Nicole D. White

Treatment of Depression in Patients with Concomitant Cardiac Disease

Depressed patients are at increased risk of cardiovascular (CV) disease (CVD) and those with concomitant depression and CVD are at increased risk of death. The safety and efficacy of antidepressants in patients with CVD varies greatly between the agent used and type of disease. This review will summarize the CV adverse effect and drug interaction profile of antidepressants and discuss the use of antidepressants in CVD patients. We searched MEDLINE, PubMed, CINAHL, Web of Science, PsycINFO, and The Cochrane Library from inception to June 2014 to identify studies relevant to antidepressant use in patients with CVD. Primary references from the identified articles were also evaluated for inclusion. Descriptive analysis was performed for the included studies in this review. Orthostatic hypotension was more common with tricyclic antidepressants (TCAs), trazodone and monoamine oxidase inhibitors (MAOIs). Hypertension can be significant with serotonin norepinephrine reuptake inhibitors (SNRIs) and MAOIs. The potential for QT prolongation is present with TCAs, certain selective serotonin reuptake inhibitors (SSRIs), certain SNRIs and mirtazapine. Due to its low risk of drug-drug interactions, adverse effect profile and potential for beneficial antiplatelet activity, sertraline could be considered the choice antidepressant for patients with ischemic heart disease. SSRIs and potentially SNRIs are relatively safe and effective options for patients with heart failure. In patients at high risk for ventricular arrhythmias, bupropion has the overall lowest risk for QT prolongation. TCAs and MAOIs should be avoided in patients with concomitant CVD. In conclusion, due to the increased morbidity and mortality associated with comorbid CVD and depression, practitioners should readily assess and initiate management of depression in such patients. The choice of antidepressant should take into account the potential CV impact of the various agents balancing safety and efficacy.

Comparison of cardiovascular risk calculation tools in pharmacy practice

OBJECTIVE To examine the use of various cardiovascular disease (CVD) risk estimation calculators in pharmacy practice. DESIGN Longitudinal cohort study. SETTING Midwestern university worksite from August 2008 through May 2012. PARTICIPANTS University employees with hypertension, dyslipidemia, and diabetes. INTERVENTION Risk estimation calculators were applied to data from a pharmacist-run chronic disease management program. MAIN OUTCOME MEASURE Difference in estimated CVD risk from multiple estimation calculators. RESULTS At baseline and 12 months, non-lab-based tools reported significantly higher 10-year CVD risk percentages compared with lab-based tools among the same cohort of patients (10.63% vs. 8.71% at baseline, P < 0.001; 9.34% vs. 7.31% at 12 months, P < 0.001). In addition, the electronic version of 10-year CVD risk reported significantly higher values than the paper version when applied to the same patient cohort (7.31% vs. 6.60% at 12 months, P = 0.018). CONCLUSION CVD risk estimation tools report significantly different values and are not interchangeable. Pharmacists using non-lab-based tools should expect significantly higher risk estimates than estimates derived from lab-based tools and therefore should use the same version of the estimation tool over the long term.

Tool guide for lifestyle behavior change in a cardiovascular risk reduction program

Lifestyle medicine behaviors such as a healthy diet, physical activity, and tobacco avoidance, are the cornerstone of treatment in many chronic disease conditions, especially those related to the cardiovascular system. In fact, 80% of premature heart disease, stroke, and diabetes may be prevented through modification of these behaviors. The rate-limiting step in cardiovascular disease prevention is the implementation and maintenance of healthy lifestyle behaviors. The purpose of this paper is to provide and discuss a series of tools and strategies that can be used by health care providers to promote health behavior change in their practice.

Drug-Induced Photosensitivity and the Major Culprits

Photosensitivity is a condition that occurs when sunlight or artificial forms of radiation interact with a medication to produce an adverse cutaneous drug eruption. This adverse reaction may increase the incidence of skin cancer and can be prevented with proper counseling. There are 2 major types of photosensitivity: phototoxic reactions, which occur when an individual is exposed to both high doses of medication and radiation, and photoallergic reactions, which require an immune-mediated response. Several classes of drugs are commonly implicated in photosensitivity reactions, including tetracyclines, floroquinolones, sulfonamides, diuretics, phenothiazine antipsychotics, and nonsteroidal anti-inflammatory drugs. This review will discuss photosensitivity reactions, the most commonly reported photosensitizing agents, and treatment and prevention measures for the condition.

Potential Benefits of Cinnamon in Type 2 Diabetes

Long known as a spice, cinnamon’s potential efficacy in the treatment of type 2 diabetes has been gaining interest. Evidence from animal models shows efficacy as an insulin mimetic and insulin sensitizing agent, in addition to other potential mechanisms of action. Human clinical data regarding its efficacy have shown inconsistent results but may be related to differentials in baseline glucose control, type of cinnamon used, and duration of study. Overall, a significant number of trials have shown cinnamon to be an effective option for lowering blood sugar in uncontrolled type 2 diabetics. Cinnamon’s reasonable cost, over-the-counter availability, and safety profile make it a relatively low-risk option for this population.

Gut Microbiota and Obesity: Potential Therapeutic Targets and Probiotic Treatment

The gut bacteria model attributes obesity to the variable makeup of gut microbiota and its ability to modulate host energy homeostasis, adiposity and inflammation. To counteract these deleterious effects, strains of probiotics have been developed to manipulate gut microbiomes and improve health. The current article explores the mechanisms by which gut microbiota modulate host metabolism and highlights recent human study data assessing the effects of probiotic supplementation on the prevention and treatment of obesity.

Opioid Abuse and Overdose Prevention Strategies

Prescription drug misuse has reached epidemic proportions in the United States. Given the magnitude of the problem, strategies to prevent initiation of prescription opioid misuse, treat existing opioid use disorders, and prevent overdose are of utmost importance. This article will summarize such strategies, including improved prescriber education, prescription drug monitoring programs, medication take-back programs, controlled substance lock-in programs, and community-based naloxone distribution.

Two Year Sustainability of the Effect of a Financial Education Program on the Health and Wellbeing of Single, Low-Income Women

Financial stress is implicated in poor health and decreased Quality of Life (QOL). The purpose of this project was to assess the 2-year effect of a financial education program on the health of single, low-income women. A total of 30 women were enrolled and 20 continued through follow-up. Two years following intervention, women demonstrated a

Lifestyle and Pharmacotherapy for Weight Loss in Preventing or Delaying Diabetes

8,026 increase in mean annual income and significant improvements in health-related QOL and hopefulness. Half of the participants lost weight, and while not statistically significant, mean weight decreased by 2.2 pounds. Trends in decreased fast food consumption were observed. The results suggest that financial education has a significant, sustained effect on the health and health-related QOL of single, women of low income.

Lifestyle Medicine and Health and Wellness Coaching in Pharmacy Practice

Preventing or delaying the conversion of prediabetes to overt diabetes can reduce mortality and morbidity rates, improve health-related quality of life, and reduce other comorbid complications associated with diabetes. Studies have shown that a modest weight loss is one strategy for preventing or delaying diabetes diagnosis. First-line therapy in preventing progression of prediabetes to overt diabetes is weight loss through lifestyle modifications; however, pharmacotherapy for weight loss may be initiated if lifestyle alone is ineffective. The purpose of this article is to describe the pharmacotherapeuptic options for weight loss that can be used in conjunction with lifestyle in the prevention or delay of diabetes in patients with prediabetes.