Ambulatory Care Self-Assessment Program (ACSAP) Book 3: Nephrology and Dermatology Care (Cert # L249253)

The target audience for Ambulatory Care Self-Assessment Program (ACSAP) Book 3: Nephrology and Dermatology Care is board-certified and advanced level ambulatory care clinical pharmacists.

Board-certified pharmacists are eligible to receive up to 19.5 contact hours of recertification credit for completing this course. To earn recertification credit, learners must review the course content and successfully complete the online assessments by the deadline.   

ASHP provides an opportunity for remediation. Participants who are unsuccessful with the first assessment attempt may take a second assessment. The second assessment is included at no additional cost. 

ACCP and ASHP are approved by BPS as a provider for the recertification of BCACP .

Nephrology and Dermatology Care I
ACPE #: 0217-9999-24-251-H01-P
Chapter: Managing Anticoagulation in Kidney Disease

• Distinguish the causes and consequences of endothelial dysfunction, platelet hyperreactivity, coagulation factor imbalances, and fibrinolytic system activation in patients with chronic kidney disease (CKD)/end-stage kidney disease (ESKD).
• Assess the risk factors and clinical scenarios that warrant anticoagulation therapy in patients with CKD, such as atrial fibrillation (AF) and venous thromboembolism (VTE).
• Analyze the current evidence-based guidelines and recommendations from various sources, such as the Kidney Disease Improving Global Outcomes and American College of Cardiology, to select the most appropriate anticoagulant therapy for individual patients with AF and/or VTE in CKD, based on their kidney function, comorbidities, preferences, and goals of care.
• Evaluate the benefits and risks of vitamin K antagonists in patients with CKD and ESKD, considering their efficacy in preventing thromboembolic events, their safety in terms of bleeding complications, and their potential adverse effects on vascular/valvular calcification, bone health, and kidney function.
• Evaluate the mechanism of action, pharmacokinetics, and pharmacodynamics of direct oral anticoagulants (DOACs) in patients with CKD and ESKD and determine their efficacy in preventing thromboembolic events, and their safety in terms of bleeding.
• Distinguish low-molecular-weight heparins from other anticoagulant options, such as vitamin K antagonists and DOAC agents, in terms of their efficacy, safety, and convenience in patients with CKD and ESKD.
• Develop a therapeutic bridging plan for patients with CKD/ESKD on anticoagulation undergoing invasive procedures. 

Case Series: Pain Management in Chronic Kidney Disease and End-Stage Kidney Disease

• Apply best practices for assessing pain in adults with chronic kidney disease (CKD).
• Classify pain management therapies (including pharmacologic and nonpharmacologic) by safety and efficacy parameters in CKD, including end-stage kidney disease.
• Develop a pain management regimen for acute pain in CKD.
• Develop a pain management regimen for complex, mixed pain in CKD.
• Demonstrate understanding of pain medication monitoring in CKD and evaluate strategies to mitigate risk. 

Nephrology and Dermatology Care II
ACPE #: 0217-9999-24-252-H01-P
Chapter: Hypertension and Dyslipidemia in Patients with Chronic Kidney Disease and/or Receiving Dialysis

• Evaluate current clinical practice guidelines, recommendations, and pertinent clinical trials regarding optimal blood pressure therapy, staging and blood pressure goals, and blood pressure measurement for patients with chronic kidney disease (CKD) or end-stage kidney disease.
• Distinguish pharmacologic and nonpharmacologic treatments for patients with CKD and hypertension including initiation, dose adjustments, and management of adverse drug reactions.
• Analyze strategies used to mitigate hypertension in patients receiving dialysis, and recommend nonpharmacologic and pharmacologic treatments for hypertension in these patients.
• Assess current clinical practice guidelines, recommendations, and pertinent clinical trials regarding optimal lipid control and dyslipidemia (DLD) management.
• Using laboratory values and risk-enhancing factors, design a treatment plan including nonpharmacologic and pharmacologic treatments for a patient with DLD and CKD for primary or secondary prevention including initiation, dose adjustments, management of adverse drug reactions, and discontinuation.
• Design a nonpharmacologic and pharmacologic treatment plan for a patient with DLD who is receiving dialysis. 

Case Series: Evaluation of Kidney Function

• Analyze various methods for calculating and assessing glomerular filtration rate (GFR), including direct measurements and estimation formulas.
• Implement staging criteria for chronic kidney disease (CKD) using estimated GFR (eGFR) and albuminuria, and design appropriate monitoring and intervention strategies.
• Distinguish between SCr and cystatin C as biomarkers for estimating GFR, and evaluate their clinical applications and limitations.
• Evaluate current GFR assessment methods to synthesize patient-specific data and direct clinical decision-making in medication management.
• Assess factors that affect drug regimen design in patients with CKD. 

Nephrology and Dermatology Care III
ACPE #: 0217-9999-24-253-H01-P
Chapter: Complications of Chronic Kidney Disease: Anemia and Mineral and Bone Disorder

• Evaluate anemia of chronic kidney disease (CKD).
• Classify patients at risk of developing CKD-mineral and bone disorder (MBD).
• Apply clinical practice guidelines to manage anemia and CKD-MBD.
•  Assess iron agents to treat anemia of CKD.
• Assess the standards of laboratory parameters for managing CKD-MBD.
• Distinguish the differences between erythropoiesis stimulating agents (ESAs) and their place in therapy for the management of anemia of CKD.
• Devise a case-based therapeutic plan that considers drug therapy selection for patients with anemia and/or CKD-MBD.
• Evaluate hyporesponsive issues and red blood cell transfusion in anemia management of CKD.
• Evaluate other considerations related to CKD-MBD. 

Case Series: Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

• Assess the pathophysiology and genetic predisposition for Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN).
• Analyze factors that worsen SJS/TEN.
• Distinguish SJS/TEN from similar skin conditions (e.g., erythema multiform major, staphylococcal scalded skin syndrome, acute generalized exanthematous pustulosis).
• Demonstrate the diagnosis of SJS/TEN.
• Given patient-specific factors, design an appropriate treatment plan for SJS/TEN. 

Nephrology and Dermatology Care IV
ACPE #: 0217-9999-24-254-H01-P
Chapter: Plaque Psoriasis

• Classify the severity of a patient’s psoriasis using the Psoriasis Area and Severity Index (PASI) and Physician Global Assessment (PGA) scales.
• Develop a pharmacotherapy and monitoring plan for a patient with moderate to severe plaque psoriasis.
• Assess the impact of associated comorbidities on treatment selection for plaque psoriasis.
• Evaluate the mechanism of action, efficacy, safety, and adverse effects of biologic agents approved for the treatment of plaque psoriasis.
• Evaluate the role of novel and emerging therapies in the treatment of plaque psoriasis. 

Chapter: Acne/Urticaria/Atopic Dermatitis

• Evaluate appropriate pharmacotherapy for acne, based on the classification of severity.
• Develop a patient-specific treatment plan for acne by incorporating both pharmacologic and nonpharmacologic approaches.
• Distinguish treatment approaches for acute and chronic urticaria.
• Distinguish the clinical presentation of atopic dermatitis and other common skin disorders.
• Assess patient-specific treatment for atopic dermatitis.

Faculty Information

In accordance with our accreditor’s Standards of Integrity and Independence in Accredited Continuing Education, ACCP and ASHP requires that all individuals in control of content disclose all financial relationships with ineligible companies. An individual has a relevant financial relationship if they have had a financial relationship with an ineligible company in any dollar amount in the past 24 months and the educational content that the individual controls is related to the business lines or products of the ineligible company. 

An ineligible company is any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. The presence or absence of relevant financial relationships will be disclosed to the activity audience. 

The following persons in control of this activity’s content have relevant financial relationships: 

Consultancies: Marisa Battistella (Otsuka Canada; Bayer Canada); Lavinia Salama (Dexcom)

Stock Ownership: Christopher M. Herndon (Ardelyx; LiveLife Natural Products); Sara Lingow (Amgen; Gilead; GSK; Pfizer; Viatris; Vertex; Johnson & Johnson; Haleon); Erin L. Thompson (Agilon Health; United HealthGroup; Invitae; Gilead Sciences; Moderna; CVS Health; Walgreens)

Grants: Islam Ghazi (Merck; Astellas)

Honoraria: Marisa Battistella (Otsuka Canada)

Other: Calvin J. Meaney (GSK Advisory Board)

Activities consist of educational materials, assessments, and activity evaluations. In order to receive continuing pharmacy education credit, learners must:

• Complete the attestation statement
• Review all content
• Complete and pass the assessments
• Complete the evaluations 

Follow the prompts to claim, view, or print the statement of credit within 60 days after completing the activity. 

ACCP and ASHP collaborate on this activity.