Presentation Outline ICHP Annual Meeting September 13-15

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Options in Action: A Case‐Based Approach to Pulmonary Hypertension Kimberly Ackerbauer, PharmD, BCPS Clinical Pharmacy Specialist, Cardiac Intensive Care Unit Rush University Medical Center September 13, 2012 Objectives • Describe key elements to ensure safe and effective use of injectable agents to manage pulmonary hypertension • List steps involved in transitioning a patient from hospital p to home Additional Goals • Review differences between injectable prostacyclin therapies • Recognize potential complications associated with preparation and administration Pulmonary Hypertension • Pulmonary hypertension is a syndrome resulting in increased blood pressure in the pulmonary arteries which eventually leads to right sided heart failure • Hemodynamic definition: Mean pulmonary artery pressure >25mmHg with pulmonary capillary wedge pressure ≤15mmHg http://www.hwcrc.org/Health/Disease/circulatory%20system.htm Conflict of Interest • No conflicts of interest to disclose DW: Presents to Hospital • Chief Complaint: Shortness of breath and lower extremity edema x 2 days • History of Present Illness: DW is a 51 year old F with a past medical history significant for idiopathic pulmonary hypertension with symptoms of right heart failure. She presents to the ED with shortness of breath with minimal exertion and also notes lower extremity edema. She denies fever or other infectious symptoms. • Past Medical History: Idiopathic pulmonary hypertension Diabetes mellitus • Medications: –Metformin 1000mg BID –Sildenafil 20 mg q8h –Digoxin 125mcg daily –Furosemide 40mg daily WHO Classification I. Primary Pulmonary Arterial Hypertension • Idiopathic, familial, connective tissue disorders, HIV, portal hypertension, toxins, etc II. Associated with left heart disease III. Associated with lung g disease • COPD, interstitial lung disease, etc IV. Chronic thrombotic or embolic disease V. Miscellaneous • Sarcoidosis, compression of pulmonary vessels, etc 8/29/2012 1
Pulmonary Hypertension • Approximately 15% mortality within 1 yr on modern therapy 1 • Predictors of a poor prognosis: • Advanced functional class (NYHA Functional classes) • Measured by 6‐minute walk test (20mmHg • Low cardiac index
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: Considerations • Central vs. peri
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
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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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Page 139 and 140:
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
Page 167 and 168:
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
Page 191 and 192:
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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Page 205 and 206:
Green Zone • Patient is not havin
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Page 209 and 210:
• A hormone produced by the pancr
Page 211 and 212:
Unraveling Unraveling The The Puzzl
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The Reward Center In time, serious
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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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NIAAA = best resource for alcohol d
Page 223 and 224:
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
Page 231 and 232:
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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Evidence: Inpatient ICU MRSA Coloni
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Residency Project Pearls Adherence
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650 subjects id identified tifi d R
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Overtreatment versus Appropriate Tr
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Adherence to and Outcomes Associate
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Background • Lack of comprehensiv
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Results Results‐User User Audits
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Special thanks to: • Carol Heunis
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Antibiotic Prophylaxis American Hea
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Study Limitations • Dependent on
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Study Background • Observation of
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A patient has a CrCl of 25 mL/min.
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• Cysteine hydrochloride: antioxi
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Sample Preparation • Intravenous
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Questions? Residency Project Pearls
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The Interview: Your Preparation •
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PGY1 Residency Options Carol Heunis
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RESIDENCY PROGRAM BASICS • Progra
Page 277 and 278:
CV: The key to a top curriculum vit
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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
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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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