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In an era where technology is quite literally at our fingertips—or in this case on our wrist—smartwatches have become every day health companions for millions of individuals. By 2026, it is estimated that more than 100 million  Americans will be using a smart watch. Along with there being additional technology we can use, these watches are hugely marketed as fitness trackers and wellness tools. These sleek devices promise to monitor everything from your daily steps to your heart rate, sleep patterns, and even blood oxygen saturation. But as wearable technology becomes more advanced and expensive, a critical question arises: Are these watches truly capable of tracking vital health data, or are they just popular pedometers?

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Consumers are increasingly relying on these smartwatches not only to meet fitness goals but also to gain insight into their overall health. Smartwatches are poised to significantly reshape the healthcare landscape, with research predicting that wearable technology could lead to global cost savings of around $200 billion. A key development in this area is the integration of smartwatch data into electronic health records (EHRs), which is increasingly being adopted to improve patient tracking and support more tailored healthcare services. This can allow providers to use the time they would be using to collecting vital signs to instead spend more time completing other important areas during their patient’s appointment. It is to be noted that to retrieve the data one’s watch is collecting, the person much also have a smart phone and connect via Bluetooth.

Let’s dive into some health that can be tracked by the watch, that isn’t your typical 10,000 steps a day.

How Smartwatches Work

Modern smartwatches use photoplethysmography (PPG) to measure pulse and blood oxygen levels. This technique involves a light source and a photodetector that track variations in light absorption on the skin’s surface, reflecting changes in blood volume throughout the cardiac cycle. In practical use, PPG signals consist of two components: a quasi-static direct current (DC) element, which reflects light interactions with static tissues such as skin, venous blood, and non-pulsatile arterial blood; and a pulsatile alternating current (AC) component, which corresponds to dynamic changes in arterial blood volume with each heartbeat. By capturing thousands of readings per second, smartwatches can analyze these fluctuations to estimate heart rate, blood flow, and oxygen saturation levels. This high-frequency sampling allows for ongoing, non-invasive checking of heart activity, helping to spot problems early and improve health monitoring.

Reference photo: Unsplash

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Heart Rate

Samsung Galaxy, Fitbit Sense, and Apple Watch are among the few smartwatches that are approved by the US Food and Drug Administration to detect irregular heart rhythms for adults who have never had a history of atrial fibrillation or AF (irregular heart rhythm). This is very significant because over 400,000 hospitalizations in the United States are due to atrial fibrillation. Failure to detect and diagnose AF can lead to more complication or even potential cardiac events.

 A recent study, “Accuracy of a Smartwatch-Derived ECG for Diagnosing Bradyarrhythmias, Tachyarrhythmias, and Cardiac Ischemia,” explored how well the Apple Watch’s one-lead ECG can detect abnormal heart rhythms. The results were promising: the smartwatch was generally accurate in identifying common rhythm disturbances like bradycardia, tachycardia, and atrial fibrillation. However, its accuracy dropped significantly when detecting more complex arrhythmias like atrial flutter and atrial tachycardia—correctly identifying them only about 25% of the time. This highlights both the potential and the current limitations of smartwatch-based ECGs; while they can be helpful tools for basic heart rhythm monitoring, they’re not yet reliable enough for diagnosing more subtle or complex cardiac conditions.

Initially, devices using PPG technology are legally required to include a statement that they are not intended to diagnose medical conditions. In 2022, recent modifications to that statement were made by the FDA enabling the addition of features such as an “atrial fibrillation history,” making it easier for users to track their heart rhythm over time and share that information with their healthcare providers.

If a person with no known history of heart issues receives this type of alert, they should reach out to their primary care physician to discuss what to do next. This may involve undergoing an in-office electrocardiogram (EKG) and potentially using continuous, medical-grade monitoring for further evaluation.

Blood Pressure

Typical blood pressure cuffs have vibration sensors in a pneumatic cuff to obstruct one’s artery before it detects a systolic and diastolic pressure. In cuffless blood pressure monitoring systems, users are initially required to calibrate the device—typically a smartwatch or smartphone—by pairing it with a traditional blood pressure cuff. Multiple blood pressure readings are taken and compared to the PPG-derived blood flow data. This calibration allows the device to estimate future blood pressure readings using only PPG signals, without needing the cuff again.

In one of the first head-to-head comparisons between a wearable watch and a traditional upper-arm ambulatory. researchers evaluated both in-office and out-of-office readings in 50 adults, who both had these devices on the same non-dominant arm.

Researchers found that the wearable devices provided readings that closely matched those of the standard monitor in both environments, suggesting its reliability for continuous blood pressure monitoring. The findings support the clinical potential of wearable technology as a practical and accurate tool for managing hypertension, especially in out-of-office contexts where traditional monitoring can be less convenient.

Oxygen Levels

Next, a recent systematic review assessed how accurately the Apple Watch Series 6 measures blood oxygen levels (SpO2 ) compared to standard medical devices. The findings showed for the most part, the watch provides reasonably reliable readings in healthy adults. However, some discrepancies were noted, especially in cases of low oxygen saturation or among individuals with certain skin tones.

While the Apple Watch isn’t a replacement for clinical pulse oximeters, it can serve as a helpful tool for general wellness monitoring—so long as users recognize its limitations and don’t treat it as a diagnostic device.

Concerns in Regard to Wearable Technology

While wearable technology offers exciting possibilities for health monitoring and early detection of medical issues. It raises several important concerns. There’s a risk of over-reliance on wearables, where users might prioritize device feedback over professional medical advice. Next, accessibility and health equity come into play, as these technologies may be financially out of reach for some populations, potentially widening health disparities. Moreover, many wearables are not FDA-approved medical devices and can produce false positives or miss significant health events, leading to unnecessary anxiety or a false sense of security. Lastly, ensuring that these devices are fully charged and not experiencing any malfunctions, ensure they are computing accurate data.

Conclusion

Smartwatches have evolved far beyond simple step counters like offering users a glimpse into their cardiovascular health, sleep habits, and even blood oxygen levels. With increasing FDA oversight and emerging studies supporting their potential, these devices are starting to find a place in preventive healthcare. However, while the technology is advancing quickly, it still has limitations. Smartwatches can support wellness and early detection, but they are not substitutes for professional medical evaluations. Users must understand that wearable data should not replace clinical advice. As these tools become more integrated into our healthcare systems, staying informed, cautious, and connected to medical professionals will be key to using them safely and effectively. If one starts to feel heart palpitation, chest pain, or other unusual symptoms suddenly, they should contact their physician even if their smart watch says otherwise. Always trust your intuition and seek the appropriate medical attention to prevent further complications.

Grace N., APPE Student

References:

Caillol, T., Strik, M., Ramirez, F. D., Abu-Alrub, S., Marchand, H., Buliard, S., … & Bordachar, P. (2021). Accuracy of a smartwatch-derived ECG for diagnosing bradyarrhythmias, tachyarrhythmias, and cardiac ischemia. Circulation: Arrhythmia and Electrophysiology, 14(1), e009260. Accessed: June 9^th, 2025

Canali, S., Schiaffonati, V., & Aliverti, A. (2022). Challenges and recommendations for wearable devices in digital health: Data quality, interoperability, health equity, fairness. PLOS Digital Health, 1(10), e0000104. Accessed: June 11^th, 2025

Hudock, Nicholas L., et al. “Wearable health monitoring: wave of the future or waste of time?.” Global Cardiology Science & Practice 2024.3 (2024): e202421. Accessed: June 11^th, 2025

Kario, K., Shimbo, D., Tomitani, N., Kanegae, H., Schwartz, J. E., & Williams, B. (2020). The first study comparing a wearable watch‐type blood pressure monitor with a conventional ambulatory blood pressure monitor on in‐office and out‐of‐office settings. The Journal of Clinical Hypertension, 22(2), 135-141. Accessed: June 9^th, 2025

Köhler, Charlotte, et al. “The Value of Smartwatches in the Health Care Sector for Monitoring, Nudging, and Predicting: Viewpoint on 25 Years of Research.” Journal of Medical Internet Research 26 (2024): e58936. Accessed: June 9^th, 2025

Should I use a smartwatch to track my health. A doctor explains. https://www.cnn.com/2024/07/26/health/smartwatch-health-tracking-wellness. Accessed June 9, 2025. Accessed: June 9^th, 2025

Windisch, Paul, et al. “Accuracy of the apple watch oxygen saturation measurement in adults: a systematic review.” Cureus 15.2 (2023). Accessed: June 11^th, 2025.

Reference photo: Unsplash

In an age where artificial intelligence can write essays, compose music, and even mimic human conversation, it’s no surprise that many people are turning to tools like ChatGPT for health advice. With just a few keystrokes, you can receive a seemingly intelligent, well-worded explanations for your symptoms, with no waiting room required or appointment needed at that. But as convenient as this sounds, it raises a critical question: Can AI like ChatGPT diagnose you more effectively than a trained healthcare provider? While AI can process vast amounts of medical data in seconds, there’s more to patient care than pattern recognition.

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Speed and Accessibility vs. Clinical Judgement

Artificial intelligence has already surpassed humans in various domains like no other, specifically ChatGPT. ChatGPT is available 24/7, doesn’t require insurance, and can provide answers in seconds. This accessibility is a game-changer, especially for people in rural areas, the uninsured, or those facing long wait times to see a provider. AI doesn’t get tired, distracted, or emotionally biased. It processes symptoms and produces a potential diagnosis instantly.

However, speed isn’t everything. Trained providers consider subtle clinical signs, ask tailored follow-up questions, and factor in non-verbal cues. A doctor may hear a patient describe fatigue, weight loss and, based on tone and appearance, explore depression or cancer. These are paths AI might not prioritize without that context. Human judgement remains essential for navigating ambiguous symptoms and considering the full complexity of a patient’s story.

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Personalized Care from A.I.

A major 2024 study published in the Journal of Medical Internet Research found that ChatGPT-4 actually outperformed emergency room doctors in diagnostic accuracy in a retrospective analysis. The AI was better at generating the correct diagnosis within its top three suggestions and did so without the common cognitive biases that can cloud human judgment, such as premature closure (settling on a diagnosis too early).

The New York Times followed up on these findings, reporting that AI chatbots like ChatGPT were not only accurate but also often provided more thorough explanations of the reasoning behind a diagnosis. According to the article, researchers were surprised by just how sophisticated the AI’s diagnostic reasoning was, especially for a tool not specifically trained as a physician. This kind of data-driven precision makes AI an invaluable reference—especially when physicians are overworked, rushed, or dealing with diagnostic uncertainty.

Reference photo: Pexels

However, this doesn’t mean AI can replace the personal touch. Doctors don’t just match symptoms to diagnoses. They take into account medical history, mental health, lifestyle, and even socioeconomic factors that influence treatment decisions. AI might be better at identifying textbook presentations, but medicine isn’t always textbook. Real-life clinical care involves subtleties that no AI can fully grasp for example, how a patient’s demeanor changes when asked about stress, how a single comment may reveal hidden trauma, or how knowing a patient’s family situation might influence the type of treatment they’re realistically able to follow. For instance, a doctor might recognize that a patient with frequent migraines is actually suffering from medication overuse headache. A diagnosis like that may be rooted more in familiarity with the patient’s habits than in textbook criteria.

As noted by researchers at the University of Virginia, when AI was used in collaboration with providers, it helped improve diagnostic accuracy but only when guided by human insight. It’s not a matter of one replacing the other, but rather how they can complement each other.

Ethics in Diagnosis

Perhaps the most important distinction is this: if an AI gives you incorrect medical advice, who is responsible? A human provider is bound by legal, ethical, and professional standards. AI is not.A Frontiers article, Human-versus Artificial Intelligence argues that human intelligence is adaptive and intuitive in a way AI simply is not. Humans integrate emotional context, moral reasoning, and situational awareness, making decisions even when data is incomplete or contradictory. AI, by contrast, is only as good as the dataset it was trained on—meaning it can perpetuate biases and overlook rare but critical cases.

So while AI may have raw data accuracy on its side, doctors bring depth, personalization, and an essential understanding of the human condition. The power lies in combining these strengths—AI for its breadth of knowledge and consistency, and physicians for their nuance, empathy, and lived clinical experience.

Reference photo: Pexels

All in All

Think of ChatGPT as a tool, not a replacement. AI like ChatGPT shows immense promise in aiding diagnostics, especially in flagging potential conditions and prompting earlier medical attention. But it lacks the nuance, empathy, and lived experience of a real provider. The smartest approach is not choosing either-or, but rather embracing AI as a supplement, not a substitute.

In short, ChatGPT might help you recognize what’s wrong but it’s your doctor who helps you understand what it means, what to do, and how to heal. Traditional practices will always remain superior when it comes to provide the most exceptional care to patients.

Grace N., APPE Student

References:

A.I. Chatbots Defeated Doctors at Diagnosing Illness. https://www.nytimes.com/2024/11/17/health/chatgpt-ai-doctors-diagnosis.html#. Accessed: June 11^th, 2025.

Does Chat GPT Improve Doctors’ Diagnoses? Study Puts It to the Test. https://news.med.virginia.edu/research/does-chat-gpt-improve-doctors-diagnoses-study-puts-it-to-the-test/. Accessed: June 11, 2025.

Hoppe, John Michael, et al. “ChatGPT With GPT-4 outperforms emergency department physicians in diagnostic accuracy: retrospective analysis.” Journal of Medical Internet Research 26 (2024): e56110. Accessed: June 11^th, 2025

Korteling, J. H., van de Boer-Visschedijk, G. C., Blankendaal, R. A., Boonekamp, R. C., & Eikelboom, A. R. (2021). Human-versus artificial intelligence. Frontiers in artificial intelligence, 4, 622364.

By the beginning of June 2025, the Centers for Disease Control and Prevention (CDC) has reported over 1,000 confirmed cases of measles in the United States. Given that disease control depends on vaccination efforts, pharmacists play a key role in preventing and reducing the spread of measles outbreaks. In many states, pharmacists are authorized to administer the Measles, Mumps, and Rubella (MMR) vaccine to eligible patients without a prescription. Furthermore, an outbreak of measles serves as an indicator for health disparities within a community. Pharmacists following trends in outbreaks can identify these gaps in immunization programs and address these challenges early on. 

What is Measles?  

Measles is one of the most contagious diseases, according to the World Health Organization (WHO). Measles is caused by the measles virus, which spreads by airborne transmission or after contact with contaminated surfaces. Almost everyone without immunity will contract the disease if they have been exposed to the virus. One person infected with measles can infect nine out of 10 of their unvaccinated close contacts. Although the measles virus can infect anyone, children are the most affected.

Common symptoms include fever, cough, runny nose, conjunctivitis (red, watery eyes), and a characteristic maculopapular rash. Symptoms usually begin 10-14 days after exposure. Measles diagnosis is confirmed by using laboratory methods.

Measles can be fatal due to complications from the disease. On average, 3 out of every 1,000 cases will end in death from complications. Complications from the disease include ear infections, severe diarrhea, pneumonia, or permanent neurological damage from encephalitis (swelling in the brain). Individuals most at risk for complications are unvaccinated young children (<5 years old) and those who are pregnant.  There is no antiviral therapy or other FDA-approved agent indicated for the treatment of measles, and treatment largely consists of supportive care. 

Vaccine Overview 

The Measles, Mumps, and Rubella (MMR) vaccine is indicated for the routine immunization of children and adolescents by the Food and Drug Administration (FDA). Disruptions to routine vaccination activities during the COVID-19 pandemic have left millions of children vulnerable to measles. This is believed to be a major contributor to the current resurgence of the disease. 

The MMR vaccine is formulated with live attenuated viruses. This means that although the virus is alive, it is a weakened or modified version. Because it is attenuated, the vaccine is harmless and less virulent but remains highly effective. The vaccine works by stimulating the immune system to protect against measles, in addition to mumps and rubella.  

The vaccine requires a two-dose series, which is typical for attenuated vaccines in order to achieve lifetime immunity. Regarding measles specifically, there is 95% effectiveness after the first dose, and 99% after the second dose. The first dose is typically administered to individuals aged 12-15 months, followed by the second dose given between the ages of 4-6 years. 

Although it is preferred to have the 2-dose series completed prior to school entry, the vaccine can be administered in 2 doses in individuals aged 12 months to 12 years old. Booster doses after appropriate vaccination are not necessary. Adults should also be up to date on MMR vaccinations, unless they have presumptive evidence of immunity. This is often the case for individuals born before 1957. 

The Measles, Mumps, Rubella, and Varicella (MMRV) vaccine is not recommended for children aged 12-47 months, per the CDC. The MMRV is typically given as a preference to parents or caregivers. Ten percent of vaccine recipients experience adverse effects to the MMR vaccine. The most common side effects being fever are redness and pain at the injection site. Less than 10% experience a rash and/or severe fever. 

The vaccine is not indicated for everyone. The MMR vaccine should not be administered to the following populations: 

• Pregnant individuals  

• Patients on long-term immunosuppressive treatment with high doses of steroids 

• Patients with Human Immunodeficiency Virus (HIV) and patients with severe immunocompromised conditions

• Individuals with a family history or confirmed immunodeficiency  

• Patients on chemotherapy or who have solid tumors  

Prevention 

The WHO reports that maintaining high population immunity is required in order to prevent outbreaks. Those who are eligible for the vaccine should receive it to protect themselves as well as the individuals who are not able to be vaccinated (see above in MMR vaccine overview). This contributes to herd immunity, indirectly protecting those who are not immune.  Post-exposure prophylaxis with the MMR vaccine or immunoglobulin may be indicated for individuals exposed to the virus who do not have immunity. The MMR vaccine should be given within 72 hours after exposure. Immunoglobulin should be given within 6 days after exposure. 

Measles can be transmitted from an infected person up to 4 days prior to the onset of their rash, and up to four days after the rash erupts. To prevent spreading the virus, it is crucial for someone with measles to isolate themselves, especially from high-risk individuals. 

How Pharmacist Can Make a Difference 

To prevent outbreaks, vaccination efforts must be made. As highlighted from the COVID-19 pandemic, pharmacists provide an invaluable contribution to vaccination activities. In the case of parents or patients who are hesitant to vaccinate, pharmacists can address individualized concerns. Their clinical expertise can provide accurate information and dismiss misinformation. Furthermore, pharmacists have access to pertinent information that can be used to identify patients who are eligible for the MMR or MMRV vaccine. This allows pharmacists to streamline the vaccination process and opens an opportunity to answer questions and provide education.  

Pharmacists also play a key role in monitoring outbreak trends to help protect their communities. If confirmed measles cases are reported near their area, pharmacists can provide timely public health interventions. As members of interdisciplinary healthcare teams, they bring strong collaborative skills, enabling them to effectively partner with local health systems to strengthen vaccine programs. 

Timely vaccination is needed to prevent measles and reduce the risk of severe complications associated with the disease. The role of the pharmacist supports outbreak prevention by encouraging widespread immunization and educating patients about the disease. 

Cierra L., APPE student

References:  

1. Hübschen JM, Gouandjika-Vasilache I, Dina J. Measles. Lancet. 2022;399(10325):678-690. doi:10.1016/S0140-6736(21)02004-3  

2. Centers for Disease Control and Prevention. Measles (Rubeola): Data and Statistics. Updated June 6, 2025. Accessed June 9, 2025. 

3. Texas Department of State Health Services. Measles: Frequently Asked Questions. Updated March 18, 2024. Accessed June 11, 2025. https://www.dshs.texas.gov/measles/measles-frequently-asked-questions#:~:text=Call%20your%20doctor%20before%20going,readily%20kill%20the%20measles%20virus 

4. World Health Organization. Measles and Rubella Strategic Framework 2021–2030. World Health Organization; 2021. Accessed June 11, 2025. https://www.who.int/publications/i/item/measles-and-rubella-strategic-framework-2021-2030 

5. Johns Hopkins Medicine. Measles: What You Should Know. Johns Hopkins Medicine website. Accessed June 11, 2025. https://www.hopkinsmedicine.org/health/conditions-and-diseases/measles-what-you-should-know 

6. Patel P, Tobin EH. MMR Vaccine. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; January 2025–. Updated May 5, 2025. Accessed June 11, 2025. https://www.ncbi.nlm.nih.gov/books/NBK554450/ 

7. Centers for Disease Control and Prevention. Measles, Mumps, and Rubella (MMR) Vaccination: Recommendations for Healthcare Professionals. Updated February 5, 2018. Accessed June 11, 2025. https://www.cdc.gov/vaccines/vpd/mmr/hcp/recommendations.html#:~:text=Post%2Dexposure%20prophylaxis-,Measles,dose%20of%20MMR%20or%20MMRV. 

8. PowerPak CE. Managing measles resurgence and stemming the tide. Accessed June 11, 2025. https://journalce.powerpak.com/ce/managing-measles-resurgence-and-stemming 

Antipsychotic agents are a key approach in the treatment and management of schizophrenia. Despite their crucial role, medication non-adherence remains a significant concern. Long-acting injectable (LAI) antipsychotics are specifically designed formulations of antipsychotics that release medication consistently over a period of days to weeks, ensuring patients receive stable therapeutic concentrations. LAI’s offer more stable drug levels that minimize peak-related side effects, reduction in the risk of relapse, and improved adherence due to less dosing frequency than oral antipsychotics.  

Who Should Receive an LAI?  

Patients with recent-onset schizophrenia or those who are expected to need long-term antipsychotic therapy may benefit from incorporating LAI into their treatment. In cases where there are concerns about adherence to oral medications, LAIs should be highly considered. LAIs can support autonomy in treatment decisions, which may empower vulnerable populations such as individuals living with schizophrenia. However, the decision to use an LAI should be guided by a patient-centered approach. 

How Do LAI Antipsychotics Treat Schizophrenia?  

The Dopamine Hypothesis of schizophrenia proposes that dysregulation of activity in dopamine receptors located in distinct brain pathways contributes to symptoms. Specifically, excess dopamine in the mesolimbic pathway contributes to positive symptoms such as hallucinations and delusions. On the other hand, decreased dopamine in the mesocortical pathway is associated with negative (flat affect) and cognitive symptoms. The primary therapeutic goal in managing schizophrenia is to restore the balance of dopamine across these pathways.  

The primary mechanism of action for antipsychotic medications is dopamine antagonism, specifically at D2 receptors. Although D2 receptors are inhibitory, blocking them reduces overstimulation and restores normal activity of dopamine.  

Reformulating traditional dopamine antagonists in a way that allows them to be deposited under the skin or in muscle is what causes the sustained release of the medication. This medication depot allows for an extended dosing interval. Depending on the formulation, the site of injection varies from subcutaneous, deltoid, or gluteal.  

The following antipsychotic medications are available in LAI formulations: 

Please note that not all LAI formulations are FDA approved for the treatment of schizophrenia. 

How do I Know Which LAI is Right for My Patient?  

LAIs offer differing pharmacokinetic properties from each other. Pharmacists play an important role in assessing and selecting the most appropriate LAI for individual patients.  

First generation antipsychotics (FGAs) also known as typical antipsychotics, carry a high binding affinity for D2 receptors. The high binding affinity keeps them bound for longer. This extended period of activity on the receptor is associated with a higher risk of extrapyramidal symptoms (EPS). In contrast, second generation antipsychotics, or atypical antipsychotics, tend to not bind as tightly. As a result, they tend to dissociate more rapidly, making them less likely to cause EPS. However, second generation antipsychotics are associated with a risk of metabolic disturbances (e.g., weight gain, diabetes, high cholesterol). 

Establishing prior tolerance to an oral antipsychotic is a first step in determining what LAI is the most appropriate for your patient. While some LAIs require a period of oral overlap, others do not. Collecting a thorough patient history can offer valuable insight into past medication tolerability, which can guide your selection. For example, you will want to steer away from choosing an FGA LAI if the patient has a history of EPS from prior oral medication. However, if a patient has had a good response with prior oral antipsychotic treatment, it should be used as their LAI. 

Insurance coverage is another key consideration. All LAI formulations of aripiprazole, risperidone, and paliperidone are FDA approved for the treatment of schizophrenia, in addition to fluphenazine and haloperidol. Insurance plans may restrict coverage to FDA approved treatments; FDA-approved options should be prioritized to avoid the prior authorization process or denial. If a patient does not have current prescription coverage, it is vital to discuss out of pocket expenses prior to initiating LAI therapy. Certain LAIs, such as aripiprazole and paliperidone have patient assistance programs.  

Other considerations include post-injection monitoring requirements. For example, patients are at a very high risk for developing Post-Injection Delirium/Sedation Syndrome (PDSS) after each injection of olanzapine pamoate. Because of this, patients are required to be observed at a registered facility for at least 3 hours post injection. 

How Do I Start an LAI? 

Certain LAIs require oral overlap before injection. To determine if the LAI you have selected requires an oral bridge, or other important prescribing information, refer to the package insert or the manufacturer’s website.  

Reasons for LAI Underutilization and Addressing These Challenges 

Psychiatric practitioners may carry the false assumption that their patients will reject LAI as a treatment option. Negative attitudes and perceptions are a common barrier to LAIs, with one study identifying perceived negative patient attitudes as the most reported barrier among practitioners. However, the same study found that the presence of a psychiatric pharmacist helped to reduce barriers. This highlights the valuable role of pharmacists in psychiatric care. Pharmacists can provide education about LAIs to help dismiss misconceptions and guide more informed treatment decisions. 

Another barrier is the complex dosing schedules for formulations that require oral overlap. The skills pharmacists carry allow them to be well-equipped in navigating these challenges, including an assessment of the patient’s history. They can help to determine if past treatment failures were caused by medication intolerance or non-adherence. In cases where a patient is hesitant to start or restart oral medications, the pharmacist can guide appropriate LAI selection based on the patient’s side effect profile and treatment history. Additionally, pharmacists can use their clinical expertise to ensure oral overlap requirements have been met.

There is a unique opportunity for hospital pharmacists to evaluate and initiate appropriate long-term treatment plans. Pharmacists can collaborate with the patient’s healthcare team to select a LAI regimen and coordinate the necessary overlap as needed. Because the patient is being monitored and their medications are provided, the concern for adherence is greatly reduced. This strategy can expedite the LAI initiation process, allowing patients to receive their first dose before or shortly after discharge.  

The Final Say in the Role of LAIs in Schizophrenia 

LAIs offer a unique alternative to oral antipsychotics. Given the challenges of nonadherence to antipsychotics, LAIs provide an advantage for patients to receive a sustained release of medication without the need for daily dosing. The decision to initiate LAI therapy should be patient-centered, with the selection of a specific agent tailored to the patient’s individualized needs and history. 

Cierra L., APPE student

References:  

1. Schwartz S, Carilli C, Mian T, Ruekert L, Kumar A. Attitudes and perceptions about the use of long-acting injectable antipsychotics among behavioral health practitioners. Ment Health Clin. 2022;12(4):232-240. Published 2022 Aug 23. doi:10.9740/mhc.2022.08.232  

2. Patel, K. R., Cherian, J., Gohil, K., & Atkinson, D. (2014). Schizophrenia: overview and treatment options. P & T: a peer-reviewed journal for formulary management, 39(9), 638–645. 

3. Krishna A, Goicochea S, Shah R, Stamper B, Harrell G, Turner A. Long-acting injectable antipsychotics in primary care: A review. J Am Board Fam Med. 2024;37(4):773–784. https://www.jabfm.org/content/37/4/773. Accessed June 5, 2025.  

4. PsychDB. Long-Acting Injectable (LAI) Antipsychotics. PsychDB. https://www.psychdb.com/meds/antipsychotics/0-long-acting-injectables. Accessed June 9, 2025.  

5. Acosta, F. J., Hernández, J. L., Pereira, J., Herrera, J., & Rodríguez, C. J. (2012). Medication adherence in schizophrenia. World journal of psychiatry, 2(5), 74–82. https://doi.org/10.5498/wjp.v2.i5.74 

6. Texas Health and Human Services. Long-Acting Injectable Antipsychotics: Quick Reference Guide. Published February 2022. Accessed June 10, 2025. https://www.hhs.texas.gov/sites/default/files/documents/lai-antipsychotic-quick-reference.pdf 

Reference photo: Unsplash

GLP-1 Indications

Glucagon-like peptide (GLP-1) medications were first approved by FDA in 2005 for type 2 diabetes. In the treatment of type 2 diabetes, GLP-1s work by stimulating insulin secretion from the pancreas to lower glucose levels. Since then, these medications have had many additional indications. Some of those indications include cardiovascular, weight management, and chronic kidney disease (CKD).  

On December 20, 2024, the U.S. Food and Drug Administration added another indication to that list. Zepbound (tirzepatide) was initially FDA approved in 2023 to treat adults with obesity or those who are overweight who have weight-related medical issues. Later, tirzepatide was approved for the treatment of moderate to severe obstructive sleep apnea (OSA) in adults with obesity. Tirzepatide (Zepbound) works on agonism of GLP-1 receptors and glucose dependent insulinotropic polypeptide (GIP) receptors. The duality of this medication is multi-faceted and is making great strides for patients with OSA.

Obstructive Sleep Apnea and Zepbound’s Role

So, what is obstructive sleep apnea (OSA)? Obstructive sleep apnea is a very serious sleep disorder that involves one’s airway to become repeatedly blocked during sleep, causing the person to stop breathing briefly and oxygen deprivation. This is typically caused by the closing of the throat tissue, leading to choking noises, loud snoring, gasping for air during sleep, and frequent awakening. Now, OSA can affect anyone, but is it more likely to affect those who are overweight or obese.

Continuous airway positive pressure (CPAP) is considered to be the gold standard of therapy for the treatment of OSA. A CPAP machine uses a hose connected to a mask or nose piece that delivers constant air while one sleeps. A comprehensive systematic literature review was conducted in 2016 using reliable databases searching for data regarding CPAP adherence. The research revealed that over a 20-year period, 1994-2015, a CPAP non-adherence rate of 34.1% occured when assuming a sleep duration of 7 hours per night. This rate showed no significant improvement throughout the studied timeframe. Even after behavioral intervention, adherence only improved by about 1 hour per night on average.

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 Reference photo: Unsplash

So where does Zepbound come to aid in the treatment of OSA? Zepbound functions by suppressing appetite and decreasing food consumption. Research indicates that by promoting weight loss, Zepbound can also lead to improvements in obstructive sleep apnea. Zepbound is also approved for use alongside a reduced-calorie diet and increased physical activity to help adults with obesity. Zepbound is also indicated for those who are overweight with at least one weight-related health condition and this can help patients lose excess weight and maintain long-term weight reduction.

FDA Approval

The FDA approval for using Zepbound came from the SURMOUNT-OSA Phase 3 clinical trials. This study randomized 469 participants, where two Phase 3, double-blind controlled trials were conducted in adults with moderate-to-severe obstructive sleep apnea and obesity. Trial 1 included participants who were not on positive airway pressure (PAP) therapy at the start, while Trial 2 included those already using PAP therapy. Participants were randomly assigned in a 1:1 ratio to receive either a placebo or their maximum tolerated dose of tirzepatide (10 mg or 15 mg) for a duration of 52 weeks.

Reference photo: Unsplash

After one year of treatment, Zepbound led to a reduction in breathing interruptions by 25 to 29 events per hour, compared to a 5 to 6 event reduction with placebo. Remission or transition to mild sleep apnea was observed in 42% of participants not using PAP therapy and 50% of those using PAP (versus 16% and 14%) respectively, in the placebo groups.

Participants treated with Zepbound also experienced substantial weight loss, averaging 18–20% of their body weight (approximately 45–50 pounds), while those receiving placebo lost only about 2% (roughly 4–6 pounds). The weight reduction was more pronounced in individuals using PAP therapy. The improvement in the Apnea- Hypopnea Index (AHI), a key measure used to diagnose and assess the severity of OSA, in participants with OSA is more than likely related to body weight reduction with Zepbound.

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The Bottom Line

Like any other GLP-1 medication, the side effects remain the same with the most reported being nausea, vomiting, and diarrhea. Other side effects include constipation, abdominal (stomach) discomfort and pain, injection site reaction, fatigue, and more. Additionally, if Zepbound is taken alongside insulin or medications that increase insulin production, it’s important to discuss with a healthcare provider whether adjustments to those medications are needed to help lower the risk of hypoglycemia (low blood sugar). Health care providers should routinely monitor weight, kidney function, complete blood count, and blood glucose levels. Dieticians also need to make recommendation for patients to consume smaller meals, eating slowly, and avoiding fatty foods while taking these medications so the patient can continue to achieve maximum treatment benefit.  

Zepbound (tirzepatide) represents a significant advancement in the management of obstructive sleep apnea (OSA), particularly for individuals with obesity. With longstanding challenges in CPAP adherence and the strong link between excess weight and OSA severity, the introduction of a medication that addresses both issues offers a promising new approach. The SURMOUNT-OSA Phase 3 trials demonstrated meaningful reductions in apnea events and body weight, highlighting Zepbound’s dual benefit in both sleep and metabolic health. While side effects are consistent with those seen in other GLP-1 therapies, the potential improvements in quality of life and disease burden make this an important new option for appropriate patients. As with any treatment, shared decision-making between patients and healthcare providers will be essential in weighing risks, benefits, and individual goals.

Grace N., APPE Student

References:

CPAP machines: Tips for avoiding 10 common problems. https://www.mayoclinic.org/diseases-conditions/sleep-apnea/in-depth/cpap/art-20044164#:~:text=Continuous%20positive%20airway%20pressure%20(CPAP,you%20breathe%20while%20you%20sleep. Accessed: June 5, 2025.

FDA Approves First Medication for Obstructive Sleep Apnea. https://www.fda.gov/news-events/press-announcements/fda-approves-first-medication-obstructive-sleep-apnea. Accessed: June 4, 2025.

Latif, W., Lambrinos, K. J., & Rodriguez, R. (2021). Compare and contrast the glucagon-like peptide-1 receptor agonists (GLP1RAs).

Malhotra, Atul, et al. “Tirzepatide for the treatment of obstructive sleep apnea and obesity.” New England Journal of Medicine 391.13 (2024): 1193-1205.

Romariz, Livia, et al. “GLP-1 receptor agonists for the treatment of obstructive sleep apnea and obesity.” European Journal of Internal Medicine 132 (2025): 153-155. Accessed June 4, 2025.

Rotenberg, B. W., Murariu, D., & Pang, K. P. (2016). Trends in CPAP adherence over twenty years of data collection: a flattened curve. Journal of Otolaryngology-Head & Neck Surgery, 45(1), 43. Accessed: June 5, 2025

Zepbound approved by FDA as first sleep apnea medication. https://aasm.org/zepbound-approved-fda-first-sleep-apnea-medication/. Accessed June 4, 2025.

Zepbound Approved for Obstructive Sleep Apnea in Patients With Obesity. https://www.pulmonologyadvisor.com/news/zepbound-approved-for-obstructive-sleep-apnea-in-patients-with-obesity/#:~:text=%E2%80%9CNearly%20half%20of%20clinical%20trial,1%20weight%2Drelated%20comorbid%20condition.&text=References:,us/zepbound%2Duspi.pdf. Accessed: June 5, 2025.

Why SMART Should be Adopted in Asthma Management

Single Maintenance and Reliever Therapy (SMART) is a technique where a single inhaler is used for daily asthma control and used for as- needed symptom relief. This strategy combines prescription inhalers containing an inhaled corticosteroid (budesonide or mometasone) and a long-acting beta2-agonist (formoterol), which are indicated for indicated for SMART. Given its dual-purpose approach, adopting SMART in asthma management improves disease control and enhances the quality of life for patients.

Components of SMART Therapy

Inhaled corticosteroids (ICS) function to reduce and control inflammation within the lungs through its potent glucocorticoid activity, which helps prevent the occurrence of asthma attacks. Below are examples of ICS medications:

Inhaled corticosteroids  (ICS) 

• Fluticasone
• Budesonide 
• Mometasone
• Beclomethasone
• Flunisolide 

The intended use for ICS in asthma is for controller therapy. During episodes of inflammation, capillaries in the lung become more permeable or “leaky.” This contributes to immune cells and fluid accumulating in the surrounding tissues, and ultimately it leads to swelling and airway narrowing. Budesonide and mometasone, two ICSs typically used in SMART, work to reverse the permeability of capillaries, leading to the reduction of airway obstruction caused by swelling. In addition, budesonide and mometasone also work to prevent tissue damage. They contribute to the lysosome stabilization, which reduces the quantity of degrading enzymes released. This limits the extent of injury to tissues in the airway.  Previously, ICS treatment was only used in patients who experienced persistent symptoms. However, large clinical studies have demonstrated that regularly using ICS reduces the risk of severe asthma exacerbation. This reduction decreases the number of asthma-related hospitalizations and death.

Long-acting Beta2-agonist (LABA) drugs functions as a potent bronchodilator through stimulating beta2 receptors located on bronchial smooth muscle, increasing cyclic adenosine monophosphate (cAMP). The downstream effects of cAMP lead to muscle relaxation and bronchodilation. Below are examples of LABA medications:

Long-acting Beta2-agonist (LABA)

• Salmeterol
• Formoterol
• Vilanterol

Compared to short-acting Beta2-agonists (SABAs), LABAs have a higher degree of selectivity for bronchial smooth muscle beta2 receptors. This increased receptor selectivity contributes to a more favorable adverse effect profile, offering a therapeutic advantage over SABAs. However, the greatest difference between LABAs and SABAs is their onset of action and duration of therapeutic effects. SABAs act quickly, but wear off quickly, making them ideal for the use of rescue/reliever therapy. In contrast, LABAs have a slower onset of action and a longer duration of action. Because of this, we have typically have only seen LABAs used as controller therapy. However, unlike other LABAs, formoterol offers a rapid onset of action, typically seen within 1-2 minutes. This unique pharmacokinetic profile gives formoterol the advantage over other LABAs because it may be of being used as a rescue/reliever in addition to controller therapy. There is an FDA black box warning for LABA monotherapy in asthma treatment. It is important to note that LABA without ICS is contraindicated in asthma due to the increase in severe exacerbations and asthma-related death. 

Where do SABAs Fit in SMART?

Previously, SABA monotherapy was a cornerstone approach to patients with mild asthma. However, the use of SABA monotherapy in asthma treatment has been found to have severe clinical consequences, largely due to their unfavorable dose-response relationship. One of the key concerns is the development of tolerance, which can occur within a week of regular use. Tolerance is driven by the downregulation of bronchial smooth muscle beta2-receptors and a decrease in drug-receptor binding affinity. As a result, the bronchodilator response to SABAs becomes less effective over time, which results in reduced symptom control. In addition to reduced efficacy, there is evidence to support that the frequent use of SABA alone, even over short durations, is associated with an increased risk for asthma-related death. This prompted The Global Initiative for Asthma (GINA) to reassess the role of SABAs, and search for a new approach in the treatment and management of asthma. Formoterol has been found to be effective as a controller and as a rescue/reliever, causing a shift in what the guidelines previously recommended in 2019.

Why use SMART?

GINA and the National Asthma Education and Prevention Program (NAEPP) recommend SMART in patients with mild asthma who are 12 years of age or older. ICS-formoterol combination is the preferred approach to SMART because it is widely available as either Symbicort or Dulera. In addition, since SMART uses a single inhaler to provide maintenance and symptom control, patients no longer will need two inhalers for asthma management. Simplifying the treatment regimen to one inhaler leads to reduced confusion, increased adherence, and potentially cost savings.

The FDA has not approved the use of ICS-formoterol inhalers as part of SMART in the United States. This can affect prescription drug coverage as insurance may not cover a treatment that has not formally been approved. Despite this, GINA and the NAEPP endorse SMART for asthma. Although there is no FDA approval for SMART, ICS-formoterol can still be prescribed “off-label” as a rescue/reliever and controller.

Where do Pharmacists Fit in with SMART?

There is an overwhelming  overwhelming number of medications available on the market for management and treatment of asthma. Pharmacists specialize in product selection and therapeutic substitution to ensure that patients receive the most appropriate medication regimen. For patients who are currently using separate inhalers for controller and rescue/reliever therapy, or those relying solely on SABA monotherapy due to adherence challenges or other barriers, pharmacists can recommend SMART. Pharmacists can help identify formulary-preferred options that are covered by the patient’s insurance plan, leading to cost savings. Additionally, pharmacists can advocate for this therapeutic switch in practices that operate under a Collaborative Practice Agreement (CPA), and pharmacists are also authorized to initiate this change directly. Another impactful way pharmacists can support the implementation of SMART is through comprehensive patient education, particularly in teaching proper inhaler techniques and reinforcing adherence. Ensuring that patients understand the dual purpose of the inhaler and clarifying when and how to use it is important to optimize treatment. Lastly, pharmacists can monitor for potential drug-drug interactions that may interfere with treatment or exacerbate asthma symptoms.

SMART Takeaway

SMART represents a significant advancement in the treatment and management of asthma by combining an ICS with formoterol in a single inhaler for both control and symptom relief. This approach simplifies therapy and reduces costs. Clinical trials have demonstrated effectiveness in reducing exacerbations and improving overall asthma control. Supported by current guideline recommendations, including those from GINA, SMART is now the preferred treatment strategy for patients 12 years of age or older. Adopting SMART into clinical practice provides the opportunity to significantly enhance patient outcomes and quality of life.

Cierra L., APPE Student

References: 

1. Reddel HK, FitzGerald JM, Bateman ED, et al. GINA 2019: a fundamental change in asthma management: Treatment of asthma with short-acting bronchodilators alone is no longer recommended for adults and adolescents. Eur Respir J. 2019;53(6):1901046. Published 2019 Jun 27. doi:10.1183/13993003.01046-2019
2. Liang TZ, Chao JH. Inhaled Corticosteroids. Updated May 8, 2023. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; January 2025–. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470556/
3. Hsu E, Bajaj T. Beta2-Agonists. Updated June 20, 2023. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; January 2025–. Available from: https://www.ncbi.nlm.nih.gov/books/NBK542249/
4. Suissa S, Ernst P, Benayoun S, Baltzan M, Cai B. Low-dose inhaled corticosteroids and the prevention of death from asthma. N Engl J Med. 2000;343(5):332-336. doi:10.1056/NEJM200008033430504
5. Sharma S, Hashmi MF, Chakraborty RK. Asthma Medications. [Updated 2023 Jun 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK531455/
6. American Academy of Allergy, Asthma & Immunology. SMART Therapy for Asthma. Published 2024. Accessed June 5, 2025. https://www.aaaai.org/tools-for-the-public/conditions-library/asthma/smart