A Review of the Renoprotective Effects of Novel Antidiabetic Agents

The objective of this review article was to identify and examine current evidence surrounding the potential renoprotective effects of newer antidiabetic agents such as sodium-glucose cotransporter 2 (SGLT-2) inhibitors, glucose-like peptide 1 (GLP-1) agonists, and dipeptidyl peptidase 4 (DPP-4) inhibitors. A literature search of MEDLINE and PubMed (January 2000 to April 2019) was performed using the following search terms: "diabetes treatment," "renoprotection," "kidneys," "SGLT-2 inhibitors," "GLP-1 receptor agonists," "DPP-4 inhibitors," and the drug names in each of those classes as well as any combination of these terms. Literature was excluded if published in a language other than English, performed in nonhuman subjects, did not include patients from the United States, was nonrandomized, or the data were available from poster presentations. There were 11 studies that met the search criteria. The majority of the studies focused on renal outcomes as secondary end points and looked at albuminuria, estimated glomerular filtration rate changes from baseline, urinary albumin-to-creatinine ratio, serum creatinine, and need for renal replacement therapy. There are fewer studies that focused on renal protection as a primary end point. After reviewing the available literature, the use of SGLT-2 inhibitors and GLP-1 agonists in addition to standard of care may be considered in patients with or at risk of developing chronic kidney disease. SGLT-2 inhibitors and GLP-1 agonists should be considered when patients' diabetes is no longer well controlled with metformin. Other factors such as cost, cardiovascular disease, and other comorbidities may also be taken into consideration when recommending therapy for patients.

Topiramate-Induced Chest Pain: A Case Report

Background:

Topiramate, an anticonvulsant used for prophylaxis of migraines and epilepsy, is commonly associated with adverse effects of cognitive dulling and fatigue. Chest pain is a potential adverse effect that to our knowledge has not been reported with the use of topiramate.

Case Presentation:

We present the case of a 38-year-old female with a seizure disorder who experienced chest pain after the first dose of topiramate. On day 1, she presented to the emergency department, was admitted, and over the course of 3 days had a chest X-ray, electrocardiogram (ECG), and echocardiogram, and her vitals, basic metabolic panel, complete blood counts, troponin, and d-dimer levels were monitored. The chest pain improved when the topiramate was held. No identifiable causes of chest pain were apparent, other than the topiramate.

Discussion:

The Naranjo probability scale was utilized to determine the causality of topiramate. The resulting score of 3 indicates that it is possible that the chest pain was due to the topiramate.

Conclusion:

This report demonstrates an example of a patient who experienced chest pain possibly caused by the initiation of topiramate. The objective of this case report is to increase the awareness of chest pain as an adverse effect of topiramate.

The Potential Clinical Implications and Importance of Drug Interactions Between Anticancer Agents and Cannabidiol in Patients With Cancer

The objective of this review was to identify and examine the pharmacokinetic and pharmacodynamic interactions between cannabidiol (CBD)-only products, such as CBD oil, and anticancer agents. A literature search of PubMed (1980 to September 2018) and the Cochrane Collection (1980 to September 2018) was performed using the following search terms: "cannabidiol," "cancer," "cannabis," "marijuana," and "interaction," as well as any combination of these terms. Literature was excluded if it did not appear in the search when limited to the "full text" filter on PubMed, if it was not published in the English language, or if it did not explore potential pharmacodynamic or pharmacokinetic interactions of CBD and anticancer agents. There were 10 studies that met these inclusion criteria. The majority of the facts regarding the interactions with CBD were found using in vitro studies and the true in vivo implications are not well-known. Minimal data were available regarding the interactions between CBD and anticancer agents. However, pharmacists should always consider the possibility of interactions and their consequences whenever they are aware of a patient using CBD products.

Integration of transgender care into a pharmacy therapeutics curriculum

BACKGROUND AND PURPOSE

To examine the impact of a lecture on transgender health given during a special populations therapeutics course on third-year (P3) pharmacy students' knowledge and confidence of transgender care.

EDUCATIONAL ACTIVITY AND SETTING

A two-hour lecture that included both cultural sensitivity and pharmacotherapy aspects of care for transgender individuals was added to a required two-credit therapeutics series offered at the end of the P3 year of a doctor of pharmacy curriculum. Following the lecture, students completed a 17-item knowledge-based survey and ranked their confidence with each answer on a 5-point scale. Students in the fourth-year (P4) class, who had not been given the lecture, also completed the survey.

FINDINGS

Students who attended the lecture had a significantly higher mean knowledge score and mean confidence score than students who did not attend. The P3 class had a mean knowledge score of 72.5% while the mean knowledge score for the P4 class was 63.4% (P < 0.01). The P3's mean confidence score was 76.8% and the P4's mean confidence score was 60.6% (P < 0.01).

DISCUSSION

To the authors' knowledge, this is the first report on incorporating the topic of transgender care to a required disease and therapeutics series in a college of pharmacy curriculum.

SUMMARY

Students who attended a lecture on care of transgender individuals performed significantly better on a knowledge-based assessment and reported having greater confidence in their answers than students who did not attend the lecture.

Evaluation of Hypoglycemia and Potential Risk Factors in a Veterans Affairs Community Living Center

OBJECTIVES

To describe hypoglycemic events in a Veterans Affairs (VA) community living center (CLC) population and to determine predictive risk factors associated with hypoglycemia.

DESIGN

Retrospective, exploratory, observational chart review.

SETTING

Tertiary-care VA Healthcare System CLC.

PATIENTS

Residents residing in a VA CLC with at least one active order for insulin between June 1, 2009, and June 30, 2013, were evaluated over a 90-day study period.

MAIN OUTCOME MEASURES

The primary outcome was the number of days to the first hypoglycemic event as described by the survival curve analysis. The secondary outcomes included the overall incidence of hypoglycemia, the association of potential risk factors on the proportion of hypoglycemic events, and the association of potential risk factors on the development of an additional hypoglycemic event.

RESULTS

There was a 49% incidence of a hypoglycemic event in the 90-day study period with a 24% incidence within the first 7 days of resident admission, representing approximately half of all events that occurred. The only statistically significant risk factor for having a hypoglycemic event was the number of units of insulin/kg/day (hazard ratio = 1.008, 95% confidence interval 1.001, 1.015; P = 0.0317) that a resident was prescribed.

CONCLUSIONS

Residents are at increased risk for hypoglycemia within the first seven days of admission to a CLC. It is imperative that providers closely monitor and reevaluate antidiabetic regimens at this time of transition.