Presentation Outline ICHP Annual Meeting September 13-15

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Residency Project Pearls Prolonged Antibiotic Prophylaxis After Cardiovascular Implantable Electronic Device Implantation and Its Effect on Device‐Related Infections Background Natasha Lopez, PharmD, BCPS Critical Care Pharmacist Rush University Medical Center Chicago, IL • Cardiac implantable electronic device (CIED) infections have remained a major complication after implantation • The incidence of infection related to CIED implantation ranges from 0.<strong>13</strong>% to 19.9% • Variations in the populations and practices at different sites account for this range of incidence rates • With the expanded indications for CIED implantation and higher risk patient population receiving therapy, the prevention and management of CIED infections continues to be studied DiMarco, et al. NEJM. 2003;349:1836‐1847. Risk Factors Patient Factors Procedural Characteristics •Diabetes mellitus •Heart failure •Malignancy •Renal R lddysfunction f i (glomerular ( l l filtration rate
Antibiotic Prophylaxis American Heart Association (AHA) • Preoperative prophylaxis with an antibiotic that has in vitro activity against staphylococci should be administered (Level of Evidence: A) • Antimicrobial prophylaxis in the postoperative period is not recommended due to lack of evidence and risk of adverse drug events and antimicrobial resistance Baddour L, et al. Circulation. 2010;121:458‐477. Study Purpose • To determine if postoperative antibiotic prophylaxis with cephalexin administered for 72 hours reduces the incidence of infection in patients undergoing CIED procedure Research Hypothesis • There is no difference in the incidence of CIED infection between 72 hour postoperative cephalexin and no postoperative antibiotic regimens Methods‐ Outcomes Endpoint Primary Compare the incidence of CIED related infections between 72 hour postoperative cephalexin to no postoperative antibiotics Secondary •Identify the patient characteristics that correlated with the primary outcome •Time to infection Background • At Rush University Medical Center (RUMC), 72 hours of postoperative prophylactic antibiotics are used after CIED implantation • Currently no study has specifically examined the efficacy of postoperative antibiotic prophylaxis in this patient population Methods ‐ Design • Retrospective chart review – January 2007 – October 2011 • Single center, Rush University Medical Center – 673 bed, university affiliated medical center Methods‐ Patient Population Inclusion criteria Exclusion criteria • Age ≥ 18 and < 89 years • Documented penicillin and/or cephalosporin allergy • Recipients of a new, upgrade, generator replacement revision or lead revision of CIED • Received antibiotics for another iindication di ti prior i to t CIED •Received preoperative antibiotics with cefazolin prior to CIED procedure • Pregnancy • Patients who underwent thoracotomy with implantation 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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Bortezomib-Thalidomide-Dexamethason
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Case 2 ST is a 76 y/o African Ameri
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Thalidomide and Lenalidomide • Ad
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Fixed Low-Dose Warfarin Study Thera
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New Drugs 2012 Anna Nowobilski‐Va
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Pulmonology » Cystic Fibrosis •
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Oncology » MTX Toxicity • MTX 1o
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NEW DRUGS AND BIOLOGICALS 2012 RESO
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Disease State Reviews for Pharmacy
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Chronic Obstructive Pulmonary Disea
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Disease State Reviews for Pharmacy
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Page 207 and 208: Disease State Reviews for Pharmacy
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
Page 217 and 218: How to find a treatment center Onli
Page 219 and 220: Internet Drug Abuse Study conducted
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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 and 234: References • Schechter, Leslie N.
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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 247 and 248: Overtreatment versus Appropriate Tr
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Page 251 and 252: Background • Lack of comprehensiv
Page 253 and 254: Results Results‐User User Audits
Page 255: Special thanks to: • Carol Heunis
Page 259 and 260: Study Limitations • Dependent on
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Page 267 and 268: Sample Preparation • Intravenous
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
Page 277 and 278: CV: The key to a top curriculum vit
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
Page 285 and 286: Initiating therapy CHEST 2012 2.1.8
Page 287 and 288: What is “Consistently Stable?”
Page 289 and 290: Puzzle # 2A: patient has just compl
Page 291 and 292: What would you do for JJ? • A. Ho
Page 293 and 294: Considerations for SB • Bleeding
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Presentation Outline ICHP Annual Meeting September 13-15

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