The Global Asthma Initiative (GINA) has updated its guidelines for 2025. Some ofthe key changes include looking at additional biomarkers for Type 2 inflammation,additional risk factors for severe exacerbation in adults, including environmentalfactors and air quality that they are exposed to, and the impact of extreme weather.The diagnosis criteria have also been updated for clarity because variability insymptoms and expiratory airflow are two distinct characteristics of Asthma.Additionally, a reference to a calculator of peak expiratory flow variability was alsoadded.
Treatment recommendations for adults are in two treatment tracks for better clarity,and due to poor access to some preferred combination inhaled products. The mainkey difference is the medication that is used for symptom relief. Track one maintainsan"as needed" inhaled corticosteroid (ICS) - formoterol combination product such asSymbicort or Dulera as the preferred treatment approach. Formoterol substantiallyreduces the risk of severe exacerbations and systemic corticosteroid exposure ascompared to short-acting beta agonists (SABA) based regimens. Also, thecombination products provide a simpler regimen and better overall compliance.
Track 2 uses the alternative approach of “as needed” SABA or as needed ICS-SABA(ie, Airsupra -combo product or albuterol and a steroid inhaler separately), which maybe a good option for patients with controlled stable asthma and no exacerbations. Itis recommended to ensure the patient is good with medication adherence beforeusing one of these suggested products.
The U.S. Department of Veterans Affairs (VA) and Department of Defense alsoreleased updated clinical practice guidelines for Asthma in March 2025. Like the GINAguidelines, the VA also makes strong recommendations for the use of ICS incombination with a long-acting beta agonist (LABA) such as formoterol as both acontroller and reliever for those with uncontrolled asthma.
Lastly, the latest studies show that the use of Proton Pump Inhibitors (PPI) has beenassociated with increased asthma incidence. While PPIs are used to manage GERD,which itself can also worsen symptoms of asthma, the use of PPIs may not be thebest option in asthma patients. If there are residents who are on PPIs and seem tocontinue having asthma that is uncontrolled, consider switching to an H2-receptorantagonist such as famotidine or ranitidine.
Asthma is a chronic condition that can affect many residents in the nursing homesetting. Proper management by identifying triggers, educating residents and staff,and having up-to-date knowledge of new and preferred treatment options can begreatly beneficial in better controlling and reducing asthma exacerbations in theelderly.
The vaccine manufacturers (Pfizer, Moderna) expect the new vaccine will be available mid to late August, while Novavax anticipates a slightly later release in September but still in time to begin the fall vaccine administrations once the final approval is received by the FDA. The current COVID-19 2023-24 vaccine is still approved for administration, likely for the remainder of the summer, however, production of the 2023-24 formulation has stopped as manufacturers gear for the new formulation.
Currently, Pfizer has stopped shipping all 2023-24 from Pfizer direct. Going forward, additional doses of Pfizer and Moderna may be obtained through regular wholesalers or vendors IF they have any more stock remaining. Once the 2023-24 is completely depleted from all Vendors, facilities should wait until the new formulation is available early fall.
Facilities are encouraged to review all patients who did not receive any vaccine or dose of the 2023-24 formula and administer it as a priority for those patients. For all others who have already received at least one dose of the 2023-24 formula in recent months, it may be beneficial to wait for the new formulation at the discretion of the healthcare provider and facility protocol.
The ACIP and CDC advisory group made official recommendations on June 27, 2024, for who should get the new vaccine in the fall. They continue to support vaccination against Covid-19 with one dose of the new 2024-25 formulation in all individuals ages 6 months and older irrespective of whether they were previously vaccinated for COVID-19.
Medications such as prednisone or methylprednisolone are some of the most commonly known offenders of affecting glycemic control in diabetics and even causing new onset diabetes or steroid induced diabetes. Management of glucose depends on duration of glucocorticoid therapy, and how well the patient’s glucose was controlled prior to initiating therapy.
Many drugs in this class can cause weight gain as a common side effect. As we know, obesity is a risk factor in contributing to or developing diabetes. Antipsychotics can also lead to insulin resistance. Some antipsychotics that more commonly affect glucose are Clozapine, Olanzapine, and Haloperidol. Alternatively, Ziprasidone is known to have less effects on glucose.
Specifically, thiazide diuretics are a common first line therapy and adjunct in the management of high blood pressure. Some thiazide diuretics are Metolazone and Hydrochlorothiazide. Thiazide diuretics can also cause increased glucose levels in addition to affecting electrolyte levels such as potassium (hypokalemia). Studies show that hypokalemia due to thiazide diuretics can cause diabetes and reduce insulin sensitivity.
It is likely that your diabetic resident has other comorbidities such as high cholesterol which require treatment with statins. Statins are also on the list of medications that can reduce insulin secretion and sensitivity. In diabetics, statins may increase the hemoglobin A1C slightly. However, if you look at the risk vs benefit of statin therapy vs the development of diabetes, statin therapy should be initiated as the benefit to prevent cardiovascular disease and can outweigh risks with hyperglycemia.
Beta blockers are commonly used for high blood pressure, coronary artery disease, and heart failure. Metoprolol and atenolol are associated with increasing hemoglobin A1C but also associated with increased risk of hypoglycemia. It is also important to keep in mind that beta blockers can mask the symptoms of hypoglycemia.
Throughout the fall, much of the focus has been on vaccination as a key preventive measure.However, it is equally important to recognize flu symptoms and understand current treatmentoptions and guidelines. Early identification and timely treatment can help limit the severityand duration of illness for individuals who test positive for influenza.
The CDC has released updated influenza treatment guidelines that place special emphasison individuals at high risk for serious flu-related complications. While many otherwise healthyindividuals can recover with rest, hydration, and symptom management, high-risk populationsoften require closer monitoring and prompt antiviral treatment.
If influenza is suspected and at least one symptom is present—or if there has been knownexposure to others who have tested positive—the individual should be tested for flu. This iscritical because antiviral medications are most effective when initiated within 48 hours ofsymptom onset.
Nursing staff play a key role in early detection by closely monitoring symptoms and routinelyasking residents about how they are feeling. This is especially important for residents whomay be confused, disoriented, or unable to clearly communicate symptoms. When flu isstrongly suspected, treatment may be started empirically, even before test results areavailable.
When administered promptly, antiviral medications can reduce symptom severity, shorten theduration of illness, and—most importantly—help prevent serious complications such aspneumonia and hospitalization.
Currently, four antiviral medications are approved and recommended for influenza treatment,available in various dosage forms. Tamiflu is available as a tablet or liquid, Relenza as aninhaled powder, and Rapivab as a single intravenous dose. The most appropriate optiondepends on factors such as patient age, renal function, dosage form, and ability to adhere totreatment.
The table below lists anti-viral options, dosage, routes, and common directions:
Renal Impairment dosing Tamiflu: Mild (60-90ml/min = 75mg twice daily x 5 days); Moderate(30-60ml/min = 30mg twice daily x 5 days); Severe (10-30ml/min = 30mg once daily x 5days); ESRD requires further adjustment dosing with hemodialysis cycle
***Renal Impairment dosing Relenza in Adults: CrCL >50 = 600mg x 1 dose; CrCL 30-49= 200mg x 1 dose; CrCL 10-29 = 100mg x 1 dose***
Having antiviral options, dosing information, and directions readily available can help ensuretimely and accurate pharmacy orders, allowing treatment to begin as quickly as possiblewhen flu is suspected or confirmed.
SpecialtyRx wishes you a warm, safe, and healthy rest of the holiday season—and a healthyflu season, too.
While there are many categories of medications used to manage diabetes, insulin is oftenamong the most effective. However, it also carries the greatest risk—particularly the risk ofhypoglycemia.
A team-based approach involving all members of the healthcare team—nurses, prescribers,and pharmacists—is key to ensuring safety and success. Collaboration on protocols, safetymeasures, and education is especially important when managing insulin therapy. Education on the different types of insulin (including onset, duration of action, and peak time) cangreatly improve safety. Understanding which insulins are interchangeable is also vital.
Maintaining an insulin and conversion chart provides nurses and prescribers with a quickreference tool containing essential information and recommendations, supporting safe andeffective patient care.
Earlier this year, the American Diabetes Association (ADA) updated its Standards of Care torecommend continuous glucose monitoring (CGM) for all individuals with diabetes to improveglycemic control and overall patient care. Although access to CGM devices can bechallenging, it is strongly recommended—particularly for individuals on insulin and long-termcare residents—to enhance safety, improve glucose management, and reduce the need forfrequent finger sticks, thereby improving quality of life.
To support this effort, SpecialtyRx has developed a quick reference guide that categorizesdifferent insulin types, provides cost ranges, and includes key notes for each. The goal issimple: to promote teamwork and achieve the best possible patient care and outcomes.
This observance aligns perfectly with flu and respiratory virus season, a timely reminder forfacilities and individuals to take simple, effective steps to reduce the spread of illness.Beyond seasonal viruses, nursing homes also face ongoing risks from infections such as C.diff, UTIs, MRSA, Norovirus, and more.
CMS requires every nursing home to have a dedicated, specially trained infectionpreventionist nurse. At Specialty, we’d like to reinforce some of the basic yet essentialpractices that make a lasting impact on infection prevention.
Below are key elements that should be included in every infection prevention program orpolicy:
Stay ahead – and in the know – in our rapidly evolving industry.
SpecialtyRx Celebrates Ribbon-Cutting of Expanded Orlando Pharmacy
SpecialtyRx proudly marked a significant milestone with a ribbon-cutting ceremony celebratingthe expansion of its Orlando location, now the state's largest single-site pharmacy. The eventbrought together leadership, team members, and partners to commemorate the organization'sgrowth and its continued commitment to excellence in pharmacy services.The expanded facility enhances the company’s ability to better serve patients and partners whilecontinuing to invest in advanced technology, operational excellence, and its growing team.SpecialtyRx looks forward to building on this momentum as it continues to grow and servecommunities across Florida and beyond.
Thank you to everyone who joined us for the Tropical Paradise Cruise Connect!
From engaging CE sessions to meaningful conversations (and maybe a few dance moves), it was an unforgettable day spent connecting with industry leaders and partners who share our commitment to advancing long-term care pharmacy.
We’re grateful for the opportunity to learn, grow, and cruise together — and we’re just getting started.
A special thank you to our friends at The Açaí Co. NJ, Pizza Biza, The Drip Bar, Hookahman Events, and Tovia Roth for their support in making this event a success!
#TBT We were honored to be invited as a vendor for the Gem City Grand Opening in Dayton, Ohio!
At SpecialtyRx, we’re proud to support our facility partners and show up where it counts. Thank you for the opportunity to be part of such a meaningful day; we’re excited to grow together in the Dayton community.
It's been a great few days at Florida Health Care Association's Annual Conference & Trade Show!
A huge thank you to everyone who stopped by the SpecialtyRx booth to connect, learn, and share. We loved meeting so many dedicated professionals who are passionate about advancing long-term care.
Shoutout to Zack Ilarraza, Herman Freilich, Rivka Serruya, Yonina Pomper, and our entire team for representing SpecialtyRx with energy, knowledge, and heart. Your commitment to service and partnership truly shines.
We’re excited to be attending the 2025 Ohio Health Care Association Convention & Expo! 🎉
Stop by booth #325 to meet our team and learn how we’re redefining long-term care pharmacy services.
A huge shoutout to Purple Exhibits for our stunning new booth design — come see it in person! 💜
A big thank you to our incredible
SpecialtyRxFamily in Harrisburg, PA, for their amazing support at the recent Career Fair & Hiring Event! Your energy, professionalism, and passion for LTC care made a lasting impression on future healthcare heroes. We’re proud to have such dedicated partners on our team!
𝗦𝗣𝗘𝗖𝗜𝗔𝗟𝗧𝗬𝗥𝗫 𝗜𝗦 𝗢𝗣𝗘𝗡 𝗜𝗡 𝗧𝗘𝗫𝗔𝗦!
We are grateful to our incredible team that’s been working around the clock to get operations at our newest pharmacy in Austin, Texas off the ground!
Thanks to their dedication and hard work, we’re able to deliver world-class pharmacy services that the facilities and patients we serve have come to know and expect.
We are proud to be putting the SpecialtyRx mission into action in the lonestar state!
Thank you to everyone who made yesterday's Career Open House at our pharmacy in Harrisburg, PA, a success! We love networking and sharing why SpecialtyRx is the leader in long-term pharmacy care and a great place to work.
If you missed our event, you can still apply for open positions on our website srxltc.com or contact Yoamna M. directly.
Exciting News from Sweet Home Alabama! 🎉
We’re thrilled to have celebrated the official grand opening of our long-term care pharmacy in Cullman, Alabama! This milestone expands our world-class pharmacy services to approximately 2,500 people across Alabama and beyond.
At SpecialtyRx, we’re committed to providing personalized care and innovative solutions to improve the well-being and health of our community.
Thank you to Vice President of Operations Zack Ilarraza, Pharmacist in Charge Jennifer Conway and our incredible
SpecialtyRxFamily for making this goal a reality. Your dedication is the heart of our mission. And a special thank you to City of Cullman Mayor Woody Jacobs for joining us at our ribbon-cutting event!
Our team had a wonderful time at Ky. Assoc. of Health Care Facilities/Ky. Center for Assisted Living/Ky. Senior Living Assoc. Convention & Expo in Louisville!
Thank you to everyone who stopped by our booth to connect and learn more about SpecialtyRx's mission to provide world-class pharmacy services. We're excited to bring back new relationships and continue our commitment to excellence in patient care.
SpecialtyRx is out in full force at the Health Care Association of New Jersey (HCANJ) Annual Convention & Expo! We love getting together with other healthcare professionals to network and learn.
Be sure to visit us at booth 426!
What an amazing turnout at our Fall Kick-Off Job Event! It was a pleasure to meet so many candidates and showcase why SpecialtyRx is a great place to work! A special thank you to Pamela Armistead, Yoamna M. and the rest of our SpecialtyRxFamily in Ohio for helping to make this event a success!
If you missed the hiring event - you can apply for open positions on our website srxltc.com/#Careers
🎉🏥 Exciting News from the Heart of America! 🏥🎉
We are thrilled to announce the official grand opening of our long-term care pharmacy in the beautiful Commonwealth of Kentucky! This milestone is a testament to our commitment to delivering world-class pharmacy services, and we’re proud to expand our reach to help over 3,000 people across Kentucky and beyond.
At#SpecialtyRx, we’re dedicated to providing personalized care and innovative solutions to meet the unique needs of our community. Our goal is to ensure the well-being and health of every individual we serve and make a positive impact on their lives.
A special thank you goes out to Director of Operations Kyrillos Elsobky, Pharmacist in Charge Jason Newton, and the rest of our incredible hashtag#SpecialtyRxFamily whose tireless work and leadership have made this milestone a reality. You are the heart and soul of our mission, and we are grateful for each and every one of you. We couldn’t be prouder to celebrate this achievement together.
Here’s to a brighter, healthier future for all!
It was great to see everyone at PHCA's Annual Conference & Expo for in-person education and networking at Wind Creek Casino & Resort in Bethlehem, PA. hashtag#SpecialtyRx is proud to be a part of Pennsylvania's long-term care continuum, helping to improve patients' lives by providing top-notch pharmacy services.
Pennsylvania Health Care Association SpecialtyRx, Inc
