The Drug Enforcement Agency (DEA) and the Wisconsin Department of Justice (DOJ) will be sponsoring another prescription drug disposal day on Saturday, April 27th, 2024. This free, anonymous event provides people the opportunity to safely dispose of unwanted, unused, or no longer needed medications.
Some guidelines for those wanting to dispose of unwanted medications through this event include:
Both the DEA and Wisconsin DOJ have links promoting the drug disposal day, including the ability to search for participating locations based upon city, county, or zip code. You can find more information by following the links below:
The good news is that if an individual misses one of these organized “take back” days, search mechanisms exist to locate permanent drug disposal boxes within Wisconsin that are always available to patients. Click here to be connected with this helpful resource!
Although not a new problem, the daily complexities that drug shortages pose to the healthcare system have only seemed to multiply over time. When medications become unavailable, physicians and pharmacists must often work together to find solutions when preferred treatments are not an option. The shortages facing us today do not discriminate among medication type, cost, or brand vs. generic status. At present, family physicians are probably all too familiar with the supply shortages being seen across many of the prescription GLP-1 agonists. However, the depth of the problem extends far deeper, from what seems like relatively “simple” products (ex. injectable vitamins or sterile water for injection) to life-saving chemotherapies.
The U.S. Department of Health and Human Services (HHS) recently released a white paper in an attempt to identify actions that can be taken to address current shortages and prevent future ones. Some of the themes of the paper include:
To read the white paper in its entirety, click here: Policy Considerations to Prevent Drug Shortages and Mitigate Supply Chain Vulnerabilities in the United States.
If you’re interested in searching the status of a current medication shortage, we direct you to a searchable database the FDA has established. It can be particularly useful as it provides up-to-date information on the current status of an item’s availability as well as when any projected resolution is thought to be a possibility. Click here to be directed to the database.
An investigation appearing in the March 22, 2024 JAMA Network Open suggests that providers and pharmacists have reason to be on alert when using SSRIs and OACs together.
While it is generally known that SSRIs inhibit platelet activity and may carry with them a small inherent increased risk of major bleeding, the level of risk incurred by concomitant use of SSRIs with oral anticoagulants has not been well-defined.
Researchers in the United Kingdom conducted a nested case-control study of over 42,000 major bleeding cases in atrial fibrillation patients matched with over 1.1 million controls between January 1998 and March 2021, with a focus on concomitant use of SSRIs and oral anticoagulants. SSRIs included citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine and sertraline. Oral anticoagulants included direct agents apixaban, dabigatran, edoxaban, rivaroxaban and vitamin K antagonist warfarin. The main outcome was defined as bleeding-related hospitalization or death. The mean age of subjects in both the case and control group was 74 years, and both groups had identical percentages of men, at 59.8%.
Concomitant use of SSRIS and OACs resulted in a 33% risk (Incidence rate ratio 1.33, 95% CI, 1.24-1.42) for major bleeding compared to OACs alone. The risk was highest within the first 30 days of use (IRR 1.74, 95% CI, 1.37-2.22) and persisted for up to 6 months, and “did not vary with age, sex, history of bleeding, chronic kidney disease, and potency of SSRIs”.
Furthermore, an association was present with both classes of OACs with SSRIs compared with the anticoagulants alone (direct oral anticoagulants: IRR 1.25, 95% CI, 1.12-1.40; warfarin: IRR 1.36, 95% CI, 1.25-1.47).
Because SSRIs are among the most utilized medications worldwide, including 19% of people aged 60 and older, the authors urge caution when using SSRIs and anticoagulants together. The risks are not believed to be significant enough to warrant withholding therapy with either SSRIs or anticoagulants, but extra caution and close monitoring are advised, particularly within the first 6 months of therapy. Prescribers may choose to give preference for direct oral anticoagulants, as the risk does appear to be slightly lower than with warfarin, and prescribers may also elect to use acid suppression therapy to mitigate risk as well.
Another addition to the Sodium Glucose Co-Transport Inhibitors (SGLT2i) drug class has been FDA approved and is available. Data from clinical trials has led to the use of drugs in the class beyond their efficacy for glycemic control, and now recognizes the benefits of decreased ASCVD risk factors via decreasing blood pressure and body weight, decreases in heart failure hospitalizations and acute heart failure, and decreases in the progression of kidney disease, which led to FDA approvals for these indications for specific agents. (See table below)
Clinical Pharmacy Practitioner in Primary Care
Mike Grunske, PharmD, BCPS
Mike Grunske is a Board-Certified Pharmacotherapy Specialist (BCPS). Mike transitioned his practice to the Clement Zablocki VA Medical Center where he has since practiced in the Primary Care Clinics as a Clinical Pharmacist Practioner. Within this role, his practice involves direct care and management of patients’ medication regimens. He has worked as an active preceptor for both pharmacy students and residents throughout his entire career. Mike is also Past-President and former Foundation Chair of the Pharmacy Society of Wisconsin (PSW).
Mike is married to a fellow PharmAid contributor (Vanessa Grunske). Together they have a teenage daughter and son. He enjoys traveling with his family, attending his kid’s cheer, baseball, and basketball events, and spending any available leftover time running and hunting.
Pharmacist at Advocate Aurora Health
Vanessa Grunske, PharmD, BCACP
Vanessa practices with Advocate Aurora Health in Milwaukee, where she sees patients at Aurora Sinai Medication Management Clinic and maintains a dispensing practice at St. Luke’s Medical Center. Board-certified in ambulatory care pharmacotherapy, her practice interests include diabetes, hypertension, smoking cessation, geriatrics, improving health literacy, and medication adherence. She particularly enjoys and spends a good share of her work hours teaching and mentoring pharmacy students, family medicine residents and pharmacy residents.
She and her husband, Mike, live in the Milwaukee area with their two teenage children. In her free time, she enjoys cooking, baking, visiting our national parks with her family or relaxing on a beautiful Caribbean beach.
Professor at Concordia University Wisconsin School of Pharmacy
Beth Buckley, PharmD, CDCES
Beth Buckley, PharmD, CDCES (Certified Diabetes Care and Education Specialist), is a Professor of Pharmacy Practice at the Concordia University Wisconsin School of Pharmacy, where she has a teaching role within all years of the curriculum with a focus on Applied Patient Care Skills Lab, Diabetes Pharmacotherapy, and electives in the areas of diabetes and wellness. Her current role is ambulatory care pharmacist where she works with a Collaborative Practice Agreement to provide chronic disease state management within a primary care clinic.
When not working, she enjoys reading, gardening, traveling with her husband, volunteering within the community, and active fun: hiking, biking, dog walking, practicing yoga, mindfulness, and living with intention and gratitude.
Disclaimer: The Wisconsin Academy of Family Physicians (WAFP) has entered into a business relationship with Pharm Aid to offer our members discounts and exclusive savings. This or other affinity program relationships presented by the WAFP in no way implies a WAFP endorsement of the program, supplier, or vendor.
