Pharmacotherapy Specialty Recertification Literature Study: Module 2A-C (Cert # L239189)

Module 2A: Pain
ACPE #: 0204-0000-23-957-H08-P

This module focuses on current issues in the management of pain. Topics include guidelines for preventing diversion of controlled substances and prescribing opioids for pain, as well as pain management in the emergency department.

Clark J, Fera T, Fortier C et al. ASHP Guidelines on preventing diversion of controlled substances. Am J Health Syst Pharm. 2022; 79:2279-2306.

Learning Objectives:

• Describe the ASHP guidelines on preventing diversion of controlled substances.
• Develop recommendations for comprehensive controlled substance (CS) diversion prevention programs (CSDPPs) in health systems.

Dowell D, Ragan KR, Jones CM, Baldwin GT, Chou R. CDC Clinical Practice Guideline for Prescribing Opioids for Pain — United States, 2022. MMWR Recomm Rep. 2022; 71(No. RR-3):1–95. DOI: http://dx.doi.org/10.15585/mmwr.rr7103a1.

Learning Objectives:

• Describe the 2022 Centers for Disease Control and Prevention (CDC) clinical practice guideline for prescribing opioids for pain.
• Develop recommendations for prescribing opioids for pain in adult outpatients with acute, subacute, or chronic pain.

Rech MA, Griggs C, Lovett S, Motov S. Acute pain management in the emergency department: use of multimodal and non-opioid analgesic treatment strategies. Am J Emerg Med. 2022; 58:57-65.

Learning Objectives:

• Describe pain management strategies and multimodal regimens that involve non-opioids for patients with acute pain in the emergency department (ED).
• Develop recommendations for pain management strategies and multimodal regimens that involve non-opioids for patients with acute pain in the emergency department (ED).

Module 2B: Guideline Updates
ACPE #: 0204-0000-23-958-H01-P

This module focuses on updates to guidelines and reviews. Topics include hypercalcemia of malignancy, pharmacologic interventions for obesity, use of complementary and alternative medicine in heart failure, the role of pharmacists in rapid sequence intubation, and the risks and benefits of long-term use of proton pump inhibitors.

Fuleihan GE, Clines GA, Hu MI et al. Treatment of hypercalcemia of malignancy in adults: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2023; 108:507-28. doi: 10.1210/clinem/dgac621.

Learning Objectives:

• Describe the clinical practice guideline from the Endocrine Society for the treatment of hypercalcemia of malignancy (HCM) in adults.
• Develop recommendations for the treatment of hypercalcemia of malignancy (HCM) in adults.

Grunvald E, Shah R, Hernaez R et al. AGA Clinical Practice Guideline on pharmacological interventions for adults with obesity. Gastroenterology. 2022; 163:1198 - 1225.

Learning Objectives:

• Describe the 2022 clinical practice guideline from the American Gastroenterological Association (AGA) on pharmacological interventions for adults with obesity.
• Develop recommendations for the long-term pharmacologic management of overweight and obesity in adults.. 

Chow SL, Bozkurt B, Baker WL et al. Complementary and alternative medicines in the management of heart failure: a scientific statement from the American Heart Association. Circulation. 2023; 147:e4-30. DOI: 10.1161/CIR.0000000000001110.

Learning Objectives:

• Describe the American Heart Association (AHA) scientific statement on complementary and alternative medicines (CAM) in the management of heart failure (HF).
• Develop recommendations for the use of complementary and alternative medicines (CAM) for the management of patients with heart failure (HF).

Hampton JP, Hommer K, Musselman M, Bilhimer M. Rapid sequence intubation and the role of the emergency medicine pharmacist: 2022 update. Am J Health Syst Pharm. 2023; 80:1882-95. doi: 10.1093/ajhp/zxac326.

Learning Objectives:

• Describe the use of common pharmacologic agents as part of rapid sequence intubation (RSI) in the emergency department (ED).
• Develop recommendations for the use of pharmacologic agents as part of rapid sequence intubation (RSI) in the emergency department (ED).

Thurber KM, Otto AO, Stricker SL et al. Proton pump inhibitors: understanding the associated risks and benefits of long-term use. Am J Health-Syst Pharm. 2023; 80:487-94.

Learning Objectives:

• Describe the long-term efficacy and safety of proton pump inhibitor (PPI) use.
• Develop recommendations for the use of proton pump inhibitors (PPIs) taking into consideration the available evidence of potential benefits and long-term safety.

Module 2C: New Drugs and Therapeutic Updates

This module includes updates on new drugs and dosing considerations. Topics include tirzapetide, osteconazole, lenacapavir and administration of antibiotics via subcutaneous route, as well as the implications of obesity with subcutaneous and intramuscular injections.

Dahl D, Onishi Y, Norwood P, et al. Effect of subcutaneous tirzepatide vs placebo added to titrated insulin glargine on glycemic control in patients with type 2 diabetes: The SURPASS-5 randomized clinical trial. JAMA. 2022; 327:534-545.

Learning Objectives:

• Describe the SURPASS-5 study by Dahl and colleagues of the addition of tirzepatide to titrated insulin glargine for improving glycemic control in patients with type 2 diabetes mellitus.
• Develop recommendations for the use of tirzepatide in adults with type 2 diabetes mellitus and inadequate glycemic control despite the use of insulin glargine.

Jastreboff AM, Aronne LJ, Ahmad NN, et al. Tirzepatide once weekly for the treatment of obesity. N Engl J Med. 2022; 387:205-216.

Learning Objectives:

• Describe the SURMOUNT-1 trial by Jastreboff and colleagues of tirzepatide for treating obese and overweight patients.
• Develop recommendations for the use of tirzepatide in adults with obesity or overweight.

Martens MG, Maximos B, Degenhardt T, et al. Phase 3 study evaluating the safety and efficacy of oteseconazole in the treatment of recurrent vulvovaginal candidiasis and acute vulvovaginal candidiasis infections. Am J Obstet Gynecol. 2022; 227:880.e1-11.

Learning Objectives:

• Describe the study by Martens and colleagues of oteseconazole for the treatment of acute and recurrent vulvovaginal candidiasis (VVC) infections.
• Develop recommendations for the treatment of acute and recurrent vulvovaginal candidiasis (VVC) in adolescent and adult women.

Segal-Maurer S, DeJesus E, Stellbrink HJ, et al. Capsid inhibition with lenacapavir in multidrug-resistant HIV-1 infection. N Engl J Med. 2022; 386:1793-1803.

Learning Objectives:

• Describe the study by Segal-Maurer and colleagues of the capsid inhibitor lenacapavir in patients with multidrug-resistant human immunodeficiency virus type 1 (HIV-1) infection.
• Develop recommendations for the treatment of patients with multidrug-resistant human immunodeficiency virus type 1 (HIV-1) infection.

Erstad BL, Barletta JF. Implications of obesity for drug administration and absorption from subcutaneous and intramuscular injections: a primer. Am J Health-Syst Pharm. 2022; 79:1236-1244.

Learning Objectives:

• Describe the impact of obesity on the absorption of medications after administration by the subcutaneous (SC) and intramuscular (IM) routes and the implications for choosing between the two routes.
• Develop recommendations for the route of administration of common medications to obese, acutely ill patients when an alternative parenteral route to the intravenous route is needed.

Jumpertz M, Guilhaumou R, Million M, et al. Subcutaneously administered antibiotics: a review. Journal of Antimicrobial Chemotherapy. 2023; 78:1-7.

Learning Objectives:

• Describe the efficacy, safety, and tolerability of subcutaneous (SC) administration of antibiotics.
• Develop recommendations for the use of the subcutaneous (SC) route of administration of antibiotics in adults.