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Considerations for Daliresp (roflumilast) Use in Hospice

Managing drug therapy in terminally ill COPD patients can certainly be challenging. Patients may be resistant to changing long-term medication regimens.1 Patients and caregivers may even interpret medication adjustments as giving up, patient abandonment, or as a suggestion that death is imminent.1 In this patient population, especially, some medications that were once effective may no longer provide adequate symptom relief and many of these drugs have significant cost implications. One medication that often raises questions about how to proceed once patients elect hospice care is Daliresp (roflumilast).

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Adlarity: A New Way to Deliver Donepezil

About 6.5 million Americans over 65 have Alzheimer disease and that number’s expected to balloon to 14 million by 2060.1 Many transition to hospice services, so hospice clinicians are sure to encounter patients taking the latest branded medications. One is a drug approved by the U.S. Food and Drug Administration (FDA) in March 2022 called Adlarity.1-3 While it’s not the first transdermal acetylcholinesterase inhibitor (AChEI), it’s the first non-oral donepezil formulation. Like its oral counterpart, it’s approved for patients with mild to severe Alzheimer disease.1-4

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What are the differences between diltiazem dosage forms?

With seemingly innumerable generic variants among dosage forms, diltiazem undoubtedly causes more confusion than any other drug when it comes to generic substitutions. As of August 2022, the FDA Orange Book lists a whopping 117 active diltiazem formulation/strength/manufacturer combinations. So, how do prescribers and pharmacists sort this mess out?

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Albuterol vs. Levalbuterol: What’s the Difference?

Albuterol and levalbuterol are short-acting beta-2 agonists (SABAs) that are used to manage acute breathlessness associated with asthma, COPD, or bronchospasm.1-3 Both drugs exert their primary effects by binding to beta-2 receptors in the lungs, which causes smooth muscle relaxation and bronchodilation.1-3 So, what’s the difference between the two?

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Factors that influence NSAID selection

Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat pain and inflammation.1,2­ With more than 20 different (but similarly effective) NSAIDs on the market, why would a provider prescribe or recommend one NSAID over another?3-5

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Inhaled Isopropyl Alcohol for Nausea

Antiemetics like prochlorperazine, haloperidol, or ondansetron are often prescribed to alleviate nausea in hospice patients, but there are always situations where symptoms don’t respond, contraindications exist, or medications aren’t readily available. One outside-the-box remedy that hospice clinicians might consider adding to their nausea management toolbox is inhaled isopropyl alcohol vapor.

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Deprescribing Proton Pump Inhibitors

An Update from the American Gastroenterological Association

Deprescribing (the planned process of reducing a medication’s dose or stopping it completely) is now a relatively well-known term among hospice clinicians.1 Clear deprescribing guidance is lacking for many drugs, but this isn’t the case for proton pump inhibitors (PPIs). In addition to robust resources from Deprescribing.org and Primary Health Tasmania, the American Gastroenterological Association (AGA) recently published their deprescribing advice for PPIs.

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Together as One | Iris Jiao

Our “Together as One” series spotlights nurses, physicians, pharmacists and others who positively impact the lives of hospice patients and their families every day. Through the dedicated and compassionate work of these inspiring professionals, patients receive the high-quality care and attentive consideration they deserve. Together with innovative and responsive hospice partners, they create the network of support so essential to hospice care. We invite you to meet the people behind the mission—and see what one can do.

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Together as One | Lisa Sandoval

Our “Together as One” series spotlights nurses, physicians, pharmacists and others who positively impact the lives of hospice patients and their families every day. Through the dedicated and compassionate work of these inspiring professionals, patients receive the high-quality care and attentive consideration they deserve. Together with innovative and responsive hospice partners, they create the network of support so essential to hospice care. We invite you to meet the people behind the mission—and see what one can do.

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In the News: New Oral Antiviral Drugs Added to the Armamentarium Against COVID-19

Lately, it seems like new developments concerning the COVID-19 pandemic have been flying around at a head-spinning pace. You’ve probably been bombarded with news of a highly contagious variant, sky-rocketing case numbers, or constantly evolving clinical guidance. One of the more encouraging developments is that oral antiviral drugs for COVID-19 have finally arrived. In late December 2021, the U.S. Food and Drug Administration (FDA) first granted Emergency Use Authorization (EUA) for Pfizer’s Paxlovid (nirmatrelvir/ritonavir) and then for Merck and Ridgeback Biotherapeutics’ molnupiravir, giving the drug makers the green light to begin distributing their products in the United States.1,2 While other COVID-19 treatment options exist, oral antiviral drugs are being touted as potential game changers since they can be used in the outpatient setting to keep patients out of the hospital (freeing up resources for sicker patients) and prevent death.3

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Charlie Otterbeck

OnePoint Patient Care

P 847-583-5652

cotterbeck@oppc.com

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