Presentation Outline ICHP Annual Meeting September 13-15

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Key Pearls with Bridging • See patients at least one week prior to the scheduled surgery date to plan appropriately – Balance risks of VTE vs. perioperative bleeding – Communicate with patient and involved providers – Factor in other issues such as cost/insurance coverage, ability to inject • Make sure you have updated labs and weight (CrCl and CBC) Date Enoxaparin dose/frequency Warfarin dose SB‐ to bridge or not to bridge? • Bridge and hold warfarin x 5‐7 days prior • Not bridge and hold warfarin x 5‐7 days prior Key Pearls with Bridging • Provide patients and providers with a calendar • Patient and caregiver education on injection technique and calendar • If possible possible, check INR on the date before surgery • Assess post‐op bleeding to help determine restart of anticoagulant medications • Close follow up of INR following procedure/surgery Remember SB? • SB is a 92 y/o African American female with PMH of AF (diagnosed 2004), HTN, OA, PUD (ulcer 1960) and history of breast cancer. • SB will be undergoing a spinal epidural in two weeks and is wondering what to do. • She tells you that one of her friends had to take some sort of shots when off of warfarin and she is wondering if she needs to do this too? SB ‐ to bridge or not to bridge? A. Bridge and hold warfarin x 5‐7 days prior BB. Do not bridge and hold warfarin x 5‐7 days prior 0% 0% 1 2 9/4/2012 10
Considerations for SB • Bleeding risk – Age – Spinal procedure‐ risk of bleeding is high • Thrombosis risk – CHADS2 score of 2: HTN and age >75 y/o • Low risk‐ do not bridge. – Lots of discussion needed in these scenarios between patient, anticoagulation provider, PCP and other physicians involved! Piecing together the new CHEST guidelines g Erika Hellenbart, PharmD, BCPS Shaunte Pohl, PharmD, BCPS Brooke Griffin, PharmD Brian Cryder, PharmD, BCACP, CACP Kathleen Vest, PharmD, CDE 2. GM is a 66yo male who has atrial fibrillation and renal insufficiency (CrCl 25ml/min) He brings a prescription to your pharmacy for rivaroxaban. Which of the following is a true statement? a. GM should not use rivaroxaban because it is contraindicated in patients with CrCl
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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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Green Zone • Patient is not havin
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• A hormone produced by the pancr
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Unraveling Unraveling The The Puzzl
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The Reward Center In time, serious
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So what makes addicted pharmacists
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How to find a treatment center Onli
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Internet Drug Abuse Study conducted
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NIAAA = best resource for alcohol d
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Impact of Postoperative Pain • Pi
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Safety Profile • Amar et al confi
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References 1. Rømsing J, Møiniche
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Society of Regional Anesthesia Meet
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A New Approach IV Acetaminophen •
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References • Schechter, Leslie N.
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Bupivacaine liposome injectable sus
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Error Potential • Inadvertent IV
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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 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 and 288: What is “Consistently Stable?”
Page 289 and 290: Puzzle # 2A: patient has just compl
Page 291: What would you do for JJ? • A. Ho
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Presentation Outline ICHP Annual Meeting September 13-15

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