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Marijuana Use - Medical, Health, and Legal Issues (I)

Kari Franson, Pharm.D., Ph.D., BCPP - Associate Dean for Professional Education at the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences - talks to us about the medical use of marijuana, THC, and CBD. Key Lessons: Cannabis plants have been used for medical, recreational, and industrial purposes for thousands of years. The two active ingredients in cannabis plants include tetrahydrocannabinol (THC) and cannabidiol (CBD) - collectively known as cannabinoids.  They have distinctly different pharmacological properties. Cannabis plants that contain less than 0.3% of THC by dry weight are legally classified as hemp.  Cannabis plants can be cultivated to have more (or less) THC and CBD content. Prescription products containing THC have been available for more than 30 years. A buccal spray containing THC + CBD has been approved (but not in the United States) for the treatment of muscle spasms/stiffness associated with multiple sclerosis.  A purified CBD product was approved by the FDA for the treatment of rare childhood seizure disorders in 2018. There is a long list of claimed medical uses of marijuana (typically contains high concentrations of THC).  Not all claims are supported by sufficient evidence and some have been refuted by the evidence.  Far less is known about the medical uses of CBD. Cannabinoids are erratically and slowly absorbed from the GI tract. There are substantial legal barriers to studying cannabis and its health consequences in the United States. View and Download the Show Notes


18 Jun 2019

Rank #1

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It's All About Quality (I)

Troy Trygstad, Pharm.D., MBA, Ph.D. - Executive Director of CPESN-USA, a network of pharmacies that provides a portfolio of medication optimization and patient care services - talks about the "quality movement" and how it's impacting the practice of pharmacy in community and ambulatory care settings. Key Lessons:  Create supports to help patients to optimally use medications; follow-up is critical; fully engage staff and student pharmacists to deliver care.


15 Feb 2018

Rank #2

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Gender Identity & Transgender Care (I)

Nicole Avant, PharmD, BCACP - Assistant Professor at the University of Cincinnati and Founder/CEO of Avant Consulting Group - and Tennille McKinney - HIV Educator and Consultant with Avant Consulting Group - talk with us about gender expression/identity, cis-privilege, and transphobia. Key Lessons: Sex and gender are not synonymous.  Sex is based on biology and gender is a social construct. Sex is determined by genes and assigned at birth. Gender is influenced by cultural norms and internal sense of self. Transgender persons identify with a gender that is different from the sex that was assigned at birth.  Cis-gender persons identify with the gender that is congruent with the sex assigned at birth. Some transgender persons, but certainly not all, seek medical and/or surgical gender-affirming treatments to express their gender identity. Cis-privilege includes the rights and advantages that cis-gender persons enjoy.  This includes respect for one's gender identity and freedom from harassing comments or intrusive questioning. Deadnaming is the act of referring to and calling someone by their birth name rather than their chosen name which is congruent with their current identity. Transgender persons face social stigma from both the lay public and health professionals.  This sigma often results in transgender persons seeking care outside of traditional institutions and relying on self-care. To learn more, view and download the Show Notes!


18 Dec 2019

Rank #3

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It's All About Quality (III)

Rosemary Duncan, Pharm.D., BCPS - Medication Safety Officer - and Jacob Smith, Pharm.D. - Assistant Director of Medication Safety and Quality at The Johns Hopkins Hospital talk about measuring quality in hospital settings and how quality metrics are used for accreditation and value-based payments. Key Lessons:  Measuring quality is difficult and event rates are not an adequate metric of medication safety; pharmacists can help improve HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) scores by providing patient and provider education; quality in healthcare is advanced by implementing high-reliability systems and processes by interprofessional teams.


17 Apr 2018

Rank #4

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Digital Health Devices and Apps! (I)

Timothy Aungst, Pharm.D. - Associate Professor at the MCPHS University in Worcester, Massachusetts and the author of The Digital Apothecary blog talks to us about the current digital health landscape. Key Lessons:  Stand alone mobile health devices and apps have limited value; patient-specific data can inform diagnosis and treatment decisions; aggregated data from 1000's of users can help direct public health efforts; and pharmacists can and should play a bigger role in mHealth/digital health.


17 May 2018

Rank #5

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Marijuana Use - Medical, Health, and Legal Issues (III)

William J Stilling, BS Pharm, JD - Founding Partner, Stilling & Harrison, PLLC and Clinical Associate Professor, Department of Pharmacy Practice at the University of Utah College of Pharmacy - talks to us about some of the legal issues related to the medical and recreational use of marijuana. Key Lessons: Marijuana (in its raw form) is a schedule I substance under Federal Law.  However, the US Congress has prohited the Department of Justice from using its funds to enforce Federal law superceding State laws related to marijuana. Medical marijuana is typically legal to use under State laws only in specific "use cases" or "qualifying conditions."  Physicians and other prescribers can't legally prescribe marijuana because it would violate their DEA issued license but may "recommend" or "authorize" the use of marijuana. Healthcare instutitions need to consider the use of marijuana for therapeutic purposes by their patients and develop clear policies and procedures on how marijuana use will be accommodated in their facility. Pharmacists and pharmacies are subject to oversight by the board of pharmacy and most state boards require pharmacists to abide by Federal laws.  Thus, pharmacists who use marijuana, even for "legal" therapeutic purposes, may be subject to sanctions and lose their license to practice. Employers may terminate a pharmacist or health professional for marijuana use because it is a violation of Federal law. The FDA is unlikely to approve marijuana (in its raw form) for medical indications because it can not be easily studied or standardized. The legal status of marijuana in the years to come will be significantly impacted by political and economic forces. View and Download the Show Notes


15 Aug 2019

Rank #6

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Digital Health Devices and Apps! (II)

Julie Lauffenburger, Pharm.D., Ph.D. - Assistant Director of the Center for Healthcare Delivery Sciences at the Brigham and Women's Hospital and co-investigator for the MedISAFE-BP study talks to us about the use of smartphone applications to improve medication adherence. Key Lessons: Improvements in medication adherence don't necessarily lead to improvements in outcomes (e.g. blood pressure control or cardiovascular events) unless patient-monitoring data is shared and used by clinicians to make medication adjustments; smartphone apps should provide nudges to patients in a manner they find most useful; technology should make the medication use process easier, not more difficult.


13 Jun 2018

Rank #7

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Opioid Overdose Crisis (II)

Suzanne Nesbit, Pharm.D., BCPS - Clinical Pharmacy Specialist in Pain and Palliative Care at the Johns Hopkins Health System - and Lucas Hill, Pharm.D., BCPS, BCACP - Clinical Assistant Professor at the University of Texas at Austin and Director of Operation Naloxone - discuss how to improve patient safety by implementing opioid stewardship and harm-reduction strategies. Key Lessons Opioid stewardship requires multiple components starting first with a commitment to change and includes opioid prescribing guidelines, provider feedback, and patient education. Discussing the goals of therapy, intended treatment duration, and realistic expectations with patients when opioids are prescribed is critical. Patients at high risk of opioid overdose should receive naloxone and trained how to use it. Naloxone standing orders or collaborative practice agreements can facilitate access. Information from prescription drug monitoring programs can be helpful during the medication review process but providers must recognize their limitations. Pain relief requires a patient-specific approach. Patients with a substance use disorder deserve to have their pain addressed too. View and Download the ShowNotes!


13 Dec 2018

Rank #8

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Marijuana Use - Medical, Health, and Legal Issues (II)

Laura Borgelt, Pharm.D., BCPS - Professor, Departments of Pharmacy Practice and Family Medicine at the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences - talks to us about the recreational use of marijuana and its potential health consequences. Key Lessons: Cannabis (marijuana) use has increased substantially in the past decade.  Young adults are the most likely to report using marijuana in the past year or month but use among older adults (age > 65 years) is growing as well. Its important to ask patients in a non-judgmental, open-ended manner about their cannabis use including the intended purpose(s), frequency of use, and forms used. Numerous cannabis products are available. Inhaling (smoking or vaping) remains the most common method for use.  Edible products are available in a wide variety of food-like delivery systems (e.g. baked goods, candies).  Topical products are more commonly used for medical purposes. The THC concentrations found in cannabis products today are much higher than years ago. This has resulted in higher rates of unintentional overdoses leading to paranoia and psychotic symptoms. Overdosing is most common with edible products due their delayed absorption. There are several short-term and long-term health consequences related to marijuana use. Regular cannabis use can lead to neurocognitive effects including impaired memory. Cannabis use is more likely to have a detrimental impact for adolescents and young adults. Cannabis use during pregnancy also appears to have detrimental neurocognitive effects on children. There are several potential drug-drug interactions with THC and medications metabolized through CPY2C9 and CPY3A4 as well as receptor interactions. Pharmacists have an important public health role by screening for cannabis use, educating patients about the potential risks associated with marijuana use, and identifying potential drug-drug interactions. View and Download the Show Notes


18 Jul 2019

Rank #9

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Opioid Overdose Crisis (I)

Jeffrey Bratberg, Pharm.D., BCPS - Professor of Pharmacy Practice at the University of Rhode Island talks with us about the opioid overdose crisis - it's causes and potential solutions. Key Lessons The causes of the opioid overdose crisis are multifactorial but rooted in hopeless and despair Illicitly obtained synthetic opioids are very potent and the leading cause of opioid overdose deaths today Opioid use disorder is a brain disease and all patients deserve compassionate care The response to the opioid overdose crisis (to date) has been anemic due to societal stigma and unconscious bias Supply-side solutions (e.g. prescription drug monitoring programs) to the problem may seem helpful but have unintended consequences Naloxone should be widely available and all health professionals should carry it View and Download the ShowNotes!


14 Nov 2018

Rank #10

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Pharmacists Patient Care Process (I)

Todd Sorensen, Pharm.D. - Professor in the Department of Pharmaceutical Care and Health Systems at the University of Minnesota College of Pharmacy and Executive Director of the Alliance for Integrated Medication Management talks with us about the importance of applying a systematic process of care during every patient encounter. Key Lessons: All health professions have a similar process of care but each has a different focus and assessment strategy; inconsistencies in the process of care provided by pharmacists has led to inconsistent outcomes in clinical trials; several new resources are available to help pharmacy practitioners deliver the pharmacists patient care process with greater "fidelity." Helpful Resources:  Check out the Patient Care Process chapter in Pharmacotherapy: A Pathophysiologic Approach and the Patient Care Process for Delivering Comprehensive Medication Management report.


14 Aug 2018

Rank #11

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Credentialing & Privileging (I)

Joseph Saseen, Pharm.D., BCPS, BCACP, CLS - Professor of Clinical Pharmacy and Family Medicine, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences - discusses the various credentials pharmacists can earn following graduation and licensure. Key Lessons Credentials include degrees, licensure, post-graduate training, and board certification. Earning a certificate is not synonymous with becoming board certified. Board certification requires candidates to meet specific eligibility criteria and pass a comprehensive examination to validate the breadth and depth of knowledge in the area of specialization. Board certification can give pharmacists a competitive advantage for employment and open doors to new opportunities. Candidates should consider preparing for a board certification exam either through a formal, structured program or forming a study group ... or both. Obtaining advanced credentials is ultimately about improving the quality of care pharmacists provide to patients. View and Download the Show Notes!


14 Mar 2019

Rank #12

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Opioid Overdose Crisis (III)

Carol Ott, Pharm.D., BCPP - Clinical Professor of Pharmacy Practice, Purdue University College of Pharmacy and Residency Program Director for the Eskenazi Health/Purdue University PGY2 Psychiatric Pharmacy Residency Program - discusses how sigma adversely impacts patients with opioid use disorder and how the BoilerwoRx program is helping to address the opioid crises at the community level. Key Lessons Health professionals too often use stigmatizing language when describing patients with a substance use disorder and their behaviors. We need to critically examine our unconscious biases toward patients with substance use disorder. Substance use disorders are most often co-morbid with other mental health conditions. Needle exchange programs are an evidence-based intervention that can reduce harm by preventing the spread of infectious diseases and be an important touchpoint to get people into treatment. There are numerous ways pharmacists can help patients with substance use disorders - approaching them with empathy, volunteering, and using evidence-based resources to guide care and combat misinformation. View and Download the ShowNotes!


16 Jan 2019

Rank #13

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Gender Identity & Transgender Care (III)

Cheyenne C. Newsome, PharmD, BCACP and Jessica Conklin, PharmD, BCACP, CDE, AAHIV — passionate advocates for the role of pharmacists in the care of transgender persons — talk with us about the need for patient and provider education and about the benefits and risks of gender-affirming treatment. Key Lessons: Gender-affirming therapy is highly effective, improving the quality of life in more than 80% of patients. Hormonal therapy is the cornerstone of gender-affirming therapy.  Testosterone is used for masculinization by trans-men.  It is traditionally given by intramuscular injection but subcutaneous injections are easier to administered and may have a smoother effect (e.g. lower peak effect).  Side effects from testosterone are common including body and facial hair growth (you don't get to pick!), deepened voice (irreversible), clitoral enlargement, acne, menstrual irregularities, and weight gain from increased appetite. Estradiol (preferred estrogen) is used for feminization by trans-women. In addition, spironolactone is used in high doses for its anti-androgen effects.  Side effects are similar to those experienced by cisgender women. While trans-men often develop amenorrhea, pregnancy is still possible.  Frank discussions about the use of contraception, if sexually active, is important. A number of great resources are available to inform drug therapy decision making particularly the Endocrine Society Guidelines. Pharmacists can uniquely contribute to optimizing the care of trans-men and -women. To learn more, view and download the Show Notes!


18 Feb 2020

Rank #14

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Social Determinants of Health and Healthcare Delivery (I)

Magaly Rodriguez de Bittner, PharmD, BCPS, CDE - Professor and Associate Dean for Clinical Services and Practice Transformation, University of Maryland School of Pharmacy - talks to us about the impact of culture on behaviors and health outcomes ... and why healthcare practitioners need to develop cultural awareness and move toward cultural proficiency to achieve optimal outcomes for the patients they serve. Key Lessons: Culture is the characteristics, knowledge, and beliefs of a group of people including their shared language, religious/spiritual beliefs, habits, and values.   Culture impact beliefs about diseases, medications, and healthcare. Many patients are reluctant to tell healthcare providers about their culturally-related health behaviors for fear of being judged or may believe such information is irrelevant. Behaviors and beliefs, regardless of source, can impact health outcomes and can augment, detract, or have no impact on the recommended treatment plan. Openly discussing beliefs and behaviors is critical.  Supporting patient decisions based on their beliefs builds trust. Communicating in the patient's preferred language is mandated by law. Use trained interpreters. Have written materials available in the patient's preferred language. Cultural awareness and moving toward cultural proficiency makes good business sense as you are better able to understand the needs of your patients.


24 Sep 2019

Rank #15