Ambulatory Care Pharmacy Specialty Recertification Literature Study: Module 1A-B (Cert # L229137)

Module 1A: Updates in Heart Failure
ACPE #: 0204-9999-22-956-H01-P

This module focuses on updates in heart failure, including the management of diuretic resistance, as well as new heart failure guidelines. 

Agarwal R, Sinha AD, Cramer AE et al. Chlorthalidone for hypertension in advanced chronic kidney disease. N Engl J Med. 2021; 385:2507-19. 

Learning Objectives:

• Describe the Chlorthalidone in Chronic Kidney Disease (CLICK) study by Agarwal and colleagues of patients with advanced chronic kidney disease (CKD) and poorly controlled hypertension.
• Develop recommendations for the use of the thiazide-like diuretic chlorthalidone in patients with advanced chronic kidney disease (CKD) and poorly controlled hypertension despite antihypertensive drug therapy. 

Felker GM, Ellison DH, Mullens W et al. Diuretic therapy for patient with heart failure–JACC state-of-the-art review. J Am Coll Cardiol. 2020; 75:1178-95.  

Learning Objectives:

• Describe renal physiology and response to diuretics, the pharmacology and pharmacodynamics of diuretics, mechanisms and strategies for overcoming diuretic resistance, and loop diuretic use in patients with acute or chronic heart failure.
• Develop recommendations for the use of diuretic therapy in patients with heart failure. 

Anker SD, Butler J, Filippatos G et al. Empagliflozin in heart failure with a preserved ejection fraction. N Engl J Med. 2021; 385:1451-61.  

Learning Objectives:

• Describe the Empagliflozin Outcome Trial in Patients with Chronic Heart Failure with Preserved Ejection Fraction (EMPEROR-Preserved).
• Develop recommendations for the use of empagliflozin in patients with chronic heart failure with preserved ejection fraction (HFpEF). 

Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guideline for the management of heartfailure: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2022;79:e263–e421. IMPORTANT: For this Literature Study, the following sections are assessed: 4.1, 4.2, 7.3, 11.1, 12, 13 

Learning Objectives:

• Describe the 2022 American Heart Association (AHA)/American College of Cardiology (ACC)/Heart Failure Society of America (HFSA) guideline for the management of heart failure (HF).
• Develop recommendations for the management of patients with heart failure with reduced ejection fraction (HFrEF). 

Module 1B: Challenges in Ambulatory Care Pharmacy
ACPE #: 0204-9999-22-957-H01-P

This module focuses on challenges in ambulatory care pharmacy, including management of patients with depression or obesity, as well as optimizing antithrombotic therapy after acute coronary syndromes. 

Rodriguez F, Harrington RA. Management of antithrombotic therapy after acute coronary syndromes. N Engl J Med. 2021; 384:452-60. 

Learning Objectives:

• Describe the currently recommended approach and evidence base for use of antiplatelet and anticoagulant therapies in patients with acute coronary syndrome (ACS).
• Develop recommendations for the use of antithrombotic therapy in patients with acute coronary syndrome (ACS). 

Wilding JPH, Batterham RL, Calanna S et al for the STEP 1 Study Group. Once-weekly semaglutide in adults with overweight or obesity. N Engl J Med. 2021; 384:989-1002. 

Learning Objectives:

• Describe the STEP 1 study by Wilding and colleagues of semaglutide as an adjunct to lifestyle intervention for overweight or obese adults without diabetes mellitus.
• Develop recommendations for the use of subcutaneous semaglutide as an adjunct to lifestyle intervention in adults with overweight or obesity without diabetes mellitus. 

Wadden TA, Bailey TS, Billings LK et al. Effect of subcutaneous semaglutide vs placebo as an adjunct to intensive behavioral therapy on body weight in adults with overweight or obesity: the STEP 3 randomized clinical trial. JAMA. 2021; 325:1403-13. 

Learning Objectives:

• Describe the STEP 3 study by Wadden and colleagues of semaglutide as an adjunct to intensive behavioral therapy with an initial low-calorie diet for patients with overweight or obesity.
• Develop recommendations for the use of subcutaneous semaglutide as an adjunct to behavioral therapy, dietary intervention, and other lifestyle modifications in adults with overweight or obesity without diabetes mellitus. 

Rubino D, Abrahamsson N, Davies M et al. Effect of continued weekly subcutaneous semaglutide vs placebo on weight loss maintenance in adults with overweight or obesity: the STEP 4 randomized clinical trial. JAMA. 2021; 325:1414-25. 

Learning Objectives:

• Describe the STEP 4 study by Rubino and colleagues of the long-term use of subcutaneous semaglutide as an adjunct to lifestyle intervention for weight loss maintenance in overweight or obese adults without diabetes mellitus.
• Develop recommendations for the long-term use of subcutaneous semaglutide as an adjunct to lifestyle intervention for weight loss maintenance in overweight or obese adults without diabetes mellitus. 

Lewis G, Marston L, Duffy L et al. Maintenance or discontinuation of antidepressants in primary care. N Engl J Med. 2021; 385:1257-67. IMPORTANT: Information contained in the Supplement is also assessed. 

Learning Objectives:

• Describe the Antidepressants to Prevent Relapse in Depression (ANTLER) trial by Lewis and colleagues.
• Develop recommendations for the duration of antidepressant therapy in primary care patients with a long history of depressive episodes, antidepressant use, or both.