Bulletin Today
Fourteen national pharmacy associations, including APhA, have signed onto a joint statement against racial injustice. The National Pharmaceutical Association (NPhA), the professional organization of pharmacists that is committed to serving the underserved and promoting minorities in pharmacy, led the effort in issuing the joint statement.
“The recent deaths of George Floyd, Breonna Taylor, Ahmaud Arbery, and too many others have ignited strong emotions and continue to shed a glaring light on the day-to-day experiences of Black Americans,” says the statement. “Sadly, racism and discrimination are a thread that has been woven into the fabric of this country for far too long. Adding to the challenges of the global pandemic of COVID-19, which disproportionately impact communities of color, there is a greater public health crisis plaguing our country: racism and discrimination. People of color and other marginalized groups experience a continuum of systemic racism, discrimination, and injustices that result in ongoing health inequities created by numerous factors impacting social determinants of health.”
The statement lists specific actions for pharmacists to take to uphold the highest standards. The actions include, but are not limited to:
- Working together to provide opportunities to address health care disparities and strengthen affected communities.
- Providing pharmacist, student pharmacist, and pharmacy technician education on social injustices and systematic challenges impacting health care.
- Delivering strategies that focus on change through communications, partnerships, and solutions to address health care disparities.
- Continuing dialogue among pharmacy organizations and stakeholders to identify and implement change.
Supporting organizations of the joint statement include NPhA, APhA, the Academy of Managed Care Pharmacy, the American Association of Colleges of Pharmacy, the American College of Apothecaries, the Accreditation Council for Pharmacy Education, the American College of Clinical Pharmacy, the American Society of Health-System Pharmacists, the American Society of Consultant Pharmacists, the College of Psychiatric and Neurologic Pharmacists, the Hematology/Oncology Pharmacy Association, the National Alliance of State Pharmacy Associations, the National Association of Boards of Pharmacy, and the National Community Pharmacists Association. The icons of the 14 organizations appear below.
CDC updates list of who’s most at risk for severe COVID-19 illness
According to CDC, a substantial number of Americans are at increased risk of getting severely ill from COVID-19. Based on the available evidence to date, the agency has further defined its list of who is most at risk.
Under risk related to age, CDC removed the specific age threshold from the older adult classification. Recent data shows that the older people are, the higher their risk of severe illness from COVID-19. “Age is an independent risk factor for severe illness, but risk in older adults is also in part related to the increased likelihood that older adults also have underlying medical conditions,” said CDC in a news release.
CDC also updated the list of underlying medical conditions that increase the risk of severe illness from COVID-19. Based on consistent evidence, the following conditions increase a person’s risk:
- Chronic kidney disease
- COPD
- Immunocompromised state from solid organ transplant
- Obesity
- Serious heart conditions, such as heart failure, coronary artery disease, or cardiomyopathies
- Sickle cell disease
- Type 2 diabetes
About 60% of adults in the United States have at least one chronic medical condition, according to CDC. Obesity is one of the most common underlying conditions that increases one’s risk for severe illness, and about 40% of adults in the United States are obese. The more underlying medical conditions people have, the higher their risk, CDC stated.
In addition, the agency clarified its list of conditions that might increase a person’s risk. They include moderate-to-severe asthma, high blood pressure, neurologic conditions such as dementia, cerebrovascular diseases such as stroke, and pregnancy.
“Understanding who is most at risk for severe illness helps people make the best decisions for themselves, their families, and their communities,” said CDC Director Robert Redfield, MD, in the news release. “While we are all at risk for COVID-19, we need to be aware of who is susceptible to severe complications so that we take appropriate measures to protect their health and well-being.”
Study links azithromycin to increased risk of cardiovascular death
The antibiotic azithromycin may be associated with a greater risk of cardiovascular death, according to a recent study in JAMA Network Open.
Azithromycin has been connected with an increased risk of cardiovascular death in some observational studies before. As one of the most commonly prescribed antibiotics in the United States, researchers of the new study wanted to examine this further. They looked at the risk of cardiovascular death and sudden cardiac death in a diverse, community-based population comparing the use of azithromycin with amoxicillin, an antibiotic not associated with adverse cardiovascular events.
Their cohort study included more than 7.8 million antibiotic exposures from the Kaiser Permanente database—1,736,976 were azithromycin exposures and 6,087,705 were amoxicillin exposures.
The cohort included patients aged 30 to 74 years who had at least 12 months of health plan enrollment prior to antibiotic exposure. Data were analyzed from December 1, 2016, to March 30, 2020.
According to the results of the study, an outpatient prescription for azithromycin was associated with an elevated risk of cardiovascular death within 5 days of exposure compared with amoxicillin. The study also found an increased risk of noncardiovascular and all-cause death within a 5-day window after dispensing prescribed azithromycin for patients.
Authors of the study wrote that although these analyses cannot establish causality, prescribers should be aware of the potential association between cardiovascular death and azithromycin use.
Pharmacists in New York will be ready when the COVID-19 vaccine becomes available
New York Governor Andrew Cuomo signed legislation on June 17 that will allow New York State pharmacists to provide the COVID-19 vaccine when it becomes available. The legislation (S.8182-A/A.10508-A) adds COVID-19 to the list of illnesses for which pharmacists in the state can vaccinate.
“Now is the time to make sure that people will be able to get their COVID-19 vaccination as soon as it becomes available,” said Community Pharmacy Association of New York State President Mike Duteau and National Association of Chain Drug Stores (NACDS) President and CEO Steven C. Anderson in a joint statement. “It is essential that all states continue to remove barriers for pharmacies to help meet the needs of patients during this phase of the pandemic.”
They go on to say that a federal government study found that in a pandemic situation, 80% of the population in the United States can be vaccinated 7 weeks faster when pharmacies are involved. In addition, a poll conducted by Morning Consult and commissioned by NACDS found that 79% of New York State voters say pharmacists should be allowed to provide a COVID-19 vaccine.
“The H1N1 pandemic of 2009 taught the critical lesson that pharmacies and pharmacists play an irreplaceable role in vaccination campaigns, and since that time patients have come to know that they can obtain more and more of their vaccinations safely and conveniently at the pharmacy,” Duteau and Anderson said in the joint statement.
The legislation was led by New York State Senator Brad Hoylman (D) and New York State Assemblymember Amy Paulin (D).
Older adults prescribed concerning amount of muscle relaxants
Office visits for ongoing prescribing of skeletal muscle relaxant drugs tripled from 2005 to 2016, according to a new study published in JAMA Network Open. Researchers found that the number of office visits resulting in new muscle relaxant prescriptions remained stable at approximately six million per year from 2005 to 2016. However, office visits for continued muscle relaxant drug therapy skyrocketed from 8.5 million in 2005 to 24.7 million in 2016.
What worries researchers the most is that muscle relaxants were prescribed more to older adults—they accounted for 22.2% of all muscle relaxant office visits in 2016, even though older adults make up about 14.5% of the population in the United States. National guidelines warn that this class of drugs should almost always be avoided in older adult patients.
According to the American Geriatrics Society, muscle relaxants can have serious side effects including falls, fractures, abuse, dependence, and overdose, which is why older adults should avoid them. In general, muscle relaxants should be limited to a 3-week duration when prescribed.
Researchers of the study hypothesized that the opioid epidemic may have led clinicians to prescribe muscle relaxants as an alternative to opioids for long-term pain management. Their research findings proved that 67% of the continued muscle relaxant visits in 2016 also recorded therapy with an opioid.
“For older adults, I think the message should be to avoid using muscle relaxants, especially when we consider the side effects and increased risk of falls and fractures, and to find alternatives for pain management,” said lead author Samantha Soprano, MPH, in a press statement.
In the same press statement, Charles Leonard, PharmD, MSCE, an assistant professor of epidemiology at the Perelman School of Medicine at the University of Pennsylvania, who was also involved in the research, said muscle relaxants may not be any more effective in managing pain than medications like Tylenol or Advil.
FDA warns against coprescribing muscle relaxants and opioids because of the risk of serious side effects, including slowed or difficult breathing and even death.
The results of the study were based on publicly available data from the National Ambulatory Medical Care Survey, which is an annual survey for nonfederally funded office-based physicians.