Pharmacy News

Entries for May 2018

Preview of the 2018 ASHP House of Delegates

By Jesse Hogue, Pharm.D., pharmacy education coordinator, Bronson Methodist Hospital, Kalamazoo

The American Society of Health-System Pharmacists (ASHP) will convene its 70th Annual Session of the House of Delegates in Denver in June to address an agenda that includes considering 31 policy recommendations, receiving board and committee reports and addressing a variety of other society business items. Your elected delegates this year are Dave Bach, Jim Lile, Mike Ruffing and myself, Jesse Hogue. In addition to attending the two official “live” House sessions, I, and the other Michigan delegates, have participated in the Regional Delegate Conferences and will participate in various other forums and caucuses at the Summer Meeting to fully understand all the issues being voted upon. Included in this are discussions regarding possible amending language, new business items and recommendations of delegates. While a full discussion of each of the policy recommendations is beyond the scope of this article, I would like to highlight a few that I feel are of interest to Michigan Society of Health-System Pharmacists (MSHP) members.

Health Insurance Policy Design. This policy is of interest to Michigan pharmacists because Michigan Pharmacists Association (MPA) has been actively advocating for pharmacy benefit manager (PBM) transparency for several years. This policy recommendation updates an existing ASHP policy to include a statement that ASHP advocate that health insurance payers and PBMs provide public transparency regarding, and accept accountability for, coverage decisions and policies, which is very consistent with what MPA has been pursuing.

Availability and Use of Appropriate Vial Sizes. This policy calls for ASHP to advocate that manufacturers provide drug products in vial sizes that reduce waste. As any health-system pharmacist is aware, available vial sizes often do not align with typical doses, resulting in waste. In the rationale for this policy, it was noted that a study in 2016 estimated that the United States may spend close to $2 billion on oncology drug products that are discarded because they come in vials in which the volume of drug product exceeds what is needed for most doses. It was also noted that manufacturers are already producing the more logical vial sizes for use in other countries, but they are not approved for use here.

Use of Closed-System Transfer Devices to Reduce Drug Waste. This is another welcome policy targeted at reducing drug waste. There is research supporting use of closed-system transfer devices (CTSDs) to maintain sterility beyond the in-use time currently recommended by USP 797, when those devices are used with aseptic technique and following current sterile compounding standards. Unfortunately, CTSDs are not FDA approved for such use, and therefore USP 797 requires each institution to do their own (very time consuming and costly) studies prior to employing CSTDs in such a way. This policy seeks to foster research on standards and best practices for use of CSTDs for drug vial optimization, with the implied (although not clearly stated, which may result in an amendment) intent to convince standard-setting entities and regulators to permit the practice.

Impact of Drug Litigation Ads on Patient Care. Similar to ASHP’s strong stance opposing direct-to-consumer advertising, this proposed policy would set ASHP in firm opposition to drug litigation ads that could lead patients to modify or discontinue therapy without consulting their providers because such action could result in adverse patient outcomes.

Federal Review of Anticompetitive Practices and Price Increases by Drug Product Manufacturers. ASHP has existing policy strongly opposing anticompetitive practices by drug product manufacturers that adversely affect drug product availability and price. This policy recommendation seeks to update that policy to also delineate that manufacturers be required to provide public notification in advance of significant price increases. This is a very timely proposal, and of note, is consistent with current pending Michigan legislation (HB 5691).

Intravenous Fluid Manufacturing Facilities as Critical Public Health Infrastructure. This is another timely policy recommendation considering the very difficult experiences we have all been having with IV fluids this year. The Department of Homeland Security’s list of key infrastructure includes public health infrastructure. This policy would call for ASHP to advocate that public health infrastructure be defined to include manufacturing sites of IV fluids. The result would be that those sites would be afforded the same protections as other critical infrastructure and would call for the involved entities to make necessary changes to ensure that manufacturing is not at risk for supply disruption.

Responsible Medication-related Clinical Testing and Monitoring. Just like with medications, the Council on Therapeutics notes that overuse of clinical testing leads to unnecessary costs, waste and patient harm. Therefore, they crafted this policy recommendation which recognizes the impact pharmacists can make on ensuring appropriate but judicious use of testing and encourages pharmacists to further engage in these activities. I would note that this policy recommendation is relevant to all MSHP members, not just those of us who practice in the hospital!

Student Pharmacist Drug Testing. This policy recommendation has generated some interesting conversation, so I thought it was important to include here. Last year, the House of Delegates passed ASHP Policy 1717 which dealt with drug testing and recovery programs for pharmacy staff members. The ASHP Pharmacy Student Forum noted that pharmacy students would not be covered in the policy; however, their Executive Committee drafted this policy which advocates for drug testing throughout pharmacy education and prior to pharmacy practice experiences as well as encouraging colleges of pharmacy to develop policies and processes to identify impaired individuals, to facilitate access to programs for treatment and recovery and to use validated testing panels. Much of the discussion focused on how far ASHP policy should go when dealing with colleges of pharmacy. It was also noted that there is an American Association of Colleges of Pharmacy statement on the development of addiction and related disorders policies for colleges and schools of pharmacy. State laws may also dictate how colleges will deal with individual cases involving offenses that may prevent the student from obtaining licensure. There is a good chance this policy recommendation will be amended to remove the clause discussing treatment and recovery.  

This discussion merely scratches the surface of the policy recommendations. Many of the other policy recommendations will also be of significant interest to MSHP members and health-system pharmacists, so I would encourage all of you to review the proposed policies and contact one of the delegates with any questions or comments you may have (Jesse: hoguej@bronsonhg.org; Mike: mruffing@dmc.org; Dave: david.bach@beaumont.org; Jim: lile1j@cmich.edu). I have listed the titles of all the policy recommendations below for your review. Members can view the official language of the policy recommendations at the ASHP House of Delegates website as well as follow online discussions via the House of Delegates community within ASHP Connect. There has already been good discussion on ASHP Connect, so feel free to join the conversation!

Policy Recommendations to be Considered by the 2018 ASHP House of Delegates:

Council on Pharmacy Management

1.       Medication Formulary System Management

2.       Manufacturer-sponsored Patient Assistance Programs

3.       Product Reimbursement and Pharmacist Compensation

4.       Patient Access to Pharmacist Care Within Provider Networks

5.       Health Insurance Policy Design

6.       Pharmacy Accreditations, Certifications, and Licenses 

Council on Pharmacy Practice

1.       Use of International System of Units for Patient-related Measurements

2.       Availability and Use of Appropriate Vial Sizes

3.       Use of Closed-System Transfer Devices to Reduce Drug Waste

4.       Collaborative Drug Therapy Management 

Council on Public Policy

1.       ASHP Statement on Advocacy as a Professional Obligation

2.       Direct and Indirect Remuneration Fees

3.       Impact of Drug Litigation Ads on Patient Care

4.       Approval of Biosimilar Medications

5.       340B Drug Pricing Program Sustainability

6.       Federal Review of Anticompetitive Practices and Price Increases by Drug Product Manufacturers

7.       Federal Quality Rating Program for Pharmaceutical Manufacturers

8.       Intravenous Fluid Manufacturing Facilities as Critical Public Health Infrastructure

9.       Medical Devices

10.    ASHP Statement on Principles for Including Medications and Pharmaceutical Care in Health Care Systems 

Council on Therapeutics

1.       Ensuring Effectiveness, Safety, and Access to Orphan Drug Products

2.       Rational Use of Medications

3.       Responsible Medication-Related Clinical Testing and Monitoring

4.       Clinical Practice and Application on the Use Of Biomarkers

5.       Medication Overuse 

Council on Education and Workforce Development

1.       Clinician Well-being and Resilience

2.       Student Pharmacist Drug Testing

3.       Collaboration on Experiential Education

4.       Promoting the Image of Pharmacists and Pharmacy Technicians

5.       Practice Sites for Colleges of Pharmacy

6.       Pharmacy Practice Training Models 

Posted in: Member News
Asymptomatic Bacteriuria

By Jennifer Chou, PharmD, PGY2 infectious diseases pharmacy resident, Beaumont Hospital, Royal Oak

 

Overtreatment of asymptomatic bacteriuria (ASB) remains a common problem that can lead to increased antibiotic resistance, increased risk for C. difficile infection and adverse effects. ASB is the isolation of bacteria in a urine culture from a patient without symptoms such as dysuria, urinary frequency, urgency or suprapubic pain. According to the Infectious Diseases Society of America (IDSA) guidelines for asymptomatic bacteriuria, bacteriuria in women is defined as having two consecutive samples with the same isolate at quantities ≥ 105 CFU/mL.1 The definition in men is one sample with quantities ≥ 105 CFU/mL, and in catheterized patients, a cutoff of ≥ 102 CFU/mL is used for both men and women.1 However, there are a variety of definitions used in the literature. The prevalence of ASB in healthy, premenopausal women is one to five percent, in contrast to rates closer to 20 percent among those aged ≥ 70 years in the community. Rates are as high as 50 percent among elderly in long-term care facilities, and 100 percent among those with long-term indwelling catheters.1 The IDSA guidelines recommend treatment of ASB only in pregnant women, before transurethral resection of the prostate or before urologic procedures in which mucosal bleeding is expected.


Over treatment of ASB stems from the difficulty in assessing for true ASB versus urinary tract infection (UTI). The populations with the highest prevalence of ASB can also be the most difficult to assess for symptoms. Elderly patients frequently present with altered mental status as the only potential symptom or have an inability to report symptoms due to baseline cognitive impairment. While altered mental status can be a symptom of UTI in the elderly, it is important to assess for other potential culprits, such as new and/or recent medications (opioids, benzodiazepines, etc.). It is also important to note that an elderly patient presenting to the hospital after a fall is not an automatic indication to order a urine culture. In these gray-area cases when altered mental status is the only potential symptom, the decision to treat is on a case-by-case basis, relying on a thorough history and evaluation of alternative explanations.


In a meta-analysis including 30 studies, the rate of inappropriate ASB treatment was 45 percent in North America.2 Factors associated with a higher likelihood of treatment were patients with gram-negative isolates, female gender, pyuria and nitrite positivity.2 Overtreatment of ASB is often due to a reflexive action to order a urinalysis and/or urine culture, with subsequent reaction to treat a positive culture. One potential area for intervention is preventing the ordering of the initial culture. One study group at Veterans Affairs healthcare systems developed a catheter-associated urinary tract infection (CAUTI) diagnostic algorithm with audit and feedback at two decision points: ordering of urine culture and treating a positive urine culture.3 With this intervention, rates of urine culture ordering decreased significantly from 41 to 23 per 1000 bed-days. Overtreatment of ASB also decreased significantly, without affecting under treatment of CAUTI. These decreases were sustained during the one-year maintenance period.3 However, old habits may die hard, and another study evaluated a different approach for non-catheterized patients at an acute care hospital in Toronto. Rather than reporting positive urine culture results in non-catheterized patients, the following message was posted instead: “The majority of positive urine cultures from inpatients without an indwelling urinary catheter represent asymptomatic bacteriuria. If you strongly suspect that your patient has developed a urinary tract infection, please call the microbiology laboratory.”4 Of the positive urine cultures over a period of two months, UTI was present in only two percent of patients. The ASB treatment rate dropped from 48 percent to 12 percent and calls were only made on five of 37 patients. No clinical signs of UTI or sepsis were identified in those untreated.4 Stewardship interventions should be tailored based on site-specific preferences and practices in order to be most effective. In another meta-analysis of 50 studies, there was no apparent benefit with ASB treatment among patients with no risk factors, diabetes, postmenopausal women, elderly institutionalized patients and renal transplant patients.5

 

Overtreatment of ASB remains prevalent and has been a recent focus of antimicrobial stewardship initiatives. Provider education and a multi-pronged stewardship approach is likely necessary and will be most effective in reducing overtreatment of ASB.

 

References:

1.      Nicolle LE, Bradley S, Colgan R, et al. Infectious Diseases Society of America Guideline for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infect Dis 2005;40:643–654.

2.      Flokas ME, Andreatos N, Alevizakos M, et al. Inappropriate management of asymptomatic patients with positive urine cultures: A systematic review and meta-analysis. Open Forum Infect Dis 2017;4(4).

3.      Trautner BW, Grigoryan L, Petersen NJ, et al. Effectiveness of an antimicrobial stewardship approach for urinary catheter-associated asymptomatic bacteriuria. JAMA Intern Med 2015;175:1120–7.

4.      Leis JA, Rebick GW, Daneman N, et al. Reducing antimicrobial therapy for asymptomatic bacteriuria among noncatheterized inpatients: a proof-of-concept study. Clin Infect Dis 2014;58(7):980-3.

5.      Köves B, Cai T, Veeratterapillay R, et al. Benefits and harms of treatment of asymptomatic bacteriuria: A systematic review and meta-analysis by the European Association of Urology Urological Infection Guidelines Panel. Eur Urol 2017;72(6):865-868.

Posted in: Patient Safety
Immunization Update – 2018

By Jamie George, B.H.S., Pharm.D. candidate 2019, Department of Pharmacy Practice, Wayne State University and Joseph Fava, Pharm.D., clinical assistant professor, Department of Pharmacy Practice, Wayne State University, Detroit

 

Immunization recommendations are continuously updated by the Advisory Committee on Immunization Practices (ACIP) and published by the Centers for Disease Control and Prevention (CDC). New immunization schedules are published annually based on these recommendations. The following is a summary of the major updates from ACIP as of March 2018.

Adults (aged 19 years and older)

 

Herpes Zoster

 

In October 2017, the FDA approved Shingrix® (zoster vaccine recombinant, adjuvanted – GlaxoSmithKline [GSK] – Belgium, abbreviated by the CDC as ‘RZV’) which led to the revision of the current recommendations for vaccination against herpes zoster. Table 1 shows a comparison between Zostavax® (zoster vaccine live – Merck & Co., Inc. – United States, abbreviated by the CDC as ‘ZVL’) recommendations compared to those of RZV. Overall, RZV has been recommended over ZVL as the preferred vaccine for the prevention of herpes zoster, by a slim eight to seven majority of ACIP voting members.1,2

 

Table 1. Comparison of ZVL and RZV.

TARGETED GROUP

ZOSTAVAX® (ZVL) RECOMMENDATIONS

SHINGRIX® (RZV) RECOMMENDATIONS

 

Ages 50-59 years

One dose of ZVL

Approved by FDA, but not recommended by CDC2

2 doses of RZV separated by two to six months1

Ages 60+ years

One dose of ZVL2

Previously received ZVL

Should wait at least two months after receipt of ZVL to administer RZV1

 

Immuno-
compromised patients

Contraindicated (live vaccine)2

Patients on low-dose immunosuppressive medications, those anticipating immunosuppression and those recovering from an immunocompromising illness, may receive RZV.11

 

Previous episode of herpes zoster

One dose of ZVL

 

Do not administer during an acute episode of herpes zoster; delay vaccination until after acute stage is over and symptoms subside1

No specific amount of time needed to wait before administration.12

Do not administer during an acute episode of herpes zoster; delay vaccination until after acute stage is over and symptoms subside1

 

Two key differences should be noted with regard to storage and administration of herpes zoster vaccines: 1) unlike ZVL, which is administered subcutaneously, RZV should be administered intramuscularly, preferably in the deltoid region of the upper arm, and 2) RZV is to be stored refrigerated (36-46 degrees F), unlike ZVL which is stored frozen (-58 to five degrees F).3,4

 

Meningococcal

 

In February 2017 the meningococcal polysaccharide vaccine MPSV4 (Menomune® - Sanofi Pasteur Inc. – U.S.) was discontinued in the United States. This was the only meningococcal vaccine that was FDA-approved for ages 56 years and older. Despite only having FDA approval in patients up to 55 years of age, the CDC now recommends that patients 56 years and older who are at increased risk for meningococcal disease should receive a meningococcal conjugate vaccine (MCV).5,6

 

Influenza

 

In February 2018, ACIP voted in favor of the intranasal live attenuated influenza vaccine (LAIV) for the 2018-2019 flu season.7 This recommendation is pending approval from the CDC and will be published in the Morbidity and Mortality Weekly Report (MMWR) once finalized.

 

Hepatitis B

 

The FDA and ACIP approved HEPLISAV-B® (Dynavax Technologies Corp. – U.S.) for use against all subtypes of Hepatitis B for ages 18 years and older. This new vaccine is administered as a two-dose series, which has potential to improve rates of series completion compared to the conventional three-dose series.8

 

Children (aged 0-18 years)

 

Measles, mumps, and rubella (MMR)

 

Footnotes now give guidance on a third dose during a mumps outbreak. Children > 12 months who received < two doses of a mumps-virus containing vaccine and identified at increased risk during an outbreak should receive an additional dose.9 This change also applies to adult patients and is reflected in the adult schedule footnotes.

Table 2 shows additional minor changes to the childhood immunization schedule for 2018.

Table 2. Additional Changes to Schedule for Children (Aged 0-18 years)9,10

VACCINE

RECOMMENDATION

Hepatitis B (HepB)

Footnotes now include information about vaccination in infants < 2,000 grams with hepatitis B surface antigen (HBsAG)-negative mothers.

Poliovirus

Catch-up recommendations were clarified for children four years and older, and the footnotes now include guidance for those who received the oral vaccine previously as part of their series.

Rotavirus

The maximum ages for the first and last doses have been specified and added to the catch-up schedule.

Meningococcal

MenACWY and MenB footnotes are now separated for clarity.

HIV

The HIV disease state parameters (CD4 cell counts) for using live vaccines are clearer.

 

 This review provides a brief summary of updated vaccine recommendations as of March 2018. Pharmacist immunizers must stay up-to-date on schedule updates, evidence and product availability. One of the easiest ways to do this is through the following electronic resources:

·            CDC’s Vaccines & Immunizations webpage

§  https://www.cdc.gov/vaccines/index.html

·            Immunization Action Coalition’s (IAC) Ask the Experts webpage

§  http://www.immunize.org/askexperts/

·            American Pharmacist Association’s Immunization Center webpage

§  http://www.pharmacist.com/immunization-center

 

References

1.      Dooling KL, Guo A, Patel M, et al. Recommendations of the Advisory Committee on Immunization Practices for Use of Herpes Zoster Vaccines. MMWR. 2018;67(3):103-108.

2.      Centers for Disease Control and Prevention. What Everyone Should Know about Zostavax. CDC website. https://www.cdc.gov/vaccines/vpd/shingles/public/zostavax/
index.html. Feb. 28, 2018.

3.      Zostavax [package insert]. Whitehouse Station, NJ: Merck Sharp & Dohme Corp.; 2018.

4.      Shingrix [package insert]. Research Triangle Park, NC: GlaxoSmithKline; 2017.

5.      Centers for Disease Control and Prevention. Meningococcal: Who Needs to Be Vaccinated? CDC website. https://www.cdc.gov/vaccines/vpd/mening/hcp/who-vaccinate-hcp.html. Feb. 28, 2018.

6.      Kim DK, Riley LE, and Hunter P. Advisory Committee on Immunization Practices Recommended Immunization Schedule for Adults Aged 19 Years or Older — United States, 2018. MMWR. 2018;67:1-3.

7.      Centers for Disease Control and Prevention. Advisory Committee on Immunization Practices (ACIP). CDC website. https://www.cdc.gov/vaccines/acip/index.html. March 29, 2018.

8.      Dynavax’s HEPLISAV-B™ [Hepatitis B Vaccine (Recombinant), Adjuvanted] Recommended by CDC Advisory Committee on Immunization Practices for the Prevention of Hepatitis B in Adults. GlobeNewswire website. https://globenewswire.com/news-release/2018/02/21/1372711/0/en/Dynavax-s-HEPLISAV-B-Hepatitis-B-Vaccine-Recombinant-Adjuvanted-Recommended-by-CDC-Advisory-Committee-on-Immunization-Practices-for-the-Prevention-of-Hepatitis-B-in-Adults.html. March 2, 2018.

9.      Robinson CL, Romero JR, Kempe A, et al. Advisory Committee on Immunization Practices Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger — United States, 2018. MMWR. 2018;67(5):156-157.

10.  Centers for Disease Control and Prevention. Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger, United States, 2018. CDC website. https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html. March 2, 2018.

10.  Centers for Disease Control and Prevention. Frequently Asked Questions About Shingrix. CDC website. https://www.cdc.gov/vaccines/vpd/shingles/hcp/shingrix/faqs.html. May 5, 2018.

11. Centers for Disease Control and Prevention. Frequently Asked Questions About Shingrix. CDC website. https://www.cdc.gov/vaccines/vpd/shingles/hcp/shingrix/faqs.html. May 5, 2018.

12. Centers for Disease Control and Prevention. Shingrix Recommendations. CDC website. https://www.cdc.gov/vaccines/vpd/shingles/hcp/shingrix/recommendations.html. May 5, 2018. 


 

Posted in: Professional Practice
Extended Duration VTE Prophylaxis: An Indication or a Myth?

By Bradley St. Pierre, PharmD; Michelle Crisher, PharmD; Domenico Grande, Pharm D; Vitaliy Perets, PharmD, pharmacy residents, St. John Hospital and Medical Center, Detroit

The increased risk of venous thromboembolism (VTE) in patients hospitalized for an acute medical illness has been well documented in the literature.1 Uncertainty exists as to whether this risk extends beyond hospitalization, as some literature suggests that the risk of VTE may persist for 30 or more days after discharge.2  Extended duration prophylaxis in medically ill patients has been studied with enoxaparin, apixaban and rivaroxaban. Although overall incidence of VTE is decreased, this benefit is offset by the increase in major bleeding events and cost. As such, clinical practice guidelines recommend against VTE prophylaxis extending beyond that of the acute hospital stay.1

Betrixaban is a new direct oral anticoagulant that is FDA-approved for extended duration VTE prophylaxis in adult patients hospitalized for an acute medical illness who are at high risk for thromboembolic complications. In the APEX (Acute Medically Ill VTE Prevention with Extended Duration Betrixaban) trial, patients with acute medical illness were randomized to receive either betrixaban 80 mg once daily for 35 to 42 days, or enoxaparin 40 mg subcutaneously for six to 14 days.4 Included patients were divided into three cohorts: patients with elevated d-dimer levels, patients with elevated d-dimer levels and age greater than 75 years, and all enrolled patients. Sequential, pre-specified cohort analyses were performed assessing a composite primary efficacy endpoint of asymptomatic proximal deep vein thrombosis and symptomatic venous thromboembolism. Given the first analysis in cohort one (patients with elevated d-dimer levels) showed no significant difference between groups, subsequent analyses were deemed exploratory. In these analyses, including one assessing the overall population, betrixaban had a statistically significant decrease in the composite endpoint. For safety, there was no difference in major bleeding between groups at any point during therapy until seven days after discontinuation of study medications. Given these results, should extended-duration anticoagulation be standard practice?

Studies looking at VTE risk following hospitalization

Several studies have investigated the risk of thromboembolic events following hospital discharge, evaluating the need for extended duration thromboprophylaxis. One retrospective study of administrative claims data (n=11,139) noted 366 symptomatic VTE events within a 180 day period, 56.6 percent of which occurred post discharge. Amin and colleagues concluded that the risk for VTE is highest during the first 19 days after hospital admission extending into the period after discharge. The major limitations of this study are that fewer than half of patients (46.7 percent) received thromboprophylaxis during hospitalization and that ~80 percent of VTE events during days zero to 19 occurred during hospitalization.2

Another study by Fanikos and colleagues looked at the incidence of post-discharge VTE in high risk discharge patients based on a validated risk scoring tool incorporating major and minor risk factors for VTE.5 This was a case-control study of patients ordered to continue VTE prophylaxis with heparin or enoxaparin after hospital discharge (n=461) compared to no prophylaxis (n=922). There was no difference in the incidence of VTE events in patients receiving extended pharmacologic prophylaxis versus no prophylaxis (5 percent vs. 4.3 percent; P = 0.58). However, fewer patients were alive at 90 days in the group receiving extended prophylaxis and major bleeding occurred more frequently. To note, close to 50 percent of patients had cancer, since this was considered a high risk factor for VTE, whereas little emphasis was placed on immobilization in the validated risk scoring tool. Therefore, immobilized patients may have been underrepresented compared to the study populations, which showed a benefit of extended duration prophylaxis.

Based on the available evidence, the risk of VTE extending beyond hospitalization and benefit of thromboprophylaxis is unclear. Further studies are needed to evaluate the risk of VTE after discharge, to define the patient population that may benefit from extended duration prophylaxis, and to conduct a cost analysis of extended VTE prophylaxis beyond the acute hospital stay.

References

  1. Kahn SR, Lim W, Dunn AS, et al. Prevention of VTE in nonsurgical patients antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012;41(2):e195S-e226S.
  2. Amin AN, Varker H, Princic N, et al. Duration of venous thromboembolism risk across a continuum in medically ill hospitalized patients. J Hosp Med. 2012;7(3):231-238.
  3. Cohen AT, Spiro TE, Büller HR, et al. Rivaroxaban for thromboprophylaxis in acutely ill medical patients. N Engl J Med. 2013;368:513-23.
  4. Cohen AT, Harrington RA, Goldhaber SZ et al. Extended thromboprophylaxis with betrixaban in acutely ill medical patients. N Engl J Med. 2016;375(6):534-544
  5. Fanikos J, Rao A, Seger AC et al et al. Venous thromboembolism prophylaxis for medical service—mostly cancer—patients at hospital discharge. Am J Med. 2011;124(12):1143-50
Posted in: Patient Safety
Capital Area Pharmacist Association Update

By Cathleen Edick, Pharm.D., CDE, pharmacy program manager, McLaren Greater Lansing, central regional representative

 

The Capital Area Pharmacists Association (CAPA) began 2018 with a very informative continuing education (CE) presentation delivered by Diplomat’s pharmacy residents. In January, Millie Mo, Pharm.D. and Johnson Ching, Pharm.D., educated pharmacists and pharmacy technicians about the many intricacies surrounding specialty pharmacy, from prescription to delivery.

 

March, as always, was one of our busiest months of the year. On March 17, pharmacists and pharmacy interns spoke to many parents and children about the dangers of poison at the Impression 5 Children’s Museum in Lansing. At the “Meds vs. Candy” board, it was an eye opener for all involved as parents and children tried to guess which was the medication and which was the candy. During that same week, CAPA hosted its second CE, given by Curtis Smith, Pharm.D., BCPS. Curtis delivered a very informative talk regarding opioids and pain therapy and educated attendees about the proper use of opioid medications and methods to decrease incidence of addiction. On Thursday, March 22, CAPA held a fundraising event at Blaze Pizza in the Frandor Plaza in Lansing. Many thanks to those who brought in the CAPA flyer and purchased a meal! Twenty percent of the cost of those meals will be donated to CAPA for the CAPA student scholarship fund. March ended with a 5th Saturday, so like every month with a 5th Saturday, CAPA served a meal at the Advent House.

 

Things will start to wind down for CAPA as summer approaches; however, May still has some really fun events! CAPA provided a CE from the Meijer pharmacy residents on May 10 that educated attendees about the newest 2017 hypertension guidelines. Then on May 20, CAPA will have a social event at Potter Park Zoo in Lansing for all CAPA members and their families. Watch for the zoo sign-up sheet in your mailbox if you have not already seen it. CAPA hopes to see you there!

 

Although things settle down over the summer months for CAPA, keep watch for more fun in the later part of 2018. CAPA will serve meals at the Advent House in Lansing on the following 5th Saturdays: June 30, Sept. 29 and Dec. 29. In addition, mark your calendars for the following CE events: Oct. 22 with a “Wits and Wagers” game and Dec. 5 for a yearly law review.  


   

 

Posted in: Member News
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