What are effective medication combinations for dyslipidemia?

Many combination drug therapies are effective in treating dyslipidemia. Compared with statin monotherapy, combinations that include ezetimibe (Zetia), a bile acid sequestrant, or niacin further lower low- density lipoprotein (LDL) cholesterol (strength of recommendation [SOR]: A), and increase the likelihood of attaining National Cholesterol Education Program (NCEP) LDL cholesterol goals (SOR: B). Adding ezetimibe to a bile acid sequestrant reduces LDL cholesterol (SOR: B). Fibrate or niacin added to statin monotherapy provide mixed lipid-modifying effects for combined dyslipidemia (SOR: A)

What is the best regimen for newly diagnosed hypertension?

Low-dose thiazide diuretics (eg, hydrochlorothiazide 12.5 to 25 mg/d) are the best first-line pharmacotherapy for treating uncomplicated hypertension(strength of recommendation [SOR]: A, based on randomized trials [RCTs] and 1 meta-analysis). Alternate first-line agents include angiotensinconverting enzyme (ACE) inhibitors, beta blockers, and calcium channel blockers (SOR: A, based on RCTs)

Evaluation of fracture risk and potential drug holidays for postmenopausal women on long-term bisphosphonate therapy

This is the publisher's version, also available electronically from http://www.dovepress.com/evaluation-of-fracture-risk-and-potential-drug-holidays-for-postmenopa-peer-reviewed-article-IJWHStudy objective: To describe characteristics of postmenopausal women on long-term bisphosphonate therapy who fall into one of four fracture risk categories (low, mild, moderate, high), and to determine the prevalence of women eligible for a drug holiday. Design: Retrospective electronic health record review. Setting: Eight primary care clinics within a university-based health care system. Patients: A total of 201 postmenopausal women of ages 55–89 years, with osteopenia or osteoporosis, prescribed bisphosphonate therapy for >4 years, between October 10, 2002 and September 9, 2012. Main results: The patients' mean age was 71.4 (±8.2) years; their mean body mass index was 25.3 (±5.6) kg/m2; and 73.1% were white. Seventy-four out of 201 patients (36.8%) were low-risk; 10/201 (5.0%) were mild-risk; 72/201 (35.8%) were moderate-risk; and 45/201 (22.4%) were high-risk. Eighty-one women (40.3%) were eligible for a drug holiday or discontinuation. The estimated drug cost avoided per eligible patient was $574.80. Calcium and/or vitamin D supplementation was documented in 52.7% of women. Conclusion: More than one-third of postmenopausal women taking long-term bisphosphonate therapy had low fracture risk, and over 40% of our patients were eligble for a drug holiday or discontinuation. These data emphasize the need to accurately assess risk and benefit in patients treated with bisphosphonate therapy

Assessment of Achieved Systolic Blood Pressure in Newly Treated Hypertensive Patients Aged 60-79 Years Before and After Eighth Joint National Committee Recommendations

Objective: To determine whether patients who were newly prescribed antihypertensive therapy after the Eighth Joint National Committee (JNC 8) update were treated to a relaxed systolic blood pressure (SBP) goal compared with patients treated before the update. Methods: A retrospective cohort study approved by the Colorado Multiple Institutional Review Board. Patients aged 60–79 years, without diabetes or chronic kidney disease (CKD), newly treated for hypertension at a University of Colorado primary care clinics were included. The mean first-achieved and last-stable SBPs of patients newly prescribed antihypertensive medications from 1 January 2012 to 31 December 31 2013 (before cohort) were compared with patients newly prescribed antihypertensive therapy from 1 January 2014 to 1 October 2015 (after cohort). The mean number of antihypertensive medications at first-achieved SBP, the time to first-achieved SBP, and the class of initial antihypertensive medications were also evaluated. Results: A total of 128 patients were included, 64 patients in each cohort. The coprimary outcome of first-achieved mean SBP did not differ between the groups (131.3 mmHg versus 130.2 mmHg; p = 0.65). Last-stable mean SBP values were also similar between the groups (130.2 mmHg versus129.5 mmHg; p = 0.74). Angiotensin converting enzyme inhibitors (ACE-I) were the most frequently initiated antihypertensive agent in both cohorts (43.8% versus 48.4%; p = 0.72). Conclusions: Our findings suggest that the JNC 8 recommendations did not alter SBP goals among patients aged 60–79 years newly treated for hypertension at University of Colorado primary care clinics

Bridging health disparities: a national survey of ambulatory care pharmacists in underserved areas

Background : There is a shortage of primary care medical providers, particularly in rural communities and communities of racial and ethnic minority groups. Clinical pharmacists can help fill gaps in care among these vulnerable populations. Obj ective : To identify characteristics of ambulatory care pharmacists that pursue and maintain employment within underserved areas. Methods : An original survey was distributed nationwide to ambulatory care clinical pharmacists in underserved settings. Respon dent characteristics were analyzed using descriptive statistics. Results : Of the 111 completed surveys, a majority of respondents were White, non - Hispanic, female, with English as their only spoken language. A majority of pharmacists completed a clinical experience or specialized training focused on underserved care prior to their position. The top three motivators for pharmacists accepting their clinical position as well as staying at their job were pas sion for caring for underserved populations, the pres ence of a faculty appointment, or the freedom and flexibility of advanced clinical roles. Conclusions : With a large majority of our respondents identifying as White and unilingual, there remains a large opportunity to increase diversity in the clinical ph armacy ambulatory care workforce caring for underserved populations. There is an observed correlation between early experiential or specialized training in underserved care and pharmacists pursuing employment in the se areas. Thus, one potential long - term s trategy to diversify and grow the ambulatory care clinical pharmacist workforce in underserved settings is for clinical practice sites to partner with colleges of pharmacy to recruit and maintain quality individuals who can meet the needs of diverse patien t populations as well as expand student and resident training opportunities in underserved settings