Presentation Outline ICHP Annual Meeting September 13-15

More documents

Recommendations

Info

Dabigatran vs. Rivaroxaban for AF? Dabigatran Rivaroxaban Main Trial RE‐LY1 ROCKET‐AF2 Patients in Trial Efficacy Compared to Warfarin •N=18,000; mean age 71; male 65% •CHADS‐2 score ≥3 (33%) •110mg twice daily: Non‐inferior (not approved) •150mg twice daily: Superior Renal Dosing CrCl 15‐30ml/min: 75mg twice daily, however, pts with CrCl
Puzzle # 2A: patient has just completed 6 months of warfarin therapy after an unprovoked distal deep vein thrombosis. What is your long term anticoagulation recommendation? 1. D/c all anticoagulants 2. Continue warfarin 3. Switch to aspirin 4. Switch to dabigatran 5. Order other diagnostic tests 6. Other 0% 0% 0% 0% 0% 0% 1 2 3 4 5 6 Making the case for halting anticoagulants or continuing warfarin • CHEST 2012 (3.1.4) – “In patients with unprovoked DVT of leg (distal or proximal), we recommend… at least 3 months over treatment of shorter duration. After 3 months …should be evaluated l t df for th the risk‐benefit ikb fitratio ti of f extended t d dth therapy” ” (1B) • CHEST 2012 (3.4) – “In patients with DVT of leg who receive extended therapy, we suggest treatment with the same anticoagulant chosen for the first 3 months” (2C) Making the case for transition to dabigatran • CHEST 2012 (remarks on section 3.3) – “Treatment of VTE with dabigatran or rivaroxaban, in addition to being less burdensome…may prove to be associated with better clinical outcomes” – PPostmarketing t k ti studies t di not t available il bl at t time ti of f guideline id li preparation • RE‐MEDY : dabigatran = warfarin in 6‐36 month extension but ↑ MI rate with dabigatran • RE‐SONATE: dabigatran > placebo in 6 month extension, no difference in MI rate • Both studies were presented as abstracts at International Society on Thrombosis and Haemostasis July 2011 2012 vs 2008: different answers? • CHEST 2008 – More generalized recommendations 2.1.1 provoked (transient risk factor) 2.1.2 unprovoked 2.1.3 concurrent malignancy 1. Kearon C, Kahn S, Agnelli G, et al. Antithrombotic therapy for venous thromboembolic disease. CHEST 2008; 133: 454S‐545S. • CHEST 2012 – Much more specific for patient subgroups 3.1.1: provoked proximal (surgery) 3.1.2: provoked proximal (transient risk factor) 3.1.3: any provoked distal 3.1.4(.1‐5): unprovoked (various) 3.1.5: concurrent malignancy Making the case for transition to aspirin • CHEST 2012: no mention of aspirin as an option in this context • WARFASA study (2012) – RCT of f 402 unprovoked kdVTE VTE patients ti t after ft 6‐18 6 18 months of VKA therapy – ASA 100mg daily vs placebo – ASA decreased DVT rate but no difference in PE 1. Becattini, et al. Aspirin for preventing recurrence of venous thromboembolism. N Engl J Med 2012; 366 (21): 1959‐67. Making the case for re‐evaluating objective testing • D‐Dimer – systematic review of 1 st unprovoked VTE • Negative result ~ 3.5% annual recurrence rate • Positive result ~ 8.9% annual recurrence rate • Verhovsek, et al. Ann Intern Med 2008; 149: 481‐490. • Venous doppler – mixed opinion pp p • Prandoni, et al: (+) residual thrombus = ↑ risk • PROLONG: (+) residual thrombus = not a risk factor • Prandoni, et al. Ann Intern Med 2002; 137: 955‐960. • Cosmi, et al. Eur J Vasc Endovasc Surg 2010; 39: 356‐365. • Thrombophilia screening • No evidence to support benefit of testing routinely • CHEST guidelines: do not address topic for duration of therapy 9/4/2012 7
Page 1 and 2:
ACTIVITY DESCRIPTION Target Audienc
Page 3 and 4:
Current Challenges • Expansion of
Page 5 and 6:
Examples of Medication Consideratio
Page 7 and 8:
Etiology (Dana Point, 2008) 1’. P
Page 9 and 10:
PAH Therapy Targets Schulze-Neick I
Page 11 and 12:
Chronic Adjuvant Therapies in PAH D
Page 13 and 14:
Cummulative suurvival Survival in I
Page 15 and 16:
ACCF/AHA Consensus PAH Treatment Al
Page 17 and 18:
Study Name Drug SUPER-1 Oral silden
Page 19 and 20:
IV Epoprostenol in PAH Due to Scler
Page 21 and 22:
70 60 50 40 30 20 10 Inhaled Ilopro
Page 23 and 24:
Conclusions • PAH therapy improve
Page 25 and 26:
ESC/ERS Guidelines Galie N, et al.
Page 27 and 28:
FUTURE DIRECTIONS WHICH MAY IMPACT
Page 29 and 30:
Rationale for “Front-Loaded” Ap
Page 31 and 32:
Addressing gthe Challenges g in PAH
Page 33 and 34:
Considerations • Central vs. peri
Page 35 and 36:
Pulmonary Hypertension • Approxim
Page 37 and 38:
Example Cassette Calculations • V
Page 39 and 40:
Assessment Question 1 Which of the
Page 41 and 42:
Illinois Council of Health‐System
Page 43 and 44:
Patient Activity ‐ 1 Patients in
Page 45 and 46:
Hospitalists National Trends • Ja
Page 47 and 48:
Pharmacy Landscape • PGY‐2: So
Page 49 and 50:
Primary Care Physicians by Field, F
Page 51 and 52:
Health Systems Pharmacy and TATAI
Page 53 and 54:
Readings The 21 Irrefutable Laws of
Page 55 and 56:
What is a “Practice Model”? •
Page 57 and 58:
Completing the Self Assessment •
Page 59 and 60:
Residency trained (B23p) Illinois N
Page 61 and 62:
Solving the PPMI Puzzle ‐ Here Ar
Page 63 and 64:
Overview of Value Based Purchasing
Page 65 and 66:
Implementation of Medication‐ rel
Page 67 and 68:
Question #1 Within which programs a
Page 69 and 70:
Solving the PPMI Puzzle‐ Here are
Page 71 and 72:
Discharge Education/Med Rec • New
Page 73 and 74:
Media‐Worthy Trials? Making Sense
Page 75 and 76:
Prevention of Recurrent VTE • Unp
Page 77 and 78:
VTE recurrence during study period
Page 79 and 80:
Which patient might be a candidate
Page 81 and 82:
Azithromycin and CV Death • Endpo
Page 83 and 84:
Azithromycin and CV Death Azithromy
Page 85 and 86:
Hormonal Contraception and VTE •
Page 87 and 88:
• Age • Calendar year • Educa
Page 89 and 90:
ARR=2.20, 2.28 for stroke, MI when
Page 91 and 92:
Which of the following combinations
Page 93 and 94:
3 Months of Treatment for Latent TB
Page 95 and 96:
3 Months of Treatment for Latent TB
Page 97 and 98:
T/F: Rifapentine in combination wit
Page 99 and 100:
2. Which of the following statement
Page 101 and 102:
Fitting the Counseling Piece into M
Page 103 and 104:
Current Evidence: Implementing Bund
Page 105 and 106:
Teach Back Process • Step 1 Expla
Page 107 and 108:
Questions for Consideration and Dis
Page 109 and 110:
Why do we care about ADE? • Adver
Page 111 and 112:
True or False • Medication errors
Page 113 and 114:
Check Point Which of the following
Page 115 and 116:
Proactive Screening Process Patient
Page 117 and 118:
MTI Pilot at NAH PharmD Students tr
Page 119 and 120:
ASHP PPMI Case Study Adding Value:
Page 121 and 122:
Interdisciplinary Teamwork: How Phy
Page 123 and 124:
Highly Effective Healthcare • Wha
Page 125 and 126:
Inter‐Professional Teams ‐ Chan
Page 127 and 128:
Meeting the PPMI Goals for Technolo
Page 129 and 130:
Drug‐Bug Mismatch Example Con’t
Page 131 and 132:
Drug‐Bug Mismatch Build Rules •
Page 133 and 134:
Page 135 and 136:
Patient Scanning Compliance Sample
Page 137 and 138:
Page 139 and 140:
Global Immunizations 3 • Jan 2012
Page 141 and 142:
Mobile Devices: Beyond Angry Birds
Page 143 and 144:
Google Play • Google Play - Inter
Page 145 and 146:
Other Useful Productivity Apps •
Page 147 and 148:
Mobile Devices: Beyond Angry Birds
Page 149 and 150:
Net Activations by Industry Source:
Page 151 and 152:
News Readers/Aggregators Features S
Page 153 and 154:
Contact Information • E‐mail: -
Page 155 and 156:
Early‐Onset Sepsis • Sign and s
Page 157 and 158:
• BR is on day 2 of cefotaxime wi
Page 159 and 160:
Immunizations: The Superheroes to P
Page 161 and 162:
Current ACIP Recommendations Influe
Page 163 and 164:
Herpes Zoster Vaccine Recommendatio
Page 165 and 166:
Assessment Questions 1. What are th
Page 167 and 168:
HIV Linkage and Retention in Care T
Page 169 and 170:
DHHS Guidelines, March 2012: When t
Page 171 and 172:
Protease Inhibitors • Require “
Page 173 and 174:
Mean Change (mg/ /dL) STARTMRK: Lip
Page 175 and 176:
RAL Drug Interactions • Does not
Page 177 and 178:
Instructions for Credit In order to
Page 179 and 180:
Staging Stage Criteria (Durie‐Sal
Page 181 and 182:
Salvage Therapy Partial List Regime
Page 183 and 184:
Bortezomib-Thalidomide-Dexamethason
Page 185 and 186:
Case 2 ST is a 76 y/o African Ameri
Page 187 and 188:
Thalidomide and Lenalidomide • Ad
Page 189 and 190:
Fixed Low-Dose Warfarin Study Thera
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 203 and 204:
Page 205 and 206:
Green Zone • Patient is not havin
Page 207 and 208:
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
Page 221 and 222:
NIAAA = best resource for alcohol d
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
Page 229 and 230:
Society of Regional Anesthesia Meet
Page 231 and 232:
A New Approach IV Acetaminophen •
Page 233 and 234:
References • Schechter, Leslie N.
Page 235 and 236:
Bupivacaine liposome injectable sus
Page 237 and 238: Error Potential • Inadvertent IV
Page 239 and 240: Decolonization Methods • Anti-sep
Page 241 and 242: Evidence: Inpatient ICU MRSA Coloni
Page 243 and 244: Residency Project Pearls Adherence
Page 245 and 246: 650 subjects id identified tifi d R
Page 247 and 248: Overtreatment versus Appropriate Tr
Page 249 and 250: Adherence to and Outcomes Associate
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
Page 257 and 258: Antibiotic Prophylaxis American Hea
Page 259 and 260: Study Limitations • Dependent on
Page 261 and 262: Study Background • Observation of
Page 263 and 264: A patient has a CrCl of 25 mL/min.
Page 265 and 266: • Cysteine hydrochloride: antioxi
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: What is “Consistently Stable?”
Page 291 and 292: What would you do for JJ? • A. Ho
Page 293 and 294: Considerations for SB • Bleeding
show all

Presentation Outline ICHP Annual Meeting September 13-15

Create successful ePaper yourself

Delete template?

Save as template?