2012 APhA/ASHP Ambulatory Care Specialty Recertification Program: Literature Study Module 2

ACPE Number: 0204-9999-12-988-H04-P
Knowledge-based: 8.0 Credit Hours
Release Date: 10/1/2012
Expiration Date: 10/1/2015

APhA members: To receive the member rate when purchasing this activity, enter “APhALS2012M2” in the promotion code field at checkout.

This literature study is an online program that provides information on contemporary topics related to ambulatory care specialty practice.  To earn CE credit, you must read the instructional materials and successfully complete the online assessment by the deadline. Only completed tests are eligible for credit; no partial or incomplete tests will be processed.

Literature Study Module 2 Topics include:

Care of the patient with:
 - Diabetes
 - Rheumatoid Arthritis
 - Attention Deficit Hyperactivity Disorder


Learning Objectives:
1.    Inzucchi SE, Bergenstal RM, Buse JB et al. Management of hyperglycemia in type 2 diabetes: a patient-centered approach. Position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2012; 35:1364-79.

After reading this article, the participant should be able to:

• Recommend appropriate glycemic targets for a patient with type 2 diabetes, including A1c, fasting blood glucose, and postprandial blood glucose, based on the 2012 position statement of the American Diabetes Association (ADA) and European Association for the Study of Diabetes (EASD).
• Identify comorbid conditions and other patient-related factors that influence the selection of antidiabetic treatment for a patient with type 2 diabetes.
• Compare and contrast the potential advantages and disadvantages of using alpha-glucosidase inhibitors, amylin mimetics, biguanides, bile acid sequestrants, dipeptidyl peptidase-4 (DDP-4) inhibitors, dopamine agonists, insulins, glucagon-like peptide-1 (GLP-1) receptor agonists, meglitinides, sulfonylureas, and thiazolidinediones in a patient with type 2 diabetes.

2.    Russell-Jones D, Cuddihy RM, Hanefeld M et al. Efficacy and safety of exenatide once weekly versus metformin, pioglitazone, and sitagliptin used as monotherapy in drug-naive patients with type 2 diabetes (DURATION-4): a 26-week double-blind study. Diabetes Care. 2012; 35:252-8.

After reading this article, the participant should be able to:

• Explain the primary objective of the Diabetes Therapy Utilization: Researching Changes in A1C, Weight and Other Factors Through Intervention with Exenatide Once-Weekly (DURATION-4) study.
• Describe the measures of β-cell function and insulin sensitivity used in the DURATION-4 study and interpret the study findings with regard to the impact of each study medication on β-cell health.
• Discuss the findings of the DURATION-4 study related to the comparative efficacy of once-weekly exenatide, metformin, sitagliptin, and pioglitazone for reducing A1c in drug-naïve patients with type 2 diabetes.
• Identify the potential strengths and weakness of the research methods used in the DURATION-4 study.
• Explain the potential clinical relevance, applicability, and limitations of the DURATION-4 study findings for therapeutic decision making for a patient with type 2 diabetes.

3.    Bakker MF, Jacobs JW, Welsing PM et al. Low-dose prednisone inclusion in a methotrexate-based, tight control strategy for early rheumatoid arthritis: a randomized trial. Ann Intern Med. 2012; 156:329-39.

After reading this article, the participant should be able to:

• Identify measures used to determine disease activity in this study of patients with early rheumatoid arthritis (RA).
• Describe treatment outcomes that were improved by use of a low-dose prednisone plus methotrexate treatment strategy compared with a non-corticosteroid approach (methotrexate alone) in patients with early RA.
• Interpret and discuss the findings of significant differences between treatment groups in adverse effects, although the study was not powered to compare adverse effects.

4.    Singh JA, Furst DE, Bharat A et al. 2012 update of the 2008 American College of Rheumatology recommendations for the use of disease-modifying antirheumatic drugs and biologic agents in the treatment of rheumatoid arthritis. ArthritisCare Res (Hoboken). 2012; 64:625-39.

After reading this article, the participant should be able to:

• Choose appropriate treatment options for patients with rheumatoid arthritis (RA) and a history of hepatitis, malignancy, or congestive heart failure.
• Identify a live vaccine that is not recommended for use in patients treated with biologic disease-modifying anti-rheumatic drugs.
• Outline an effective approach for the screening of patients with RA for latent tuberculosis (TB).

5.    Cooper WO, Habel LA, Sox CM et al. ADHD drugs and serious cardiovascular events in children and young adults. N Engl J Med. 2011; 365:1896-904.

After reading this article, the participant should be able to:

• Discuss the events that led to the study by Cooper et al of the risk of serious cardiovascular events in children and young adults treated with attention-deficit/hyperactivity disorder (ADHD) drugs.
• Compare and contrast the characteristics of nonusers and current or former users of ADHD medications evaluated by Cooper et al and the rates of serious cardiovascular events in these groups.
• Identify confounding variables and limitations in the study design and discuss the potential effect on the study findings.

6.    Post RE, Kurlansik SL. Diagnosis and management of adult attention-deficit/hyperactivity disorder. Am Fam Physician. 2012; 85:890-6.

After reading this article, the participant should be able to:

• Describe the diagnostic work up for attention-deficit/hyperactivity disorder (ADHD) in adults and discuss the limitations of current diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders, 4th ed (DSM-IV) for this age group.
• Identify guideline-recommended treatment options for ADHD and discuss the limitations and contraindications to use of these agents in an adult population.
• Recommend an approach to treatment of concomitant psychiatric disorders in the adult patient with ADHD.

7.    Wolraich M, Brown L, Brown RT et al, American Academy of Pediatrics Subcommittee on Attention-Deficit/Hyperactivity Disorder. ADHD: clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics. 2011; 128:1007-22.

After reading this article, the participant should be able to:

• Compare and contrast the approach to treating attention-deficit/hyperactivity disorder (ADHD) in preschool-aged children (4-5 years of age) to that in elementary school-aged children (6-11 years of age) as outlined by the American Academy of Pediatrics.
• Identify coexisting conditions that should be considered in the differential diagnosis of ADHD in children and adolescents.
• Discuss the role of behavior therapy and the quality of evidence supporting its use in the treatment of ADHD in children and adolescents.

APhA has been granted permission by the respective publishers to post the articles/links used in this educational offering. A reprint fee has been paid where requested.


Continuing Education Accreditation

The American Society of Health-System Pharmacists and the American Pharmacists Association are accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. This activity provides 8.0 hours (0.8 CEUs) of continuing pharmacy education credit (ACPE activity #0204-9999-12-988-H04-P).

Attendees must complete a Continuing Pharmacy Education Request online and may immediately print their official statements of continuing pharmacy education (CPE) credit at the ASHP eLearning site at http://elearning.ashp.org following the activity.
 

Target Audience: Pharmacists with an interest in contemporary topics related to ambulatory care specialty practice.

Development: This activity was developed by The American Society of Health-System Pharmacists and the American Pharmacists Association.

Advisory Board
Kelly Epplen, Pharm.D., BCACP
Assistant Professor of Clinical Pharmacy Practice
The James L. Winkle College of Pharmacy
University of Cincinnati
Cincinnati, OH

Stuart T. Haines, Pharm.D., BCPS, BCACP, BC-ADM
Professor and Vice Chair for Clinical Services
University of Maryland School of Pharmacy
Baltimore, MD
Clinical Pharmacy Specialist – Primary Care
West Palm Beach VA Medical Center
West Palm Beach, FL


Art Schuna, M.S., B.S.Pharm.
Clinical Pharmacy Coordinator and Residency Director
William S. Middleton VA Medical Center
Clinical Professor
University of Wisconsin School of Pharmacy
Madison, MI

Disclosure Statement
In accordance with the Accreditation Council for Continuing Medication Education’s Standards for Commercial Support and the Accreditation Council for Pharmacy Education’s Standards for Commercial Support, APhA and ASHP require that all individuals involved in the development of activity content disclose their relevant financial relationships. A person has a relevant financial relationship if the individual of his or her spouse/partner has a financial relationship (e.g., employee, consultant, research grant recipient, speakers bureau, or stockholder) in any amount occurring the in the last 12 months with a commercial interest whose products or series may be discussed in the educational activity content over which the individual has control. The existence of these relationships is provided for the information of participants and should not be assumed to have an adverse impact on the content.

In keeping with this requirement, APhA and ASHP ask that all faculty, advisory board members, planning committee members, content development consultants, and staff complete a disclosure form for each program in which they are involved. Anyone who refuses to disclose relevant financial relationships must be disqualified from any involvement with a continuing pharmacy education activity.

All of the above listed advisory board members and APhA and ASHP staff and consultants report no relationships pertinent to this program.

APhA and ASHP identify and resolve conflicts of interest prior to an individual’s participation in development of content for an educational activity.