp3
Category:general -- posted at: 6:00am EDT

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.

Direct download: 122_-_journal_club.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we will discuss some of the interesting and unusual warfarin interactions such as acetaminophen, alcohol, agents with antiplatelet properties, non-green vitamin K foods, and CBD/THC.

Direct download: 121_-_warfarin_drug_interactions.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we discuss the pathophysiology, drug-related causes, diagnosis, and treatment of a common type of hyponatremia called the syndrome of inappropriate antidiuretic hormone (SIADH).

Direct download: 120_-_siadh.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we discuss the latest dyslipidemia treatment agent bempedoic acid and dive into its pharmacology, use, and clinical evidence.

Direct download: 119_-_bempedoic_acid.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we discuss the proposed risks of using beta blockers in patients with cocaine use disorders and whether evidence supports this drug interaction as an “absolute” contraindication.

Direct download: 118_-_cocaine_b-blockers.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we dive into the pharmacology of ACE inhibitors and ARBs, particularly understanding how they assist in preserving renal function in CKD and yet at the same time can harm the kidneys (e.g. cause AKI).

Direct download: 117_-_ckd_and_aki_with_acei-arb.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we partner with Dr. Danielle Candelario and Dr. Sneha Srivastava, clinical skills faculty at our college, to discuss tips, tricks, and common pitfalls to avoid when performing medication counseling.

Direct download: 116_-_pt_counseling_pearls.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we discuss the historical significance of Staphylococcus aureus including its patterns of antimicrobial resistance and recommended treatments.

Direct download: 115_-_staph_aureus.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we discuss important nutritional deficiencies as well as pharmacologic changes that occur in post-bariatric surgery patients.

Direct download: 114_-_bariatric_surgery_nutrition_deficiencies.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we review ten clinical pearls about total parenteral nutrition (TPN) that all pharmacists should know.

Direct download: 113_-_tpn_pearls.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we will discuss the most recent evidence for the use of omega-3 fatty acids (fish oil) for ASCVD risk reduction.

Direct download: 112_-_fish_oil.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we chat with Eris Tollkuci, PharmD, BCOP regarding what every non-onc healthcare provider should know about immune checkpoint inhibitors (specifically PD-1/PD-L1 inhibitors) in patients with cancer.

Direct download: 111_-_immune_checkpoint_inhibitors.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we summarize some of the most significant changes in the newest version of American Diabetes Association - 2020 Standards of Medical Care in Diabetes guidelines.

Direct download: 110_-_dm_2020.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we review the pros, cons, and literature regarding the use of DOACs versus warfarin in obese patients with venous thromboembolism.

Direct download: 109_-_DOACs_obesity.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we provide an overview of lifestyle medicine, its six pillars, and how it plays a role in improving health outcomes.

Direct download: 108_-_lifestyle_medicine.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we discuss clinical pearls and management related to chronic and acute hyperkalemia.

Direct download: 107_-_hyperkalemia.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we discuss the important updates in the 2019 IDSA Community Acquired Pneumonia (CAP) guidelines with Dr. Christie Bertram, PharmD, an Infectious Diseases Clinical Pharmacist and Assistant Professor at Rosalind Franklin University’s College of Pharmacy.

Direct download: 106_-_CAP.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we review the three oral P2Y12 inhibitors on the market (clopidogrel, prasugrel, ticagrelor) and discuss each agent’s clinical pearls, comparative effectiveness, and unique precautions.

Direct download: 105_-_P2Y12.mp3
Category:general -- posted at: 6:30am EDT

In this episode, we will discuss what is the latest and greatest from the GINA (Global INitiative for Asthma) 2019 guidelines, including new recommendations regarding rescue inhalers, tiotropium, and azithromycin for asthma.

Direct download: 104_-_gina2019.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we discuss the newly published DAPA-HF trial, which studied dapagliflozin (a drug for diabetes) among patients who had heart failure with reduced ejection fraction (HFrEF) many of which did NOT have a history of diabetes.

Direct download: 103_-_dapa-hf.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we provide an overview of chronic idiopathic constipation and discuss available treatment options with a particular focus on lubiprostone, linaclotide, plecanatide, and prucalopride.

Direct download: 102_-_CIC.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we will be discussing the recent updates in measles outbreaks, where the vaccination recommendations stand, and other preventative strategies.

Direct download: 101_-_measles.mp3
Category:general -- posted at: 6:00am EDT

We are proud to announce our 100th HelixTalk episode! In celebration, we sit down with Dr. Marc Abel, the Dean of the College of Pharmacy at RFUMS to discuss the profession of pharmacy and the future of pharmacy education.

Direct download: 100_-_future_of_pharmacy.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we enlist the help of Associate Dean for Student Affairs, Janeen Winnike, to discuss the various professional pharmacy organizations and the importance of networking via joining at least one as a student or pharmacist.

Direct download: 099_-_pharm_organizations.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we review guideline recommendations and recent evidence for secondary prevention of stroke, including risk factor modification, anticoagulant therapy (in patients with atrial fibrillation), and antiplatelet therapy (in patients with noncardioembolic stroke).

Direct download: 098_-_secondary_prevention_of_stroke.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we discuss the latest and the greatest updates regarding aspirin use in primary prevention and provide you with a summary of results from recently published primary literature.

Direct download: 097_-_Aspirin_primary_prevention.mp3
Category:general -- posted at: 6:00am EDT

In this episode we discuss the recent FDA approval of esketamine (Spravato) for the management of treatment resistant depression as an add on to oral antidepressant therapy. The agent is novel though so, too, may be its adverse effect profile and logistics of administration.

Direct download: 096_-_esketamine.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we will review the pharmacology, efficacy, and safety of the most common NSAIDs on the market.

Direct download: 095_-_NSAIDs.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we discuss the changes made in the American Diabetes Association’s 2019 Standards of Diabetes Care guideline as well as updates in therapy recommendations per ADA and ESDA consensus statement published in Fall 2018.

Direct download: 094_-_DM_update_2019.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we take a deep dive into the use of stimulants and other medications for management of ADHD. After decades of use, technology has resulted in changes to how they are administered. Furthermore new agents have become available, but are they an improvement?

Direct download: 093_-_stimulants_for_ADHD.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we discuss IV fluids for hospitalized patients, including normal saline (0.9% NaCl) and lactated ringer’s. In addition, we review the newest literature supporting the use of balanced crystalloids over normal saline from the SMART and SALT-ED trials.

Direct download: 092_-_balanced_crystalloids.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we are excited to have a special guest with us. Dr. Dyson Wake is Senior Clinical Specialist in Pharmacogenomics at NorthShore University HealthSystem’s Center for Molecular Medicine here in Chicagoland and is here to explain the current and future applications of pharmacogenomics to the area of personalized medicine, as well as expose some misconceptions.

Direct download: 091_-_pharmacogenomics.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we review some of the most important new recommendations from the 2018 ACC/AHA guidelines for the management of blood cholesterol.

Direct download: 090_-_2018_lipid_guidelines.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we will review the FDA’s Unapproved Drugs Initiative and how it has impacted the availability and pricing of commonly used (but old) medications, such as colchicine and vasopressin.

Direct download: 089_-_Unapproved_Drugs_Initiative.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we will discuss a new class of medications for preventing migraines called CGRP antagonists, including an overview of their development, clinical efficacy, and future goals of further research in this area.

Direct download: 088_-_CGRP.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we continue to review insulin therapy including dosing-related specifications, dosing adjustments, injection technique, patient counseling pearls, and the concept of a sliding scale.

Direct download: 087_-_insulins_part_2.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we discuss a broad overview of insulin topics ranging from the various types of insulins, dosage forms, brand/generic names, pharmacokinetic nuances, injection technique, and a wide variety of clinical pearls.

Direct download: 086_-_insulins_part_1.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we discuss vaccine related updates with our vaccine expert, Dr. Lauren Angelo. The updates discussed in this episode include the new shingles vaccine, the variety of influenza vaccines on the market, and several other updates.

Direct download: 085_-_vaccine_update.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we will discuss the advantages and disadvantages of a rate versus rhythm control strategy for atrial fibrillation.

Direct download: 084_-_Rate_vs_rhythm.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we discuss the importance of accurately recognizing depressive symptoms in patients with kidney disease and provide review the limited available literature regarding treatment in this population. We then discuss guidelines to determine some of the best treatment options for this unique subgroup of patients.

Direct download: 083_-_ESRD_antidepressant.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we take a closer look at deuteration, specifically involving the medication deutetrabenazine (discussed back in episode 76). We feature a guest contributor from our pharmacy sciences department who assists us as we look at the drug design aspects of this unique molecule and its implications for research moving forward.

Direct download: 082_-_deuteration.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we discuss some ways APPE students not only survive, but excel in the APPE rotations.

Direct download: 081_-_APPE_rotations.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we will review the diagnosis and treatment of heparin-induced thrombocytopenia (HIT).

Direct download: 080_-_HIT.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we interview Kathleen Lynch, PharmD and Ciantel (Adair) Blyler, PharmD, coauthors of the New England Journal of Medicine article, published in March 2018, investigating the role of pharmacist-led interventions for blood pressure reduction in black barbershops.

Direct download: 079_-_NEJM_barbershop.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we interview Janeen Winnike, Dean of the Office of Students Affairs at the RFUMS College of Pharmacy, regarding transitions from a student life to a practitioner life. With her previous role as an HR official within a large community pharmacy chain, she offers some “do’s and don’ts” for students transitioning into new practitioners.

Direct download: 078_-_Professional_transitioning.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we discuss five clinical pearls about pulmonary embolism ranging from PE diagnosis, classification, and treatment. We specifically examine when and how alteplase is given for PE and its use with concurrent anticoagulation.

Direct download: 077_-_PE_pearls.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we discuss two new agents (valbenazine and deutetrabenazine) -- the first of their kind to receive FDA approval to manage tardive dyskinesia most commonly associated with antipsychotic use.

Direct download: 076_-_Tardive_dyskinesia.mp3
Category:general -- posted at: 6:00am EDT

In the previous episodes, we discussed how we should evaluate a patient’s bleeding and clotting risks as well as looked at recommendation for management for various anticoagulants. In this episode, we will continue the discussion to management of antiplatelets as well as when to resume both antiplatelets and anticoagulants following a procedure.

Direct download: 075_-_Periop_anticoag_II.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we will discuss some important factors to consider in management of various anticoagulants. We will also provide agent specific pharmacodynamic and pharmacokinetic based recommendations.

Direct download: 074_-_Periop_anticoag_I.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we discuss the efficacy and safety of probiotics for the prevention of antibiotic-associated diarrhea (AAD) and Clostridium difficile-associated diarrhea (CDAD).

Direct download: 073_-_Probiotics.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we will review the surprising results of the VA/DoD's 2017 Clinical Practice Guidelines on Management of PTSD, particularly as it relates to the use of one particular agent, prazosin.

Direct download: 072_-_PTSD_guidelines.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we review the important changes in 2017 ACC/AHA guidelines for hypertension management in adults.

Direct download: 071_-_2017_JNC.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we discuss the difficulty in identifying adverse drug reactions (ADR) that ACTUALLY occur from a drug therapy, how tertiary drug references (such as Micromedex or LexiComp) may be misleading, and what tips and tricks you can use to recognize the most clinically relevant ADRs for patient counseling.

Direct download: 070_-_ADR.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we interview Dylan Moe, PharmD, our very own alumnus, regarding the new Illinois rule requiring patient counseling for all new prescriptions and inquire how the new rule has impacted his pharmacy, work environment, and his opinions on the implementation of the rule.

Direct download: 069_-_IL_counseling_rule.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we will discuss the current state of benzodiazepine use, expected trends in prescribing, and risks associated with use. Lastly, we will discuss techniques for ensuring that a benzodiazepine taper is performed in a safe manner with lowest risk of harm.

Direct download: 068_-_Benzo_taper.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we discuss new evidence for cardiovascular outcomes in diabetics based on the LEADER trial (liraglutide) and CANVAS trials (canagliflozin). We also discuss the new FDA warning for canagliflozin regarding amputation risk.

Direct download: 067_-_DM2017_Part2.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we discuss updates in diabetes management that includes nuances from the ADA’s Standards of Care 2017. We also review some newer pharmacologic agents, a fixed dose GLP-1 agonist and basal insulin combinations.

Direct download: 066_-_DM2017_Part1.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we discuss three "older" antihypertensives that are not preferred first-line therapies: clonidine, methyldopa, and minoxidil.  We outline why these agents are not first-line therapies and review their pharmacology and adverse effect profiles.

Direct download: 065_-_Old_HTN_drugs.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we discuss the history of ergot products for treatment of migraines. We compare their safety and efficacy to newer agents such as the triptans and assess their resultant place in therapy.

Direct download: 064_-_Ergots.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we discuss several aspects of serotonin syndrome including the typical clinical presentation, its etiology and common drug-induced combinations, and how to appropriately manage the syndrome.

Direct download: 063_-_Serotonin_syndrome.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we discuss the pathophysiology of embolic stroke in patients with atrial fibrillation and review the use of left atrial occlusion devices, such as the WATCHMAN device, to reduce the risk of stroke in patients with atrial fibrillation without the use of anticoagulants like warfarin.

Direct download: 062_-_LAA_onclusion.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we review the 12 recommendations from the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain.  These recommendations are intended to help curb the opioid epidemic and provide guidance to healthcare providers regarding safer use o

Direct download: 061_-_CDC_opioid_guidelines.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we discuss the concept of professional advocacy, with a particular focus on how to advocate for the profession of pharmacy and what tools and organizations are available to assist in being an advocate.

Direct download: 060_-_Pharmacy_advocacy.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we discuss with Dr. Megan Hartranft the five oncology drugs that every pharmacist should know about, which is a great review for P4 students who are currently preparing for the NAPLEX.  We cover cyclophosphamide, cisplatin, methotrexate, doxorubicin, and vincristine.

Direct download: 059_-_Top_5_Oncology_Drugs.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we discuss the newest definition of sepsis and septic shock according to the Sepsis-3 criteria and the 2016 Surviving Sepsis guidelines.  We also review the scoring systems of “qSOFA” and “SOFA” and use a patient case to help demonstrate the new definitions.

Direct download: 058_-_Sepsis-3.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we discuss the overuse of proton pump inhibitor (PPI) therapy and several concerns regarding chronic use of this medication class, including hypomagnesemia, fracture risk, low seurm B12 levels, anemias, and increased risk of certain infections.

Direct download: 057_-_PPI_overuse.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we discuss the new FDA categorizations of biosimilars, the legal implications of biologic/biosimilar prescriptions, and the new "follow-on" approval pathway of Basaglar, a new insulin glargine U-100 product.

Direct download: 056_-_Biosimilars.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we discuss the SPRINT trial (intensive vs. standard blood pressure control) using a case vignette of Mr. Wilson, a 55 year old patient presenting to a clinic with a blood pressure of 139/89 mmHg.

Direct download: 055_-_SPRINT.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we discuss precepting tips and clinical pearls with Dr. Brad Cannon.

Direct download: 054_-_Preceptor_dev.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we discuss more of the most important drug interactions, including grapefruit juice with statins and calcium channel blockers, QT prolonging medications, levothyroxine with cations and PPIs, and PDE-5 inhibitors with nitrates.

Direct download: 053_-_Drug_Interactions_II.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we discuss some of the most important drug interactions, including serotonin syndrome, St. John's wort, statins and CYP inhibitors, and antihypertensive medications with NSAIDs.

Direct download: 052_-_Drug_Interactions_I.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we discuss two new naloxone devices (intramuscular Evzio and intranasal Narcan) and review new state laws that are expanding the role of pharmacists in dispensing these opioid reversal products.

Direct download: 051_-_Naloxone.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we discuss three shocking recommendations from the CHEST 2016 VTE guideline update.  We focus on (1) the debate between NOAC, DOAC, or TSOAC nomenclature, (2) the controversial recommendation of preferring NOACs over warfarin in VTE treatment, and (3) the efficacy of compression stocking for prevention and treatment of post-thrombotic syndrome.

Direct download: 050_-_CHEST_2016.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we discuss RFUMS's Interprofessional Community Clinic (ICC), a student-run clinic providing health services to underserved populations.  The students in this episode discuss how the ICC evolved and highlight pearls and challenges in starting and running a free health clinic or screening event.

Direct download: 049_-_Interprofessional_Community_Clinic.mp3
Category:general -- posted at: 6:00am EDT

In this episode, we discuss the self-care of nasal congestion and allergies, including systemic/topical decongestants, nasal corticosteroids, antihistamines, cromolyn, and alternative medicine therapies.

Direct download: 048_-_OTC_Nasal_Congestion_and_Allergies.mp3
Category:general -- posted at: 6:00am EDT