Type-2 Diabetes
Don't use DIABETES as a CV risk equivalent
As a pharmacy doctor, you will see more consensus on using statins for diabetes patients. We all know the controversy about the ACC/AHA cholesterol guidelines that abandoned LDL goals and recommended specific statin doses instead. Now the American Diabetes Association is following suit and providing similar guidance on when to use a statin in diabetes patients. …
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Type-2 Diabetes
Personalize glycemic targets for patients with diabetes
As a clinical pharmacist, people with diabetes will rely on your help to tailor A1c goals and decipher continuous glucose monitoring (CGM) metrics. Continue to emphasize individualizing glycemic goals, explain that a “one-size-fits-all” approach isn’t safe, practical, or recommended... A1c. Rely on A1c to asses…
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Pregnancy and Breastfeeding
PCOS pharmacotherapeutic approach for junior pharmacists
Polycystic Ovarian Syndrome (PCOS) is a multifaceted endocrine disorder prevalent among women of reproductive age. This article aims to provide pharmacists in clinical practice with a nuanced understanding of PCOS assessment, suspicion, and an evidence-based pharmacotherapeutic approach. ASSESSMENT The diagnostic cr…
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Thyroxine
Avoid the ELDERLY to get too MUCH levothyroxine
As a pharmacy specialist, you should avoid many older adults to get too much levothyroxine ( Synthroid, Euthyrox, Eltroxin, etc) , increasing their risk of atrial fibrillation and fractures . Levothyroxine requirements decrease as people age, but doses are often not reduced accordingly. Younger adults need about 1.7 mcg/kg/da…
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Pts W/ DM and HF
Carvedilol is better than Metoprolol for HF and DM patients
As a clinical pharmacy specialist, cardiologists will ask you for your recommendations on which beta-blockers are better, carvedilol or metoprolol in patients with heart failure and diabetes . There is tantalizing evidence that carvedilol MIGHT be better. But the truth is not so clear. The first head-to-head comparison sugges…
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Thyroxine
Strict control of HYPOthyroidism during pregnancy
As a clinical pharmacist, you should know how to treat hypothyroidism in pregnant women. New guidelines will call for tighter and more aggressive control of hypothyroidism before and during pregnancy. Levothyroxine needs rapidly increase when a woman becomes pregnant, leaving many patients undertreated during early pregnancy. …
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Vitamin D Supplements
Take MORE vitamin D and LESS calcium!
As a nutrition support pharmacist, people are asking you if they should take MORE vitamin D and LESS calcium. This follows some recommendations by many experts... According to Vitamin D , some experts recommend that adults get 1000 IU/day of vitamin D instead of just 400 IU/day. They say that vitamin D is MORE important than calcium for bone health and has o…
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Pregnancy and Breastfeeding
Medications for PolyCystic Ovary Syndrome (PCOS)
As a pharmacist, you will be asked more about polycystic ovary syndrome (PCOS) . There's growing interest in PCOS, it's the MOST common endocrine disorder in young women. It affects up to 10% of reproductive-age women. These women usually have insulin resistance and evidence of increased androgens. This leads to irregular periods, infertility, obesity, and hi…
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Endocrine Diseases
Answer questions about INSULIN for type 2 diabetes
As a clinical pharmacist, you can help answer questions about how to use insulin for patients with type 2 diabetes. Continue to start basal insulin first-line in some cases, such as if A1c is over 10% or in patients with symptomatic hyperglycemia (polyuria, polydipsia, etc). Or consider adding insulin if other medication…
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Pregnancy and Breastfeeding
PCOS treatment based on symptoms
As a community pharmacist, you will get questions abouttreatm ent of polycystic ovary syndrome (PCOS), since it affects about 1.4 million Canadian women. They often need help managing irregular periods, excess androgen (acne, hirsutism, etc) and CV risks (obesity, diabetes, etc). Plus PCOS is one of the most common causes of infertility... …
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Pregnancy DM
Focus on lifestyle and insulin for gestational diabetes
As a nutrition support pharmacist, you should focus on lifestyle for gestational diabetes . Gestational diabetes rates have risen sharply in the past few years, likely driven by obesity, which was worsened by the pandemic. We know these patients are at increased risk of C-section, fetal macrosomia, future diabetes , etc. Emphasize a…
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Type-2 Diabetes
Finerenone (Kerendia) role for Diabetic Kidney Disease
As a hospital pharmacist, you will hear about a new medication finerenone ( Kerendia ) for patients with chronic kidney disease (CKD) due to type 2 diabetes. It's the first "nonsteroidal mineralocorticoid receptor antagonist", and is approved to slow CKD progression and improve CV outcomes in these patients. Finerenone is thought to limit fibrosis and …
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Type-2 Diabetes
Optimize management of CKD in patients with diabetes
As a clinical pharmacist, you should optimize treatment of chronic kidney disease (CKD) in patients With diabetes. Patients with CKD have a much higher rate of hospitalization, especially if they have diabetes. Use a hospital stay to optimize treatment. Ensure patients are on an ACEI or ARB to manage blood pressure (BP) . Continue to us…
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SGLT-2 Inhibitors
Add SGLT2 inhibitors to your HF patients
As a clinical pharmacist, you will need to ensure appropriate use of SGLT2 inhibitors (empagliflozin, etc), as more hospitals add these medications to formulary. It’s partly because guidelines for heart failure with reduced ejection fraction (HFrEF) now recommend “quad therapy” adding an SGLT2 inhibitor (SGLT2i) to triple therapy , regardless of diabetes. …
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Weight Loss
Rybelsus may be prescribed for weight loss
As a nutritional support pharmacist, you will hear about using Rybelsus (semaglutide) for weight loss , it is now available in Egypt . Rybelsus will be the first ORAL GLP-1 agonist for type 2 diabetes, it's a tablet version of injectable Ozempic . Glucagon-like peptide-1 (GLP-1) is inactivated in the…
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Thyroxine
Take Euthyrox FIRST THING on an empty stomach
As a clinical pharmacist, you should advice your patient that It's important to take levothyroxine FIRST THING in the morning on an empty stomach, because absorption can be decreased by calcium , iron , fiber, and other substances. New evidence suggests that even coffee MIGHT reduce absorption. Tell patients to wait at least 30 mins before ea…
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Weight Loss
Explaining the role of Mounjaro for Type 2 Diabetes
As a pharmacy doctor, you will hear buzz about new injectable Mounjaro (tirzepatide), the first "twincretin" for type 2 diabetes . Think of Mounjaro as similar to a glucagon-like peptide-1 (GLP-1) agonist, BUT it’s also a glucose-dependent insulinotropic polypeptide (GIP) agonist. More twincretins are in the works. GL…
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