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Hypothyroidism in Long-Term Care: The Pharmacist's Role | YARAL Pharma · Pharmacy Podcast Network

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Speaker 1: You are listening to the Pharmacy podcast Network. You're roll Pharma,
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Speaker 1: an innovative player in the US generics marketplace, has partnered
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Speaker 1: with the Pharmacy Podcast Network to educate and build a
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Speaker 1: network of pharmacists. Learn more at your rolpharma dot com.
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Speaker 2: This podcast is sponsored by Your All Pharma. Today we're
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Speaker 2: talking about in an important topic for our aging population,
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Speaker 2: managing hypothyroidism and long term care settings. In this episode,
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Speaker 2: we are focusing on the management of hypothyroidism, a treatable
0:56
Speaker 2: but not curable condition, and we'll explore unique challenges for
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Speaker 2: pay with hypothyroidism and long term care, from taller ability
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Speaker 2: and formulation considerations to consistent dosing and patient needs. Doctor
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Speaker 2: Tamorro Rugles is not affiliated with Your All Pharma. All
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Speaker 2: views and opinions regarding hypothyroidism are solely her own and
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Speaker 2: are not attributable to Your All or the Pharmacy Podcast Network.
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Speaker 3: Hey listeners, this is Todd. You're a founder of the
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Speaker 3: Pharmacy podcast Network. I am pumped up. Today we have
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Speaker 3: a deep dive into managing hypothyroidism in long term care
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Speaker 3: the impact on our seniors. This is a pharmacist perspective.
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Speaker 3: A pharmacist that I've trusted for years who's a member
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Speaker 3: of the Pharmacy Podcast Network, Doctor Tomara Rugel, It's so
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Speaker 3: good to have you here tomorrow. How are you.
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Speaker 4: I'm wonderful. Thanks for having me, Todd. I appreciate the opportunity, and.
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Speaker 3: Thank you to my co host Steven Beckman, CEO of
1:52
Speaker 3: your Ral Pharma, as we dig into this subject. This
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Speaker 3: is a conversation interview that we're excited to have because
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Speaker 3: there's a rise in the new need for long term
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Speaker 3: care pharmacy expertise, especially with the expansion of long term
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Speaker 3: care pharmacy at home services, and this is an opportunity
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Speaker 3: pharmacists who are interested in senior care and institutional care.
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Speaker 3: We have the access expertise, we have the consultant expertise,
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Speaker 3: and we know with the discontinuation with the expansion of
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Speaker 3: long term care facilities, there's going to be more patients
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Speaker 3: that are going to need services in their home. Welcome
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Speaker 3: back to the Pharmacy Podcast Network, Stephen.
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Speaker 5: It's always a pleasure, Todd. We're very excited to be
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Speaker 5: extending a number of podcasts around these key topics and
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Speaker 5: could be more grateful to have Tamar with us today.
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Speaker 5: So Tamra, why don't we just jump in. You know,
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Speaker 5: as Todd said, you know, one of the key areas
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Speaker 5: that we're we're focused in the company's hypothibism and when
2:55
Speaker 5: we look at how we help support downstream patients and
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Speaker 5: pharmacists looking at those different populations. And you know, one
3:03
Speaker 5: of the areas that we have started taking a very
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Speaker 5: close look at is the aging population and how that's
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Speaker 5: translating into the utilization and growing utilization of long term care.
3:16
Speaker 5: I think most of us know that the US population
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Speaker 5: continues to age. We're now pushing towards sixty million adults
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Speaker 5: age sixty five and above. We're seeing that over two
3:27
Speaker 5: million Americans at least some of the data shown that
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Speaker 5: are using long term care settings now. And I think
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Speaker 5: one of the interesting things is maybe to kick it
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Speaker 5: off with, is you know, when we think about those
3:41
Speaker 5: type of patients, it's tough to be a long term
3:44
Speaker 5: care pharmacist, right because you've got patients that some data
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Speaker 5: shows that are taking upwards of ten plus medications done,
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Speaker 5: the number of different core mobidities, and when you're dealing
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Speaker 5: with something like multiple chronic conditions and so forth, so
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Speaker 5: how do you make maybe kick us off start by
4:01
Speaker 5: how do you try to manage these patients with some
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Speaker 5: of those dynamics.
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Speaker 4: Yeah, I mean you bring up great points. We do
4:09
Speaker 4: have an aging population, and our aging population is taking
4:12
Speaker 4: more medications than ever before, probably more disease states than
4:16
Speaker 4: have been managed in the past as well, So we've
4:19
Speaker 4: got a lot of complexities here. One of the main
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Speaker 4: things I want to speak of to start with is
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Speaker 4: hypothyroidism in itself and how it kind of looks like aging.
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Speaker 4: People get cold, people get dry skin, people have depression,
4:33
Speaker 4: brittle nails, coarse hair, constipation, so the symptoms of hypothyroidism
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Speaker 4: look like symptoms of aging. So that is one of
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Speaker 4: the tricky parts too. Is hypothyroidism always caught? Probably not,
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Speaker 4: So that's one thing we need to look at, is
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Speaker 4: the underdiagnosis of hypothyrotism. And then second, once we have
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Speaker 4: that diagnosis and patients are being treated, let's look at
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Speaker 4: the complex medicationmens. Of course, with levothyroxine, which is synthetic
5:04
Speaker 4: T four that we give patients with hypothyroidism, there are
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Speaker 4: some binding interactions to start with, So you want to
5:11
Speaker 4: give levothyroxine right away in the morning with just a
5:15
Speaker 4: sip of water before you give any other medications or food,
5:19
Speaker 4: and so that can be tricky in of itself. Right,
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Speaker 4: if you have patients that are on maybe eight to
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Speaker 4: ten morning medications, you might be giving your levothyroxine at
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Speaker 4: seven am and the rest of their medications between nine
5:32
Speaker 4: and ten. But of course in long term care, you
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Speaker 4: don't have just one patient. You might have twenty five
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Speaker 4: patients and they're all on eight medications in the morning,
5:41
Speaker 4: and so that's two hundred medications you're trying to give
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Speaker 4: on one floor in the morning from one medication aid.
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Speaker 4: So you can see how this can be tricky to
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Speaker 4: get that levothyroxine in that patient in the morning without
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Speaker 4: running into an interaction. Second is our patients, a lot
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Speaker 4: of them are on calcium, they're on I, they're on
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Speaker 4: those binding medications, So to make sure we separate the
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Speaker 4: lebo thyroxine from a binding medication is very important. Another
6:08
Speaker 4: thing is there are medications out there that will decrease
6:11
Speaker 4: your thyroid function. I think of amiodorone and lithium, So
6:15
Speaker 4: making sure we're monitoring patients on those medications and their
6:18
Speaker 4: thyroid function. So that's a good place to start, I
6:22
Speaker 4: have lots more to save, but wondered if you want
6:24
Speaker 4: to interject with anything.
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Speaker 5: Oh, I think you kind of hit the point really well.
6:28
Speaker 5: And one of the things I think most people don't
6:31
Speaker 5: think enough about is, you know, we think about maybe
6:34
Speaker 5: drug to drug interactions, but then we also and usually
6:38
Speaker 5: we think about some kind of side effects. But what
6:41
Speaker 5: we're talking about here is efficacy of products and managing
6:46
Speaker 5: multiple products at the same time and how they're sequenced.
6:50
Speaker 5: And so when you think about as a pharmacist and
6:53
Speaker 5: the caregivers that are in long term, how do you
6:56
Speaker 5: how do you manage that? You know, how how much
7:01
Speaker 5: engagement does the pharmacists have to have or is there
7:03
Speaker 5: a high dependency on the staff and so forth, and
7:07
Speaker 5: how do you continue to monitor that is being done successfully?
7:11
Speaker 4: Well, it's definitely a collaboration, right, and so the pharmacists
7:16
Speaker 4: can work with the facility to make sure if a
7:18
Speaker 4: patient is on lebo thyroxine, that there's a separate medpass
7:21
Speaker 4: in the morning to give just that medication and then
7:24
Speaker 4: several hours later they can take the rest of their medications.
7:28
Speaker 4: There is also a collaboration with a physician to say, hey, look,
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Speaker 4: this patient is on lebal thyroxine, make sure they have
7:34
Speaker 4: a lab order to get their thyroid function test check
7:39
Speaker 4: at least every year, or if there's dose adjustments every
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Speaker 4: six weeks, and so we're part of the team there
7:44
Speaker 4: to make sure everything's being monitored correctly. We're also part
7:48
Speaker 4: of the team where if a patient would have Celiac disease,
7:51
Speaker 4: that their medications don't contain gluten. We're part of the
7:54
Speaker 4: team where if a patient has had gasterc bypass, you
7:57
Speaker 4: know in the past that their medications are going to
8:01
Speaker 4: be okay for their stomach to handle, that there's no
8:03
Speaker 4: inactive ingredients that's going to cause problems for them. We're
8:07
Speaker 4: part of the team where if they have a neuroggenerative
8:10
Speaker 4: disease such as you know, dementia or parkinson and they
8:13
Speaker 4: have trouble swallowing, that we can give a patient a
8:16
Speaker 4: formulation that's easier for the patient to swallow. And so
8:21
Speaker 4: there's lots of different nuances there, and there's things you
8:24
Speaker 4: don't think of. What if the patient's on dialysis and
8:27
Speaker 4: they leave for dialysis early in the morning, so we're
8:29
Speaker 4: scheduling the lego thyroxine around that. What if a patient
8:32
Speaker 4: has heartburn and they have an order from their physician
8:35
Speaker 4: that they can have tombs at their bedside. So how
8:38
Speaker 4: are we making sure if they are okay to have
8:40
Speaker 4: tombs at their bedside, that they're not taking their legal
8:43
Speaker 4: thyroxine in the morning. But hey, their gurd is flared
8:47
Speaker 4: up in the morning and they're taking tombs and no
8:49
Speaker 4: one really knows about it. So definitely lots to consider
8:52
Speaker 4: when it comes to the treatment of hypoththiritism and our
8:55
Speaker 4: older adults in the long term care population.
8:58
Speaker 5: So what do you do in terms of then assessing
9:03
Speaker 5: this on a regular basis, Because everything you said makes
9:05
Speaker 5: a huge amount of sense. You've got all these different
9:08
Speaker 5: factors and as part of the team, So is this
9:11
Speaker 5: something that you guys have to monitor weekly daily, How
9:16
Speaker 5: do you guys go about ensuring that Because obviously with
9:19
Speaker 5: lebo th rocks and there are multiple options out there
9:23
Speaker 5: still we have some other branded products we have Obviously
9:29
Speaker 5: the majority of patients in the US now use generic
9:33
Speaker 5: tablets and there's multiple suppliers of that, and each of
9:37
Speaker 5: those products can be actually slightly a little different. So
9:42
Speaker 5: how do you go about managing the patient in the
9:46
Speaker 5: context of you're determining that some of those other factors
9:51
Speaker 5: are not involved, but they're still having compliance issues or challenges.
9:55
Speaker 5: How do you guys go about choosing what to do
9:59
Speaker 5: or how to prove it if it's not going as
10:01
Speaker 5: well as planned, especially from a compliance standpoint.
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Speaker 4: Yeah, that's a great question. So a majority of the
10:08
Speaker 4: work is done upon admission to a long term care
10:11
Speaker 4: facility to make sure the timing is correct. There's no
10:13
Speaker 4: interactions things like that. Once they've been in the facility
10:17
Speaker 4: for a while and we're monitoring those routine labs. If
10:20
Speaker 4: a patient's labs come back normal, we continue what we're doing.
10:24
Speaker 4: The problem comes when the labs don't come back normal
10:27
Speaker 4: and we need to make adjustments. You have to look
10:29
Speaker 4: at more than just dosing, right, So then you would
10:32
Speaker 4: look at different formulations. Was did the patient get a
10:36
Speaker 4: different generic this time than they did last time? Has
10:39
Speaker 4: the pharmacy been switching their supplier? That could definitely come
10:42
Speaker 4: into play. You know, is there a new order for
10:46
Speaker 4: a medication that's interacting There is a patient taking a
10:49
Speaker 4: new medication that's that's affecting their thyroid function. There's just
10:54
Speaker 4: lots of things to look at. So if the if
10:56
Speaker 4: the patient's labs are normal, great, let's continue the course.
11:00
Speaker 4: But when they're not normal, we've got to look at
11:02
Speaker 4: more than just adjusting the dose. Let's look at some
11:04
Speaker 4: of that background stuff. If the patient has been on
11:06
Speaker 4: the same formulation, if they've been getting at the same time,
11:10
Speaker 4: nothing like that's changed, maybe it's time to adjust the dose,
11:12
Speaker 4: of course.
11:13
Speaker 5: Yeah, you know, one of the things we don't always
11:18
Speaker 5: think about too is the supply chain or the flow
11:22
Speaker 5: of product in So one of the things that'd be
11:24
Speaker 5: interesting I think maybe people don't realize is how does
11:27
Speaker 5: long term care actually access What is the dynamic in
11:31
Speaker 5: terms of accessing drug? Is it coming through a specific pharmacy,
11:37
Speaker 5: are they aligned? Maybe you could talk a little bit
11:39
Speaker 5: as a pharmacist, how you ultimately are receiving your products,
11:42
Speaker 5: and then how there's control of products that are being
11:45
Speaker 5: purchased and not purchased, because I think maybe some people
11:48
Speaker 5: don't really understand that there's pharmacy in house or the
11:51
Speaker 5: pharmacy outhouse outside the facility, how is that usually managed
11:56
Speaker 5: so that you're also looking at the kind of flow
11:59
Speaker 5: of product into long term care.
12:03
Speaker 4: Yeah, so long term care pharmacy is kind of a
12:05
Speaker 4: different beast than retail pharmacy. So typically a long term
12:10
Speaker 4: care facility will have its provider or preferred provider pharmacy
12:15
Speaker 4: that could be in house. It could be kind of
12:17
Speaker 4: a central pharmacy that fills for many long term care facilities.
12:21
Speaker 4: The long term care facilities will get their medications from
12:24
Speaker 4: a long term care pharmacy that are packaged in a
12:26
Speaker 4: specific way that the facility is going to spend. So
12:30
Speaker 4: it might be carted in a month, in a monthly
12:33
Speaker 4: fill and right beside you know the number one. You
12:36
Speaker 4: give that pill on the first of the month, and
12:39
Speaker 4: there's a pill with a marking of two, and you
12:42
Speaker 4: give that pill the second of the month, and there's
12:44
Speaker 4: a bubble for three, and you give that on the
12:46
Speaker 4: third of the month. It could be that way. It
12:49
Speaker 4: could be where you just kind of fill on demand
12:50
Speaker 4: and you get them carted and when you have three
12:53
Speaker 4: or four left, you ask the pharmacy to fill it
12:55
Speaker 4: for you. It could be a weekly supply, but in
12:58
Speaker 4: long term care, medication are typically packaged. You know, you
13:01
Speaker 4: don't have a bunch of bottles sitting in med cards
13:04
Speaker 4: that you're trying to fumble around with, so so the
13:06
Speaker 4: pharmacy will package them for you and send them to you,
13:09
Speaker 4: but there is still that kind of same wholesaler feel, right,
13:13
Speaker 4: So a long term care pharmacy would have a wholesaler
13:16
Speaker 4: just like a retail pharmacy would, and typically, you know,
13:19
Speaker 4: you kind of get the cheapest the cheapest generic you
13:22
Speaker 4: can because you're trying to make money, and honestly and pharmacy,
13:25
Speaker 4: our dispensing fees are down. We're not getting paid as
13:28
Speaker 4: much as we used to. And then if a patient's
13:30
Speaker 4: on a medicare a stay, we're getting a rate for
13:34
Speaker 4: that medication, but is the lowest we can get that
13:37
Speaker 4: medication for the more money we make in the pharmacy,
13:39
Speaker 4: And so it is. It's part of that scenario where
13:43
Speaker 4: you reorder medication from the wholesaler and sometimes they'll substitute
13:47
Speaker 4: the cheapest generic, and sometimes they won't, but the manufacturer
13:52
Speaker 4: is being switched often typically, especially with a medication like
13:56
Speaker 4: legal thyroxine, you'll have different manufacturers coming in all the
14:00
Speaker 4: time unless you hit that do not substitute mark on
14:03
Speaker 4: your wholesaler when you're ordering.
14:06
Speaker 5: So, when you think about the treatment of hypothyroism, how
14:12
Speaker 5: do you go about making those changes if you are
14:16
Speaker 5: getting variability and the tablets that are coming because obviously
14:19
Speaker 5: they're coming in and they're let's say they're being prepackaged,
14:23
Speaker 5: they're provided for the month, but then they are patients
14:26
Speaker 5: not being compliant with their medication because they're having tolerability
14:30
Speaker 5: other issues. So how do you go about addressing that
14:34
Speaker 5: or how does that information come back into Does it
14:36
Speaker 5: come back into the pharmacy and the pharmacist is now
14:39
Speaker 5: working with the physicians to do that. Are they read
14:42
Speaker 5: testing or do you just kind of do continuous trial
14:45
Speaker 5: by error Because obviously, for any chronic condition like hypothibism,
14:50
Speaker 5: you know, maintaining a good level of compliance is the
14:54
Speaker 5: most important thing because if a patient's not taking the medicine,
14:56
Speaker 5: they surely are not going to be getting the benefit
14:58
Speaker 5: of that. So any thoughts around that in terms of
15:01
Speaker 5: how you go about approaching that, especially when you're talking
15:03
Speaker 5: about these patients that I've got these comobidities, they've got
15:07
Speaker 5: other risk factors, you know, cardiovascular or other what kind
15:11
Speaker 5: of things that do you think about in terms of
15:13
Speaker 5: making those changes when you need to do make those changes.
15:18
Speaker 4: Well, I can kind of speak to the ideal world
15:20
Speaker 4: and also the real world. So ideally, when we have
15:23
Speaker 4: a patient come back with labs that are not within
15:26
Speaker 4: normal limits, that are too high, too low, we would
15:29
Speaker 4: look at, you know, has there been a switch in
15:31
Speaker 4: the manufacturer, a switch in the generic. Is the patient
15:34
Speaker 4: being compliance or does their stomach hurt from some inactive
15:38
Speaker 4: ingredient in that medication, So that would be ideal, you know. Unfortunately,
15:43
Speaker 4: in the real world, what happens is a patient gets
15:46
Speaker 4: their TSH drawn and it's too high, so the provider
15:49
Speaker 4: will adjust the dose and so six weeks later they'll
15:52
Speaker 4: recheck it, but it oftentimes ends up being we're just
15:56
Speaker 4: chasing a normal lab with dose adjustments that just keep
16:00
Speaker 4: happening over and over and over again, and the patient,
16:04
Speaker 4: you know, is never really quite stable. They're all too high,
16:07
Speaker 4: too low, and then you end up with a complex
16:10
Speaker 4: medication regimen where you're taking maybe eighty eight microgram three
16:13
Speaker 4: times a week and seventy five microgram four days a week.
16:16
Speaker 4: And of course we know the more complex the regimen,
16:19
Speaker 4: the decreased compliance and the increased risk for medication errors.
16:22
Speaker 4: So I'm hoping, you know, more pharmacists will start looking into, hey,
16:28
Speaker 4: you know, their TSA is high, but we switched the
16:31
Speaker 4: brand of generic that we've been using. Maybe that was
16:34
Speaker 4: the cause, and try to try to keep a more
16:38
Speaker 4: stable or a consistent generic in the pharmacy to benefit
16:43
Speaker 4: our patients, because it doesn't feel good when your TSH
16:46
Speaker 4: is really high, and it doesn't feel good when it's
16:48
Speaker 4: really low either. I mean, you want patients to feel
16:50
Speaker 4: their best and that doesn't happen when you got this
16:53
Speaker 4: teeter tottering of lab values and thyroid fune.
16:57
Speaker 5: So you know, we see this in the retail pharmacy
17:00
Speaker 5: side a little bit, where patients abandon their prescriptions that
17:05
Speaker 5: are not filling them. They're not and that could be
17:07
Speaker 5: due to the tolerability, but ultimately compliances is a challenge.
17:13
Speaker 5: So how does long term care actually help in that regard,
17:18
Speaker 5: Because if you're going to a retail pharmacist, then you know,
17:21
Speaker 5: the pharmacists can reach out. The doctor's going to check
17:24
Speaker 5: patients talking to pharmacists or physician. But we see, you know,
17:28
Speaker 5: pretty high abandoned rates. And this is not just for hypothyroism,
17:31
Speaker 5: but it can be for other chronics. But if you
17:34
Speaker 5: have a patient that's now in a long term care
17:37
Speaker 5: setting where there's more consistent oversight, maybe that's the right word,
17:42
Speaker 5: how can that, how does that benefit patients, or how
17:45
Speaker 5: do you guys go about that so that you actually
17:47
Speaker 5: don't see it. I mean, patients come in, they get
17:51
Speaker 5: their medicine, doesn't mean that the healthcare providers watching them
17:54
Speaker 5: every second to see if they're taking their medicine. So
17:57
Speaker 5: you know, is there, what are the benefits or or
18:00
Speaker 5: how do you guys go about helping ensure better compliance
18:02
Speaker 5: or lack of abandonment of any medication, especially chronic that
18:06
Speaker 5: they're taking.
18:07
Speaker 4: Yeah, so long term care can certainly help with compliance
18:10
Speaker 4: because you have someone giving you your medication every single day. Now,
18:14
Speaker 4: let's keep in mind a patient can always refuse to
18:17
Speaker 4: take a medication. You can't force a patient to take
18:20
Speaker 4: a medication, and so they have that right. So it's
18:23
Speaker 4: important you know, if a patient does refuse their medications
18:26
Speaker 4: that that's documented because that way, if a thied function
18:30
Speaker 4: test does come back abnormal, you could look at the
18:33
Speaker 4: Medication Administration Record or MAR and see that the patient
18:37
Speaker 4: refuse their medications three out of seven days last week.
18:40
Speaker 4: So that could kind of clue you into why there
18:42
Speaker 4: would be an abnormal lab. But there's other things as well,
18:45
Speaker 4: I mean medication aids are so wonderful at doing their
18:48
Speaker 4: job and they have so many patients to manage. But
18:50
Speaker 4: let's not forget they are human, right, so humans make errors. Unfortunately,
18:55
Speaker 4: Pharmacists do, nurses do, medics do. We all do in
18:57
Speaker 4: healthcare and can be the case where you're giving the
19:01
Speaker 4: wrong patient the wrong medication. Maybe you have three Dorothy's
19:04
Speaker 4: on the same unit and they're all sitting at the
19:06
Speaker 4: same table for lunch. How do you know?
19:08
Speaker 6: You know?
19:09
Speaker 4: So, yes, compliance theoretically should be one hundred percent in
19:13
Speaker 4: a long term care facility because they have your medications,
19:16
Speaker 4: they're signing it off on the mar they're giving it
19:18
Speaker 4: to you every day. But let's not forget that we're
19:21
Speaker 4: all humans. We can refuse medications, we can Pharmacists could
19:24
Speaker 4: fill the wrong medication, medids could give the wrong medication.
19:28
Speaker 4: There are errors. Fortunately in long term care, I mean
19:32
Speaker 4: that is looked upon from surveyors. Federal and state surveyors
19:36
Speaker 4: make sure your medication air rate does not exceed five percent,
19:39
Speaker 4: and if it does, you will get cited with an
19:43
Speaker 4: f TAG or a deficiency and need a plan of correction.
19:45
Speaker 4: So it is monitored that we don't make those medication errors.
19:49
Speaker 4: Consistently that it's a low rate. But when you're looking
19:53
Speaker 4: at thyroid function tests and you're looking at abnormal ones,
19:57
Speaker 4: I do think it's you should not assume one hundred
20:01
Speaker 4: percent compliance, whether patients in the community or in a
20:03
Speaker 4: long term care facility.
20:05
Speaker 5: Yeah, I think by far that's one of the biggest
20:07
Speaker 5: challenges we always have is compliance. And I think that's
20:10
Speaker 5: why I would like to go off off script just
20:13
Speaker 5: a little bit, because I want to ask you two
20:14
Speaker 5: questions that are not specific to long term care. You know,
20:18
Speaker 5: one of the things as a manufacturer and as a
20:21
Speaker 5: pharmaceutical injury as a whole, we've done a lot in
20:24
Speaker 5: trying to provide education and materials and things like that
20:28
Speaker 5: because we're here to add value beyond just the medication.
20:31
Speaker 5: How do we help the healthcare provider either through their
20:36
Speaker 5: own knowledge and how it's passed on the patient. So,
20:39
Speaker 5: you know, one of the reasons we do the podcast
20:41
Speaker 5: is that we want to listen as an organization, and
20:45
Speaker 5: I always like to ask this question of people like yourself,
20:48
Speaker 5: is what is it that in long term in long
20:51
Speaker 5: term care we could do as an organization. Are there
20:54
Speaker 5: things that are still missing when you think about hypothiurism,
20:59
Speaker 5: and are there tools because either resources are not available
21:03
Speaker 5: because funding is always tight and we're always you know,
21:06
Speaker 5: we have. The sad thing in life is that we
21:08
Speaker 5: still all have to be profitable in order to keep
21:10
Speaker 5: doors open and keep treating patients and doing all the
21:12
Speaker 5: things that we do. But you know, you know, as
21:16
Speaker 5: I said, you're also trying to do things different and
21:18
Speaker 5: do not act like per Se just a generic company
21:21
Speaker 5: where we're just providing product and we're negotiating with wholesales
21:25
Speaker 5: at the lowest price we can. We want to make
21:28
Speaker 5: sure that our product, especially the product that we represent,
21:31
Speaker 5: and leave both the rocks and caps because it's somewhat different.
21:35
Speaker 5: Are there tools that we can think of as an
21:37
Speaker 5: organization that we help. Are the gaps that you see
21:41
Speaker 5: within long term care that could help that we should
21:45
Speaker 5: be thinking about.
21:46
Speaker 4: Yeah, there's a couple for one, the underdiagnosis of hypothyritism
21:50
Speaker 4: kind of like I mentioned earlier, because so many of
21:53
Speaker 4: the symptoms are the same symptoms of getting older, you know,
21:56
Speaker 4: all the const of patient and the being cold all
21:58
Speaker 4: the time, things like that. So one would be to
22:01
Speaker 4: create awareness to check a TSH just to check a
22:05
Speaker 4: thyroid function and make sure when a patient's admitted that
22:08
Speaker 4: it's not being missed. So that would be one is
22:10
Speaker 4: just creating awareness to even check if a patient has
22:14
Speaker 4: a low thyroid function. And another would I love that
22:18
Speaker 4: that you would like to supply you know, long term
22:21
Speaker 4: care pharmacies with a quality product at the lowest price,
22:24
Speaker 4: because if you can get our patients to take a
22:26
Speaker 4: quality product consistently without swapping manufacturers, that would certainly help
22:31
Speaker 4: stabilize their thyroid function and make them feel better along
22:34
Speaker 4: the way.
22:35
Speaker 5: So you said something that intrigue me there, and that's awareness.
22:39
Speaker 5: You know, everything starts with awareness. If people aren't aware
22:43
Speaker 5: that there's a product or they might have a particular
22:45
Speaker 5: set of symptoms, that might So when you think about
22:48
Speaker 5: long term care, and it can and hypothism can be
22:51
Speaker 5: misinterpreted for other things. What do you think is the
22:55
Speaker 5: current awareness of hypothibism in long term care is as
22:59
Speaker 5: that something that is in the forefront of a long
23:03
Speaker 5: term care because of the age of the patient that
23:06
Speaker 5: they're dealing with or other factors.
23:09
Speaker 7: How would you rate the awareness?
23:11
Speaker 5: And you know, is that something that we could be
23:14
Speaker 5: supported by continually refreshing and reminding your patients to be
23:21
Speaker 5: tested for this, we're appropriate and so forth. So what's
23:24
Speaker 5: your thoughts on that.
23:26
Speaker 4: I think we can do better. I think, you know,
23:28
Speaker 4: a lot of providers are so good at checking for it,
23:31
Speaker 4: but I think there's room for improvement. I've had that
23:35
Speaker 4: experience where a nurse practitioner a provider has called me
23:39
Speaker 4: and said, oh, my goodness, I can't believe I missed this.
23:42
Speaker 4: They had all the tailtale symptoms of hypothyrotism. I didn't
23:45
Speaker 4: even think of it. Finally I check a tsage and
23:47
Speaker 4: it's in the fifties. I mean, it's way beyond normal, right,
23:51
Speaker 4: And then when they get the lab back, you're like,
23:52
Speaker 4: I cannot believe I missed this. It's so obvious. But
23:56
Speaker 4: we get into that rut of all this patients constipated,
23:59
Speaker 4: Let's give them some cent you know, or they're cold,
24:02
Speaker 4: Let's give them one warm blanket. You see it all
24:03
Speaker 4: the time, older adults out in eighty degree sunshine and
24:07
Speaker 4: sweatpants and a sweatshirt, because we do get colder as
24:09
Speaker 4: we get older. But it's also a symptom of hypotherism.
24:13
Speaker 4: So yes, I think providers are doing a great job,
24:15
Speaker 4: But of course I do think there's definitely room for
24:19
Speaker 4: improvement because.
24:20
Speaker 5: There's always going to be the gap, right, I mean,
24:21
Speaker 5: the provider's not looking at a meeting with the patient
24:24
Speaker 5: every day, they're not visiting the office. They go months, weeks,
24:29
Speaker 5: maybe even years without and sometimes checking, and they don't
24:34
Speaker 5: always get to see those symptoms. And as a pharmacist
24:36
Speaker 5: or a caregiver in long term care, you're most likely
24:39
Speaker 5: to see those symptoms before even a provider might.
24:43
Speaker 4: Yeah. The staff that is key, of course, is your nurses.
24:47
Speaker 4: I mean they spend so much time with your patients
24:50
Speaker 4: that they are so in tune to patients. When I
24:53
Speaker 4: have a medication question, you know, is a patient getting
24:56
Speaker 4: dry mouth from this medication, or you know, any sort
25:00
Speaker 4: of questions about a patient, I go straight to nursing
25:03
Speaker 4: because they know their patients so well, spend so much
25:05
Speaker 4: time with them. So, yes, we should be educating providers,
25:08
Speaker 4: but we should be educating everyone in the facility. Even
25:11
Speaker 4: the therapists who work with the patients three days a
25:13
Speaker 4: week are at a great spot of identifying you know,
25:17
Speaker 4: symptom side effects things. I always tell physical therapists you're
25:21
Speaker 4: at a better spot at identifying a side effect than
25:23
Speaker 4: I am. Because I might see a patient once every
25:25
Speaker 4: thirty or ninety days when they come get their prescription,
25:28
Speaker 4: but you're working with them every day or three days
25:30
Speaker 4: a week, and so it's a good collaboration from the
25:33
Speaker 4: whole healthcare team to spot, you know, symptoms and side
25:37
Speaker 4: effects and I be able to identify these things for
25:40
Speaker 4: the team.
25:41
Speaker 5: Well, I want to ask another question and take off
25:44
Speaker 5: your long term pharmacy hat and put on your community
25:47
Speaker 5: pharmacists hat, because we had the opportunity to talk a
25:49
Speaker 5: little bit before we went on the podcast, and you've
25:52
Speaker 5: had some insightful thoughts about what you see and some
25:56
Speaker 5: of the challenges with hypothyroism and the use of treatment
25:59
Speaker 5: with libothrox, And do you want to share some of
26:01
Speaker 5: those thoughts that you were talking about earlier this morning.
26:05
Speaker 4: Yes, I was, like I was telling Stephen this morning
26:08
Speaker 4: when we had a chance to meet. When I do work,
26:11
Speaker 4: I work part time in a community pharmacy, and I've
26:14
Speaker 4: been seeing more and more patients come in concerned about
26:17
Speaker 4: the products that they are getting from the pharmacy. They're
26:20
Speaker 4: concerned about is there gluten in my product? I have
26:23
Speaker 4: Celiac disease, or I have a gluten intolerance. I'm trying
26:26
Speaker 4: to heal my gut from something. Is there gluten in
26:28
Speaker 4: this medication? And so, you know, I have found myself
26:32
Speaker 4: more and more looking up inactive ingredients and seeing what's
26:35
Speaker 4: in there. There might be a red dye allergy, there
26:38
Speaker 4: might be all sorts of different inactive ingredients that a
26:41
Speaker 4: patient is allergic to are not tolerant too. That really
26:44
Speaker 4: doesn't make a big difference for their health. I've seen
26:47
Speaker 4: that more and more in the pharmacy. And I also
26:49
Speaker 4: see more and more patients that have had like gastric
26:52
Speaker 4: bypass surgery, or they're on a GLP one medication and
26:55
Speaker 4: the stomach motility is decrease, or they have a less
26:58
Speaker 4: service area of their stomach, and so some of those
27:00
Speaker 4: inactive ingredients can reak more havoc on them than you know,
27:04
Speaker 4: if they didn't have gas or pype ass, or if
27:06
Speaker 4: they weren't on a GLP one medication. I'm not saying
27:08
Speaker 4: either of those things are wrong. I'm just saying those
27:11
Speaker 4: inactive ingredients can affect you more, you know, if you're
27:14
Speaker 4: taking one of those medications or you've had a surgery
27:17
Speaker 4: in the past, and so certainly it's important to check
27:20
Speaker 4: those those inactive ingredients and make sure that they're not
27:23
Speaker 4: causing problems for patients. But it can be difficult to
27:27
Speaker 4: look up every single inactive ingredient in every single medication
27:32
Speaker 4: they're taking. And so it is very nice when there's
27:34
Speaker 4: a product on the market that we can recommend without
27:37
Speaker 4: having to search through a list of thirty to fifty
27:39
Speaker 4: inactive ingredients for patients.
27:41
Speaker 5: Well, I mean, I would think it's pretty hard given
27:44
Speaker 5: the demands on that pharmacist as I see them, it's
27:46
Speaker 5: pretty hard to have the time to go and do
27:48
Speaker 5: that research. And we're talking about a product that you
27:51
Speaker 5: had the least amount of inactive ingredients within the product itself.
27:56
Speaker 4: Correct, Yes, and I would consider the least amount of
27:59
Speaker 4: inactive ingredient and then free from dies and things like
28:02
Speaker 4: that good.
28:03
Speaker 5: And do you think most pharmacists that's something that's in
28:08
Speaker 5: their mindset or is it becoming more in their mindset
28:11
Speaker 5: now because of what you said in terms of that
28:13
Speaker 5: the patients are actually bringing this to your at tension
28:18
Speaker 5: based on what they read or what the literature they've done.
28:22
Speaker 4: I do think it's because of patients that pharmacists have
28:26
Speaker 4: thought about it more or are looking into it. Of course,
28:29
Speaker 4: as patients, we have to be our own advocates, and
28:31
Speaker 4: so patients need to ask their pharmacists and have them
28:35
Speaker 4: look into it for them. But I do think it's
28:37
Speaker 4: because of patient demand that pharmacists are starting to look
28:41
Speaker 4: into it more well.
28:44
Speaker 5: Our product, obviously is leve othox and capsules, which is
28:47
Speaker 5: a different form factor than the tablets. We're the only
28:50
Speaker 5: supplier of it along with our branded company USA, and
28:55
Speaker 5: I think one of the things that we're excited about
28:57
Speaker 5: this product is, as we were talking about earlier, is
28:59
Speaker 5: it only has four ingredients leveo throx on itself. They
29:03
Speaker 5: act the ingredient gelatine, glycerine, and water. So what do
29:06
Speaker 5: you think about that?
29:08
Speaker 4: Well, I think that makes my job much easier when
29:12
Speaker 4: patients are looking for something without gluten or dyes or
29:16
Speaker 4: any sort of inactive ingredient that may cause them some
29:19
Speaker 4: stomach upset. I mean, I do have a lot of
29:21
Speaker 4: patients who will get settled on a medication and be
29:25
Speaker 4: doing really well, and as soon as we switch manufacturers,
29:28
Speaker 4: they are not doing well anymore. I can think of
29:31
Speaker 4: my own mom, who you know, has trigeminal neuralgia. She's
29:34
Speaker 4: on oxcarbazapine. She was doing so good on one and
29:38
Speaker 4: they switched the manufacturer and it was no longer controlling
29:41
Speaker 4: her trigeminal neuralgia. So now she requests that, you know,
29:44
Speaker 4: manufacture only, And we see that all the time in
29:48
Speaker 4: retail pharmacy for all sorts of different medications. That one
29:52
Speaker 4: worked really good for me, that one didn't work for
29:54
Speaker 4: me at all. What is the difference? You know? Is
29:56
Speaker 4: it in like I don't know, but there is something
29:59
Speaker 4: there that says certain manufacturers and certain manufacturing processes work
30:04
Speaker 4: better than others. Or maybe it's the purity of the product.
30:07
Speaker 4: But certainly patients from their own experience and from my family,
30:11
Speaker 4: from my own experience, certain products generic products work better
30:16
Speaker 4: than others. So it's very nice when you can find
30:21
Speaker 4: a product that works well for everybody, that no one
30:24
Speaker 4: would have an allergy or issue with, and that you
30:26
Speaker 4: wouldn't have to keep swapping out. You know, you won't
30:29
Speaker 4: have three different bottles on your shelves from different manufacturers
30:32
Speaker 4: because one works better from one patient than other. It
30:35
Speaker 4: would certainly help us inventory to keep one clean, you
30:39
Speaker 4: know product on the shelf.
30:41
Speaker 7: Well, you know, you make an interesting point.
30:43
Speaker 5: Generic companies are always collectively as an industry, our goal
30:48
Speaker 5: is obviously to provide high quality medications and at affordable
30:53
Speaker 5: price or increase accessibility, because that's the whole reason why
30:57
Speaker 5: generic industry was formed. As you said, there are variability,
31:01
Speaker 5: and you made a comment earlier which I think is
31:04
Speaker 5: important because the reality is is that the buying practices
31:09
Speaker 5: or the drug flow practices one month, it could be
31:14
Speaker 5: one manufacturer the other. So with the variability of inactives
31:18
Speaker 5: across different products, a patient could be doing well on
31:22
Speaker 5: one one month and next month having more challenges. And
31:25
Speaker 5: obviously that's the nature of the opportunity.
31:28
Speaker 7: So when we when we think about you know, leave both.
31:32
Speaker 5: The rocks and capsules, is that it's it's meant for
31:35
Speaker 5: a certain portion of the population that really has tolerability issue.
31:39
Speaker 5: Look at the end of the day of a patient
31:40
Speaker 5: tolerting a tablet very well, that's exactly the product that
31:43
Speaker 5: they should be on. So when you find that you
31:48
Speaker 5: have a patient that is not being tolerant on leave
31:51
Speaker 5: both tablets, how do you really go about is that
31:56
Speaker 5: going back to the position because if they're going to
31:58
Speaker 5: change onto something else, they're going to read you testing
32:01
Speaker 5: and how does that process work when you find that
32:04
Speaker 5: a patient is struggling and doesn't want to take the
32:07
Speaker 5: medication and to determine it might not be other outside factors.
32:12
Speaker 5: What's that process look like?
32:14
Speaker 4: Well, if they come to the pharmacy, you know, with
32:17
Speaker 4: the problem first, it's easier because we can kind of
32:20
Speaker 4: dig and look through ingredients and find out have you
32:23
Speaker 4: ever tolerated this medication? And if you have, you know
32:26
Speaker 4: what month was that. We can kind of go back
32:28
Speaker 4: and look at the different fills and see what NDCs
32:31
Speaker 4: we use and try to you know, weed out what's
32:33
Speaker 4: causing the problem and what's not and then once we
32:35
Speaker 4: find it, then to find the product that doesn't have
32:38
Speaker 4: that inactive ingredient, and then it's easy you just you know,
32:41
Speaker 4: make a call to the doctor's office or facts over
32:44
Speaker 4: and ask them for a different maybe a different product,
32:48
Speaker 4: maybe a different brand. But a lot of times we
32:52
Speaker 4: can switch those NDCs without even contacting the doctor as
32:55
Speaker 4: long as it's the same medication in dose.
32:57
Speaker 6: And so.
32:59
Speaker 4: That's typically what it is. It's a conversation with a
33:01
Speaker 4: patient to find out when we're you doing good or
33:03
Speaker 4: have you ever been doing good? And what was that
33:07
Speaker 4: We filled that time. And if you've never been doing
33:09
Speaker 4: good well, then it's time to look at a different
33:11
Speaker 4: product without, you know, a lot of those in acting ingredients,
33:16
Speaker 4: a product with the least amount of ingredients possible to
33:20
Speaker 4: try to see, you know, are you going to tolerate
33:22
Speaker 4: that better? Is that going to affect your thyroid function
33:25
Speaker 4: the best way so that you don't have to keep
33:27
Speaker 4: getting your labs drawn every six weeks and making dose adjustments.
33:31
Speaker 4: So the thing about it is, and I tell patients
33:35
Speaker 4: this about a pixel band versus war for in two,
33:38
Speaker 4: if you find a quality product that works for you,
33:42
Speaker 4: even if you have to pay a little bit more,
33:44
Speaker 4: you might be paying less in the long run, because
33:46
Speaker 4: then maybe you don't have to get your blood drawn
33:47
Speaker 4: every six weeks, and maybe you don't have a drawer
33:50
Speaker 4: full of every different strength of levothyroxy that there is
33:54
Speaker 4: you know that you're no longer using. So yeah, you know,
33:56
Speaker 4: certain medications, certain generics may cost more upfront, but in
34:00
Speaker 4: the long run, you probably save yourself money from lab
34:03
Speaker 4: draws and unused medications and the stress of having to
34:07
Speaker 4: switch doses all the time. So there's something to be
34:09
Speaker 4: said for paying a little more for quality. But in
34:12
Speaker 4: the long run, you know, feeling better and saving money
34:15
Speaker 4: on other things.
34:18
Speaker 5: So when a patient needs to do testing in long
34:20
Speaker 5: term care, is that is a lot of that able
34:23
Speaker 5: to be done within the long term care setting or
34:25
Speaker 5: is it most patients have to still be go see
34:30
Speaker 5: outside providers of support to do those type of things.
34:34
Speaker 4: Well, there's not a lot of specialists that will come
34:36
Speaker 4: to a long term care facility other than the psychiatrists.
34:40
Speaker 4: If it is going to be an endocrinologist, typically you're
34:43
Speaker 4: going to have to go outside of the long term
34:45
Speaker 4: care facility to see one. But if your primary care
34:48
Speaker 4: is managing you know, your thyroid function and your leagal
34:51
Speaker 4: thyroxine dose, they will come in house and do that.
34:54
Speaker 4: I rarely have to have patients, you know, leave the
34:57
Speaker 4: facility to go to an appointment, unless it's like I say,
35:00
Speaker 4: cardiology and no chronology something like that. But for things
35:05
Speaker 4: like levial thyroxine dose adjustments that can be typically be
35:08
Speaker 4: done where the lab is drawn in the facility and
35:12
Speaker 4: the primary provider or their design will make around in
35:16
Speaker 4: the facility and make those dose adjustments for them.
35:19
Speaker 5: So as we start to come to conclusion to our
35:23
Speaker 5: podcast today, I wanted to give you the floor in
35:25
Speaker 5: terms of what are the things that are most important
35:27
Speaker 5: to you if you had the opportunity to share to
35:31
Speaker 5: manufacturers other things, what is that is essential to help
35:36
Speaker 5: you as a pharmacist, either within long term care or
35:39
Speaker 5: even the retail setting. What are the things that are
35:41
Speaker 5: most important that help you. I mean, obviously we've got
35:44
Speaker 5: to be able to continue to provide products at a
35:47
Speaker 5: price that's affordable throughout the supply chain, But what are
35:52
Speaker 5: the other things that our challenges that you still face
35:57
Speaker 5: as a pharmacist as it leads to treating hyper thyroism.
36:02
Speaker 4: Yeah, so my main goal, of course is for my
36:06
Speaker 4: patients to feel their best. I love working with my
36:09
Speaker 4: long term care patients. They are so wonderful and just
36:15
Speaker 4: tell you like it is and just beautiful people. So
36:18
Speaker 4: I want them to feel great. And so part of
36:21
Speaker 4: feeling great is to make sure you know that they
36:23
Speaker 4: get the medicine they need, they don't get more medicine
36:25
Speaker 4: than what they need, you know, polypharmacy, and that we
36:28
Speaker 4: can avoid a lot of those drug interactions and side effects,
36:32
Speaker 4: and that they do tolerate their medication. So you know,
36:35
Speaker 4: having a quality product that patients will tolerate, will help
36:41
Speaker 4: me get to my goal of making sure they feel
36:43
Speaker 4: their best, and also, you know, help stabilize their thyroid
36:47
Speaker 4: function tests so they don't have to have so many
36:50
Speaker 4: dose adjustments due to intolerability, and you know, medication non compliance,
36:55
Speaker 4: and so certainly there's a lot of pieces to the
36:58
Speaker 4: puzzle when it comes to helping feel their best and
37:01
Speaker 4: deep prescribing unnecessary medications and all sorts of things. But
37:06
Speaker 4: having quality medications for my patients is certainly a priority,
37:10
Speaker 4: and it helps, it helps me and it helps my patients.
37:15
Speaker 7: Well.
37:15
Speaker 5: I think one of the things I take away from
37:17
Speaker 5: conversation and the insights you shared with me, which I
37:20
Speaker 5: think are really important and sometimes we need to continue
37:23
Speaker 5: to look at that is there are so many factors
37:26
Speaker 5: that can influence the success or failure of treatment. You know,
37:31
Speaker 5: in the case of leave with Rocks, and you've got
37:32
Speaker 5: to take it in the morning, to take it plenty
37:34
Speaker 5: of time before you and just food. As you mentioned obviously,
37:39
Speaker 5: some of the drugs that can not just drug drug
37:42
Speaker 5: interaction that you have to always be thoughtful of, but
37:44
Speaker 5: you have to be thinking about how they can actually
37:47
Speaker 5: make it. A particular medication like Leave with rocks and
37:50
Speaker 5: less effective and all the other factors that you have,
37:54
Speaker 5: the communication between patients and caregivers, because we always think
37:58
Speaker 5: that in many cases when a patient and stops being compliant,
38:02
Speaker 5: it's usually the pharmacist in many cases that's going to
38:06
Speaker 5: know before even a provider, just because one they're not
38:09
Speaker 5: seeing that phil come in or they're reaching out to
38:13
Speaker 5: the pharmacist first because either they have easier access and
38:17
Speaker 5: so forth. So you know, that's really what we're about
38:21
Speaker 5: that eral is that you know, it's important as a
38:25
Speaker 5: company that it's not just about making good, high quality medications.
38:29
Speaker 5: It's about how we engage into the system and helping
38:34
Speaker 5: support ultimately the patient. I mean, anybody that's in this business.
38:38
Speaker 5: You know, I'm not a doctor, I'm not nervous, I'm
38:40
Speaker 5: not a pharmacist, but I take great pride and I
38:43
Speaker 5: know our organization does and being a part of that
38:46
Speaker 5: positive grouping of individuals to take care and making patients
38:51
Speaker 5: feel their best. As you said, so, so we want
38:55
Speaker 5: to continue to listen and support and understand that there's
38:57
Speaker 5: variances and differences within the pharmacce. Right, there's the retail pharmacists,
39:02
Speaker 5: there's community pharmacists, When I say retail, I'm talking ones
39:05
Speaker 5: that service large populations metrol areas maybe, but not the
39:09
Speaker 5: community pharmacists. They're dealing with a whole different dynamic of
39:12
Speaker 5: interface with patients if they're working in a rural area
39:15
Speaker 5: to long term care, et cetera. So it's our responsibility,
39:19
Speaker 5: I think, to really listen and understand the differences, because
39:24
Speaker 5: you have differences between being a pharmacist and long term
39:27
Speaker 5: care setting than when you are in your community setting.
39:31
Speaker 5: So any final thoughts that you would want to share
39:35
Speaker 5: about what's happening in long term care, Any final thoughts
39:41
Speaker 5: in label throcks and management, any other needs issues, wants
39:45
Speaker 5: that you would have as a long term care pharmacist.
39:49
Speaker 4: Well, certainly a number of Just closing thoughts for sure
39:53
Speaker 4: is that never underestimate how much of an impact one
39:58
Speaker 4: small medication change make. I've learned that in my long
40:02
Speaker 4: term care patients and in my community patients. A lot
40:05
Speaker 4: of pharmacists or healthcare providers might think you really have
40:08
Speaker 4: to do something earth shattering to make a big difference
40:11
Speaker 4: for a patient, but that is not always the case.
40:14
Speaker 4: I have had so many patients come to me at
40:17
Speaker 4: the Deeperscribing Clinic or in my work at nursing homes
40:20
Speaker 4: or in the community, and just identifying one issue and
40:24
Speaker 4: making one medication change can make a world of a
40:27
Speaker 4: difference to a patient. So I just want to tell
40:31
Speaker 4: listeners not to underestimate what a big difference one med
40:34
Speaker 4: change can make for a patient.
40:36
Speaker 5: Well, that's well said and a good way to end,
40:39
Speaker 5: because I think we have to find in our system
40:42
Speaker 5: a little bit more time to do that ability to
40:45
Speaker 5: be able to listen, observe and make those adjustments that
40:50
Speaker 5: a little adjustment, as you said, could make a big,
40:52
Speaker 5: big difference. So Tamara, first of all, thank you so
40:55
Speaker 5: much for taking time out of your busy day to
40:57
Speaker 5: be a part of the podcast. You know, I always
41:00
Speaker 5: like to say that, you know, pharmacists are like first responders.
41:04
Speaker 5: We always acknowledge them because they're really important and they
41:09
Speaker 5: save lives and they support lives, and they make quality
41:13
Speaker 5: of life better for patients, as you spoke about quit,
41:16
Speaker 5: So thank you for all that you do for the
41:18
Speaker 5: patients that you serve. Anybody that benefits from pharmacist that
41:22
Speaker 5: shows the caring and interest that you do is going
41:25
Speaker 5: to be a lot better position, and for that we
41:28
Speaker 5: thank you for all that you do.
41:30
Speaker 4: Yes, Thank you, Steven. It was a pleasure visiting with
41:33
Speaker 4: you today and getting to know you.
41:36
Speaker 3: What a wonderful conversation. Thank you so much Tomorrow and
41:39
Speaker 3: Steven for this great podcast episode. Pharmacists play a critical
41:44
Speaker 3: role in ensuring long term care pharmacy services. Patients receive
41:48
Speaker 3: the right medications in the right form at the right time.
41:52
Speaker 3: This is up to our pharmacists and pharmacy teams out there.
41:56
Speaker 3: As we discussed today, these are essential services for managing
42:00
Speaker 3: patients with hypothyroidism and it's so good to have a
42:04
Speaker 3: pharma manufacture like you Raal Pharma standing alongside pharmacists in
42:08
Speaker 3: support of this important work. Hey, keep listening for important
42:13
Speaker 3: safety information for levothyroxine and thank you so much for
42:17
Speaker 3: listening to the Pharmacy Podcast Network.
42:19
Speaker 6: Important safety information for levothoroxin sodium capsules indication and usage.
42:24
Speaker 6: Levothyroxine sodium capsules are l thyroxin T four Indicated for
42:29
Speaker 6: adults and pediatric patients six years and older with hypothyroidism
42:33
Speaker 6: as replacement therapy in primary thyroidal, secondary pituitary, and tertiary hypothalamic,
42:39
Speaker 6: congenital or acquired hypothyroidism. Pituitary therotropin thyroid stimulating hormone TSH
42:45
Speaker 6: suppression as an adjunct to surgery and radioiodine therapy in
42:49
Speaker 6: the management of thyrotropin dependent well differentiated thyroid cancer. Limitations
42:53
Speaker 6: of use. Levothorroxine sodium capsules are not indicated for suppression
42:58
Speaker 6: of benign thyroid nodules and nontoxic diffuse goiter in iodine
43:01
Speaker 6: sufficient patients, as there are no clinical benefits and overtreatment
43:05
Speaker 6: with leveotheroxine sodium capsules may induce hyperthyroidism to T three.
43:10
Speaker 6: Leve Othoroxin sodium capsules are not indicated for treatment of
43:13
Speaker 6: transient hypothyroidism during the recovery phase of subacute thyroiditis. Warning
43:18
Speaker 6: not for the treatment of obesity or for weight loss.
43:21
Speaker 6: Thyroid hormones, including leveotheroxin sodium capsules, either alone or with
43:25
Speaker 6: other therapeutic agents, should not be used for the treatment
43:28
Speaker 6: of obesity or for weight loss in eutheroid patients. Doses
43:31
Speaker 6: within the range of daily hormonal requirements are ineffective for
43:34
Speaker 6: weight reduction. Larger doses may produce serious or even life
43:37
Speaker 6: threatening manifestations of toxicity, particularly when given in association with
43:41
Speaker 6: sympathomometic amines, such as those used for their anorectic effects, contraindications,
43:47
Speaker 6: uncorrected adrenal insufficiency, warnings and precautions, cardiac adverse reactions in
43:52
Speaker 6: the elderly and in patients with underlying cardiovascular disease. Initiate
43:56
Speaker 6: lebotheroroxin sodium capsules at less than the full replacement dose
44:00
Speaker 6: because of the increased risk of cardiac adverse reactions, including
44:03
Speaker 6: atrial fibrillation mixidema coma. Do not use oral thyroid hormone
44:07
Speaker 6: drug products to treat mixidema coma. Le Key acute adrenal crisis.
44:11
Speaker 6: In patients with concomitant adrenal insufficiency, treat with replacement glucocorticoids
44:16
Speaker 6: prior to initiation of lebotheroxine sodium capsule's treatment. Prevention of
44:21
Speaker 6: hyperthyroidism or incomplete treatment of hypothyroidism. Proper dose titration and
44:26
Speaker 6: careful monitoring is critical to prevent the persistence of hypothyroidism
44:30
Speaker 6: or the development of hyperthyroidism upris worsening of diabetic control.
44:35
Speaker 6: Therapy in patients with diabetes molitis may worsen glycemic control
44:39
Speaker 6: and result in increased antidiabetic agent or insulin requirements, carefully
44:43
Speaker 6: monitor glycemic control after starting, changing or discontinuing thyroid hormone therapy.
44:48
Speaker 6: Decreased bone mineral density associated with thyroid hormone over replacement.
44:53
Speaker 6: Over replacement in increase bone reabsorption and decrease bone mineral
44:57
Speaker 6: density give the lowest effective dose. Adverse reactions. Common adverse
45:02
Speaker 6: reactions with levetheroxin therapy are primarily those of hyperthyroidism due
45:06
Speaker 6: to therapeutic overdosage. They include the following general fatigue, increased appetite,
45:11
Speaker 6: weight loss, heat intolerance, fever, excessive sweating, central nervous system headache, hyperactivity, nervousness, anxiety, irritability,
45:21
Speaker 6: emotional lability, insomnia, musculoskeletal tremors, muscle weakness, cardiovascular palpitations, tachycardia, arrhythmias,
45:32
Speaker 6: increased pulse and blood pressure, heart failure, angina, myocardial infarction,
45:37
Speaker 6: cardiac arrest, respiratory dyspnea, gastrointestinal gi diarrhea, vomiting, abdominal cramps,
45:46
Speaker 6: elevations in liver function tests, dermatologic air loss, flushing, endocrine,
45:52
Speaker 6: decreased bone mineral density, reproductive menstrual irregularities, impaired fertility. Adverse
45:58
Speaker 6: reactions in children, Pseudo t tumor cerebrie and slipped capital
46:01
Speaker 6: femeral epiphesis have been reported in children receiving libotheroxin therapy.
46:06
Speaker 6: Overtreatment may result in craniosinostosis in infants and premature closure
46:11
Speaker 6: of the epipheses in children with resultant compromised adult height.
46:14
Speaker 6: Seizures have been reported rarely with the institution of levetheroxin therapy.
46:18
Speaker 6: Hypersensitivity reactions hypersensitivity reactions to inactive ingredients in this product
46:23
Speaker 6: or other leveotheroxin products have occurred in patients treated with
46:27
Speaker 6: thyroid hormone products. These include urticaria, pruritis, skin rash, flushing, angioedema,
46:34
Speaker 6: various GI symptoms, abdominal pain, nausea, vomiting and diarrhea, fever, arthrolgia,
46:40
Speaker 6: serum sickness, and wheezing. Hypersensitivity to levetheroxine itself is not
46:45
Speaker 6: known to occur. Drug interactions. Many drugs and some foods
46:48
Speaker 6: can exert effects on thyroid hormone pharmacokinetics, for example, absorption, synthesis, secretion, catabolism,
46:54
Speaker 6: protein binding, and target tissue response. And may alter the
46:58
Speaker 6: therapeutic response to levotheroroxine sodium capsules administer at least four
47:02
Speaker 6: hours before or after drugs that are known to interfere
47:04
Speaker 6: with absorption. See full prescribing information for drugs that affect
47:08
Speaker 6: thyroid hormone, pharmacokinetics and metabolism. To report suspected adverse reactions,
47:13
Speaker 6: contact Yarrol Pharma Inc. At One eight six six two
47:17
Speaker 6: one eight nine zero zero nine or FDA at one
47:21
Speaker 6: eight hundred FDA one zero eight eight or www dot
47:26
Speaker 6: FDA dot gov slash MedWatch. For full prescribing information, including
47:30
Speaker 6: boxed warning, go to www dot euylpharma dot com slash
47:35
Speaker 6: levethyroxine dash PI