Presentation Outline ICHP Annual Meeting September 13-15

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• Trained nurses – Programming rates – Alarms – Priming lines – Monitoring Administration/Nursing • Miscellaneous – Secondary means of IV access – Do not interrupt infusion – Do not FLUSH line, single lumen preferred – No other medications should be administered through the same line – Do not change dose based on daily weights Home Training • Training – Disease state – Mixing, documented mixing partner, aseptic technique, quiet area – Pump use, titrations, alarms – Drug and supply distribution – Extra supply – Signs and symptoms of too much/too little medication • When to call • Specialty RN determines when safe to go home • Mar 10: HOME!! Questions? Specialty Pharmacy Training • Training typically started prior to initiation • Safety screen/cleanliness – Patients generally not send to SNF • MMar 9 and d 10 10: specialty iltpharmacy h training t i i Home Therapy • Example: SQ treprostinil titration protocol • 63.6kg Dose ng/hr Conc (mg/mL) Rate Syringe volume (mL) 15.5ng/kg/min g g 59,148 , 2.5 0.024mL/hr 1.8mL 17ng/kg/min 64,872 2.5 0.026mL/hr 1.9mL 18.5ng/kg/min 70,596 2.5 0.028mL/hr 2.1mL 19.5ng/kg/min 74,412 2.5 0.030mL/hr 2.2mL 21ng/kg/min 80,136 2.5 0.032mL/hr 2.4mL 22ng/kg/min 83,952 2.5 0.034mL/hr 2.5mL 23ng/kg/min 87,768 5 0.018mL/hr 1.3mL 24ng/kg/min 91,584 5 0.018mL/hr 1.4mL 26ng/kg/min 99,216 5 0.020mL/hr 1.5mL References 1. McLaughlin VV, Archer SL, Badesch DB, et al. ACCF/AHA 2009 expert consensus document on pulmonary hypertension: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. J Am Coll Cardiol 2009;53:1573–619. 2. Farber HW, Loscalzo J. Pulmonary Arterial Hypertension. N Engl J Med 2004; 351:1655‐65. 3. Flolan [package insert]. Research Triangle Park, NC: GlaxoSmithKline; 2011. 4. Remodulin [package insert]. Research Triangle Park, NC: GlaxoSmithKline; 2011. 5 Veletri [package insert] South San Francisco CA : Actelion Pharmaceuticals US Inc 5. Veletri [package insert]. South San Francisco, CA : Actelion Pharmaceuticals US Inc. 6. Sitbon O, Manes A, Jais X, et al. Rapid switch from intravenous epoprostenol to intravenous treprostinil in patients with pulmonary arterial hypertension. J Cardiovasc Pharmacol. 2007 Jan;49(1):1‐5. 7. Gomberg‐Maitland M, Tapson VF, Benza RL. Transition from intravenous epoprostenol to intravenous treprostinil in pulmonary hypertension. Am J Respir Crit Care Med 2005; 172:1586–89. 8. Rubenfire M, McLaughlin VV, Allen RP, et al . Transition from IV epoprostenol to subcutaneous treprostinil in pulmonary arterial hypertension. Chest 2007; 132:757‐763 8/29/2012 5
Assessment Question 1 Which of the following is NOT true regarding injectable epoprostenol? A. Half life ̃6mins B. Can be administered SQ C. Requires 24h cassette changes with the CADD pump. Assessment Question 3 Which of the folloiwng are potential complications of IV treprostinil use? A. Infected lines B. Calculation errors C. Flushing the line it is infusing in D. All of the above Assessment Question 2 Which of the following should NOT change throughout a patient’s course of therapy? A. Dosing weight B. Drug concentration C. Dose 8/29/2012 6
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: Example Cassette Calculations • V
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
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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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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
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CV: The key to a top curriculum vit
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Tips for a Top Notch CV • Focus o
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What is PhORCAS? • PhORCAS is the
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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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