Pharmacotherapy Specialty Recertification Literature Study: Module 2A-C (Cert # L229105)

Module 2A: Critical Care and Cardiology
ACPE #: 0204-0000-22-935-H01-P

This module focuses on critical care and cardiology issues including sepsis, heart failure, and diuretic use.

Evans L, Rhodes A, Alhazzani W et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2021. Crit Care Med. 2021; 49:e1063-e1143.

Learning Objectives:

• Describe the 2021 Surviving Sepsis Campaign guidelines for management of sepsis and septic shock.
• Develop recommendations for the management of patients with sepsis or septic shock.

Rech MA, Gurnani PK, Peppard WJ et al. PHarmacist Avoidance or Reductions on Medical Costs in CRITically Ill Adults: PHARM-CRIT study. Crit Care Explor. 2021; 3(12): e0594.

Learning Objectives:

• Describe the PHARM-CRIT study of the role of pharmacists in reducing medical costs for critically ill adults.
• Develop recommendations for pharmacists to use to minimize medical costs in critically ill adults.

Mathew R, Di Santo P, Jung RG, et al. Milrinone as compared with dobutamine in the treatment of cardiogenic shock. N Engl J Med. 2021;385:516-25. 

Learning Objectives:

• Describe the Dobutamine Compared with Milrinone (DOREMI) trial.
• Develop recommendations for the use of inotropic therapy in patients with cardiogenic shock.

Felker GM, Ellison DH, Mullens W, et al. Diuretic therapy for patients with heart failure. 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.

Agarwal R, Sinha AD, Cramer AE et al. Chlorthalidone for Hypertension in Advanced Chronic Kidney Disease. N Engl J Med. 2021; 385:2507-19.

• 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.

Module 2B: New Drug Therapy and Guideline Updates
ACPE #: 0204-0000-22-936-H01-P

This module focuses on new drug therapy and guideline updates. Topics include heart failure, obstructive cardiomyopathy, chronic kidney disease, diabetic neuropathy, and cirrhosis.

Olivotto I, Oreziak A, Barriales-Villa R et al. Mavacamten for treatment of symptomatic obstructive hypertrophic cardiomyopathy (EXPLORER-HCM): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet. 2020; 396:759-69.

Learning Objectives:

• Describe the EXPLORER-HCM trial by Olivotto and colleagues of mavacamten for treating patients with symptomatic obstructive hypertrophic cardiomyopathy.
• Develop recommendations for the use of mavacamten in patients with symptomatic obstructive hypertrophic cardiomyopathy.

Teerlink JR, Diaz R, Felker GM et al. Cardiac myosin activation with omecamtiv mecarbil in systolic heart failure. N Engl J Med. 2021; 384:105-16.

Learning Objectives:

• Describe the Global Approach to Lowering Adverse Cardiac Outcomes through Improving Contractility in Heart Failure (GALACTIC-HF) study by Teerlink and colleagues of omecamtiv mecarbil for heart failure with reduced ejection fraction.
• Develop recommendations for the use of omecamtiv mecarbil in patients with heart failure and reduced ejection fraction.

Felker GM, Solomon SD, Claggett B et al. Assessment of omecamtiv mecarbil for the treatment of patients with severe heart failure: a post hoc analysis of data from the GALACTIC-HF randomized clinical trial. JAMA Cardiol. 2022; 7:26-34.

Learning Objectives:

• Describe the post-hoc analysis by Felker and colleagues of data from the Global Approach to Lowering Adverse Cardiac Outcomes Through Improving Contractility in Heart Failure (GALACTIC-HF) trial.
• Develop recommendations for the use of omecamtiv mecarbil in patients with severe heart failure.

Filippatos G, Anker SD, Agarwal R et al. Finerenone and cardiovascular outcomes in patients with chronic kidney disease and type 2 diabetes. Circulation. 2020; 143:540-52.  

Learning Objectives:

• Describe the prespecified subgroup analysis of the Finerenone in Reducing Kidney Failure and Disease Progression in Diabetic Kidney Disease (FIDELIO-DKD) study of patients with chronic kidney disease (CKD) and type 2 diabetes mellitus.
• Develop recommendations for the use of finerenone in patients with chronic kidney disease (CKD) and type 2 diabetes mellitus.

Pitt B, Filippatos G, Agarwal R et al for the FIGARO-DKD investigators. Cardiovascular events with finerenone in kidney disease and type 2 diabetes. N Engl J Med. 2021; 185:2252-63. 

Learning Objectives:

• Describe the Finerenone in Reducing Cardiovascular Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial.
• Develop recommendations for the use of finerenone in patients with chronic kidney disease (CKD) and type 2 diabetes mellitus.

Wong F,  Pappas SC, Curry MP et al. Terlipressin plus albumin for the treatment of type 1 hepatorenal syndrome. N Engl J Med. 2021; 384:818-28. 

Learning Objectives:

• Describe the CONFIRM study of terlipressin plus albumin for the treatment of type 1 hepatorenal syndrome (HRS-1).
• Develop recommendations for the use of terlipressin plus albumin for the treatment of patients with type 1 hepatorenal syndrome (HRS-1).

Price R, Smith D, Franklin G et al. Oral and topical treatment of painful diabetic polyneuropathy: practice guideline update summary. Report of the AAN Guideline Subcommittee. Neurology. 2022; 98:31-43.

Learning Objectives:

• Describe the American Academy of Neurology practice guideline update summary on the oral and topical treatment of painful diabetic polyneuropathy.
• Develop recommendations for the use of oral and topical treatments for painful diabetic polyneuropathy. 

O'Shea RS, Davitkov P, Ko CW, et al. AGA clinical practice guideline on the management of coagulation disorders in patients with cirrhosis. Gastroenterology. 2021; 161:1615-27. 

Learning Objectives:

• Describe the clinical practice guideline from the American Gastroenterological Association (AGA) Institute for the management of coagulation disorders in patients with cirrhosis.
• Develop recommendations for the management of coagulation disorders in patients with cirrhosis.

Module 2C: Allergy, Asthma and Immunology
ACPE #: 0204-0000-22-937-H01-P

This module focuses on allergy, asthma, and immunology issues including asthma guidelines, long-acting antiretroviral therapy, and various topics related to adverse drug reactions and allergies.

Expert Panel Working Group of the National Heart, Lung, and Blood Institute (NHLBI) administered and coordinated National Asthma Education and Prevention Program Coordinating Committee (NAEPPCC). 2020 focused updates to the asthma management guidelines: a report from the National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group. J Allergy Clin Immunol. 2020; 146:1217-70. **Select readings only: Sections IV and V (pgs 1247 - 1258)** 

Learning Objectives:

• Describe the 2020 focused updates to the asthma management guidelines from the National Asthma Education and Prevention Program Coordinating Committee (NAEPPCC).
• Develop recommendations for the management of patients with asthma.

Menzies-Gow A, Corren J, Bourdin A, et al. Tezepelumab in adults and adolescents with severe, uncontrolled asthma. N Engl J Med. 2021; 384:1800-9.

Learning Objectives:

• Describe the NAVIGATOR trial of tezepelumab for the treatment of severe, uncontrolled asthma.
• Develop recommendations for the use of tezepelumab in patients with severe uncontrolled asthma.

Lee LM, Carias DC, Gosser R et al. ASHP guidelines on adverse drug reaction monitoring and reporting. Am J Health-Syst Pharm. 2022; 79:e83-e89.

Learning Objectives:

• Describe the ASHP guidelines on adverse drug reaction (ADR) monitoring and reporting.
• Develop recommendations for a comprehensive adverse drug reaction (ADR) monitoring and reporting program.

Alvarez-Arango S, Ogunwole SM, Sequist TD et al. Vancomycin infusion reaction−moving beyond "Red Man Syndrome." N Engl J Med. 2021; 384:1283-6.

Learning Objectives:

• Describe the rationale for the changes proposed by Alvarez-Arango and colleagues to the terminology and best practices used by healthcare providers to describe and document vancomycin infusion reaction.
• Develop recommendations for systemwide improvements in drug-allergy recognition and documentation that ensure the equitable delivery of health care to diverse patient populations.

Wulf NR, Schmitz J, Choi A, Kapusnik-Uner J. Iodine allergy: common misperceptions. Am J Health-Syst Pharm. 2021; 78:781-93.

Learning Objectives:

• Describe the analysis by Wulf and colleagues of evidence of allergy to medications that contain iodine or seafood.
• Develop recommendations for the use of iodine-containing medications in patients reporting an allergy to iodine or seafood and for documenting reactions to these substances.

Johnson JL, Hawthorne A, Bounds M, Weldon DJ. New perspectives on propofol allergy. Am J Health-Syst Pharm. 2021; 78:2195-203. 

Learning Objectives:

• Describe the available evidence of cross-reactivity to propofol in patients reporting an allergy to products containing egg, soy, or peanut; methods for screening for such allergies and determining whether to use propofol in these patients; and the evaluation and management of patients experiencing an anaphylactic reaction to propofol.
• Develop recommendations for the screening of adults for allergy to products containing egg, soy, or peanut; use of propofol or alternative strategies for sedation in these patients; and evaluation and management of patients experiencing an anaphylactic reaction to propofol.

Howe ZW, Norman S, Lueken AF et al. Therapeutic review of cabotegravir/rilpivirine long-acting antiretroviral injectable and implementation considerations at an HIV specialty clinic. Pharmacotherapy. 2021; 41:686-99. 

Learning Objectives:

• Describe the long-acting injectable antiretroviral agent cabotegravir/rilpivirine and considerations in implementing its use in an HIV specialty clinic setting.
• Develop recommendations for implementing the use of the long-acting injectable antiretroviral agent cabotegravir/rilpivirine in an HIV specialty clinic setting.