Presentation Outline ICHP Annual Meeting September 13-15

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Decisions, Decisions…Debates in Therapeutics Bupivacaine liposomal injection Will it stick ti k around? d? Elizabeth Short, Pharm.D. PGY2 Critical Care Northwestern Memorial Hospital Additional Goals • Determine criteria necessary for formulary approval • Interpret clinical trial data and apply to formulary management • Efficacy • Safety Formulary Criteria • Avoid superfluous, expensive additions Conflicts • I have no conflicts of interest to declare Bupivacaine liposome injectable suspension (Exparel) Approved Indication: FFor administration d i i t ti iinto t th the surgical i lsite it tto produce postsurgical analgesia1 1. http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=59067 http://www.drugdevelopment‐technology.com/projects/6855/images/<strong>13</strong>8835/large/1‐bottle.jpg Bupivacaine liposome injectable suspension (Exparel) • Pacira Pharmaceuticals, Inc. • FDA Approval: October, 2011 • Intended to provide longer duration of effect 8/29/2012 1
Bupivacaine liposome injectable suspension (Exparel) Multivesicular Liposomes http://www.exparel.com/images/exparel_how_to_use.jpg Efficacy Primary efficacy endpoint: Pain intensity score summation over time Percentage of Patients Pain‐free vs Hours Golf, et al. Adv Ther. 2011;28:776-88 Liposomal bupivacaine 120 mg Placebo FDA Approval Based on two clinical trials • Bunionectomy (Golf 2011) • Hemorrhoidectomy (Gorfine 2011) Golf, et al. Adv Ther. 2011;28:776-88 Gorfine et al. Dis Colon Rectum. 2011;54:<strong>15</strong>52-9. Efficacy Primary efficacy endpoint: Pain intensity score summation over time No benefit beyond 24 hours No Opioid Rescue Medications vs Hours Golf, et al. Adv Ther. 2011;28:776-88 Liposomal bupivacaine 120 mg Placebo 8/29/2012 2
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ACTIVITY DESCRIPTION Target Audienc
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Current Challenges • Expansion of
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Examples of Medication Consideratio
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Etiology (Dana Point, 2008) 1’. P
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PAH Therapy Targets Schulze-Neick I
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Chronic Adjuvant Therapies in PAH D
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Cummulative suurvival Survival in I
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ACCF/AHA Consensus PAH Treatment Al
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Study Name Drug SUPER-1 Oral silden
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IV Epoprostenol in PAH Due to Scler
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70 60 50 40 30 20 10 Inhaled Ilopro
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Conclusions • PAH therapy improve
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ESC/ERS Guidelines Galie N, et al.
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FUTURE DIRECTIONS WHICH MAY IMPACT
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Rationale for “Front-Loaded” Ap
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Addressing gthe Challenges g in PAH
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Considerations • Central vs. peri
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Pulmonary Hypertension • Approxim
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Example Cassette Calculations • V
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Assessment Question 1 Which of the
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Illinois Council of Health‐System
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Patient Activity ‐ 1 Patients in
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Hospitalists National Trends • Ja
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Pharmacy Landscape • PGY‐2: So
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Primary Care Physicians by Field, F
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Health Systems Pharmacy and TATAI
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Readings The 21 Irrefutable Laws of
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What is a “Practice Model”? •
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Completing the Self Assessment •
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Residency trained (B23p) Illinois N
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Solving the PPMI Puzzle ‐ Here Ar
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Overview of Value Based Purchasing
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Implementation of Medication‐ rel
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Question #1 Within which programs a
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Solving the PPMI Puzzle‐ Here are
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Discharge Education/Med Rec • New
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Media‐Worthy Trials? Making Sense
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Prevention of Recurrent VTE • Unp
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VTE recurrence during study period
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Which patient might be a candidate
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Azithromycin and CV Death • Endpo
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Azithromycin and CV Death Azithromy
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Hormonal Contraception and VTE •
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• Age • Calendar year • Educa
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ARR=2.20, 2.28 for stroke, MI when
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Which of the following combinations
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3 Months of Treatment for Latent TB
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3 Months of Treatment for Latent TB
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T/F: Rifapentine in combination wit
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2. Which of the following statement
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Fitting the Counseling Piece into M
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Current Evidence: Implementing Bund
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Teach Back Process • Step 1 Expla
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Questions for Consideration and Dis
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Why do we care about ADE? • Adver
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True or False • Medication errors
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Check Point Which of the following
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Proactive Screening Process Patient
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MTI Pilot at NAH PharmD Students tr
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ASHP PPMI Case Study Adding Value:
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Interdisciplinary Teamwork: How Phy
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Highly Effective Healthcare • Wha
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Inter‐Professional Teams ‐ Chan
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Meeting the PPMI Goals for Technolo
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Drug‐Bug Mismatch Example Con’t
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Drug‐Bug Mismatch Build Rules •
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Patient Scanning Compliance Sample
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Global Immunizations 3 • Jan 2012
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Mobile Devices: Beyond Angry Birds
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Google Play • Google Play - Inter
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Other Useful Productivity Apps •
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Mobile Devices: Beyond Angry Birds
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Net Activations by Industry Source:
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News Readers/Aggregators Features S
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Contact Information • E‐mail: -
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Early‐Onset Sepsis • Sign and s
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• BR is on day 2 of cefotaxime wi
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Immunizations: The Superheroes to P
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Current ACIP Recommendations Influe
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Herpes Zoster Vaccine Recommendatio
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Assessment Questions 1. What are th
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HIV Linkage and Retention in Care T
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DHHS Guidelines, March 2012: When t
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Protease Inhibitors • Require “
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Mean Change (mg/ /dL) STARTMRK: Lip
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RAL Drug Interactions • Does not
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Instructions for Credit In order to
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Staging Stage Criteria (Durie‐Sal
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Salvage Therapy Partial List Regime
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Page 191 and 192: New Drugs 2012 Anna Nowobilski‐Va
Page 193 and 194: Pulmonology » Cystic Fibrosis •
Page 195 and 196: Oncology » MTX Toxicity • MTX 1o
Page 197 and 198: NEW DRUGS AND BIOLOGICALS 2012 RESO
Page 199 and 200: Disease State Reviews for Pharmacy
Page 201 and 202: Chronic Obstructive Pulmonary Disea
Page 205 and 206: Green Zone • Patient is not havin
Page 209 and 210: • A hormone produced by the pancr
Page 211 and 212: Unraveling Unraveling The The Puzzl
Page 213 and 214: The Reward Center In time, serious
Page 215 and 216: So what makes addicted pharmacists
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Page 223 and 224: Impact of Postoperative Pain • Pi
Page 225 and 226: Safety Profile • Amar et al confi
Page 227 and 228: References 1. Rømsing J, Møiniche
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Page 231 and 232: A New Approach IV Acetaminophen •
Page 233: References • Schechter, Leslie N.
Page 237 and 238: Error Potential • Inadvertent IV
Page 239 and 240: Decolonization Methods • Anti-sep
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Page 243 and 244: Residency Project Pearls Adherence
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Page 251 and 252: Background • Lack of comprehensiv
Page 253 and 254: Results Results‐User User Audits
Page 255 and 256: Special thanks to: • Carol Heunis
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Page 269 and 270: Questions? Residency Project Pearls
Page 271 and 272: The Interview: Your Preparation •
Page 273 and 274: PGY1 Residency Options Carol Heunis
Page 275 and 276: RESIDENCY PROGRAM BASICS • Progra
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Page 279 and 280: Tips for a Top Notch CV • Focus o
Page 281 and 282: What is PhORCAS? • PhORCAS is the
Page 283 and 284: Piecing together the new CHEST guid
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Initiating therapy CHEST 2012 2.1.8
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What is “Consistently Stable?”
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Puzzle # 2A: patient has just compl
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What would you do for JJ? • A. Ho
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Considerations for SB • Bleeding
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Presentation Outline ICHP Annual Meeting September 13-15

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