October 16, 2024 • 29 mins
October is American Pharmacist Month, and to help recognize the many ways pharmacists care for communities, we talk to Chris about the influence and increasing importance of the clinical pharmacist in correctional and institutional healthcare settings. Chris details the primary strategies he and the OPTICS team use to impact patient care, reflects on the evolution of the clinical pharmacist role, explains how providers can better take advantage of pharmacist knowledge, and more.
We also go “Into the Clinic” to talk medication news (including the recent approval of Cobenfy for schizophrenia), and, in anticipation of Halloween, look at the real connections between pharmacy and witchcraft in our Trivia Capsule segment.
Links to material informing this episode's discussions.
Sponsor Links:
SapphireHealth- https://www.sapphire-health.com/
OPTICS- www.diamondpharmacy.com/clincal-services
Music Heard in Today's Episode:
The Retro Synth by Art Haiz
Medical Logo (5 Versions) by SoulProdMusic
Medical by PaulYudin
Ambient Relax Background by PaulYudin
Fun & Quirky Upbeat Retro by yourtunes
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
From Diamond Pharmacy and Optics, this is Podcast RX with Chris Bender.
(00:11):
When he's not on the mic, Chris is a clinical pharmacist with the Office of Pharmacy Therapeutics
and Integrated Clinical Services, or OPTICS.
He routinely helps providers in correctional and long-term care facilities make better
medication decisions to improve patient care.
And we're so happy that he's sharing his expertise with you.
Hoping that today can be a real knowledge booster.
A classic Batman and Robin or Jordan and Pippen type scenario.
(00:35):
A full armamentarium of options that clinicians can choose from.
October is American Pharmacist Month, and to help recognize the many ways pharmacists
care for communities, I talked with Chris about the influence and increasing importance
of the clinical pharmacist in correctional and institutional healthcare settings.
Chris details the primary strategies that he and the Optics team use to impact patient
(00:56):
care.
His focus on the evolution of the clinical pharmacist role explains how providers can
better take advantage of pharmacist knowledge and more.
We also go into the clinic to talk medication news, including the recent approval of CoBenFeed
for schizophrenia and in anticipation of Halloween, look at the real connections between pharmacy
and witchcraft in our trivia capsule segment.
(01:16):
I'm Adam Campbell, and thank you for listening.
So the man, the myth, the apothecary, Chris Bender, how are you?
I'm good.
Good.
How are you?
I'm doing well.
How's your October so far?
It's good.
(01:36):
It's already going by quickly.
You know, fall is in full spring, enjoying all the fall festivals.
We just went to like an Apple Festival this weekend.
So it helps with with little ones.
Now you have like more excuse to go out and do all the cool fall things.
So we've been loving it.
How about you?
Oh, same, same.
We were at a pumpkin patch yesterday.
So yes, I completely understand that.
(01:57):
And it has been great with the little ones for sure.
But yeah, halfway through or, you know, almost halfway through October, halfway to Halloween.
So no, I'm already looking forward to the spooky season.
Yeah.
Oh, me too.
Me too.
It's a falls become more of a big deal in my in my life since meeting my wife.
I will admit that.
So that's a good thing.
But yes, but you know, also we're talking about Halloween, but also October American
(02:19):
Pharmacist Month.
And I wanted to start by saying happy American Pharmacist Month to you, to your colleagues
in Optics.
Thank you.
You know, the purpose of Pharmacist Month is to shine a brighter light on the profession.
And in today's main discussion, I thought we could shine more light on the work that
you're all doing over in Optics and explore the impact that you all make on patient care.
(02:40):
So any special plans for celebrating Pharmacist Month here?
You know, I remember back in the day, people would bring food into the pharmacy and stuff
like that.
It's a different time.
So I mean, all good sentiments are always good, but I plan on just still staying out
there, keeping on the grind, you know what I mean?
Yeah, fair enough.
Fair enough.
Well, it's good to have you speaking of being on the grind.
It's good to have you here in the podcast studio.
(03:00):
Normally, you and I talk remotely.
So this is really good to have you here again.
And this is always good.
Face to face is always good.
We got some new equipment too that we're using.
So that's great.
But hey, before we get into our main discussion, that's tangential to Pharmacist Month, I want
to review the latest medication headlines the providers should be aware of.
(03:20):
So let's take a trip into the clinic.
All right.
Well, let's start off with one of the more exciting pieces of news, and that's the approval
of the new antipsychotic called cobenfi that was recently approved for the treatment of
(03:43):
schizophrenia in adults.
Now, this is obviously at the top of my list because obviously of how much we deal with
schizophrenia and antipsychotics in the correctional population.
But it's also really exciting because it's the first antipsychotic with a novel mechanism
since the advent of antipsychotics in the 1950s.
I wanted to say, Chris, that is a really standout historical milestone.
(04:06):
And I also saw that the approval came 35 years to the day after clozapine was approved.
And that was the last new quote unquote treatment in this area.
Yeah, yeah.
Very interesting.
And one in clozapine in and of itself, despite the, you know, the warnings surrounding surrounding
it, it's a pretty revolutionary medication, particularly in the area of like treatment
resistant schizophrenia.
(04:28):
So you know, hopefully this can be a pretty revolutionary drug in and of itself as well.
So you know, just for context, you know, you know, for decades, treatment of schizophrenia
has relied primarily on blocking dopamine.
And that strategy has, you know, to be fair, has been largely successful.
However, dopamine blockade also results in many of the adverse effects that we see with
(04:50):
antipsychotics like movement disorders, tardive dyskinesia, and even elevated prolactin levels.
Additionally, antipsychotics, you know, some more, some less, carry some risk of metabolic
effects, most notably like weight gain, increased risk for diabetes and increased lipid levels.
(05:11):
They can also induce QT prolongation and sedation, which is one of the more notable side effects.
Cobenphi on the other hand, doesn't work on the dopamine pathway, but rather it works
on the acetylcholine pathway.
Now, cobenphi is a combination of two medications.
So we have xenomaline, which is procholinergic, so it's cholinergic effects, and trospium,
(05:33):
which is anticholinergic.
Now, this may seem contradictory to some, but in reality, the trospium only works outside
of the brain and really is only included to reduce the procholinergic effects of xenomaline
outside of the brain, which would otherwise cause symptoms such as like excess salivation,
diarrhea, increased urination, all things that would make this medication otherwise
(05:57):
like very intolerable.
Now, FDA approval was based on results from the emergent clinical trial program, which
showed that individuals taking cobenphi had their PANS score or PANS score decreased
by about eight to 10 points greater than those taking placebo.
Now, for those who are unaware, the PANS tool is essentially a tool that adds up all of
(06:20):
the positive symptoms.
So things like psychosis and delusions and negative symptoms like social withdrawal and
depression.
So a reduction in the score shows an improvement in schizophrenia severity overall.
Now, for reference, a PANS reduction of eight to 10 points is pretty comparable to what
we see with traditional antipsychotics, but what could potentially set cobenphi apart
(06:44):
is that it also significantly improved negative symptoms like the social withdrawal stuff,
and that's what has been historically difficult to achieve with traditional antipsychotics
in the past.
And noting its adverse effect profile, it's also better tolerated without those significant
aforementioned side effects of the traditional antipsychotics.
Chris, I was doing some light reading about the development of cobenphi.
(07:07):
And what was really interesting is it started over 30 years ago with xanolamine, which Lilly
had originally intended as an Alzheimer's drug and then accidentally discovered its
antipsychotic properties, but Lilly couldn't improve upon the harsh side effect profile
that you were talking about.
And they were also putting a lot of stock into another schizophrenia drug of theirs
(07:30):
called Zyprexa.
So they basically put xanolamine in the back drawer.
And this pharma firm called Karuna Therapeutics then licenses xanolamine from Lilly for just
$100,000.
They figure out how to partner it with the tropspium to reduce those harsh side effects.
Like you were describing there.
(07:52):
And then they're bought by Bristol-Myers Squibb in December of 2023.
And now we've got this new drug.
So it's just an interesting story of one drug being used for something else.
And then you see that all the time in drug development, but it's nonetheless always fascinating.
It's nice whenever you can find something from the past and kind of repurpose it moving
forward.
(08:12):
I just was kind of like, it interests me being able to use two medications that you would
think would compete with each other.
Right.
To kind of help improve one another or at least improve the one drug.
So I thought that was pretty cool.
And that's a good little tidbit there.
Yeah.
So I know we devoted quite a bit of time to that one.
(08:33):
So I just wanted to make a couple quick mentions.
There was a new biologic approved for atopic dermatitis called ebglis.
It joins dupixant and adbrey.
And it showed strong efficacy with up to 58% of individuals achieving at least a 75% reduction
in symptoms.
So this actually may be able to give dupixant a run for its money in this condition, seeing
(08:55):
that dupixant has kind of been like the market leader in terms of biologics for atopic dermatitis.
And just to tease our main segment discussion a little bit, I know you love your biologics.
I do.
So finally, there was a guideline update by the American College of Gastroenterologists
on the treatment of H. pylori that kind of shook up the previous recommendations.
(09:19):
So one of the key points is that clarithromycin and levofloxacin based regimens are no longer
recommended unless you can confirm H. pylori sensitivity to those drugs.
Now clarithromycin based regimens have been a cornerstone of therapy for years, but efficacy
has actually been decreasing lately due to high rates of bacterial resistance.
(09:41):
Now there are four first line regimens recommended for treatment naive individuals.
The first is called optimized bismuth quadruple, which is a combination of a PPI or proton
pump inhibitor like omeprazole, pentoprazole, et cetera.
In addition to bismuth, tetracycline and metronidazole all taken separately.
(10:03):
And the next three are actually branded combination products.
So we have teletia, which is a rifabutin based triple therapy, and we have voquezna dual
pack and triple pack.
Interestingly voquezna is a branded product that uses a novel acid blocker called vanoprazan
and it was actually approved.
I forget it was kind of I think it was approved back in like 2022, something like that.
(10:27):
So it's still one of like the newer products that we have on the market.
Well while we're on the subject of digestion really quickly, Chris, did you see the recent
headlines about the shortages of terzepatide, which is a drug we've talked about extensively
on this show, those shortages being resolved?
Yeah, it's super exciting because I know that it's been impacting a lot of people just trying
to be, you know, I know personally a lot of people have been like dancing back and forth
(10:50):
between different GLP ones and the like, just trying to find anything available.
So I know it's only one of the three, three or four main products that we see on the market,
but having one of them back completely is really good for patient continuity.
Yeah, absolutely.
We're going to take a quick break.
(11:14):
Everyone knows that pharmacists dispense medication, but the clinical pharmacists in Diamond Pharmacy's
optics team dispense more potent resources, information and education.
The optics pharmacists are frontline medication experts for Diamond's many institutional partners.
Whether you work as a provider in corrections or long-term care, the optics team is standing
(11:36):
by to answer your on-demand medication questions.
But optics is far more than a drug information hotline.
They also create proactive knowledge resources like webinars and this podcast to keep partners
up to speed with the latest drug developments.
And they help providers to better manage costs and therapeutic outcomes with their in-house
medication surveillance monitoring program.
(11:58):
Learn more about the optics team by going to diamondpharmacy.com and clicking the clinical
support tab.
See pharmacy care more clearly with optics.
Let's get back to Podcast RX.
All right.
Well, October is American Pharmacists Month.
(12:18):
And here at Diamond Pharmacy, we have a lot of pharmacists to celebrate, you know, from
our production pharmacists, our retail pharmacists, compounding pharmacists, long-term care consultants,
correctional consultants, and of course, the clinical mavens of the optics team of which
Chris is a member.
So Chris, you and your optics colleagues have a unique position in the companies.
You occupy a strategic role regarding cost management and patient outcomes with our partner
(12:40):
facilities.
And pharmacists have long outgrown the role of medication dispensers, have been given
a bigger seat at the table overall.
And today I want to ask you how providers can maximize the expertise that you all provide
for those wholly unfamiliar with the work of optics.
I would encourage you to listen to Podcast RX Episode 25.
It's a two-part roundtable discussion with Chris and his colleagues, Zangray, Nancy Asieru,
(13:04):
Henry So, Stephen Ford, that really gets into the heart of what they do more so than what
we're going to talk about today.
But there is a video discussion over on Diamond Pharmacy's YouTube channel if you prefer to
watch rather than listen.
But at least to get this discussion started for Pharmacists Month, Chris, for those that
don't know, what are the primary strategies and tactics that the optics team seeks to
(13:24):
integrate clinical pharmacists' expertise or how you all seek to integrate clinical expertise
into patient care beyond just providing drug information and well, being on podcasts?
I do love being on the podcast.
But you know, I do consider there to be three main areas.
And so the first is education.
So we present at national and local conferences.
(13:46):
We distribute clinical materials to our partners, such as the monthly clinical watch and the
quarterly clinical update.
And we also participate in P&T or even provider meetings when requested by our partners.
Second is formulary management.
We help our partners when requested make changes to their formularies.
This is usually done when we participate in P&T meetings.
(14:09):
We are able to provide information about new medications, guideline changes, or important
pricing changes.
And we really are then able to help our partners make educated decisions with regard to their
formulary.
And then for some of our partners, we actually actively enforce the formulary, meaning we
review non-formulary orders or requests as they come in and make alternative recommendations
(14:34):
if that is appropriate.
Third is what I consider to be active patient care, which for us takes two forms.
The first is more reactive in nature.
And that's when providers simply call or email us regarding a patient asking, you know, asking
us for our treatment recommendations or our thoughts on their particular treatment strategy.
(14:57):
And the second way that we participate in active patient care is through chronic care
integration, for which we've actually partnered with a facility.
We, the Optics pharmacists, proactively review patients' medications, labs, and diagnoses.
And that allows us to make treatment recommendations proactively.
That then allows the providers who are then able to review our notes prior to the patient
(15:21):
encounter and then they can incorporate the recommendations if they agree.
Obviously this both allows the Optics pharmacists to be more involved and play a larger role.
But you know, more importantly, it improves the efficiency of chronic care clinic and
ultimately saves the provider's time.
Now you've been doing this a while, Chris.
(15:41):
So how well overall do you feel that providers are incorporating your clinical pharmacist
expertise into care decisions?
I assume this is pretty established procedure.
There's still lots of room for growth.
Yeah.
I've actually just hit 10 years as a pharmacist this year, which...
Congratulations.
Thanks.
Which, you know, may not seem like a lot in the grand scheme of things, but I do feel
(16:04):
like we've seen an evolution in the field even just since, you know, whenever I've come
out of school.
You know, I remember when I was in school that integrating clinical pharmacists was
certainly becoming a thing, but it wasn't as widespread as the concept is today.
So generally speaking, I'd say that providers and institutions are incorporating clinical
(16:25):
pharmacists well, but of course there's always going to remain room for growth.
Some entities have embraced this concept more than others.
You know, for example, the VA has a long history of incorporating clinical pharmacists and
were one of the first examples of using collaborative practice agreements, which basically allow
clinical pharmacists to actively engage patients independently.
(16:48):
And then on the other hand, you have corrections, which I feel is an entity with room for...
With a lot of potential for growth for clinical pharmacy.
Now, you know, in my opinion, this isn't...
This likely isn't due to like lack of desire, but probably more likely the result of either
budgetary constraints or simply a mere lack of awareness.
(17:08):
And that's where I feel like our team can play a role.
By being able to participate in the care team remotely and under the diamond umbrella, facilities
could incorporate our services across many different locations without the hassle of
actually employing a pharmacist in house, which then becomes more of like a financial
and a logistical challenge.
(17:30):
From your viewpoint, what are some strategies and tactics that facilities, medical groups,
the like, and so on can adopt to better take advantage of pharmacist expertise?
Yeah, I think it's all very dependent on what the workflow of a given place looks like.
But generally speaking, you know, it helps to give the pharmacist an actual role and
(17:50):
perhaps even their own patient panel.
You know, it's more efficient than consulting with pharmacy for one off questions.
This can take the form of proactive patient reviews for chronic care visits, such as what
we do with optics.
Or it could be a referral based system, which is actually pretty common in the community.
As an example, there are pharmacists who specialize in diabetes management and providers refer
(18:14):
patients to the quote unquote diabetes pharmacist who's able to adjust their medications and
follow up with those patients.
Obviously because that pharmacist has a narrower scope of practice than say a physician, they're
often able to get into the nitty gritty with patients regarding disease state education,
medication optimization, and then ultimately lead to improve medical outcomes.
(18:39):
What are some clinical pharmacy questions that you wish providers would ask more of?
Yeah, so I love getting any question from providers that just like, how do I treat X?
Because like it gives me latitude to discuss the entire clinical picture with the provider
rather than being asked what's a cost effective alternative to drug X.
(19:01):
No, don't get me wrong.
Cost avoidance is huge.
It's one of our biggest roles.
But you know, as like a clinical pharmacist, it's always more fun to work through a full
patient case.
Now because optics serves such a broad clinical role for our partners, we all have to be well
versed in disease states across the board, whether it be diabetes, HIV, schizophrenia,
(19:25):
addiction, et cetera.
But personally, I really enjoy discussing biologics, particularly those for rheumatologic,
GI, and dermatologic conditions as you alluded to earlier.
You know, because these agents are often so expensive, providers will usually come to
us asking for cost effective ways to treat these patients.
(19:47):
And I really love getting into the details, comparing different biologic therapies with
them in terms of cost, efficacy, different considerations.
So for me personally, I like more questions of that nature.
Well, you've said before that practicing pharmacy in the optic setting allows you to practice
at the top of your pharmacist license.
(20:07):
So Chris, what's been your favorite, most memorable experiences working with sites and
providers to integrate pharmacist expertise?
Yeah, so participating in chronic care clinic has probably been my favorite experience so
far.
You know, being able to play a direct role in patient care and ultimately see the results
of that is very rewarding.
(20:27):
And ultimately, it makes you stay up to date because obviously you want to do right by
the patients.
I also really have enjoyed building relationships with providers during my time in optics.
You know, there are some providers who email me on a regular basis asking me for my opinion
on treatment decisions.
So for them to reach out to me time and again shows a level of trust that really makes me
(20:50):
feel like I'm doing a good job.
No doubt.
And my final question for you in our discussion here, how is optics evolving to make pharmacy
expertise more seamlessly integrated and accessible?
Yeah, so anything that the optics team can do to essentially meet the clinician where
they are and be incorporated into their workflow really can go a long way.
(21:14):
You know, being remote from our partners is certainly a unique challenge, but all systems
are really starting to take advantage of using remote staff to better expand their services.
And clinical pharmacy service shouldn't really be any different.
So our integration into the chronic care clinic is probably the best example, as I've alluded
to.
(21:35):
By integrating our services into a shared EHR, you know, we really kind of position
ourselves to be just a click away from the clinician.
We are also working on a new project that is more customer facing in the hopes of streamlining
the client optics engagement experience rather than the traditional call email approach,
(21:56):
which may not have been as accessible for some.
And we're also, you know, we are also continuing to identify opportunities for enhanced client
education through things such as like train the trainer types of approaches.
Well these things all sound very exciting and no doubt someday we'll be talking about
them on this very show.
(22:17):
Absolutely hope to.
Well, let's take another quick break.
In the realm of corrections health, not all electronic health records are created equally.
Sapphire EHR is a comprehensive cloud based electronic health record designed specifically
for correctional health providers.
(22:37):
Since 2011, Sapphire has worked one on one with health care staff in jails and prisons
to develop and refine a suite of features and modules to manage total inmate patient
care from med pass to dental care to documentation of lab results and creating custom forms.
Sapphire's correction specific features can be scaled to meet the needs of the largest
correctional facilities down to the smallest local jails.
(23:00):
And it's all backed up by 100% in-house hosting, training and support with a 24-7
help desk.
Get a closer look at the corrections EHR deployed in over 400 facilities across 36 states and
territories.
Visit www.sapphire-health.com and schedule a demo today.
(23:20):
Sapphire EHR cloud based compatible correction specific electronic health records.
Now back to podcast RX with Chris Bender.
All right.
With October of course ending on Halloween, we thought it would be a great idea to explore
some connections between pharmacy and spooky season.
The witch is one of the most enduring characters in all of Halloween lore to say nothing of
(23:41):
overall historical significance.
But Chris, you know, we're of a millennial age.
I was curious, is Hocus Pocus required viewing in your house this time of year?
Absolutely.
In fact, we did just try showing Hocus Pocus to our almost two year old.
Oh, yeah.
He's not so much into the live action stuff yet.
So we only got about five minutes into it before we had to had to switch that off.
(24:05):
But I must admit, my list goes Coco, Nightmare Before Christmas, and then Hocus Pocus.
I wasn't familiar with Coco at all.
I had to look at that one.
It's a tearjerker.
It's amazing.
Yeah, it looks pretty good.
But pop culture references to witches aside, naturally, when you think of witches and witchcraft,
you're thinking of fantastical spells and potions.
(24:28):
Regarding the latter, there's some very real pharmacology behind those ideas.
So Chris, what are some amazing pharmacy facts associated with witchcraft you could share
with us in this month's trivia capsule?
Well, in the modern era, witches often get a bad rap, often thought of as old, warty
(24:52):
women hunching over a bowling cauldron, only to be embraced once a year as a mascot of
Halloween.
But did you know that the women accused of witchcraft were most likely just herbalists
who were proficient in using local plants to cure illnesses and alleviate pain?
Perhaps the two best known, quote unquote, witches bruise are the sleep potion and the
(25:14):
love potion.
Both have plausible pharmacologic explanations to their effects.
Historical records suggest that sleeping potions contain foxglove flower extract, dry frog
extract, serpentine root extract, and almond oil.
Now, foxglove flower extract contains digoxin, a medication still in use today, which slows
(25:35):
the heart rate.
Dried frog or dried toad secretions contain bufotoxin, which behaves similarly to digoxin,
slowing the heart rate.
Serpentine root extract contains, among other things, reserpene, which lowers blood pressure,
depresses the central nervous system, and induces drowsiness.
And finally, almond oil acted as a solvent in the sleeping potion, which basically solubilized
(25:59):
all of the other components.
I guess it's kind of hard to stay awake when your heart rate and blood pressure are so
low.
The other two that love potions, on the other hand, commonly contain ingredients such as
mandrake root extract, henbane leaves, areca nut, and ephedrine.
Mandrake root contains hyacinamine, hyacin, and atropine, all of which are used in modern
(26:21):
medicine today, and have anticholinergic effects such as increased heart rate, palpitations,
dry mouth, and pupil dilation.
Henbane leaves also contain hyacin and atropine, which would certainly contribute to the aforementioned
effects, but in modern doses, henbane can cause hallucinations as well.
Areca nut contains aracholis, which has a nicotine-like effect, causing stimulation
(26:45):
and euphoria.
And finally, ephedrine and its derivatives are commonly used today in relieving sinus
congestion, but can cause excitability, including increases in heart rate and blood pressure.
I guess this potion just recreates that excited butterfly feeling of love at first sight.
So when you're watching Hocus Pocus for the 31st year in a row, consider the difference
(27:07):
timing can make.
Disparaged in their time, but perhaps if they were practicing their craft today, they might
be finding a cure for cancer, or they might even be pharmacists.
Well, that does it for Podcast RX with Chris Bender, October 2024 edition.
And thank you again for listening.
Please rate and review if you can and help Chris's pharmacy nerdery run amuck, amuck,
(27:30):
amuck.
That was a Hocus Pocus reference.
I'll see myself out.
But no, seriously, again, we really appreciate all the listeners we can get.
You can listen on all the major podcast platforms, Apple Podcasts, Spotify, Overcast, you name
it.
And please, again, rate and review where you can.
Let's get this show up because Chris is doing a great job.
(27:52):
I'm really happy to have him on board and move in the show here.
Hopefully everyone enjoys.
Give us five stars.
Love those stars.
Absolutely.
And everything that we talk about, anything that informs our discussion, we have links
to all that in our show notes.
I do a post on Diamond Pharmacy's blog for each new episode.
And there we've got detailed links to everything that informs our discussion for each of these.
(28:16):
So if you want to go and do some additional reading, that's very easy to do.
So Chris, thank you as always.
Happy Pharmacist Month to you.
And we'll talk in November.
Thank you.
Thank you.
(28:37):
Podcast RX features conversations with health care professionals.
The statements and opinions discussed herein are for informational purposes only.
This podcast should not be considered professional medical advice and should not be used as the
substitute for the advice of an appropriately qualified and licensed health care professional.
Therefore, listeners must not rely on the statements made herein.
(29:05):
Podcast RX is a production of Diamond Pharmacy Services.
Find our show on Apple Podcasts, Spotify, YouTube, or wherever you enjoy podcasts.
And where possible, please write and review.
If you'd like to get in touch with the show directly, shoot us an email at PodcastRXatDiamondPharmacy.com.
(29:25):
Thank you again for your support.
From Diamond Pharmacy and Optics, this is Podcast RX with Chris Bender.
(00:11):
When he's not on the mic, Chris is a clinical pharmacist with the Office of Pharmacy Therapeutics
and Integrated Clinical Services, or OPTICS.
He routinely helps providers in correctional and long-term care facilities make better
medication decisions to improve patient care.
And we're so happy that he's sharing his expertise with you.
Hoping that today can be a real knowledge booster.
A classic Batman and Robin or Jordan and Pippen type scenario.
(00:35):
A full armamentarium of options that clinicians can choose from.
October is American Pharmacist Month, and to help recognize the many ways pharmacists
care for communities, I talked with Chris about the influence and increasing importance
of the clinical pharmacist in correctional and institutional healthcare settings.
Chris details the primary strategies that he and the Optics team use to impact patient
(00:56):
care.
His focus on the evolution of the clinical pharmacist role explains how providers can
better take advantage of pharmacist knowledge and more.
We also go into the clinic to talk medication news, including the recent approval of CoBenFeed
for schizophrenia and in anticipation of Halloween, look at the real connections between pharmacy
and witchcraft in our trivia capsule segment.
(01:16):
I'm Adam Campbell, and thank you for listening.
So the man, the myth, the apothecary, Chris Bender, how are you?
I'm good.
Good.
How are you?
I'm doing well.
How's your October so far?
It's good.
(01:36):
It's already going by quickly.
You know, fall is in full spring, enjoying all the fall festivals.
We just went to like an Apple Festival this weekend.
So it helps with with little ones.
Now you have like more excuse to go out and do all the cool fall things.
So we've been loving it.
How about you?
Oh, same, same.
We were at a pumpkin patch yesterday.
So yes, I completely understand that.
(01:57):
And it has been great with the little ones for sure.
But yeah, halfway through or, you know, almost halfway through October, halfway to Halloween.
So no, I'm already looking forward to the spooky season.
Yeah.
Oh, me too.
Me too.
It's a falls become more of a big deal in my in my life since meeting my wife.
I will admit that.
So that's a good thing.
But yes, but you know, also we're talking about Halloween, but also October American
(02:19):
Pharmacist Month.
And I wanted to start by saying happy American Pharmacist Month to you, to your colleagues
in Optics.
Thank you.
You know, the purpose of Pharmacist Month is to shine a brighter light on the profession.
And in today's main discussion, I thought we could shine more light on the work that
you're all doing over in Optics and explore the impact that you all make on patient care.
(02:40):
So any special plans for celebrating Pharmacist Month here?
You know, I remember back in the day, people would bring food into the pharmacy and stuff
like that.
It's a different time.
So I mean, all good sentiments are always good, but I plan on just still staying out
there, keeping on the grind, you know what I mean?
Yeah, fair enough.
Fair enough.
Well, it's good to have you speaking of being on the grind.
It's good to have you here in the podcast studio.
(03:00):
Normally, you and I talk remotely.
So this is really good to have you here again.
And this is always good.
Face to face is always good.
We got some new equipment too that we're using.
So that's great.
But hey, before we get into our main discussion, that's tangential to Pharmacist Month, I want
to review the latest medication headlines the providers should be aware of.
(03:20):
So let's take a trip into the clinic.
All right.
Well, let's start off with one of the more exciting pieces of news, and that's the approval
of the new antipsychotic called cobenfi that was recently approved for the treatment of
(03:43):
schizophrenia in adults.
Now, this is obviously at the top of my list because obviously of how much we deal with
schizophrenia and antipsychotics in the correctional population.
But it's also really exciting because it's the first antipsychotic with a novel mechanism
since the advent of antipsychotics in the 1950s.
I wanted to say, Chris, that is a really standout historical milestone.
(04:06):
And I also saw that the approval came 35 years to the day after clozapine was approved.
And that was the last new quote unquote treatment in this area.
Yeah, yeah.
Very interesting.
And one in clozapine in and of itself, despite the, you know, the warnings surrounding surrounding
it, it's a pretty revolutionary medication, particularly in the area of like treatment
resistant schizophrenia.
(04:28):
So you know, hopefully this can be a pretty revolutionary drug in and of itself as well.
So you know, just for context, you know, you know, for decades, treatment of schizophrenia
has relied primarily on blocking dopamine.
And that strategy has, you know, to be fair, has been largely successful.
However, dopamine blockade also results in many of the adverse effects that we see with
(04:50):
antipsychotics like movement disorders, tardive dyskinesia, and even elevated prolactin levels.
Additionally, antipsychotics, you know, some more, some less, carry some risk of metabolic
effects, most notably like weight gain, increased risk for diabetes and increased lipid levels.
(05:11):
They can also induce QT prolongation and sedation, which is one of the more notable side effects.
Cobenphi on the other hand, doesn't work on the dopamine pathway, but rather it works
on the acetylcholine pathway.
Now, cobenphi is a combination of two medications.
So we have xenomaline, which is procholinergic, so it's cholinergic effects, and trospium,
(05:33):
which is anticholinergic.
Now, this may seem contradictory to some, but in reality, the trospium only works outside
of the brain and really is only included to reduce the procholinergic effects of xenomaline
outside of the brain, which would otherwise cause symptoms such as like excess salivation,
diarrhea, increased urination, all things that would make this medication otherwise
(05:57):
like very intolerable.
Now, FDA approval was based on results from the emergent clinical trial program, which
showed that individuals taking cobenphi had their PANS score or PANS score decreased
by about eight to 10 points greater than those taking placebo.
Now, for those who are unaware, the PANS tool is essentially a tool that adds up all of
(06:20):
the positive symptoms.
So things like psychosis and delusions and negative symptoms like social withdrawal and
depression.
So a reduction in the score shows an improvement in schizophrenia severity overall.
Now, for reference, a PANS reduction of eight to 10 points is pretty comparable to what
we see with traditional antipsychotics, but what could potentially set cobenphi apart
(06:44):
is that it also significantly improved negative symptoms like the social withdrawal stuff,
and that's what has been historically difficult to achieve with traditional antipsychotics
in the past.
And noting its adverse effect profile, it's also better tolerated without those significant
aforementioned side effects of the traditional antipsychotics.
Chris, I was doing some light reading about the development of cobenphi.
(07:07):
And what was really interesting is it started over 30 years ago with xanolamine, which Lilly
had originally intended as an Alzheimer's drug and then accidentally discovered its
antipsychotic properties, but Lilly couldn't improve upon the harsh side effect profile
that you were talking about.
And they were also putting a lot of stock into another schizophrenia drug of theirs
(07:30):
called Zyprexa.
So they basically put xanolamine in the back drawer.
And this pharma firm called Karuna Therapeutics then licenses xanolamine from Lilly for just
$100,000.
They figure out how to partner it with the tropspium to reduce those harsh side effects.
Like you were describing there.
(07:52):
And then they're bought by Bristol-Myers Squibb in December of 2023.
And now we've got this new drug.
So it's just an interesting story of one drug being used for something else.
And then you see that all the time in drug development, but it's nonetheless always fascinating.
It's nice whenever you can find something from the past and kind of repurpose it moving
forward.
(08:12):
I just was kind of like, it interests me being able to use two medications that you would
think would compete with each other.
Right.
To kind of help improve one another or at least improve the one drug.
So I thought that was pretty cool.
And that's a good little tidbit there.
Yeah.
So I know we devoted quite a bit of time to that one.
(08:33):
So I just wanted to make a couple quick mentions.
There was a new biologic approved for atopic dermatitis called ebglis.
It joins dupixant and adbrey.
And it showed strong efficacy with up to 58% of individuals achieving at least a 75% reduction
in symptoms.
So this actually may be able to give dupixant a run for its money in this condition, seeing
(08:55):
that dupixant has kind of been like the market leader in terms of biologics for atopic dermatitis.
And just to tease our main segment discussion a little bit, I know you love your biologics.
I do.
So finally, there was a guideline update by the American College of Gastroenterologists
on the treatment of H. pylori that kind of shook up the previous recommendations.
(09:19):
So one of the key points is that clarithromycin and levofloxacin based regimens are no longer
recommended unless you can confirm H. pylori sensitivity to those drugs.
Now clarithromycin based regimens have been a cornerstone of therapy for years, but efficacy
has actually been decreasing lately due to high rates of bacterial resistance.
(09:41):
Now there are four first line regimens recommended for treatment naive individuals.
The first is called optimized bismuth quadruple, which is a combination of a PPI or proton
pump inhibitor like omeprazole, pentoprazole, et cetera.
In addition to bismuth, tetracycline and metronidazole all taken separately.
(10:03):
And the next three are actually branded combination products.
So we have teletia, which is a rifabutin based triple therapy, and we have voquezna dual
pack and triple pack.
Interestingly voquezna is a branded product that uses a novel acid blocker called vanoprazan
and it was actually approved.
I forget it was kind of I think it was approved back in like 2022, something like that.
(10:27):
So it's still one of like the newer products that we have on the market.
Well while we're on the subject of digestion really quickly, Chris, did you see the recent
headlines about the shortages of terzepatide, which is a drug we've talked about extensively
on this show, those shortages being resolved?
Yeah, it's super exciting because I know that it's been impacting a lot of people just trying
to be, you know, I know personally a lot of people have been like dancing back and forth
(10:50):
between different GLP ones and the like, just trying to find anything available.
So I know it's only one of the three, three or four main products that we see on the market,
but having one of them back completely is really good for patient continuity.
Yeah, absolutely.
We're going to take a quick break.
(11:14):
Everyone knows that pharmacists dispense medication, but the clinical pharmacists in Diamond Pharmacy's
optics team dispense more potent resources, information and education.
The optics pharmacists are frontline medication experts for Diamond's many institutional partners.
Whether you work as a provider in corrections or long-term care, the optics team is standing
(11:36):
by to answer your on-demand medication questions.
But optics is far more than a drug information hotline.
They also create proactive knowledge resources like webinars and this podcast to keep partners
up to speed with the latest drug developments.
And they help providers to better manage costs and therapeutic outcomes with their in-house
medication surveillance monitoring program.
(11:58):
Learn more about the optics team by going to diamondpharmacy.com and clicking the clinical
support tab.
See pharmacy care more clearly with optics.
Let's get back to Podcast RX.
All right.
Well, October is American Pharmacists Month.
(12:18):
And here at Diamond Pharmacy, we have a lot of pharmacists to celebrate, you know, from
our production pharmacists, our retail pharmacists, compounding pharmacists, long-term care consultants,
correctional consultants, and of course, the clinical mavens of the optics team of which
Chris is a member.
So Chris, you and your optics colleagues have a unique position in the companies.
You occupy a strategic role regarding cost management and patient outcomes with our partner
(12:40):
facilities.
And pharmacists have long outgrown the role of medication dispensers, have been given
a bigger seat at the table overall.
And today I want to ask you how providers can maximize the expertise that you all provide
for those wholly unfamiliar with the work of optics.
I would encourage you to listen to Podcast RX Episode 25.
It's a two-part roundtable discussion with Chris and his colleagues, Zangray, Nancy Asieru,
(13:04):
Henry So, Stephen Ford, that really gets into the heart of what they do more so than what
we're going to talk about today.
But there is a video discussion over on Diamond Pharmacy's YouTube channel if you prefer to
watch rather than listen.
But at least to get this discussion started for Pharmacists Month, Chris, for those that
don't know, what are the primary strategies and tactics that the optics team seeks to
(13:24):
integrate clinical pharmacists' expertise or how you all seek to integrate clinical expertise
into patient care beyond just providing drug information and well, being on podcasts?
I do love being on the podcast.
But you know, I do consider there to be three main areas.
And so the first is education.
So we present at national and local conferences.
(13:46):
We distribute clinical materials to our partners, such as the monthly clinical watch and the
quarterly clinical update.
And we also participate in P&T or even provider meetings when requested by our partners.
Second is formulary management.
We help our partners when requested make changes to their formularies.
This is usually done when we participate in P&T meetings.
(14:09):
We are able to provide information about new medications, guideline changes, or important
pricing changes.
And we really are then able to help our partners make educated decisions with regard to their
formulary.
And then for some of our partners, we actually actively enforce the formulary, meaning we
review non-formulary orders or requests as they come in and make alternative recommendations
(14:34):
if that is appropriate.
Third is what I consider to be active patient care, which for us takes two forms.
The first is more reactive in nature.
And that's when providers simply call or email us regarding a patient asking, you know, asking
us for our treatment recommendations or our thoughts on their particular treatment strategy.
(14:57):
And the second way that we participate in active patient care is through chronic care
integration, for which we've actually partnered with a facility.
We, the Optics pharmacists, proactively review patients' medications, labs, and diagnoses.
And that allows us to make treatment recommendations proactively.
That then allows the providers who are then able to review our notes prior to the patient
(15:21):
encounter and then they can incorporate the recommendations if they agree.
Obviously this both allows the Optics pharmacists to be more involved and play a larger role.
But you know, more importantly, it improves the efficiency of chronic care clinic and
ultimately saves the provider's time.
Now you've been doing this a while, Chris.
(15:41):
So how well overall do you feel that providers are incorporating your clinical pharmacist
expertise into care decisions?
I assume this is pretty established procedure.
There's still lots of room for growth.
Yeah.
I've actually just hit 10 years as a pharmacist this year, which...
Congratulations.
Thanks.
Which, you know, may not seem like a lot in the grand scheme of things, but I do feel
(16:04):
like we've seen an evolution in the field even just since, you know, whenever I've come
out of school.
You know, I remember when I was in school that integrating clinical pharmacists was
certainly becoming a thing, but it wasn't as widespread as the concept is today.
So generally speaking, I'd say that providers and institutions are incorporating clinical
(16:25):
pharmacists well, but of course there's always going to remain room for growth.
Some entities have embraced this concept more than others.
You know, for example, the VA has a long history of incorporating clinical pharmacists and
were one of the first examples of using collaborative practice agreements, which basically allow
clinical pharmacists to actively engage patients independently.
(16:48):
And then on the other hand, you have corrections, which I feel is an entity with room for...
With a lot of potential for growth for clinical pharmacy.
Now, you know, in my opinion, this isn't...
This likely isn't due to like lack of desire, but probably more likely the result of either
budgetary constraints or simply a mere lack of awareness.
(17:08):
And that's where I feel like our team can play a role.
By being able to participate in the care team remotely and under the diamond umbrella, facilities
could incorporate our services across many different locations without the hassle of
actually employing a pharmacist in house, which then becomes more of like a financial
and a logistical challenge.
(17:30):
From your viewpoint, what are some strategies and tactics that facilities, medical groups,
the like, and so on can adopt to better take advantage of pharmacist expertise?
Yeah, I think it's all very dependent on what the workflow of a given place looks like.
But generally speaking, you know, it helps to give the pharmacist an actual role and
(17:50):
perhaps even their own patient panel.
You know, it's more efficient than consulting with pharmacy for one off questions.
This can take the form of proactive patient reviews for chronic care visits, such as what
we do with optics.
Or it could be a referral based system, which is actually pretty common in the community.
As an example, there are pharmacists who specialize in diabetes management and providers refer
(18:14):
patients to the quote unquote diabetes pharmacist who's able to adjust their medications and
follow up with those patients.
Obviously because that pharmacist has a narrower scope of practice than say a physician, they're
often able to get into the nitty gritty with patients regarding disease state education,
medication optimization, and then ultimately lead to improve medical outcomes.
(18:39):
What are some clinical pharmacy questions that you wish providers would ask more of?
Yeah, so I love getting any question from providers that just like, how do I treat X?
Because like it gives me latitude to discuss the entire clinical picture with the provider
rather than being asked what's a cost effective alternative to drug X.
(19:01):
No, don't get me wrong.
Cost avoidance is huge.
It's one of our biggest roles.
But you know, as like a clinical pharmacist, it's always more fun to work through a full
patient case.
Now because optics serves such a broad clinical role for our partners, we all have to be well
versed in disease states across the board, whether it be diabetes, HIV, schizophrenia,
(19:25):
addiction, et cetera.
But personally, I really enjoy discussing biologics, particularly those for rheumatologic,
GI, and dermatologic conditions as you alluded to earlier.
You know, because these agents are often so expensive, providers will usually come to
us asking for cost effective ways to treat these patients.
(19:47):
And I really love getting into the details, comparing different biologic therapies with
them in terms of cost, efficacy, different considerations.
So for me personally, I like more questions of that nature.
Well, you've said before that practicing pharmacy in the optic setting allows you to practice
at the top of your pharmacist license.
(20:07):
So Chris, what's been your favorite, most memorable experiences working with sites and
providers to integrate pharmacist expertise?
Yeah, so participating in chronic care clinic has probably been my favorite experience so
far.
You know, being able to play a direct role in patient care and ultimately see the results
of that is very rewarding.
(20:27):
And ultimately, it makes you stay up to date because obviously you want to do right by
the patients.
I also really have enjoyed building relationships with providers during my time in optics.
You know, there are some providers who email me on a regular basis asking me for my opinion
on treatment decisions.
So for them to reach out to me time and again shows a level of trust that really makes me
(20:50):
feel like I'm doing a good job.
No doubt.
And my final question for you in our discussion here, how is optics evolving to make pharmacy
expertise more seamlessly integrated and accessible?
Yeah, so anything that the optics team can do to essentially meet the clinician where
they are and be incorporated into their workflow really can go a long way.
(21:14):
You know, being remote from our partners is certainly a unique challenge, but all systems
are really starting to take advantage of using remote staff to better expand their services.
And clinical pharmacy service shouldn't really be any different.
So our integration into the chronic care clinic is probably the best example, as I've alluded
to.
(21:35):
By integrating our services into a shared EHR, you know, we really kind of position
ourselves to be just a click away from the clinician.
We are also working on a new project that is more customer facing in the hopes of streamlining
the client optics engagement experience rather than the traditional call email approach,
(21:56):
which may not have been as accessible for some.
And we're also, you know, we are also continuing to identify opportunities for enhanced client
education through things such as like train the trainer types of approaches.
Well these things all sound very exciting and no doubt someday we'll be talking about
them on this very show.
(22:17):
Absolutely hope to.
Well, let's take another quick break.
In the realm of corrections health, not all electronic health records are created equally.
Sapphire EHR is a comprehensive cloud based electronic health record designed specifically
for correctional health providers.
(22:37):
Since 2011, Sapphire has worked one on one with health care staff in jails and prisons
to develop and refine a suite of features and modules to manage total inmate patient
care from med pass to dental care to documentation of lab results and creating custom forms.
Sapphire's correction specific features can be scaled to meet the needs of the largest
correctional facilities down to the smallest local jails.
(23:00):
And it's all backed up by 100% in-house hosting, training and support with a 24-7
help desk.
Get a closer look at the corrections EHR deployed in over 400 facilities across 36 states and
territories.
Visit www.sapphire-health.com and schedule a demo today.
(23:20):
Sapphire EHR cloud based compatible correction specific electronic health records.
Now back to podcast RX with Chris Bender.
All right.
With October of course ending on Halloween, we thought it would be a great idea to explore
some connections between pharmacy and spooky season.
The witch is one of the most enduring characters in all of Halloween lore to say nothing of
(23:41):
overall historical significance.
But Chris, you know, we're of a millennial age.
I was curious, is Hocus Pocus required viewing in your house this time of year?
Absolutely.
In fact, we did just try showing Hocus Pocus to our almost two year old.
Oh, yeah.
He's not so much into the live action stuff yet.
So we only got about five minutes into it before we had to had to switch that off.
(24:05):
But I must admit, my list goes Coco, Nightmare Before Christmas, and then Hocus Pocus.
I wasn't familiar with Coco at all.
I had to look at that one.
It's a tearjerker.
It's amazing.
Yeah, it looks pretty good.
But pop culture references to witches aside, naturally, when you think of witches and witchcraft,
you're thinking of fantastical spells and potions.
(24:28):
Regarding the latter, there's some very real pharmacology behind those ideas.
So Chris, what are some amazing pharmacy facts associated with witchcraft you could share
with us in this month's trivia capsule?
Well, in the modern era, witches often get a bad rap, often thought of as old, warty
(24:52):
women hunching over a bowling cauldron, only to be embraced once a year as a mascot of
Halloween.
But did you know that the women accused of witchcraft were most likely just herbalists
who were proficient in using local plants to cure illnesses and alleviate pain?
Perhaps the two best known, quote unquote, witches bruise are the sleep potion and the
(25:14):
love potion.
Both have plausible pharmacologic explanations to their effects.
Historical records suggest that sleeping potions contain foxglove flower extract, dry frog
extract, serpentine root extract, and almond oil.
Now, foxglove flower extract contains digoxin, a medication still in use today, which slows
(25:35):
the heart rate.
Dried frog or dried toad secretions contain bufotoxin, which behaves similarly to digoxin,
slowing the heart rate.
Serpentine root extract contains, among other things, reserpene, which lowers blood pressure,
depresses the central nervous system, and induces drowsiness.
And finally, almond oil acted as a solvent in the sleeping potion, which basically solubilized
(25:59):
all of the other components.
I guess it's kind of hard to stay awake when your heart rate and blood pressure are so
low.
The other two that love potions, on the other hand, commonly contain ingredients such as
mandrake root extract, henbane leaves, areca nut, and ephedrine.
Mandrake root contains hyacinamine, hyacin, and atropine, all of which are used in modern
(26:21):
medicine today, and have anticholinergic effects such as increased heart rate, palpitations,
dry mouth, and pupil dilation.
Henbane leaves also contain hyacin and atropine, which would certainly contribute to the aforementioned
effects, but in modern doses, henbane can cause hallucinations as well.
Areca nut contains aracholis, which has a nicotine-like effect, causing stimulation
(26:45):
and euphoria.
And finally, ephedrine and its derivatives are commonly used today in relieving sinus
congestion, but can cause excitability, including increases in heart rate and blood pressure.
I guess this potion just recreates that excited butterfly feeling of love at first sight.
So when you're watching Hocus Pocus for the 31st year in a row, consider the difference
(27:07):
timing can make.
Disparaged in their time, but perhaps if they were practicing their craft today, they might
be finding a cure for cancer, or they might even be pharmacists.
Well, that does it for Podcast RX with Chris Bender, October 2024 edition.
And thank you again for listening.
Please rate and review if you can and help Chris's pharmacy nerdery run amuck, amuck,
(27:30):
amuck.
That was a Hocus Pocus reference.
I'll see myself out.
But no, seriously, again, we really appreciate all the listeners we can get.
You can listen on all the major podcast platforms, Apple Podcasts, Spotify, Overcast, you name
it.
And please, again, rate and review where you can.
Let's get this show up because Chris is doing a great job.
(27:52):
I'm really happy to have him on board and move in the show here.
Hopefully everyone enjoys.
Give us five stars.
Love those stars.
Absolutely.
And everything that we talk about, anything that informs our discussion, we have links
to all that in our show notes.
I do a post on Diamond Pharmacy's blog for each new episode.
And there we've got detailed links to everything that informs our discussion for each of these.
(28:16):
So if you want to go and do some additional reading, that's very easy to do.
So Chris, thank you as always.
Happy Pharmacist Month to you.
And we'll talk in November.
Thank you.
Thank you.
(28:37):
Podcast RX features conversations with health care professionals.
The statements and opinions discussed herein are for informational purposes only.
This podcast should not be considered professional medical advice and should not be used as the
substitute for the advice of an appropriately qualified and licensed health care professional.
Therefore, listeners must not rely on the statements made herein.
(29:05):
Podcast RX is a production of Diamond Pharmacy Services.
Find our show on Apple Podcasts, Spotify, YouTube, or wherever you enjoy podcasts.
And where possible, please write and review.
If you'd like to get in touch with the show directly, shoot us an email at PodcastRXatDiamondPharmacy.com.
(29:25):
Thank you again for your support.
Popular Podcasts
On Purpose with Jay Shetty
I’m Jay Shetty host of On Purpose the worlds #1 Mental Health podcast and I’m so grateful you found us. I started this podcast 5 years ago to invite you into conversations and workshops that are designed to help make you happier, healthier and more healed. I believe that when you (yes you) feel seen, heard and understood you’re able to deal with relationship struggles, work challenges and life’s ups and downs with more ease and grace. I interview experts, celebrities, thought leaders and athletes so that we can grow our mindset, build better habits and uncover a side of them we’ve never seen before. New episodes every Monday and Friday. Your support means the world to me and I don’t take it for granted — click the follow button and leave a review to help us spread the love with On Purpose. I can’t wait for you to listen to your first or 500th episode!
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Special Summer Offer: Exclusively on Apple Podcasts, try our Dateline Premium subscription completely free for one month! With Dateline Premium, you get every episode ad-free plus exclusive bonus content.
24/7 News: The Latest
The latest news in 4 minutes updated every hour, every day.