Published December 20, 2023
In the ever-evolving landscape of healthcare, staying current with the latest pharmacology guidelines can be a daunting task. When faced with competing demands of work, home, and wellness, it can be hard to find additional time for learning. Here we’ll review some quick tips and updates in the world of pharmacology.
Opioid Management
As you probably heard, the DATA-Waiver, or X-Waiver, program has been eliminated, expanding the availability of treatment for opioid use disorder (OUD). But what does that mean for you? In essence, you are now able to prescribe buprenorphine to help your patients with OUD. The Substance Abuse and Mental Health Services Administration (SAMHSA) has an easy-to-follow quick start guide available online to help assist you through the steps and process of prescribing and monitoring buprenorphine.
The Land of the Lungs
The 2023 Global Initiative for Asthma (GINA) guidelines has brought some new treatment recommendations to asthma management. Over the past several years we have learned more about the long-term effects associated with excessive use of short-acting beta-agonists (SABAs). The GINA guidelines now recommend the preferred option for treatment to include the use of an inhaled corticosteroid combined with formoterol as the PRN and maintenance treatment plan. GINA does include treatment guidance for the use of SABAs for some patients who providers feel are appropriate to be using them as a treatment option.
And let’s not forget the updates from the Global Initiative for Obstructive Lung Disease (GOLD) released in 2023. GOLD has made edits to their ABCD combined assessment tool, merging the C and D groups into a group E. It’s important to note that SABA’s remain a mainstay of treatment for acute episodes of shortness of breath in patients with COPD, a contrasting recommendation from the management of asthma.
The Cardiovascular Chronicles
Have you ever had a patient that could not meet their LDL goal despite maximizing their statin therapy and implementing all lifestyle changes that they are capable of sustaining? I know I have, and it can be frustrating and defeating for the patient, as well as the provider. But, we have non-statin therapy options available to help, such as ezetimibe. Did you know that ezetimibe can reduce LDL levels an additional 25% when combined with a statin? This could be just the right amount to help someone achieve their LDL goal! But what if they still can’t reach their goal with combo therapy? There are additional options we could try as well, such as PCSK9 inhibitors which have the potential to decrease LDL levels by 45%-64%. These are great options to help our patients meet their goals.
And we can’t forget about hypertension-that silent diagnosis that plagues so many! While there has not been a lot of updates for management of hypertension, it is always good to refresh our minds on the guidelines that we do have available. Currently we have both the 2014 JNC8 and 2017 AHA/ACC guidelines for reference. How would you approach a patient whose blood pressure is not responding to treatment. So many require combo therapy, sometimes starting two medications at the time of diagnosis. But what about that patient who is on the maximum doses of three agents, one of them being a diuretic, and still not achieving their blood pressure goal? We’re now dealing with resistant hypertension and need to refer them to a specialist.
Antibiotic Stewardship
We are full swing into cough, cold, COVID-19, and RSV season! Are you fielding the requests for antibiotics like a goalie during a power play—call after call after call? Following the lifting of pandemic restrictions, more people are contracting the common cold but due to fear of illness or inability to slow down in their day-to-day world they will ask for an antibiotic. As prescribers, we have to be diligent to prescribe antibiotics when it is appropriate. One area of antibiotic overprescribing is the sinus infection. Are you comfortable with the criteria for prescribing an antibiotic for sinusitis? Or what criteria to consider for someone who is high risk for an antibiotic-resistant infection?
It is a complex world of pharmacology and more information is available in the pharmacology podcast series where we will dive further into these topics. As a healthcare professional, you will find yourself better equipped to navigate the terrain of management for opioids, sinusitis, asthma, COPD, hypertension and hyperlipidemia. In a world where knowledge is key, these podcasts will unlock the doors to a deeper comprehension of pharmacology, ultimately enhancing your patient care.