Optimizing Medication Therapy & Improving Outcomes

June 29, 2016

Type 1 Diabetes Mellitus: Management Challenges

Type 1 diabetes mellitus (T1DM) is an autoimmune disease characterized by destruction of pancreatic beta-cells and loss of endogenous insulin. The treatment plan includes daily monitoring of the glucose level and an individualized insulin regimen. Multiple rapid-acting and long-acting insulin analogues are available for controlling hyperglycemia. In addition to multiple daily injections, insulin pens, insulin pumps, and inhaled insulin are alternative routes of administration. A sensor-augmented pump is an advanced technology that can benefit patients at risk of hypoglycemia. Oral administration of rapidly absorbed glucose is the antidote for treatment-related hypoglycemia, and severe cases require assistance from glucagon injection. Since T1DM pregnancies have higher risks for complications, frequent self-monitoring of blood glucose is needed. To foster normal growth and prevent long-term morbidity in adulthood, T1DM management in pediatric patients is often demanding, and parents need to establish a healthy parent-child interaction and attitude around diabetes care. Read more.

Medication Safety Concerns Surrounding Immunomodulators

The number of medications used to manage autoimmune disorders has increased dramatically. These agents—the immunomodulators—have resulted in improvements in patient outcomes and, in some cases, slowing of disease progression. Despite these advances, immunomodulators are also associated with substantial medication-safety concerns. The potential for adverse drug reactions, serious drug-related complications, and medication errors is significant. Pharmacists must be acutely aware of immunomodulators’ complexity and associated potential for adverse events. Attention to all aspects of the medication-use process—procurement and storage, prescribing, dispensing, administration, and monitoring—is required to assure that these agents are used in the safest and most efficacious manner. Read more.

Therapeutic Management of Autoimmune Hepatitis

Autoimmune hepatitis (AIH) is a chronic disease of unknown cause with persistent inflammation of the liver and the potential for necrosis and progression to cirrhosis associated with it. AIH can affect any ethnicity, and it appears to occur in women more frequently than in men. There is not one specific trigger that is associated with the disease. Standard treatment for AIH is a corticosteroid (prednisone) alone or in combination with azathioprine. Alternative therapies for patients who may have suboptimal response to the standard treatment options are also available. An immunosuppressive agent should be initiated as soon as possible after diagnosis to prevent further progression of the disease. Patients who fail to respond to standard treatment or the alternative therapies may develop end-stage liver disease requiring liver transplantation. Read more.

Medication Therapy Management in the News

Which Joint Replacement Patients Continue Opioids Longer Term?

A University of Michigan–led study found that one of the strongest indicators of long-term narcotic usage is previous prescriptions for high-dose opioids. Read more.

Risk, Benefit Not Clear in Antipsychotics Prescribed to Autism Patients

With about 10% of young people treated with an antipsychotic also diagnosed with autism spectrum disorder, the drugs are prescribed to about one in six of those with ASD. Read more

Exacerbations Step Up Lung Function Loss in Mild COPD Patients

Lung function loss is accelerated by exacerbations in patients with chronic obstructive pulmonary disease, especially in those in the GOLD 1 category. Read more.

Broad-Spectrum Antibiotics Could Be Riskier for Stem Cell Transplant Patients

Broad-spectrum agents could disrupt the gut microbiome and raise the risk of complications from stem cell transplantation, according to a study published recently in Science Translational Medicine. Read more.