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table of Contents departments volume 5 issue 1
STAFF Publisher & Editor-in-Chief Mike Johnston, CPhT-Adv, BCSCPT, BCNCPT Executive Assistant Cess Literatus
11
disease brief: Rheumatoid Arthritis Disease brief: bipolar disorder member spotlight
5 6 7 8 9 10
Publisher’s Note News Briefs
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product news community rx health-system rx disease brief: andropause
Creative Director Peter Ian Fazon Director of Education Josh Cano, CPhT-Adv, BCSCPT, BCNCPT Manager, Continuing Education Ashleigh Smith, CPhT Member Services Jessica Sanders Graphic Designers
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continuing education: New FDA Approved Drugs and Vaccines (2023-2024) 26 The US Food and Drug Administration (FDA) approved 55 new drugs in 2023, the highest num- ber of annual approvals since 2018. Many address unmet medical needs, including new treat- ments for Alzheimer's disease, migraine, and RSV infection. Pharmacists play a key role in ensuring patients understand how to use these new medications safely and effectively. Addi- tionally, pharmacists can help patients manage their medications and prevent medication er- rors, which are common and can have serious consequences. Written by Erin DiMuzio, PharmD. ACPE UAN: 0384-0000-24-051-H01-P, 0384-0000-24-051-H01-T 2.0 Contact Hours Balancing the Scales: Conflict Resolution in Pharmacy Practice 42 Explore how pharmacy professionals navigate the delicate balance between maintaining operational efficiency and resolving interpersonal and ethical dilemmas. Balancing the scales in pharmacy practice requires addressing operational conflicts, ethical dilemmas, and interpersonal disputes. The ACE ap - proach offers a structured method to address and resolve conflicts effectively: Active Listening, Clarity, and Empathy. To prevent future conflicts, pharmacy professionals can lead by example, participate in team building, be self-aware, learn conflict resolution techniques, and utilize stress management tools. By integrating these strategies, pharmacy professionals can create a more harmonious work environment, improve team dynamics, and enhance patient care. Written by Michelle Hill, CPhT, MPH The Push for Safe Staffing 21 The Push for Safe Staffing in Pharmacies is Growing. What Will Create Lasting Change? The pharmacy technician shortage has reached a crisis point. The lack of available technicians has led to numerous prob- lems, including medication errors, reduced pharmacy hours, increased penalties, and compromised pa- tient safety. This shortage is due in part to low wages, long hours, and a lack of job security. Burnout among pharmacy staff has also contributed to the crisis. To address these issues, the industry must improve work- ing conditions, increase wages, and prioritize the well-being of its employees. Written by Becki Hamill. The Evolution of rxtechs into Pharma- cy-Based Community Health Care Workers 15 The evolving healthcare landscape necessitates pharmacies to adapt their services to support patients comprehensively. Pharmacy Technicians and Community Health Care Workers (CHWs) play crucial roles in ensuring accessible healthcare. Pharmacy technicians manage medication dispensing and inventory, contributing to medication safety and efficient pharmacy operations. In contrast, CHWs pro - mote health and wellness within communities, providing education, supporting chronic disease man- agement, and addressing health disparities. While both contribute to healthcare delivery, their scopes differ, with pharmacy technicians primarily operating within pharmacies and CHWs actively engaging with communities outside traditional healthcare facilities. Written by Gerardo Ramirez, R-CPhT, CHW.
Amber Taylor Mariana Ruiz Precious Fazon CONTRIBUTORS Erin DiMuzio, PharmD Becki Hamil
Michelle Hill, CPhT Robin Luke, CPhT Gerardo Ramirez, R-CPhT, CHW Ashleigh Smith, CPhT and the Editorial Advisory Board
CPhT CONNECT PO BOX 683148 Houston, TX 77268 888-247-8700 All references & links:
Opinions expressed in this publication do not nec- essarily reflect the official views of NPTA. The in - formation contained in this magazine is for informa- tional purposes only and does not constitute legal advice. No part of this publication is intended to be a substitute for professional medical advice, diag- nosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something covered in this publication. The appearance of ad- vertising or new product information does not con- stitute an endorsement by NPTA of the product(s) featured. All rights reserved. No part of this publi- cation may be reproduced without written consent from the publisher.
CPhT CONNECT www.cphtconnect.com
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PUBLISHER’S NOTE
mike@pharmacytechnician.org
I recently shared this message with our members on World Pharmacy Technician Day, and it’s worth repeating because every pharmacy technician deserves to hear it.
- - - - - -
As a pharmacy technician, you’re doing far more than most people realize, and it’s important that you know how much you’re valued. You’re not "just a tech"—you are a vital part of the healthcare team, playing a crucial role in ensuring patient safety, supporting pharmacists, and delivering quality care.
Every single day, you show up with skill, dedication, and heart, making a profound impact in the lives of the patients you serve.
I know how often the phrase "just a tech" gets thrown around, but I want you to hear this loud and clear:
Mike Johnston, CPhT-Adv, BCNCPT, BCSCPT Founder & CEO, NPTA
You are so much more than that.
You are a leader , a problem-solver , an advocate , and an essential healthcare professional . Without you, the pharmacy profession—and patient care—would not function as it does. At NPTA, we see all that you do, and we’re here to support you as you continue to grow and elevate your career. You may not hear it enough, but you are appreciated , you are valued , and you are making a real impact. So take a moment to celebrate yourself and all that you’ve accomplished. You are not "just a tech"—you are a true pharmacy professional who is shaping the future of healthcare.
Thank you for everything you do. You are remarkable.
With great respect,
Mike Johnston, CPhT-Adv, BCNCPT, BCSCPT Founder & CEO, NPTA
Nunquam non paratus. Never unprepared.
CPhT CONNECT www.cphtconnect.com
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DEPARTMENTS | NEWS BRIEFS
PHARMACY TECHNICIANS AT 24/7 CVS STORE IN RHODE ISLAND VOTE UNANIMOUSLY TO FORM UNION WITH THE PHARMACY GUILD Pharmacy professionals in CVS’ home state con- tinue to rapidly unionize in demand of higher patient standards Woonsocket, RI — Pharmacy technicians at a 24/7 CVS store in Wakefield, RI, have won their union election with The Pharmacy Guild (TPG) with a unanimous vote, and now join the pharmacists at their store who voted to join TPG last month. The rapid speed of organizing reflects urgency within the industry and the solidarity between pharmacists, pharmacy technicians, and phar- macy interns to protect their patients.“I’m proud to announce that we have joined our colleagues in taking the next step to secure better conditions for our patients,” said Chris DesRochers, a phar- macy technician at CVS Wakefield and a key figure in the recent successful unionization effort. “With the establishment of a comprehensive pharmacy union encompassing all pharmacy workers at our store, we are so excited to begin advocating on behalf of our patients and our working condi- tions.” The Pharmacy Guild’s first-in-the-nation victory in April has proven to be just the start of an industry uprising. With collective bargaining units, workers will be entitled to negotiate with CVS over concerns, including safe staffing levels, patient
care standards, and other issues critical for patient safety and the future of the profession. “The united front shown by pharmacy professionals in Wakefield is a powerful testament to their unwavering dedi- cation to prioritizing patient care over corporate profit,” said Dr. Shane Jerominski, a community pharmacist, a passionate industry reform advocate, and co-founder of The Pharmacy Guild. “Our victories continue to send waves across the indus- try. Pharmacy employees are prepared to face the industry’s challenges head-on, with a fierce commit - ment to our patients and our profession.” Unsafe staffing levels for many pharmacies and store clo - sures have reached crisis levels across America, including major chains like CVS, Walgreens, and
Rite Aid. Pharmacy professionals are fighting back in a nationwide grassroots movement that launched in 2023 when thousands of pharmacy profession- als across multiple employers walked out in protest of the dangerous conditions in an action known as “pharmageddon.” The Pharmacy Guild, an initiative of IAM Healthcare, is the nation’s only union dedicated exclusively to organizing and representing phar- macy professionals across employers and industries in a specialized trade union. IAM Healthcare is a national healthcare union within the power- ful International Association of Machinists and Aerospace Workers (IAM).
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PRODUCT NEWS | DEPARTMENTS
individuals aged 12 and older. Nalmefene, an opioid receptor antagonist, comes in a pre-filled auto-injec - tor delivering 1.5 mg per dose, designed for subcuta- neous or intramuscular use. This approval, which received fast-track and prior- ity review designations, supports broader access to opioid overdose reversal agents. The injection can rapidly counteract symptoms such as respiratory depression and low blood pressure. It is available by prescription and can be administered by healthcare professionals, first responders, and even bystanders. Purdue Pharma plans to distribute it at no profit to help address the opioid crisis. symptoms compared to placebo over four weeks. Vonoprazan provided all-day and all-night relief, with the treatment group experiencing significantly more heartburn-free days. The study included 772 adults who experienced heartburn at least four days a week. The results were presented at Digestive Disease Week 2024 and published in Clinical Gastroenterology and Hepatology. Common adverse effects included abdominal pain, consti - pation, diarrhea, nausea, and urinary tract infec- tions, with upper respiratory infections and sinusitis reported during a 20-week extension period.
FDA APPROVES NALMEFENE FOR OPIOID OVERDOSE The FDA has approved nalmefene injection (Zurnai) for emergency treatment of opioid overdoses in VONOPRAZAN APPROVED FOR NONEROSIVE GERD The FDA has approved vonoprazan (Voquenza) 10 mg tablets for treating heartburn associated with nonerosive gastroesophageal reflux disease (GERD) in adults. This approval marks the third FDA approval for vonoprazan, which is also approved for treating erosive esophagitis and Helicobacter pylori infection when combined with antibiotics. The decision was based on the positive results of the PHALCON-NERD-301 study, which demon - strated significant and quick reduction in heartburn
FDA GREENLIGHTS KISUNLA FOR EARLY ALZHEIMER'S The FDA has approved donanemab-azbt (Kisunla), a groundbreaking amyloid plaque-targeting therapy for early symptomatic Alzheimer's disease. This therapy, which received Fast Track Review, Priority Review, and Breakthrough Therapy designations, is designed for adults with mild cognitive impair- ment or mild dementia stages of Alzheimer’s with confirmed amyloid pathology. Administered once a month, Kisunla works by removing amyloid plaque buildup, which is associated with Alzheimer’s pro- gression. The approval was based on data from the phase 3 TRAILBLAZER-ALZ 2 trial, which involved 1,736 participants. The study showed significant cognitive and functional improvements in patients treated with donanemab compared to those given a placebo. Specifically, the treatment group exhibited a 39% lower risk of progressing to the next stage of the disease and demonstrated considerable reductions in amyloid plaques over time. Kisunla’s ability to potentially halt treatment once amyloid plaques are sufficiently removed offers a cost-effective and less burdensome option for patients. However, the therapy carries risks such as amyloid-related imaging abnormalities (ARIA) and other infusion-related reactions. Ongoing stud- ies are exploring the prevention of symptomatic Alzheimer's and further understanding ARIA.
NEW CONTINUOUS GLUCOSE MONITORS GET FDA NOD The FDA has approved two new over-the-counter (OTC) continuous glucose monitoring (CGM) sys- tems from Abbott: the Lingo and Libre Rio. These devices are based on Abbott’s FreeStyle Libre tech- nology, widely recognized in the CGM market. The Lingo CGM is designed to help adults understand their health better and enhance their wellness, while the Libre Rio is tailored for adults with type 2 dia- betes who manage their condition without insulin, focusing on lifestyle modifications. The Libre Rio can detect a wide range of glucose levels (40-400 mg/dL) and is intended to improve glucose control, reduce HbA1c, and lower diabetes-related hospital admissions. Both devices use a biosensor worn on the arm, providing continuous glucose data via a smartphone app, offering insights into food reac - tions, exercise, and stress.
FDA WEIGHS BAYER’S HOT FLASH TREATMENT Bayer has submitted a new drug application (NDA) to the FDA for elinzanetant, a nonhormonal treatment targeting moderate to severe vasomo- tor symptoms, such as hot flashes, associated with menopause. Elinzanetant, a dual neurokinin-1 and 3 (NK-1 and 3) receptor antagonist, works by modulating estrogen-sensitive neurons in the hypo- thalamus, thereby regulating body heat control and reducing menopause-related symptoms. Data from three phase 3 clinical trials (OASIS 1, 2, and 3) demonstrated that elinzanetant significantly
reduced the frequency and severity of hot flashes and improved sleep disturbances and overall quality of life. The most common side effects were head - aches and fatigue. This FDA submission marks a significant milestone in offering a new treat - ment option for women experiencing menopause, addressing a critical gap in available therapies.
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DEPARTMENTS | COMMUNITY-RX
health, emphasizing preventive care and personal- ized services. Grocers like Kroger and Hy-Vee are using automa- tion to streamline pharmacy operations, allowing pharmacists to focus more on patient care. Initiatives to combat pharmacist burnout and enhance job sat- isfaction are also in place. Additionally, partnerships with health plans and programs like food-as-med- icine are being used to drive healthier choices among customers. The evolving pharmacy landscape presents chal- lenges such as competition, lower reimbursement rates for prescriptions, and higher operational costs. Yet, by viewing pharmacies as integral to broader health and wellness goals, grocers can maintain their relevance and profitability in the modern market. Creating a differentiated experience for customers, such as offering dietitian consultations and mobile health units, is key to long-term success in this sector. Tolearnmore:https://www.grocerydive.com/news/ grocers-pharmacies-prescription-sales/720916/
GROCERY CHAINS ENHANCE PHARMACY SERVICES Grocery chains like Hy-Vee and Kroger are enhancing their in-store pharmacies by expanding healthcare services beyond prescription sales. These expansions include offering immunizations, health screenings, and consultations. The pandemic under- scored the essential role of pharmacists, leading to PHARMACY CLOSURES HIT VULNERABLE COMMUNITIES HARD The closure of pharmacies in the United States is significantly impacting access to healthcare, par - ticularly in Western states and neighborhoods with predominantly Black and Latino populations. Pharmacy chains like CVS, Walgreens, and Rite Aid are reducing their physical footprints due to declining prescription reimbursements, rising oper- ational costs, and persistent theft. This trend has left many communities without convenient access to essential healthcare services that pharmacies provide, such as medication counseling and chronic disease management. An Associated Press analysis revealed that predomi- nantly Black and Latino neighborhoods have fewer pharmacies per capita compared to predominantly white areas. This disparity creates "pharmacy des- erts," which exacerbate healthcare inequities. The
closures are not limited to urban areas; rural regions also suffer as pharmacies often serve multiple roles, including primary health counseling and disease management, making them vital to these communities. Experts like Omolola Adepoju from the University of Houston emphasize the irreplaceable trust and accessibility that local pharmacies offer. Pharmacies often serve as the first point of contact for health - care needs, especially in areas where hospital access is limited. The reduction in pharmacy locations means fewer opportunities for face-to-face interactions with healthcare providers, which is crucial for effective patient care. To learn more: https://apnews.com/arti- cle/pharmacy-closure-drugstore-cvs-wal- greens-rite-aid-91967f18c0c059415b98fcf67ad- 0f84e a shift towards integrating pharmacies with grocery offerings to promote wellness and nutrition. Despite increasing complexities and costs, some grocers are outsourcing their pharmacy operations or closing them. However, many are finding inno - vative ways to leverage their pharmacies as valu- able assets for customer retention and community store pharmacies has been declining. The 2024 U.S. Pharmacy Study highlights that mail-order phar- macies are gaining favor due to their convenience, reliability, and ability to improve medication adher- ence by delivering prescriptions directly to patients' homes. This trend is contrasted by the challenges faced by retail pharmacies, which include long wait times, decreased trust in pharmacists, and difficul - ties in prescription retrieval. The report emphasizes that the key advantage for brick-and-mortar pharmacies remains the personal connection and trust customers have with their pharmacists. However, as awareness and accep- tance of digital pharmacies like Amazon Pharmacy grow, traditional pharmacies risk losing market share unless they adapt to meet evolving consumer
expectations. From 2023 to 2024, retail pharmacies saw a 10-point drop in customer satisfaction on a 1000-point scale, while mail-order pharmacies increased by 6 points. The study also notes that while mail-order pharma- cies provide significant convenience, retail pharma - cies still lead in the number of locations and total prescriptions filled. To stay competitive, retail phar - macies need to leverage their unique strengths, such as face-to-face interactions and personalized service, to retain customer loyalty amidst the rising popular- ity of mail-order options. To learn more: https://www.drugtopics.com/ view/patient-satisfaction-with-mail-order-pharma- cies-increases-but-shrinks-for-chain-stores
RETAIL PHARMACIES FACE DECLINING SATISFACTION RATES
According to a recent report by J.D. Power, patient satisfaction with mail-order pharmacies has been steadily increasing, while satisfaction with chain
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HEALTH-SYSTEM RX | DEPARTMENTS
INTERDISCIPLINARY SAFETY FOR HAZARDOUS DRUGS URGED Hospital leaders are advised to adopt an interdis- ciplinary approach to ensure the safe handling of hazardous drugs like antineoplastic agents. At the 2024 Compounding Pharmacy Compliance meet- ing, Dr. Kathleen Kane emphasized the importance of understanding USP General Chapter <800> and NIOSH guidelines. Dr. Kane suggests creating comprehensive lists of required and recommended practices, such as maintaining accurate hazardous drug inventories and implementing spill control procedures. An interdisciplinary committee at UChicago Medicine was formed to enhance hazardous drug safety by conducting gap analyses and advocating for necessary resources. The committee's initiatives include providing proper personal protective equip- ment and using closed system drug-transfer devices. Continuous risk assessments for new drugs are essential, considering factors like drug type, dosage form, and packaging. Involving frontline staff, such as pharmacists and nurses, in developing safety practices ensures TECHNICIANS STREAMLINE PRIOR AUTH APPROVALS Cone Health, a large health system in North Carolina, faced significant delays in obtaining prior authorizations for medications due to a lack of stan- dardized processes. This often led to up to four-week delays and increased medication errors. To address this, Cone Health established a centralized med- ication access team led by a pharmacy technician coordinator. This team, sourced from Cone Health's community and specialty pharmacies, streamlined the prior authorization process. The centralized team demonstrated impressive improvements: the average turnaround time for prior authorizations dropped to 1.4 days from the previous 15 to 30 days. Additionally, 71% of prior authorizations were completed on the same day
of submission, with an average processing time of under 30 minutes. This initiative also enhanced cus- tomer service and encouraged patients to continue using Cone Health’s internal pharmacy services. The success of this program underscores the capa- bility of pharmacy technicians to handle prior authorizations, freeing up pharmacists, nurses, and other personnel for direct patient care. However, retaining skilled pharmacy technicians remains challenging. While increased pay is one strategy, it is crucial to address workplace culture, stagnation, and burnout, which are significant factors influenc - ing technicians' job satisfaction and retention. To learn more: https://www.pharmacyprac- ticenews.com/Online-First/Article/06-24/ Centralized-Pharmacy-Technicians-Streamline- Prior-Authorizations/74028
COMMUNICATION FAILURES CAUSE MEDICATION ISSUES A study conducted by pharmacy researchers at Memorial Sloan Kettering Cancer Center (MSK) found that missing information is the leading cause of miscommunication-related medication events. The study analyzed medication events reported between July and December 2022. Out of 95 ana - lyzed events, 61% occurred in the outpatient setting, 35% in inpatient settings, and 4% in retail pharma- cies. Most errors happened during the prescribing and ordering stages (61%), followed by administra- tion (21%) and dispensing (9%). The primary type of miscommunication was the omission of information, accounting for 50% of cases, followed by incorrect information at 17%. practical and acceptable implementations. For instance, decisions about protective gear might bal- ance staff safety with patient comfort, such as not wearing full hazmat suits during certain procedures to avoid alarming patients. USP <800> aims to protect healthcare workers, much like USP Chapters <795> and <797> focus on patient safety. The collaborative efforts of various hospital depart - ments, including supply chain and environmental control, are crucial to managing hazardous drug safety effectively.
To learn more https://www.pharmacyprac- ticenews.com/Online-First/Article/06-24/ Hazardous-Drug-Safety-All-Hands-on-Deck/74104
Providers were the most common source of these errors (53%), with pharmacists and nurses contrib- uting 16% and 9% respectively. Positive interven- tions, mainly initiated by nurses (58%), were present in 53% of the cases, often preventing these errors from reaching patients. The study highlights the need for further research to understand why information omissions occur and how technology and workflow improvements can mitigate these issues. Effective communication and comprehensive information sharing are critical to reducing medication errors and improving patient safety. To learn more https://www.pharmacypractice- news.com/Online-First/Article/06-24/Missing- Information-Causes-Most-Miscommunication- Related-Medication-Events/74069
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ANDROPAUSE | DISEASE BRIEFS
Andropause, often referred to as male menopause, is a condition characterized by a gradual decline in testosterone levels in aging men. This decrease in hor- mone levels can lead to a variety of physical and emotional symptoms, impact- ing the quality of life. Understanding andropause is essential for healthcare professionals to provide comprehensive care and support to affected patients. ANDROPAUSE DISEASE STATE BRIEF UNDERSTANDING ANDROPAUSE
In addition to these standard treatments, compounded medications can be cus- tomized to meet individual patient needs. Compounding pharmacies can create personalized formulations, including: • Customized Dosages: Tailoring the dose to the patient's specific requirements. • Alternative Delivery Methods: Such as sublingual drops or troches. • Combination Formulations: Combining testosterone with other supportive hormones or medications.
Andropause typically occurs in men aged 40 and above, although the onset and severity can vary. Unlike female menopause, which involves a distinct and rapid drop in hormone levels, andropause involves a more gradual decline in testos- terone.Testosterone is a key hormone responsible for the development of male physical characteristics, libido, and overall health. The decline in testosterone levels during andropause can be influenced by factors such as genetics, lifestyle, and overall health. Diagnosis is usually confirmed through a combination of symptom assessment and blood tests measuring testosterone levels.
COMMON SIDE EFFECTS/WARNINGS
Testosterone replacement therapy can have side effects and risks, including: • Skin reactions at the application site (patches, gels) • Increased red blood cell count • Prostate enlargement and potential exacerbation of prostate cancer • Sleep apnea • Acne and oily skin • Breast enlargement and tenderness • Fluid retention Patients undergoing TRT should have regular follow-up appointments to mon- itor their response to therapy and adjust dosages as needed.
SYMPTOMS OF ANDROPAUSE
Symptoms of andropause can be varied and may include: • Fatigue and decreased energy levels • Reduced libido and sexual dysfunction • Mood swings, irritability, and depression • Decreased muscle mass and strength • Increased body fat • Osteoporosis or decreased bone density • Cognitive changes, such as difficulty concentrating and memory loss These symptoms can significantly impact a man's quality of life and well-being.
OVER-THE-COUNTER (OTC) TREATMENT OPTIONS
While OTC products cannot replace testosterone therapy, some supplements and lifestyle modifications may support overall health during andropause: • Vitamin D and Calcium Supplements: Support bone health. • Omega-3 Fatty Acids: Promote cardiovascular health. • Zinc and Magnesium: May support testosterone production and overall well-being. • Herbal Supplements: Some men use herbs like fenugreek, ashwagandha, and tribulus terrestris, though evidence of their efficacy is limited.
PHARMACEUTICAL TREATMENT OPTIONS
The primary treatment for andropause is testosterone replacement therapy (TRT), which aims to restore testosterone levels to a normal range. TRT can be administered through various forms: 1. Intramuscular Injections: Administered every 2-4 weeks. • Examples: Testosterone cypionate, testosterone enanthate 2. Transdermal Patches: Applied daily to the skin. • Example: Androderm 3. Topical Gels: Applied daily to the shoulders, upper arms, or abdomen. • Examples: AndroGel, Testim 4. Buccal Tablets: Applied to the gums twice daily. • Example: Striant 5. Implants: Small pellets inserted under the skin every 3-6 months. • Example: Testopel
CONCLUSION
Andropause is a significant condition that affects many aging men, impacting their physical and emotional well-being. Effective management of andropause involves a combination of pharmaceutical treatments, including both standard and compounded medications, as well as supportive lifestyle modifications. By understanding the complexities of andropause and the available treatment options, healthcare professionals can help improve patient outcomes and quality of life.
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DISEASE BRIEFS | RHEUMATOID ARTHRITIS
Rheumatoid arthritis (RA) is a chronic inflammatory disorder that primarily affects the joints. Unlike the wear-and-tear damage of osteoarthritis, RA is an autoimmune condition where the immune system mistakenly attacks the body's tissues, causing inflammation, pain, and joint damage. Understanding RA is essential for healthcare professionals to provide effective treatment and support to patients. RHEUMATOID ARTHRITIS DISEASE STATE BRIEF UNDERSTANDING RHEUMATOID ARTHRITIS
4. Janus Kinase (JAK) Inhibitors: Target specific pathways involved in the immune response. • Examples: Tofacitinib, Baricitinib In addition to these standard treatments, compounded medications can be tai- lored to individual patient needs. Compounding pharmacies can create personalized formulations, such as: • Topical Pain Relief: Custom creams and gels that combine various pain-relieving and anti-inflammatory agents. • Oral Medications: Adjusted doses or combinations of medications that suit the patient’s specific requirements.
SYMPTOMS OF RHEUMATOID ARTHRITIS RA can present with a variety of symptoms, which may include: • Joint pain, tenderness, swelling, or stiffness that lasts for six weeks or longer • Morning stiffness that lasts for 30 minutes or longer • Symmetrical joint involvement (affecting the same joints on both sides of the body) • Fatigue, fever, and loss of appetite • Formation of rheumatoid nodules (firm lumps under the skin) near affected joints Symptoms often start in smaller joints, such as those in the fingers and toes, and can progress to larger joints over time. RA is an autoimmune disease that causes chronic inflammation of the joints and can also affect other systems in the body, including the skin, eyes, lungs, heart, and blood vessels. The exact cause of RA is unknown, but genetic, envi- ronmental, and hormonal factors are believed to play a role. It typically mani- fests between the ages of 30 and 60, with women being more frequently affected than men.
COMMON SIDE EFFECTS/WARNINGS
Medications used to treat RA can have various side effects, and it is important to monitor patients regularly: • NSAIDs: Stomach irritation, ulcers, gastrointestinal bleeding, kidney problems • Corticosteroids: Weight gain, high blood pressure, diabetes, osteoporosis, increased risk of infections • Traditional DMARDs: Liver damage, bone marrow suppression, lung infections • Biologic DMARDs: Increased risk of infections, infusion reactions, injection site reactions • JAK Inhibitors: Risk of serious infections, blood clots, increased cholesterol levels Patients should be educated on the potential side effects and the importance of adhering to their treatment regimen.
PHARMACEUTICAL TREATMENT OPTIONS
OVER-THE-COUNTER (OTC) TREATMENT OPTIONS
The primary goals of RA treatment are to reduce inflammation, relieve symptoms, prevent joint and organ damage, improve physical function, and reduce long-term complications. Treatment usually involves a combination of medications: 1. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Relieve pain and reduce inflammation. • Examples: Ibuprofen, Naproxen 2. Corticosteroids: Reduce inflammation and suppress the immune system. • Examples: Prednisone, Methylprednisolone 3. Disease-Modifying Antirheumatic Drugs (DMARDs): Slow the progression of RA and save the joints and other tissues from permanent damage. • Traditional DMARDs: Methotrexate, Sulfasalazine, Hydroxychloroquine • Biologic DMARDs: Etanercept, Infliximab, Adalimumab • Targeted Synthetic DMARDs: Tofacitinib, Baricitinib
OTC options can complement prescription treatments and help manage symptoms: • Pain Relievers: Acetaminophen for pain relief. • Anti-Inflammatory Supplements: Omega-3 fatty acids, turmeric, and ginger may have anti-inflammatory properties. • Topical Analgesics: Capsaicin cream, menthol, and camphor- based products for localized pain relief.
CONCLUSION
Rheumatoid arthritis is a debilitating autoimmune condition that requires comprehensive management to control symptoms and prevent joint damage. Pharmaceutical treatments, including standard and compounded medications, play a critical role in managing RA. By staying informed about RA and its treat- ment options, healthcare professionals can provide better support and improve the quality of life for patients with this chronic condition.
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BIPOLAR DISORDER | DISEASE BRIEFS
Bipolar disorder, previously known as manic-depressive illness, is a mental health condition characterized by extreme mood swings that include emotional highs (mania or hypomania) and lows (depression). These mood swings can affect sleep, energy, activity, judgment, behavior, and the ability to think clearly. Understanding bipolar disorder is essential for healthcare professionals to pro- vide appropriate care and support for patients. BIPOLAR DISORDER DISEASE STATE BRIEF UNDERSTANDING BIPOLAR DISORDER • • • • • •
Increased activity, energy, or agitation
Decreased need for sleep Unusual talkativeness
Racing thoughts Distractibility
Poor decision-making, such as spending sprees, sexual indiscretions, or risky investments
•
Depressive Episode: •
Depressed mood, such as feeling sad, empty, or hopeless • Markedly diminished interest or pleasure in most activities • Significant weight loss or gain, or changes in appetite • Insomnia or excessive sleeping • Psychomotor agitation or retardation • Fatigue or loss of energy • Feelings of worthlessness or excessive guilt • Diminished ability to think or concentrate, or indecisiveness • Recurrent thoughts of death or suicide
Bipolar disorder is a lifelong condition that typically appears in late adolescence or early adulthood, although it can occur at any age. It is divided into several types based on the pattern and severity of mood swings: • Bipolar I Disorder: Characterized by manic episodes that last at least seven days, or by manic symptoms that are so severe that immediate hospital care is needed. Depressive episodes also occur, typically lasting at least two weeks. • Bipolar II Disorder: Defined by a pattern of depressive episodes and hypomanic episodes, but not the full-blown manic episodes characteristic of Bipolar I. • Cyclothymic Disorder (Cyclothymia): Periods of hypomanic symptoms as well as periods of depressive symptoms lasting for at least two years (one year in children and adolescents), but the symptoms do not meet the diagnostic requirements for a hypomanic episode and a depressive episode. • Other Types: Includes other specified and unspecified bipolar and related disorders that do not match the criteria for the above types.
Treatment for bipolar disorder is aimed at managing symptoms and preventing the recurrence of manic and depressive episodes. The primary classes of med- ications used include: 1. Mood Stabilizers: Help control manic or hypomanic episodes • Examples: Lithium, Valproate (Depakote), Lamotrigine (Lamictal), Carbamazepine (Tegretol) 2. Antipsychotic Medications: Can be used alone or in combination with mood stabilizers to treat manic episodes or mixed episodes. • Examples: Olanzapine (Zyprexa), Risperidone (Risperdal), Quetiapine (Seroquel), Aripiprazole (Abilify) 3. Antidepressants: Typically prescribed along with a mood stabilizer or antipsychotic to avoid triggering a manic episode. • Examples: Fluoxetine (Prozac), Sertraline (Zoloft), Bupropion (Wellbutrin) PHARMACEUTICAL TREATMENT OPTIONS
SYMPTOMS OF BIPOLAR DISORDER Symptoms of bipolar disorder can vary and may include: • Manic or Hypomanic Episode: • Elevated mood, euphoria, or irritability
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DISEASE BRIEFS | BIPOLAR DISORDER
CONCLUSION
4. Antidepressant-Antipsychotic Combination: Combines an antidepressant and an antipsychotic for treating both mania and depression. • Example: Fluoxetine-Olanzapine (Symbyax)
Bipolar disorder is a complex and chronic mental health condition requiring a comprehensive approach to management. Pharmaceutical treatments, includ- ing standard and compounded medications, play a critical role in managing bipolar disorder. By understanding the intricacies of the condition and the avail- able treatment options, healthcare professionals can provide better support and improve the quality of life for patients with bipolar disorder.
In addition to these standard treatments, compounded medications can be cus- tomized to meet individual patient needs. Compounding pharmacies can create personalized formulations, including: • Adjusted Dosages: Tailoring the dose to the patient’s specific requirements. • Combination Formulations: Combining medications into a single dose to simplify the treatment regimen. • Alternative Delivery Methods: Such as sublingual drops or transdermal formulations for patients who have difficulty swallowing pills.
COMMON SIDE EFFECTS/WARNINGS
Medications used to treat bipolar disorder can have various side effects, and it is crucial to monitor patients regularly: • Mood Stabilizers: Nausea, tremors, increased thirst, weight gain, thyroid and kidney issues (Lithium), liver dysfunction, pancreatitis, weight gain (Valproate), rash, Stevens-Johnson syndrome (Lamotrigine) • Antipsychotics: Weight gain, diabetes, high cholesterol, sedation, movement disorders, metabolic syndrome • Antidepressants: Nausea, weight gain, sexual dysfunction, increased risk of triggering manic episodes if not properly balanced with mood stabilizers Patients should be educated on the potential side effects and the importance of adhering to their treatment regimen.
OVER-THE-COUNTER (OTC) TREATMENT OPTIONS
OTC options can complement prescription treatments and help manage symptoms: • Omega-3 Fatty Acids: Some studies suggest they may have mood- stabilizing effects. • Nutritional Supplements: Vitamins and minerals like magnesium, folic acid, and vitamin D may support overall mental health. • Melatonin: Can help regulate sleep patterns, which is important for managing bipolar disorder.
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The Evolution of Pharmacy
Written by Gerardo Ramirez, R-CPhT, CHW Technicians into Pharmacy-Based Community Health Care Workers
The model of healthcare continues to change and with those changes, pharmacies need to adapt to support patients; the roles of Pharmacy Techni- cians and Community Health Care Workers (CHWs) develop as vital components in ensuring compre- hensive and accessible healthcare services. Phar- macy technicians, vital members of the pharmacy team, are tasked with managing various aspects of medication dispensing and inventory control, play- ing a key role in promoting medication safety and efficient pharmacy operations. In distinction, CHWs
support as promoters for health and wellness with- in communities, engaging with individuals to pro- vide education, support chronic disease manage- ment, and address health disparities. Though both provide to healthcare delivery, they vary in scope and focus, pharmacy technicians primarily operat- ing within the limitations of the pharmacy setting and CHWs actively involved with communities out- side of traditional healthcare facilities.
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Understanding the Role of Pharmacy-Based Community Health Care Workers:
Pharmacy Technicians: Pharmacy technicians are integral members of the pharmacy team, responsible for various tasks re- lated to medication management and dispensing. Their duties typically include processing prescrip- tions, compounding medications, managing in- ventory, and providing customer service. Pharmacy technicians play a crucial role in ensuring the ef- ficient operation of the pharmacy and promoting medication safety. However, their scope of practice primarily revolves around pharmacy operations and does not typically extend to direct patient care or community health initiatives. Community Health Care Workers: Community Health Care Workers (CHWs) play a vital role in promoting health and wellness within local communities. Their responsibilities encom- pass a broad range of activities aimed at improving health outcomes and addressing health disparities. CHWs engage with community members to pro- vide health education, facilitate access to health- care services, support chronic disease manage- ment, conduct health screenings, and advocate for health policy changes. Unlike pharmacy tech- nicians, CHWs prioritize holistic patient care and community engagement, working closely with individuals and families to address their unique health needs and empower them to make in- formed decisions about their health.
Comparing the Roles: While both pharmacy technicians and CHWs con- tribute to healthcare delivery, their roles differ sig- nificantly in terms of scope and focus. Pharmacy technicians primarily support pharmacy operations and medication management, whereas CHWs fo- cus on community-based health promotion and disease prevention. While pharmacy technicians may interact with pa- tients to provide medication-related information or assistance, their role is typically transactional and limited to the pharmacy setting. In contrast, CHWs engage directly with community members outside of the pharmacy, building relationships and provid- ing ongoing support to address a wide range of health concerns. Pharmacy technicians and CHWs play distinct but complementary roles within the healthcare sys- tem. While pharmacy technicians ensure the safe and efficient dispensing of medications within the pharmacy, CHWs work to improve health out- comes and address social determinants of health within the broader community. Both roles are es- sential components of a comprehensive approach to healthcare delivery, each contributing unique expertise and perspectives to promote the well-be- ing of individuals and communities alike.
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Qualifications and Training:
The transition from pharmacy technician to PBCHW necessitates a diverse skill set and special- ized training. While educational prerequisites may vary, most aspiring PBCHWs possess backgrounds in healthcare, pharmacy technology, or related fields. Certification programs, such as the Commu- nity Health Worker Certification, offer invaluable training in patient communication, cultural com- petence, and health promotion strategies. Case studies underscore the efficacy of structured curricula in equipping pharmacy technicians with the competencies required for their expanded roles. • Patient Communication and Counseling Skills: PBCHWs must excel in interpersonal communication, active listening, and empathy that effectively engages with patients from diverse backgrounds. Training programs focus on developing these essential skills through role-playing exercises, simulated patient inter- actions, and communication workshops. • Cultural Competency: Given the diverse de- mographic landscape of communities served by pharmacies, PBCHWs must exhibit cultural sensitivity and awareness. Training modules emphasize cultural competence, addressing topics such as cultural norms, health beliefs,
and linguistic diversity to ensure respectful and inclusive patient interactions.
• Health Promotion Strategies: PBCHWs tasked with delivering health education and promoting preventive care practices within their communities. Training programs provide insights into evidence-based health promotion strategies, disease prevention methods, and wellness initiatives tailored to specific popula- tion needs. • Medication Management and Adherence Support: A core aspect of the PBCHW role involves assisting patients in managing their medications effectively. Training includes com- prehensive instruction on medication therapy management (MTM), adherence counseling techniques, medication reconciliation process- es, and recognizing potential drug interactions or adverse effects. • Community Resources and Referral Net- works: PBCHWs serve as navigators, connect- ing patients with available community resourc- es, support services, and healthcare providers. Training equips PBCHWs with knowledge of local resources, social services, and referral networks, enabling them to facilitate access to essential care beyond the pharmacy setting.
Case Study: The Impact of Certification Programs
Research conducted by the National Association of Community Health Workers reveals compelling quantitative evidence regarding the efficacy of CHW certification programs. Among participants who completed such programs, there was a signif- icant increase in confidence levels, with a stagger- ing 80% reporting feeling more capable in address- ing patients' health needs. Moreover, employers noted a remarkable improvement in job perfor- mance, with a 30% increase in productivity among certified PBCHWs compared to their non-certified counterparts. Importantly, patient outcomes were also positively impacted, as indicated by a 25% re- duction in hospital readmission rates and a 15% in- crease in medication adherence rates among indi- viduals served by certified PBCHWs. The findings
underscore the tangible benefits of standardized training in enhancing the professional proficiency and credibility of pharmacy-based health workers. Responsibilities and Scope of Practice: PBCHWs assume diverse responsibilities tailored to meet the unique needs of their communities. These may include conducting medication thera- py management (MTM) sessions, organizing health screenings, facilitating support groups, and advo- cating for health policy changes. Through collab- orative partnerships with pharmacists, physicians, and community organizations, PBCHWs ensure seamless care coordination and empower individ- uals to make informed health decisions.
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Case Study: Integrating MTM into Community Pharmacies
In a collaborative endeavor between a communi- ty pharmacy chain and a local health department, PBCHWs are trained to conduct MTM sessions for patients managing chronic conditions. The quanti- tative data collected over a six-month period follow- ing the implementation of this initiative revealed significant improvements in patient outcomes. Specifically, there was a notable reduction of 20% in hospital readmission rates among patients re- ceiving MTM services from PBCHWs. Additionally; medication adherence rates saw a substantial in- crease of 30% among this patient cohort. These quantitative outcomes highlight the piv- otal role of PBCHWs in optimizing pharmacy ser- vices, enhancing patient outcomes, and reducing
healthcare costs associated with chronic disease management. Challenges and Opportunities:
Despite their invaluable contributions, PBCHWs encounter various challenges in fulfilling their roles effectively. Limited reimbursement mechanisms, inadequate inter-professional collaboration, and insufficient recognition present significant barriers to sustained integration within healthcare systems. However, emerging trends such as value-based care models, telehealth innovations, and policy re- forms offer opportunities to expand the scope and impact of pharmacy-based community health services.
Case Study: Addressing Disparities through Telehealth
illustrating the impactful role of PBCHWs in ad- dressing disparities and promoting health equity. Challenges through Telehealth Initiative Addressing healthcare disparities in underserved rural areas through telehealth initiatives presents several challenges. These include the digital divide, limited technological literacy, cultural and linguis- tic barriers, constraints in healthcare infrastructure, and issues with reimbursement and regulations. Overcoming these challenges is essential for en- suring equitable access to healthcare services and sustainable implementation of telehealth solutions in rural communities. Comprehensive strategies are needed to address these barriers effectively and promote health equity through telehealth in- terventions in underserved areas.
In addressing healthcare disparities in underserved rural areas, a pharmacy chain collaborated with telehealth providers to establish virtual care plat- forms staffed by PBCHWs. Quantitative analysis of patient outcomes follow- ing the implementation of this telehealth initiative revealed promising results. Over a one-year period, there was a 40% increase in the number of patients accessing healthcare services through the virtu- al care platform. Moreover, there was a significant improvement in health outcomes, with a 25% de- crease in emergency room visits and a 20% reduc- tion in hospital admissions among patients served by PBCHWs via telehealth. These quantitative findings underscore the effec- tiveness of leveraging telehealth innovations to enhance healthcare access and improve health outcomes in underserved communities, thereby
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Overcoming Barriers to Integrating Pharmacy-Based Community Health Workers into Healthcare Systems: A Collaborative Approach
The integration of Pharmacy-Based Community Health Workers (PBCHWs) into healthcare systems faces several potential barriers that require con- certed efforts from various stakeholders, including pharmacists, physicians, and community leaders, to overcome effectively. • Limited Reimbursement Mechanisms: One significant barrier is the lack of adequate reim- bursement mechanisms for PBCHW services, which may hinder their sustainability within healthcare systems. Pharmacists, physicians, and community leaders can collaborate to advocate for policy reforms that prioritize reim- bursement for PBCHW services, highlighting the cost-effectiveness and positive impact on patient outcomes. • Inadequate Inter-professional Collaboration: Healthcare systems often impede effective collaboration between different healthcare professionals, including PBCHWs. To overcome this barrier, pharmacists, physicians, and com- munity leaders can participate in inter-pro- fessional education and training programs, fostering a culture of collaboration and mutual respect across disciplines. • Insufficient Recognition of PBCHW Role: The valuable contributions of PBCHWs to commu- nity health may go unrecognized, leading to a lack of support and resources for their integra-
tion into healthcare systems. Stakeholders can work together to raise awareness about the role of PBCHWs and advocate for their inclu- sion in healthcare policies and programs. • Regulatory Constraints: Regulatory barriers, such as licensure requirements and scope-of- practice restrictions, may hinder the full utili- zation of PBCHWs within healthcare systems. Pharmacists, physicians, and community leaders can engage policymakers and regula- tory bodies to streamline licensing processes and expand the scope of practice for PBCHWs, ensuring they can operate effectively within legal frameworks. • Resistance to Change: Resistance to change within traditional healthcare structures can pose a significant barrier to the integration of PBCHWs. Pharmacists, physicians, and com- munity leaders can lead by example, demon- strating the benefits of incorporating PBCHWs into healthcare teams through pilot programs and evidence-based practice. Strategies for overcoming these barriers involve fos- tering collaboration and communication among stakeholders, advocating for policy reforms, raising awareness about the role of PBCHWs, and address- ing regulatory constraints.
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