Message from the Chair Sarah Anderson, Pharm.D., BCPS

Inside This Issue:

-Highlights from the 2016 ACCP Annual Meeting

-Dual Antiplatelet Therapy Duration after Cardiac Stent Placement or Acute Coronary Syndrome: How Long is Long Enough?

-The Use of Direct Oral Anticoagulants in Special Populations

-Member Accomplishments and Publications

Editor: Leigh Anne Hylton Gravatt, PharmD, BCPS

Adult Medicine PRN Newsletter

“When you’re engaged in what you love to do, it’s like driving in the fast lane. Time flies by and more roads open up to you, alternate routes you

may not have even known existed.” – T. Harv Eker As I reflect on the past year as chair of the Adult Medicine PRN, I feel like we’ve been driving in the fast lane, taken a few “scenic routes,” and have now arrived at another annual meeting. The protocol for the Adult Medicine PRN-sponsored survey to characterize pharmacist-hospitalist collaborations was finalized this summer and as of this newsletter has been reviewed by the ACCP Practice-Based Research Network (PBRN). Co-primary investigators Jacky Olin and Antoine Jenkins and the research team are engaged in completing next steps in the process to bring the research project to fruition. We are hopeful that we will have the project ready to launch at the annual meeting.

In a related effort, the Adult Medicine PBRN Research Committee has met several times since this spring and has a year-end goal of creating a dynamic Google Doc to link to the Adult Medicine PRN website that will serve as a forum for research idea discussion and identification of collaborators. This committee will maintain the document and review it for study ideas that the Adult Medicine PRN wants to support moving forward. As we continue to make strides in advancing the research mission of our PRN and of ACCP as a whole, I invite you to get involved and make this a PRN-wide collaboration.

I continue to be amazed by the efforts and dedication of all of our members involved in committee work. I would like to sincerely thank the Archives, Newsletter, Nominations, PBRN Research, Programming, Training & Travel, and Walk-Rounds committees and committee chairs/co-chairs for all of their service and work over the past year. We have been fortunate to have both veteran and new committee members working side-by-side on each of these committees. If you are interested in joining a committee, we will have opportunities for you to learn more about each committee and to sign up at our Adult Medicine PRN business meeting in Hollywood, Florida on Monday, October 24th from 6-9pm in Great Hall 6. Our Adult Medicine PRN Focus Session entitled, “An Update to the Management of Acute Bacterial Skin and Skin Structure Infections: What is the Utility of the New Agents?” will take place on Monday, October 24th from 1:30-3:00pm EDT in Great Halls 1 & 2. Please attend to learn all about this topic and support the efforts of our programming committee and outstanding speakers! As we approach another annual meeting, I would like to again personally thank all of the Adult Medicine PRN officers for their leadership, encouragement, and positivity. I would also like to thank all of our members for their involvement and dedication. It is a rewarding experience to see so many outstanding practitioners devote their time to advancing the causes of our PRN and doing so in a such an effective manner. As a PRN we are fortunate to have a large membership and high engagement from our constituents. I know that together we can accomplish great things in moving our PRN, ACCP, and our profession forward!

ACCP Adult Medicine PRN, Fall Newsletter Volume 11, Issue 2

Resident and Student Travel Awards

Ryan Owens, PharmD

2016 Resident Research Travel Award

“Heart Rate Control as a Marker of Beta-Blocker Efficacy in Hospitalized Heart Failure Patients”

Emily Shor

2016 Student Research Travel Award

“Validation of Vancomycin Dosing

Strategy in Patients with Morbid Obesity”

ACCP Annual Meeting Awards

Asha Tata, PharmD, BCPS

2016 Adult Medicine PRN Mentor Award

Kurt Wargo, PharmD, BCPS, FCCP

2016 Adult Medicine PRN Outstanding Paper

Award

Wargo KA, McCreary EK, English TM.

Vancomycin combined with clindamycin for the

treatment of acute bacterial skin and skin-

structure infections. Clin

Jacqueline Olin, PharmD, BCPS, FASHP, FCCP

2016 Adult Medicine PRN Service

Appreciation Award

Important Dates for Adult Medicine PRN

-November 30th 2016: Nominations for Fall 2017 awards (Clinical Practice, Education, Russell R. Miller and Elenbaas Service Awards, the 2018 Therapeutic Frontiers Lecture and the 2018 elected offices

-February 15th 2017: Nominations for the 2017 new awards (New Clinical Practitioner, New Educator, New Investigator), 2017 Parker Medal and the 2017 ACCP Fellows (FCCPs)

- February 17-19th 2017: ACCP Updates in Therapeutics, Jacksonville FL. http://www.updatesintherapeutics.com/

- October 7-10th 2017: ACCP Annual Meeting, Phoenix Arizona.

PRN Volunteer and Research Opportunities

Looking to get involved in the Adult Medicine PRN? Click HERE to fill out this google survey with your information.

We are looking to increase our ability to have research collaboration within our PRN,

3

Dual Antiplatelet Therapy Duration after Cardiac Stent Placement or Acute Coronary Syndrome: How Long is Long Enough?

Taryn B. Bainum, Pharm.D., BCPS, David G. Brabham, DO

Cardiovascular disease results in over 2,150 deaths each day in the United States, averaging out to approximately 1 death every 40 seconds according to 2011 data from the American Heart Association. It has been estimated that roughly 635,000 Americans have a coronary attack each year and 300,000 of these patients will have recurrent attacks. These acute coronary syndromes (ACS) and coronary artery disease (CAD) events often result in a cardiovascular procedure or operation. The number of cardiovascular procedures increased by 28% from 2000 to 2010, highlighting the need for optimal treatment for these common disease states.1

Dual antiplatelet therapy (DAPT) is used to reduce thrombotic complications associated with ACS and cardiac stent implantation as well as to reduce atherothrombotic events. Dual antiplatelet therapy generally consists of an aspirin in addition to an oral P2Y12 receptor inhibitor such as clopidogrel, ticagrelor, or prasugrel. While the combination of these medications has been shown to reduce cardiovascular events in patients following an acute coronary syndrome or stent placement2-4, the duration of this therapy has been widely debated.

This year the American College of Cardiology and American Heart Association published an updated guideline regarding the duration of dual antiplatelet therapy in patients with CAD. The recommendations published in these guidelines are presented in Table 1.5 The guideline addresses the duration of DAPT in several clinical situations in addition to recommending to utilize aspirin long-term at a dose of 75-100 mg daily rather than a higher dose of aspirin due to comparable ischemic protection and lower bleeding risks.6

Eleven randomized controlled trials were assessed to determine the optimal duration of DAPT following stent implantation, most of which focused on drug-eluting stents (DES). The DAPT trial was the largest of these, evaluating 9,961 patients. This trial was designed to assess superiority of 30 months of DAPT over 12 months after the placement of newer generation DES. The longer duration of DAPT was shown to reduce the rate of stent thrombosis, major adverse cardiac cerebrovascular events (MACCE), and myocardial infarction (MI) significantly, but was associated with significantly increased rates of moderate or severe bleeding and borderline increased mortality.7,6 Upon further study, the number of cancer-related deaths was found to be significantly different between groups and subsequently it was discovered that the more cancer patients had been enrolled into the longer DAPT duration arm.7 The guideline states a number of writing group members did not believe the data suggests increased mortality is associated with DAPT. Because the data on this subject is conflicting, clinicians are urged to evaluate patients based on factors such as the patient’s bleeding risk, tolerance of DAPT after the minimum suggested time period, and concomitant medications such as anticoagulants.5

A new risk score from the Dual Antiplatelet Therapy Study, the “DAPT score,” may be useful in determining the risk/benefit ratio of prolonged DAPT therapy in patients following coronary stent implantation. Data from this study suggests that a DAPT score of ≥ 2 after 1 year of treatment with aspirin and a P2Y12 inhibitor indicates a favorable benefit/risk ratio whereas a score of < 2 may indicate the potential benefits of prolonged DAPT therapy do not outweigh the risks.5,8 This score illustrates that younger patients are at a lower risk of bleeding and patients with prior history of ACS, or other cardiac risk factors results in a high score, are more likely to experience prevention of an ischemic event than bleeding. A study evaluating this score showed the number needed to treat in order to prevent an ischemic event for patients with a DAPT score ≥ 2 is 34 while the number needed to harm with a bleeding event was 272. Conversely for patients with a score less than 2, the number needed to prevent an ischemic event was 153 and the number needed to harm was 64. The DAPT score is shown in Table 2.5,8

ACCP Adult Medicine PRN, Fall Newsletter Volume 11, Issue 2

DAPT, cont.

Table 1. American College of Cardiology and American Heart Association Guidelines on DAPT

Clinical Presentation Recommendation Level of Evidence

SIHD following DES implantation DAPT for at least 6 months Class I B-R: Strong recommendation,

moderate-quality evidence RCTs/meta-

analyses

SIHD following BMS implantation DAPT for at least 1 month Class I A: Strong recommendation, high-

quality evidence from RCTs/meta-analyses

SIHD with DES/BMS implantation at low

risk for bleeding

DAPT for > 6 months (DES) or > 1

month (BMS) may be reasonable

Class IIb A: Weak recommendation, high-

quality evidence from RCTs/meta-analyses

SIHD with DES/BMS implantation at high

risk of bleeding or development of

bleeding

May be reasonable to discontinue

P2Y12 inhibitor after 3 months

Class IIb C-LD: Weak recommendation,

limited data

ACS following DES/BMS implantation DAPT for at least 12 months Class I B-R: Strong recommendation,

moderate-quality evidence RCTs/meta-

analyses

ACS treated with medical therapy alone DAPT for at least 12 months Class I B-R: Strong recommendation,

moderate-quality evidence RCTs/meta-

analyses

ACS following DES/BMS implantation at

low risk for bleeding

DAPT for > 12 months may be

reasonable

Class IIb ASR: Weak recommendation,

high-quality systematic review

ACS treated with medical therapy at low

risk for bleeding

DAPT for > 12 months may be

reasonable

Class IIb ASR: Weak recommendation,

high-quality systematic review

ACS following DES/BMS implantation at

high risk or bleeding or development of

bleeding

May be reasonable to discontinue

P2Y12 inhibitor after 6 months

Class IIb C-LD: Weak recommendation,

limited data

ACS requiring CABG DAPT should be resumed after

CABG to complete 12 months

Class I C-LD: Strong recommendation,

limited data

STEMI treated with fibrinolytic therapy DAPT should be continued for a

minimum of 14 days, ideally 12

months

Class I A/C-EO: Strong recommendation,

high-quality RCTs/meta-analyses and

expert opinion

STEMI treated with fibrinolytic therapy at

low risk for bleeding

DAPT for > 12 months may be

reasonable

Class IIb ASR: Weak recommendation,

high-quality systematic review

SIHD = stable ischemic heart disease RCT= randomized controlled trial CABG= coronary artery syndrome DES = drug-eluting stent BMS= bare-metal stent STEMI= ST elevation myocardial infarction

5

DAPT, cont.

Table 2

Variable Points

Age 75 years -2

Age 65 to <75 years -1

Age < 65 years 0

Current cigarette smoker 1

Diabetes mellitus 1

MI at presentation 1

Prior PCI or prior MI 1

Stent diameter < 3 mm 1

Paclitaxel-eluting stent 1

CHF or LVEF <30% 2

Saphenous vein graft PCI 2

MI = myocardial infarction PCI = percutaneous coronary intervention CHF = congestive heart failure LVEF = left ventricular ejection fraction The benefit/risk ratio for prolonged DAPT seems to be more favorable in patients with prior ACS than those with SIHD.5 An ACS event places patients at an increased risk for having another event, particularly within the first year.2 This risk can persist for several years, however it is not known how long the risk is present to warrant DAPT and the potential complications associated with this therapy. Recently the PEGASUS-TIMI 54 trial was published examining the benefit of extended DAPT with ticagrelor in patients who had an MI 1-3 years prior to enrollment. The median duration of follow-up was 33 months. Patients were randomized to receive ticagrelor 60 mg twice daily, ticagrelor 90 mg twice daily, or placebo in addition to aspirin therapy. The primary endpoint was a composite of cardiovascular death, myocardial infarction, or stroke. The 60 mg dose of ticagrelor significantly reduced the primary endpoint, in addition to several secondary endpoints, however TIMI minor and major bleeding were increased as well. There was no significant difference in rates of fatal bleeding or nonfatal intracranial hemorrhage. Dyspnea, which has been associated with ticagrelor in other studies, was increased when compared to placebo.10 Overall the study suggest there may be benefit with regard to reduced ischemic events, however this comes with increased risk of bleeding.

The ACC/AHA guidelines have incorporated data from recent trials into their recommendations for duration of DAPT, but they also encourage clinicians to use their judgment to determine which patients might benefit from prolonged therapy and which should have DAPT discontinued after the minimum suggested timeframe. Until more trials evaluate this issue the optimal duration of DAPT is still uncertain. The patient’s individual risk for ischemic events and bleeding events remains the most important factor when making the decision to continue DAPT past the minimum suggested duration.

References:

1. Mozaffarian D, Benjamin EJ, Go AS, et al. Heart Disease and stroke statistics—2015 update: a report from the American Heart Association. Circulation. 2015;131(4):e29-322. 2. Yusuf S, Zhao F, Mehta SR, et al. Effects of Clopidogrel in Addition to Aspirin in Patients with Acute Coronary Syndromes without ST-Segment Elevation. N Engl J Med. 2001;345(7):494-502. 3. Sabatine MS, Cannon CP, Gibson CM, et al. Addition of clopidogrel to aspirin and fibrinolytic therapy for myocardial infarction with ST-segment elevation. N Engl J Med. 2005;352(12):1179-89. 4. ten Berg JM, Plokker HT, Verheugt FW. Antiplatelet and anticoagulant therapy in elective percutaneous coronary intervention. Curr Control Trials Cardiovasc Med. 2001;2(3):129-140. 5. Levine, GN, Bates ER, Bittl JA, et al. 2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2016; pii: S0735-1097(16)01699-5. doi: 10.1016/j.jacc.2016.03.513. [Epub ahead of print] 6. Bittl JA, Barber U, Bradley SM, Wijeysundera DN. Duration of Dual Antiplatelet Therapy: A Systematic Review for the 2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2016; pii: CIR.0000000000000405. [Epub ahead of print]. 7. Mauri L, Kereiakes DJ, Yeh RW, et al. Twelve or 30 months of dual antiplatelet therapy after drug-eluting stents. N Engl J Med. 2014;371(23):2155-66. 8. Yeh RW, Secemsky E, Kereiakes DJ, et al. Development and validation of a prediction rule for benefit and harm of dual antiplatelet therapy beyond one year after percutaneous coronary intervention: an analysis from the randomized Dual Antiplatelet Therapy Study. JAMA. In Press. 9. Kereiakes DJ, Yeh RW, Massaro JM, et al. DAPT Score Utility for Risk Prediction in Patients With or Without Previous Myocardial Infarction. J Am Coll Cardiol. 2016; pii: S0735-1097(16)01599-0. doi: 10.1016/j.jacc.2016.03.485. [Epub ahead of print]. 10. Bonaca MP, Braunwald E, Sabatine MS, et al. Long-Term Use of Ticagrelor in Patients with Prior Myocardial Infarction. N Engl J Med. 2015;373(13):1274-5.

ACCP Adult Medicine PRN, Fall Newsletter Volume 11, Issue 2

Direct oral anticoagulant agents, also known as DOACs, have revolutionized the world of anticoagulation. The DOACs have been shown to be favorable over warfarin due to the need for less monitoring, fewer food and drug interactions, fixed dosing and less inter-patient variability.1 Agents currently on the market include rivaroxaban (Xarelto®), apixaban (Eliquis®), dabigatran (Pradaxa®) and edoxaban (Savaysa®). Rivaroxaban, apixaban and dabigatran are indicated for treatment of venous thromboembolisms (VTE), VTE prophylaxis following orthopedic surgery, and non-valvular atrial fibrillation.2,3,4 Edoxaban is currently only approved for treatment of VTE and non-valvular atrial fibrillation.5

The 2016 CHEST guidelines for Antithrombotic Therapy for VTE Disease have updated recommendations regarding the use of DOACs for treatment of VTE for the first time since 2012.6,7 The panel now recommends rivaroxaban, apixaban, dabigatran, or edoxaban over vitamin K antagonists (VKAs) and low-molecular weight heparin (LMWH) for initial and long-term treatment of deep vein thrombosis (DVT) or pulmonary embolism (PE) in patients without cancer (grade 2B recommendation). The panel’s overall assessment is that DOACs have a similar VTE risk reduction to warfarin with a reduced risk for bleeding, with apixaban possibly having the lowest bleeding risk.7

Populations included in DOAC clinical trials do not reflect patients at extremes of weight or those with renal dysfunction. With the new CHEST guideline recommendations, the question of whether DOACs can be used in a broader population will inevitably arise.

The literature is void of specific investigations of DOACs in an obese population (obesity defined as a BMI ≥ 30 kg/m2) via a large, randomized trial. Phase III efficacy and safety trials did not completely exclude this population, although studies included varying numbers of obese patients and weight categories (Table 1).9-20 The mean weight of patients receiving DOACs was between 82 kg and 86.1 kg, and only some of the trials stratified patients based on weight category. The RECOVER II (dabigatran vs. warfarin for VTE treatment) trial did include a large number of patients with a BMI ≥ 35 (23.6%) and furthermore those ≥ 100 kg (34.2%). In this analysis, the dabigatran weight subgroup of > 100 kg was more likely to experience a primary outcome (VTE) than those weighing 50-100 kg.11 In other phase III efficacy trials, DOACs were similar to warfarin in the prevention of VTE and stroke in higher weight categories.9 These studies were not consistent in the weight categories analyzed for efficacy, not adequately powered to detect differences in thrombosis or bleeding in these subgroups and they did not include individuals at the very extreme of increased weight, such as those ≥ 200 kg.

Limited pharmacokinetic (PK) and pharmacodynamic (PD) data is available to aid in guidance of the use of DOACs in obesity. Newly approved edoxaban does not currently have weight-specific pharmacokinetic studies, however pooled data suggests that non-renal clearance was higher with increasing body weight.9 Rivaroxaban has been shown to have similar peak concentrations, area under the curve (AUC) and half-lives in patients > 120 kg versus those 70 to 80 kg, with results bearing uncertain clinical significance.9 Apixaban has shown significantly lower peak concentrations in those > 120 kg versus 65 to 85 kg in conjunction with a 23% lower AUC.9 Again, the effect size of these variances was low enough that the authors did not comment on dose adjustments for patients > 120 kg. Finally, dabigatran has been shown to display an inverse relationship between trough concentration and weight, with trough values 21% lower for those > 100 kg versus 50 to 100 kg.9 In summary, these PK and PD data still beg the question of whether or not patients of extreme body weight are being under-dosed, and presently no therapeutic drug ranges have been established for these agents and it is unknown if these differences lead to a change in clinical outcomes.

The Scientific and Standardization Committee of the International Society of Thrombosis and Haemostasis (ISTH) has recommended that DOACs not be used in patients with a BMI > 40 kg/m2 or a weight > 120 kg.9 Furthermore, they recommend monitoring drug-specific peak and trough levels if used in patients meeting this weight criteria, although this practice is likely not feasible or routine at most institutions.9 Unfortunately, product labeling for the DOACs do not include specific weight cut-offs or recommendations for when to consider an alternative agent.

The utilization of these agents in patients with renal dysfunction is also controversial. Table 1 displays either the mean creatinine clearance (CrCl) or the number of patients with a reduced CrCl enrolled in major efficacy trials. The majority of trials excluded patients with a CrCl < 30 ml/min, with a range of 0.2-1.5% of the total populations falling into this category. Per the package insert, rivaroxaban should be avoided in patients with a creatinine clearance (CrCl) < 30 ml/min.4 No dosage recommendations are provided for dabigatran at this level of renal dysfunction, although patients were excluded from clinical trials at a CrCl < 30 ml/min.3

The Use of Direct Oral Anticoagulants in Special Populations

Sarah Turley, Pharm.D and Rachel Flurie, Pharm.D, BCPS

7

NOACs, continued.

Apixaban has dosage adjustments for patients with non-valvular atrial fibrillation with two of the following: serum creatinine ≥ 1.5 mg/dL, age ≥ 80 years or body weight ≤ 60 kg2. Clinical studies did not enroll patients on hemodialysis, however one PK/PD study displayed similar apixaban concentrations to those observed in the ARISTOTLE trial at usual doses. Long-term safety and efficacy data for apixaban is not available in the hemodialysis population.2 Edoxaban dosing should be reduced from 60 mg daily to 30 mg daily in CrCl 15 to 50 ml/min, and use in <15 ml/min is not recommended. Interestingly, the use of edoxaban at CrCl > 95 ml/min is not recommended in patients with non-valvular atrial fibrillation, as this subgroup had an increased rate of thromboembolism in clinical trials.5 These variances create challenges for prescribers when trying to select an appropriate agent.

Data regarding safety of the use of these agents in renal dysfunction is limited, however meta-analyses have been conducted to investigate thrombotic and bleeding outcomes in this subgroup. One such study compared the use of DOACs versus warfarin for atrial fibrillation in renal dysfunction.21 In mild and moderate renal dysfunction (CrCl 50-80 ml/min and 25-49 ml/min, respectively), the DOACs were comparable to warfarin for safety in terms of risk of major bleeding. Indirect comparisons of the DOACs showed that apixaban had less major bleeding than dabigatran, rivaroxaban, and edoxaban 60 mg daily in moderate renal impairment, however edoxaban 30 mg daily was favorable in comparison to all other agents.21 The risk in interpretation and extrapolation of these results continues to be the absence of data in CrCl ≤ 30 ml/min. This meta-analysis also assumes homogeneity in the populations as well as safety and efficacy parameters, which is an overall limitation.

Similar to the PK/PD data for the use of DOACs in obesity, variations in renal dysfunction have uncertain correlations to clinical outcomes. In moderate renal impairment (CrCL 30-50 ml/min), dabigatran has been shown to have an increased AUC and half life (from 13 hours to 27 hours) compared to patients with normal renal function.22 An increase in aPTT has also been observed, albeit with no clinically significant bleeding. Rivaroxaban has shown an increased AUC and mildly prolonged half life in severe renal impairment (average CrCl 15 ml/min) with no associated bleeding events.22 Subgroup analyses of apixaban have demonstrated increased ischemic stroke coupled with increased major bleeding in CrCl < 50 ml/min.22 Finally, edoxaban displayed a 2.1% increase in bleeding at a CrCl < 30 ml/min.22 Overall, data is conflicting in regards to safety and efficacy of the use of DOACs in this special population. No direct investigation of DOACs in renal dysfunction has been conducted, therefore caution should be utilized when considering initiation of DOACs in clinical practice.

It is the responsibility of pharmacists to provide logical, evidence-based recommendations for whom to initiate therapy with one of the direct oral anticoagulant agents. Major societies such as the ISTH recommend avoiding the use of DOACs in patients at the upper extreme of weight.9 This is due to the lack of clinical data as well as PK/PD data with mixed results. More studies are needed to determine the safety and efficacy associated with the use of DOACs in obese patients and those with renal dysfunction.

ACCP Adult Medicine PRN Newsletter Fall Newsletter 2016

NOACs Continued:

References:

1. Hinojar R, Jimenez-Natcher JJ, Fernandez-Golfin CG, et al. New oral anticoagulants: a practical guide for physicians. Eur Heart J Cardiovasc Pharmacother 2015;1:134-45.

2. Eliquis® (apixaban) package insert. Princeton, NJ: E.R. Squibb & Sons, L.L.C.; July 2016. 3. Pradaxa® (dabigatran) package insert. Ridgefield, CT: Boehringer Ingelheim Pharmaceuticals, Inc; Nov 2015. 4. Xarelto® (rivaroxaban) package insert. Titusville, NJ: Janssen Pharmaceutics, Inc.: Aug 2016. 5. Savaysa® (edoxaban) package insert. Parsippany, NJ: Daiichi Sankyo, Inc.; Sep 2016. 6. Guyatt GH, Akl EA, Crowther M, et al. Antithrombotic Therapy and Prevention of Thrombosis, 9e: American College of Chest Physicians

Evidence-Based Clinical Practice Guidelines. CHEST 2012;141:7S-47S. 7. Kearon C, Akl EA, Ornelas J, et al. Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Report Panel. CHEST

2016;149:315-52. 8. Rose AJ, Reisman JI, Allen AL, et al. Potentially inappropriate prescribing of direct-acting oral anticoagulants in the veterans health

administration. Am J Pharm Benefits 2016;8:e75-e80. 9. Martin K, Beyer-Westendorf J, Davidson BL, et al. Use of the direct oral anticoagulants in obese patients: guidance from the SSC of the

ISTH. J Thromb Haemost 2016;14:1308-13. 10. Schulman S, Kearon C, Kakkar AK, et al. Dabigatran versus warfarin in the treatment of acute venous thromboembolism. N Engl J Med

2009;361:2342-52. 11. Schulman S, Kakkar AK, Goldhaber SZ, et al. Treatment of acute venous thromboembolism with dabigatran or warfarin and pooled

analysis. Circulation 2014;129:764-72. 12. Connolly SJ, Ezekowitz MD, Yusuf S, et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 2009;361:1139-51. 13. Schulman S, Kearon C, Kakkar AK, et al. Extended use of dabigatran, warfarin, or placebo in venous thromboembolism. N Engl J Med

2013;368:709-18. 14. Bauersachs R, Berkowitz SD, Brenner B, et al. Oral rivaroxaban for symptomatic venous thromboembolism. N Engl J Med

2010;363:2499-2510. 15. Buller HR, Prins MH, Lensing A, et al. Oral rivaroxaban for treatment of symptomatic pulmonary embolism. N Engl J Med 2012;366:1287-

97. 16. Patel MR, Mahaffey KW, Garg J, et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med 2011;365:883-91. 17. Agnelli G, Buller HR, Cohen A, et al. Oral apixaban for the treatment of acute venous thromboembolism. N Engl J Med 2013;369:799-808. 18. Granger CB, Alexander JH, McMurray J, et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med 2011;365:981-92. 19. Guigliano RP, Ruff CT, Braunwald E, et al. Edoxaban versus warfarin in patients with atrial fibfillation. N Engl J Med 2013;22:2093-2104. 20. Buller HR, Decousus H, Grosso MA, et al. Edoxaban versus warfarin for the treatment of symptomatic venous thromboembolism. N Engl

J Med 2013;369:1406-15. 21. Nielsen PB, Lane DA, Rasmussen LH, et al. Renal function and non-vitamin K oral anticoagulants in comparison with warfarin on safety

and efficacy outcomes in atrial fibrillation patients: a systematic review and meta-regression analysis. Clin Res Cardiol 2015;104:418-29. 22. Morrill AM, Ge D, Willett KC. Dosing of target-specific oral anticoagulants in special populations. Ann Pharmacother 2015;49:1031-45.

- Jaime Foushee, PharmD, BCPS: Promoted to Associate Professor of Pharmacy Practice at Presbyterian College School of Pharmacy

- Lauren Hynicka, Pharm.D., BCPS: Promoted from Assistant Professor to Associate Professor, University of Maryland School of Pharmacy

- Leah Bentley Patel, PharmD, BCPS: Senior Medical Science Liaison, Mallinckrodt Pharmaceuticals

- Rima A. Mohammad, PharmD, BCPS: Promoted to Clinical Associate Professor at the University of Michigan College of Pharmacy, Department of Clinical Pharmacy

- Sarah L. Anderson, PharmD, BCPS: Promoted to Associate Professor, University of Colorado Skaggs School of Pharmacy & Pharmaceutical Sciences

- Jane Bowen, Pharm.D., BCPS: Promoted to Associate Professor of Clinical Pharmacy Department of Pharmacy Practice and Pharmacy Administration, Philadelphia College of Pharmacy, University of the Sciences

PROMOTIONS

NEW ACCP FELLOWS

- Kurt A. Wargo, PharmD, FCCP, BCPS (AQ-ID)- Associate Professor and Regional Dean, Wingate University Hendersonville Health Sciences Center

- Sarah A Nisly, PharmD, BCPS, FCCP- Wingate University School of Pharmacy

- Rima A. Mohammad, PharmD, FCCP, BCPS- University of Michigan College of Pharmacy and Health System

- Sarah L. Anderson, PharmD, BCPS (Co-Investigator), PI: Joel C. Marrs, PharmD, FCCP, FASHP, FNLA, BCPS-AQ Cardiology, BCACP, CLS; Project Title: Study of the usability and navigability of a clinical pharmacist led Heart360 web-enabled home blood pressure monitoring program within a large safety net health system; University of Colorado Skaggs School of Pharmacy & Pharmaceutical Sciences. Direct Costs: $10,250

GRANTS

- Beth H. Resman-Targoff, Pharm.D., FCCP, Clinical Professor, University of Oklahoma College of Pharmacy- Invited Presentation, “Complex Cases in Joint and Bone Disease” at

Publications

o Goodbar NH, Foushee JA, Nash K, Connolly LA, Webster LM. Hypothermia Associated with thioridazine use in an intellectually disabled patient. J Pharm Pract. 2016. 29(3):250-2.

o Foushee JA, Meredith P, Fox LM, Grace EE. Y-site physical compatibility of beta-blocker infusion with intensive care unit admixtures. Int J Pharm Compd. 2016. 20(4):328-32.

o Twilla JD, Nair SP, Talwar M, Kovalic A, Satapathy SK Severity of Systemic Inflammatory Response Syndrome Affects Outcomes in Decompensated Cirrhotics with Spontaneous Bacterial Peritonitis..Am J Gastroenterol. 2016 Jul;111(7):1043-5.

o Roe N, Twilla JD, Duhart B, Wheeler B Breast cancer patient with everolimus-induced angioedema: A rare occurrence with potential for serious consequences. J Oncol Pharm Pract. 2016 Mar 21. (epub ahead of pring)

o Higdon E, Twilla JD, Sands C. Moxifloxacin-Induced Visual Hallucinations: A Case Report and Review of the Literature. J Pharm Pract. 2016 Mar 21. (epub ahead of print)

o Owens RE, Swanson H, Twilla JD.Hemolytic Anemia Induced by Pegloticase Infusion in a Patient With G6PD Deficiency. J Clin Rheumatol. 2016 Mar;22(2):97-8.

o Van Berkel MA, Twilla JD, England BS. Emergency Department Management of a Myasthenia Gravis Patient with Community-Acquired Pneumonia: Does Initial Antibiotic Choice Lead to Cure or Crisis? J Emerg Med. 2016 Feb;50(2):281-5.

o Smith MA, Mohammad RA. Invited commentary: Ledipasvir and sofosbuvir for hepatitis C genotype 4: a proof of concept phase 2a cohort study. Lancet Infect Dis. 2015 Sep;15(9):993-5

o Smith MA, Love BL, Mohammad RA. The changing landscape of adverse drug events associated with chronic hepatitis C virus therapy. Expert Opin Drug Saf. 2015 Nov;14(11):1649-52.

o Smith MA, Regal RE, Mohammad RA. Daclatasvir: A NS5A replication complex inhibitor for hepatitis C infection. Ann Pharmacother. 2016 Jan;50(1):39-46.

o Deming P, Martin MT, Chan J, Dilworth TJ, El-Lababidi R, Love BL, Mohammad RA, Nguyen A, Spooner LM, Wortman SB. Therapeutic advances in HCV genotype 1 infection: insights from the society of infectious diseases pharmacists. Pharmacotherapy. 2016 Feb;36(2):203-17.

o Isaacs A, Doolin M, Morse C, Nisly SA. Medication utilization evaluation of dabigatran and rivaroxaban within a large, multicenter health system. Am J Health Syst Pharm 2016;73:S35-S41.

o Nisly SA, Steuber TD, Boyd AM, Foster AE. New kids on the block: the promise of PCSK9 inhibitors in the management of hyperlipidemia. Indiana Pharmacists Alliance (IPA) Continuing Pharmacy Education (CPE) 2016; Article 2.

o Steuber TD, Howard ML, Nisly SA. Strategies for the management of postoperative anemia in elective orthopedic surgery. Ann Pharmacother 2016;50(7):578-585.

o Isaacs AN, Nisly SA, Walton AM. Student-generated e-learning for clinical education. Clin Teach 2016;13:1-5.

o Steuber TD, Nisly SA, Walton AM. Metacognition: students need it and you can teach it! The feedback approach. In: Blythe H, Sweet C, Carpenter R, eds. It Works for Me, Metacognitively: Shared Tips for Effective Teaching. 1st ed. Stillwater, OK: New Forums Press Inc, 2016:46-49.

o Anderson SL, Trujillo JM. Basal insulin use with GLP-1 agonists. Diabetes Spectr 2016 [in press] o Norman JL, Anderson SL. Novel class of medicines, orexin receptor antagonists, in the treatment of

insomnia- critical appraisal of suvorexant. Nat Sci Sleep 2016;8:239-47

NOTABLE ACHEIVEMENTS

Publications, Continued

o Rhyne DN, Anderson SL, Gedde M, Borgelt LM. The effect of medical marijuana on migraine headache frequency in an adult population. Pharmacotherapy 2016;36(5):505-10.

o Soric MM, Glowczewski JE, Lerman RM. Implementing a layered learning model in a small community hospital: economic and patient satisfaction outcomes. Am J Health Syst Pharm 2016; 73(7):456-62.

o Soric MM, Moorman JM, Boyle JA, Dengler-Crish CM. Prevalence and predictors of metformin prescribing in adults with type 2 diabetes mellitus: a national cross sectional study. Pharmacotherapy 2016; 36 (7):715-22.

o Patel KS, Lau JE, Zembillas AS, et al. Single 4.5 mg fixed-dose of rasburicase for hyperuricemia associated with tumor lysis syndrome. J Oncol Pharm Pract. Prepublished April 15, 2016; DOI: 10.1177/0123456789123456.

o Self TH, Owens RE, Sakaan SA, Wallace JL, Sands CW, Howard-Thompson A. Effect of diseases on response to vitamin K antagonists. Curr Med Res Opin. 2016;32(4):613-20.

o Owens RE, Swanson H, Twilla JD. Hemolytic anemia induced by pegloticase infusion in a patient with G6PD deficiency. J Clin Rheumatol. 2016;22(2):97-8.

o Self TH, Owens RE, Mancell J, Nahata MC. Asthma as a comorbidity in hospitalized patients: a potential missed opportunity to intervene. Ann Pharmacother. 2016;50(6):511-3.

o Gravatt LAH, Patterson J, Franzese S. Educational Antimicrobial Stewardship Strategies. Current Treatment Options in Infectious Disease, 2016,; 8:84-92.

o Donohoe KL, Dane KE, Varghese D, Hylton-Gravatt LA . Evaluation of student-led journal clubs. Curr Pharm Teach Learn. 2016; 8:173-177.