Health Risks and Emerging Trends with the Use of Electronic Cigarettes

Cigarette smoking is associated with many health risks and complications. Despite smokers\u27 strong desire to quit, most battle with nicotine withdrawal and relapse. Because electronic cigarettes (e-cigarettes) do not contain tobacco, some believe them to be safer than traditional cigarettes and have used them as a replacement or adjunct nicotine source to prevent withdrawal symptoms. Electronic cigarettes are designed to mimic traditional cigarettes and expel a vapor composed of nicotine, water, glycerol, propylene glycol and other flavorings. Many e-cigarette companies use appealing platforms, which promise smoking cessation and harm reduction, to attract consumers; however, several studies have found e-cigarettes actually contain ingredients that are harmful to one\u27s health. Studies have demonstrated that the use of e-cigarettes can be toxic to patients\u27 health if patients do not research the products they intend to purchase. The flavoring of e-cigarettes may be a major contributor to e-cigarette cytotoxicity. If flavoring and other cytotoxic contents of e-cigarettes can be eliminated, e-cigarettes may be useful in smoking reduction and cessation. Many clinicians today support traditional forms of nicotine replacement therapy for smoking cessation rather than e-cigarettes. Due to the lack of regulation and studies by the U.S. Food and Drug Administration, e-cigarettes may not be as safe as users may perceive and should not be a preferred product for smoking cessation therapy until they are further studied and regulated

Comparison of Long-Term Oral Anticoagulation Therapies Including Newly Approved Reversal Agent for Dabigatran

Anticoagulants are a well-known class of agents essential for the prevention of blood clots, which may further develop into deep vein thrombosis, pulmonary embolism or stroke. Individuals at a high risk of clotting, such as those with atrial fibrillation, multiple risk factors or recent hip/knee surgery, are in need of long-term anticoagulation therapy. The purpose of this review is to highlight the pros and cons for each available anticoagulant as well as discuss pivotal clinical trials that evaluated the safety and efficacy of these agents. Warfarin, the oldest anticoagulant, requires the patient to attend frequent appointments with a health care professional in order to test their international normalized ratio (INR). Newer anticoagulants, including dabigatran, rivaroxaban and apixaban, do not require frequent INR testing and have a quicker onset of action than warfarin, providing convenience for the patient. However, many health care professionals prefer warfarin because the INR may indicate its efficacy, its dosages can be easily changed and it is typically more affordable. Additionally, dabigatran may be chosen because it is the only one of these drugs that has a reversal agent, which can be utilized in the case of major bleeding or emergent surgery. There are many opportunities for pharmacists to impact patient outcomes in the anticoagulation therapy setting. From clinics to the community pharmacy setting, the pharmacist\u27s role in patient counseling and education is crucial in reducing mortality. Additionally, drug development is a growing market as reversal agents are needed for many of these newer anticoagulation therapies

Emerging Drug Targets and New Drugs in the Treatment of Psoriatic Arthritis

Psoriasis is an autoimmune disease characterized by painful skin lesions. When joints and connective tissue also become involved, the condition is referred to as psoriatic arthritis (PsA). Current treatments for moderate to severe PsA include therapies used to treat rheumatoid arthritis (RA) despite differences in disease presentation which includes factors such as peripheral disease, sacroiliitis, stiffness, presence of rheumatoid factor and psoriasis. Treatment out-comes for PsA are measured by the American College of Rheumatology (ACR) Responder Index (ACR20) and the Dis-ease Activity Score for 28 joints (DAS28). First-line treatment includes disease-modifying antirheumatic drugs (DMARDs) such as methotrexate, sulfasalazine or leflunomide in con-junction with symptomatic therapy including nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroid injections. Oftentimes these treatments do not provide adequate management for PsA which has led to recent studies that have looked at using additional therapies in this patient population. Patients who do not experience relief from first-line options often require the use of a second DMARD added to their treatment regimen. Interleukin (IL)-12/23 inhibitors, IL-17A inhibitors, phosphodiesterase 4 (PDE4) inhibitors, janus kinase (JAK) inhibitors and tumor necrosis factor (TNF)-alpha inhibitors are discussed in this article and their benefits were examined in recent clinical trials