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Jeffrey Fudin, PharmD, DAAPM, FCCP, FASHP, discusses and debunks the myths and hysteria surrounding the use of opioid therapy in treating non-cancer pain.

A revised guideline from the American College of Chest Physicians favors the use of dabigatran, rivaroxaban, apixaban, or edoxaban over traditional vitamin K antagonist or low-molecular-weight heparin therapy for the long-term treatment of venous thromboembolism in patients without cancer..."Antithrombotic Therapy for VTE Disease," released online in December by the publishers of Chest, is the 10th published version of the guideline, which updates a guideline released in early 2012. In that version of the guideline, VKA or LMWH therapy was preferred over the two available "new oral anticoagulant drugs" for the long-term treatment of pulmonary embolism or deep vein thrombosis...

Alexander Kantorovich, PharmD, BCPS, clinical assistant professor of pharmacy practice at Chicago State University College of Pharmacy, discusses how platelet aggregation inhibitors fit into the acute coronary syndrome management picture.

• Atezolizumab/Nab-Paclitaxel Highly Effective in Breast Cancer
• Pembrolizumab Effective in ER-Positive Breast Cancer
• Neratinib 3-Year ExteNET Data Similar to Primary Analysis
• Buparlisib Modestly Effective in Breast Cancer
• Avelumab Effective in PD-L1-Positive Breast Cancer
• Adding Denosumab Improves DFS in Breast Cancer
• FDA Approves Alectinib for ALK-Positive NSCLC
• FDA Approves Cooling Cap to Prevent Hair Loss
• Priority Review Granted to Palbociclib Plus Fulvestrant
• FDA Approves Bendamustine Hydrochloride for CLL, NHL
• Priority Review to Crizotinib for ROS1 NSCLC
• FDA Approves Uridine Triacetate for Chemo Overdose

New recommendations have been developed for diabetes, focusing on areas of importance for primary care providers...a systematic review to revise or clarify recommendations for diabetes diagnosis and management for primary care providers, based on new evidence. The recommendations were rated and reviewed, and approved by the American Diabetes Association Board of Directors. Feedback from the larger clinical community was incorporated...The researchers summarized the ADA standards in eight areas of importance to primary care providers: diagnosis, glycemic targets, medical management, hypoglycemia, cardiovascular risk factor management, microvascular disease screening and management, and inpatient diabetes management. An individualized approach was recommended for each area, with self-monitoring emphasized as a key component of care...

Medication errors injure thousands of patients annually, and while mistakes occur with all medication classes, those involving antiretroviral therapies are particularly troublesome...Past studies have suggested that errors are driven by prescribers’ lack of familiarity about antiretrovirals, patients’ ignorance about their complete regimens, and low patient health literacy...Antiretroviral stewardship, which involves educating prescribers and patients and reviewing orders prospectively, helps increase the use of evidence-based medication regimens...researchers addressed the impact of such stewardship on medication errors...The researchers made the following 3 key findings:

1. Medication error rates for patients admitted in the first year were high, but decreased over the 3-year period.
2. Half of the errors occurred in the first 24 hours after admission, especially during late-night and weekend hours when formal consults were unavailable.
3. Incorrect dosing was the most common error, followed by inappropriate use of proton pump inhibitors or histamine-2 receptor antagonists with atazanavir (Reyataz) or rilpivirine (Edurant).

...the study authors recommended initiating an antiretroviral stewardship team that includes infections disease-trained medical and pharmacy staff, as well as increasing staffing to review medications during late-night and weekend hours. They reported that health care systems can further minimize medication errors by triggering an automatic consult request when HIV diagnostic codes are added, or introducing a "hard stop" signaling an infectious disease or stewardship consult...

Alexander Kantorovich, PharmD, BCPS, clinical assistant professor of pharmacy practice at Chicago State University College of Pharmacy, discusses how closer integration of pharmacists into care teams improves outcomes for patients taking new oral anticoagulants.

Your patients may not realize that the effectiveness of their medications is largely within their control...According to the Institute of Medicine, nearly 50% of US adults have trouble understanding their medications’ instructions, so pharmacists should engage patients in interactive conversations in order to ensure that they do not stop taking them...Here are some common reasons why a patient’s medications may not be working properly:

1.  Patients are not taking medications exactly as directed.
2. A patient’s diet may be interfering with medications.
3. A patient’s lifestyle habits may be interfering with medications.
4. A patient may have comorbid conditions.

Although using a patch formulation of fentanyl can have some advantages, here are 5 common problems I've encountered with it in my pharmacy practice:

1. Fentanyl patches are extremely potent
2. Lost or missing fentanyl patches should scare you
3. Fentanyl patches are meant for chronic pain
4. Fentanyl patches can cause delayed withdrawal symptoms
5. Fentanyl patches get diverted

Alongside the growing prevalence of chronic pain and prescription opioid use, drug-related overdose continues to claim the lives of 17,000 Americans each year...Deaths from unintentional opioid overdose have increased 56% since 2010. In 2013, 83% of the opioid overdoses were unintentional...In 2010, there were approximately 136,000 emergency room visits related to opioid-induced respiratory depression and overdose. Needless to say, opioid overdoses are...drastically increasing health care costs...When naloxone is administered by first responders outside an institutional setting, it can improve outcomes for emergency opioid reversal prior to a patient reaching the emergency department. There are currently 2 FDA-approved naloxone formulations for take-home use: the auto-injector...and the new intranasal formulation...

• Who Should Receive Take-Home Naloxone?
• The Risk Index for Overdose or Serious Opioid-Induced Respiratory Depression (RIOSORD)
• Risk Factors Associated with OSORD (opioid-induced respiratory depression)
• How Can I Use RIOSORD in a Community Pharmacy?
• Risk Mitigation and Patient Education
• Conclusion

With the availability of naloxone for take-home use, no one should lament over the loss of a loved one because a life-saving medication was not easily accessible...We can’t agree that naloxone availability will end opioid overdose deaths, but it certainly is our professional responsibility to ensure that we’ve taken every step to reduce risks...Pharmacists, physicians, and student clinicians have an excellent opportunity to mitigate opioid overdose risks by employing the validated RIOSORD tool. RIOSORD can aid opioid prescribers in identifying at risk patients, and it can also help encourage a candid dialogue among pharmacists, patients, and caregivers to reduce patient harm.