ASK THE PHARMACIST… about insulin sliding scales

Question: Sliding Scale orders for insulin is time consuming and sometimes confusing. Is there a better way to prescribe insulin for elderly patients? Answer: According to recent guidelines published in February 2017 by the American Diabetes Association sliding-scales are NOT RECOMMENDED in long-term care. Diabetes affects up to 33% of patients in long-term care facilities The most commonly prescribed insulin therapy for patients in long-term care is sliding-scale insulin (SSI), the use of finger-stick blood glucose testing to assess the need for insulin administration based on current blood glucose levels. Its sole use for long-term treatment is specifically not recommended Recent updates to several published guidelines, including CMS, the Beers criteria, the American Medical Directors Association, and the American Diabetes Association regarding the use of SSI-only insulin regimens for elderly patients in long-term care all advise simplified treatment regimens and avoidance of “sliding-scale” regimens. Below is a summary of the recommendations: Hypoglycemia risk is the most important factor in determining glycemic goals due to the catastrophic consequences in this population. Simplified treatment regimens are preferred and better tolerated. Sole use of SSI should be avoided. Liberal diet plans have been associated with improvement in food and beverage intake in this population. To avoid dehydration and unintentional weight loss, restrictive therapeutic diets should be minimized. Physical activity and exercise are important

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ASK THE PHARMACIST…about Pneumococcal vaccines

Question:  Is there a difference between pneumococcal vaccines? Answer:  Since 2005, Centers for Medicare and Medicaid Services required nursing home to ensure that their residents receive pneumococcal vaccinations.  Facilities must offer pneumococcal bacteria: Prevnar, Prevnar13(PCV13), Synflorix and Pneumovax23(PPSV23).  There are differences in the way that they are made.  Prevnar, Prevnar 13 and Synflorix are conjugate vaccines, while Pneumovax23 is polysaccharide vaccines. Prevnar offers protection against 7 common strains of pneumococcal bacteria, Synflroix against 10 types, Prevnar13 against 13 types and Pneumovax23 against 23 strains of the bacteria. According to recent guidelines, the Advisory Committee in Immunization Practices (ACIP) recommends sequential administration of 2 pneumococcal vaccines for adults over 65 years of age.  CMS guidelines recommends the administration of Prevnar 13 followed by Pneumovax23 6 to 12 months later. Those in the 19 to 64 age group are still recommended to receive one dose of Pneumova23 every 5 years.  The decision is based on age group and if the patient has been vaccinated previously.

ASK THE PHARMACIST…about Vitamin D deficiencies

Question:  What are your recommendations for Vitamin D supplements? Answer:  The best way to get your daily dose of Vitamin D is at your door, sunshine!  Vitamin D is essential for bone health.  In the elderly the risk of falling has been attributied to vitamin D deficiency due to muscle weakness.  Memory loss may also be seen in older adults because of calcium levels in the brain. Most of us receive vitamin D in our diets with fortified foods, such as milk, cereal, orange juice and yogurt.  Many doctors will prescribe a vitamin D supplement to ensure you have adequate levels.  

ASK THE PHARMACIST…about FDA hand sanitizer warnings

Question:  I see hand sanitizer dispensers everywhere I go, from the grocery store to the bank.  I have heard that you can “over use” this type of hand washing, is that true? Answer:  The FDA supports the CDC’s recommendation to use plain soap and water to wash your hands.  When water is not readily available, a hand sanitizer may be a suitable alternative. The FDA is concerned about hand sanitizer’s ingredients and is undertaking a review of active ingredients used in over-the-counter antiseptic hand wash products.  They are also looking at the safety and effectiveness of the different brands.  There is growing concerns about the health risks of absorbing the anti-germ ingredients of ethanol, alcohol and a type of chloride into your body after repeated daily use. Regulators are also concerned about possible links between use of antiseptic chemicals and the emergence of superbug bacteria, which are resistant to antibiotics.  Go to this link to see the FDA’s option of hand sanitizers. To answer your question, skip the hand sanitizer dispensers and purell tubes and head to the closest sink.  Soap and water is not harmful and is the most effective way to prevent the spread of infection.  

ASK THE PHARMACIST…about national drug shortages

Question:  I have an IV antibiotic ordered and the pharmacy informed me that the drug is not available because of a national backorder, what does that mean? Answer:  From time to time there are national shortages on medications mainly due to manufacturing issues. The FDA website explains drug shortages like this: When one company has a problem or discontinues manufacturing a drug, it is difficult for the remaining drug companies to increase production quickly and a shortage occurs. Hospital pharmacies have priority and are the first to receive medications after production and other pharmacies are placed on a waiting list.  In nursing homes, communication is key to prevent adverse drug therapy or delay medical treatment. Upon admission to the nursing home it is important to review hospital records and the pharmacy can recommend alternative medications based on lab tests. (Culture & Sensitivity) to determine which antibiotics would be an acceptable. Share this link to educate your staff. Bookmark this FDA Website to check national shortages:  

ASK THE PHARMACIST…about soaring drug prices

Question:  Why do drug prices change without any warning, like the EpiPen increase of 400% overnight? Answer:  Dramatic drug price increases can be devastating for patients when their insurance denies the drug and they can’t afford to pay out of pocket. The company that sells EpiPen has come under major scrutiny for their decision to jak up their prices, but they have a monopoly on the auto injector epinephrine dosage system.  Since there is not other drug to compete they can set the price at $500 for a drug that cost about $1.  Price increases can be a result of shortages, but it also can be a business strategy of pharmaceutical companies that acquire old drugs and promptly raise their prices to help their bottom line.  Another example is Doxycycline, an antibiotic, that went form $20 a bottle to $1,849. Partner Care Pharmacy will alert our clients when drug prices soar without warning and offer an alternative therapy.