Optimizing Medication Therapy & Improving Outcomes

February 27, 2017

Direct Oral Anticoagulants for the Prevention of Stroke in Nonvalvular AF

Atrial fibrillation (AF) is the most common cardiac arrhythmia in the United States. It is a complicated disease state involving an irregular heart rate and rhythm. AF generally affects the aging population and is classified as either valvular AF (VAF) or nonvalvular AF (NVAF). The two differ based on the patient’s valve status and treatment strategies. AF treatment is directed toward rate control, with or without rhythm control, and anticoagulation for prevention of cardioembolic stroke. Several direct oral anticoagulants (edoxaban, apixaban, rivaroxaban, dabigatran) have recently gained approval for use in NVAF. Pharmacists should educate patients about potential drug-drug interactions and adverse effects with this class of medications. Read more.

Management of Coronary Artery Disease and Chronic Stable Angina

Coronary artery disease (CAD) is the most common type of heart disease and the leading cause of death worldwide. Angina pectoris, a clinical syndrome characterized by discomfort typically located in the chest, neck, or left arm, is one of several clinical manifestations of CAD. The gold standard for diagnosing and evaluating CAD is coronary angiography. The goals of treatment are to maximize quality of life and minimize the risk of death through the modification of risk factors such as diabetes, hypertension, and hyperlipidemia and the management of acute ischemic symptoms. Some frequently used pharmacotherapeutic options include beta-blockers, calcium channel blockers, nitrates, ACE inhibitors, statins, and antiplatelet agents. Read more.

Triple Therapy for a Cardiac Indication in a Veteran Population

The use of triple therapy in patients after percutaneous coronary intervention is becoming more common because numerous patients requiring cardiac catheterization have risk factors for other disease states that necessitate anticoagulation, namely, atrial fibrillation. Although patients may have appropriate indications for all three medications—which often include aspirin, a thienopyridine, and an anticoagulant—concomitant use of these agents tends to result in higher rates of bleeding. Therefore, as a quality and safety measure at one Veterans Affairs facility, patients on triple therapy were identified and had an intervention to alter the medication regimen to preemptively reduce bleeding rates. Ninety-five percent of patients had an adjustment in their medication regimen without any observed instances of revascularization at follow-up. A review of safety outcomes showed that no patient experienced an admission or an adjustment of medication therapy related to gastrointestinal bleeding. Read more.

Medication Therapy Management in the News

Too Many Women Not Getting AET After Breast Cancer Surgery

One out of six women who should have received postsurgical adjuvant endocrine therapy (AET) did not receive it, according to a nationwide cancer registry. Read more.

Polypharmacy Linked to Frailty in Older Patients

A follow-up after 8 years of a large German study of older adults reports that polypharmacy, defined as receiving from five to more than 10 prescriptions, appears to be a factor in frailty in older adults. Read more

Study Emphasizes Importance of Exacerbation Rate in COPD Treatment

A recent study of 900 COPD patients in a VA medical center on Long Island, New York, found that 44% were undertreated based on Global Initiative for Obstructive Lung Disease (GOLD) clinical guidelines. Read more.

Some 20% of Psoriasis Patients Have Suboptimal Therapy Response

As many as one in five patients undergoing systemic treatment are not getting sufficient relief, according to a study recently published in the Journal of Dermatological Treatment. Read more.