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P&T July/August 2019


Health Care & Law
As marijuana legalization and use expands across the U.S., health care systems are struggling to keep abreast of the changes and trends in regulations. Considering marijuana’s federal illegality and other restrictions on its use, the limited evidence for its clinical efficacy, and the myriad psychological adverse events, caution is recommended when establishing policies and procedures regarding coverage of marijuana and CBD products.
Chronic obstructive pulmonary disease can be attributed to genetic conditions and predispositions, among other factors. Alpha-1 antitrypsin deficiency (AATD) is a significant risk factor for COPD development and progression, and aggressive screening for all patients with COPD or adult-onset asthma is encouraged.
Amiodarone, used to treat various cardiac arrhythmias, may be toxic to different organ systems. It can cause acute or chronic syndrome of inappropriate anti-diuretic hormone, which can occur with any formulation of the drug. This warrants the close monitoring of electrolytes throughout the course of amiodarone therapy.
Carcinoid syndrome causes substantial morbidity and reduces quality of life and survival. In a recent clinical trial, 97% of patients reported bowel movement-related issues, abdominal pain, flushing, and low energy. Combining somatostatin analogs with elotristat ethyl provides a new option for managing refractory CS symptoms. Health care providers should consider strategies that take advantage of approved dosing for patients with CS-related diarrhea.
Meeting Highlights
We review selected sessions on the questionable benefits of fecal microbiota transplant; intrahepatic cholestasis of pregnancy; weight-loss drugs in combination with intragastric balloon endoscopy; and beta blockers in pancreatic cancer.


Prescription: Washington
Will “All of Us” provide clues on the origins of various illnesses? Congress hopes that analyzing the medical and biological data of millions of people will boost precision medicine and help predict outcomes.
Medication Errors
Accidental IV administration of heparinized irrigation solution occurs frequently. Two cases from ISMP Canada offer some safe practice recommendations.
Approvals, new indications and formulations, and safety issues
Mavenclad (cladribine) tablets for relapsing MS forms; Duaklir Pressair (aclidinium bromide/formoterol fumarate) inhalant for COPD; Evenity (romosozumab-aqqg) injection for osteoporosis
Drug Forecast
Shingrix, a new vaccine for herpes zoster