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Learning Objectives for Pharmacists: Upon completion of this CPE activity participants should be able to:
1. Identify therapeutic targets for a given disease state for each patient presented
2. Recommend pharmacotherapeutic options that may improve the clinical course for each patient
presented
3. Review the literature for evidence-based findings that support the treatment recommendation for each
disease state discussed
4. Given a patient case, discuss pros and cons of available pharmacotherapy used to treat a clinical
problem
Speaker Disclosure: Emily Knezevich reports no actual or potential conflicts of interest in relation to this
CPE activity. Off-label use of medications will be discussed during this presentation.
Disclosure
Emily Knezevich reports no actual or potential conflicts of
interest associated with this presentation
Learning Objectives
Upon successful completion of this activity, pharmacists
should be able to:
Identify therapeutic targets for a given disease state for
each patient presented CASE 1
Recommend pharmacotherapeutic options that may
improve the clinical course for each patient presented.
Review the literature for evidence-based findings that
TYPE 2 DIABETES
support the treatment recommendation for each disease
state discussed
Given a patient case, discuss pros and cons of available
pharmacotherapy used to treat a clinical problem
KS [12]1
1
2/16/2016
KS [13]1
The case FOR basal-bolus therapy The case AGAINST basal-bolus therapy
Increased complexity of regimen = worse adherence
Efficacy demonstrated with significant FBG and A1c
reduction Hypoglycemia risk
Demonstrated to be significantly higher in all comparative trials
Dosing can be individualized
Weight gain likely with increased daily insulin dose
New delivery options make dosing mealtime insulin more
convenient The stigma of more insulin = Failure
V-Go
Afrezza
www.go-vgo.com
www.afrezza.com http://www.clinicme.com/2014/03/insulin-injecting-tips.html
2
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KEL9
1. Diamant. Diabetes Care 2014; 37:2763-73; 2. Rosenstock. Diabetes Care 2014; 37:2317-25; 3.Mathieu C. Diabetes 1. Zinman et al. NEJM 2015; 373: 2117-28.
Obes Metab 2014; 16:636-44.
3
2/16/2016
Fractures
that would be
prevented by
bisphosphonate
treatment
Fractures
associated with
bisphosphonate
treatment
Secondary analyses using the results of three large, randomized bisphosphonate trials (14,195 women) : the (under
Fracture Intervention Trial (FIT), the FIT Long-TermExtension (FLEX) trial, and the Health Outcomes and hypothetical
12,777 women 55 years of age or older sustained a fracture of the femur in 2008. they Reduced Incidence with Zoledronic Acid Once Yearly (HORIZON) Pivotal Fracture Trial (PFT). relative risk).
reviewed radiographs of 1234 of the 1271 women who had a subtrochanteric or shaft
fracture and identified 59 patients with atypical fractures
Black et al. NEJM 2010;362:1761-71
Schilcher et al. NEJM 2011;364:1728-37
4
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CASE 3 she complains of frequent diarrhea, usually shortly after taking levothyroxine.
HYPOTHYROIDISM OTC: loperamide as needed for diarrhea, usually 3-4 times weekly
Labs:
TSH 16mIu/L after dose increase 6 weeks ago
CBC significant for low Hgb of 10.6g/dL and Hct of 31%
5
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Zubarik R. Euro J of Int Med. 2015; 26:825-9 Zubarik R. Euro J of Int Med. 2015; 26:825-9
6
2/16/2016