The Consultant pharmacist : the journal of the American Society of Consultant Pharmacists
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To review the chemistry, pharmacodynamics, pharmacokinetics, efficacy, tolerability, dosing, and role of the Osmotic-controlled Release Oral delivery System (OROS) hydromorphone extended-release (ER) tablets. ⋯ Hydromorphone ER is the newest oral opioid to enter a crowded marketplace now totaling 15 different Schedule 2 opioids (including tapentadol), and tramadol, available in oral, parenteral, rectal, transdermal, transmucosal, and intranasal formulations. It does not appear to have any unique assets or liabilities and should be considered as one of many oral opioids available for the management of persistent pain of moderate-to-severe intensity.
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Prediabetes encompasses a variety of abnormalities, including impaired fasting glucose, impaired glucose tolerance, and metabolic syndrome. Prediabetes also increases the risk of developing type 2 diabetes mellitus (T2DM) by 3- to 10-fold, but the complications associated with hyperglycemia begin early in the patient's progression from normal glucose levels to diabetes. Early identification and treatment of prediabetes has the potential to reduce or delay progression to overt diabetes, to preempt related cardiovascular and microvascular disease, and to significantly improve morbidity and mortality. This clinical review provides a vehicle to examine management of prediabetes in patients 65 years of age and older, including diagnostic criteria and recommendations for management. ⋯ Effective prediabetes management is important to reducing the risk of progression to T2DM. Recommended first-line therapy is lifestyle modification that may include exercise, nutritional therapy, and weight loss. Pharmacological therapies, when indicated, can aid in improving glucose, blood pressure, and lipid parameters in this patient subgroup.
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Pharmaceutical compounding-the process by which a pharmacist combines ingredients into a customized medication for an individual patient-has ancient roots, with popularity that has waxed and waned throughout history. Elderly individuals and other long-term care patients may be among those who need customized medications, so pharmacists should be aware of the current scope and regulations for compounded medications.
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This clinical review highlights emerging data regarding the complex relationship among glycosylated hemoglobin (A1C) goals, risk of cardiovascular disease, and hypoglycemia in elderly patients with type 2 diabetes mellitus (T2DM). According to the ADVANCE and VADT trials, lowering patients' A1C levels did not decrease the risk of cardiovascular disease, and the ACCORD trial found a slightly higher risk of cardiovascular disease with tighter glycemic control. Long-term follow-up data from the UKPDS indicated good glycemic control, when achieved early in newly diagnosed patients, lowered cardiovascular risk over the long-term (at least 15 to 20 years). Moreover, tight glycemic control, if it results in severe hypoglycemic events, may pose a serious risk among elderly patients with T2DM. ⋯ If it can be achieved safely, early glycemic control is beneficial to elderly patients with T2DM. Treatment goals for older adults should be an individualized process and must include a number of considerations. Pharmacists need to manage the dual issues of avoiding intensive lowering of A1C levels and averting the risk of hypoglycemia.