Implementation of a Synergistic, Complementary Pharmacy Practice Model for an Advanced Heart Failure/Heart Transplant Program.

A pharmacy practice model for an Advanced Heart Failure (HF)/Transplant program was designed to address gaps in medication access, medication education and transitions of care (ToC). Activities specific to these initiatives performed by a four-member pharmacy team (3 pharmacists, 1 specialty technician) are described. Data were prospectively collected in 2020 for 284 admissions involving a high-risk cohort of advanced HF/transplant patients and a similar cohort seen in an ambulatory HF clinic.

A Multidisciplinary Educational Approach to Anticoagulation Management for a Percutaneous Endovascular Mechanical Circulatory Support Device.

Background: Anticoagulation (AC) management of the Impella varies considerably among treatment centers. Published data regarding the management of complications including heparin-induced thrombocytopenia, bleeding and thrombosis are limited.

Objective: A multidisciplinary team was assembled to 1) identify baseline knowledge of nurses and pharmacists involved in Impella anticoagulation management; 2) develop an educational tool specific to Impella anticoagulation; 3) reassess knowledge following implementation of the tool.

A lesson in clinical reasoning for the pharmacy preceptor.

Purpose: In this article, the pharmacy preceptor is introduced to the core components of the clinical reasoning process. Teaching strategies based on script theory and experiential educational theory are described to aid the pharmacy preceptor in facilitating the development of clinical reasoning in novice practitioners.

Summary: The development of clinical reasoning skills is essential for all healthcare providers.

Bivalirudin for treatment of LVAD thrombosis: a case series.

Both platelet- and fibrin-rich thrombi have been described in patients with pump thrombosis associated with continuous flow left ventricular assist devices (LVADs). Bivalirudin is a direct thrombin inhibitor that also inhibits platelet adhesion. Compared to heparin, this hirudin analog is less immunogenic, binds to both free- and clot-bound fibrin, and has a lower risk of major bleeding.

Prasugrel use in a patient allergic to clopidogrel: effect of a drug shortage on selection of dual antiplatelet therapy.

Purpose: A case illustrating multiple considerations in choosing safe and effective dual antiplatelet therapy for a patient with a history of clopidogrel allergy-including concerns relating to a national drug shortage-is described.

Summary: A 75-year-old woman required dual antiplatelet therapy (aspirin plus a thienopyridine) after a cardiac catheterization procedure; during a prior emergency department visit for acute coronary syndrome, she had experienced an allergic reaction within 24 hours of receiving dual therapy including clopidogrel. A team of pharmacy and allergy staff determined that challenging the patient with prasugrel was the best treatment option.

Assessment of the 4Ts pretest clinical scoring system as a predictor of heparin-induced thrombocytopenia.

Study Objective: To evaluate the utility of the 4Ts clinical scoring system as a pretest probability method for the detection of heparin-induced thrombocytopenia (HIT).

Design: Prospective observational study.

Setting: Medical and surgical inpatients at a tertiary care medical center.

Vancomycin-induced leukocytoclastic vasculitis.

Vancomycin is well recognized as causing the nonallergic skin reaction known as red man syndrome; however, it is rarely suspected as causative in the setting of an immune-mediated skin reaction. We describe a 76-year-old Caucasian woman with a history of penicillin and sulfa allergies who was transferred to our medical center while receiving vancomycin for treatment of persistent methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia. After admission, the patient's pacemaker was explanted; cultures from the pacemaker grew MSSA.

Nonbloody, red stools from coadministration of cefdinir and iron-supplemented infant formulas.

Cefdinir is an extended-spectrum, third-generation cephalosporin that may be used for treatment of acute otitis media in patients allergic to penicillin. When administered with iron-containing products, including infant formulas, cefdinir or one of its metabolites may bind to ferric ions, forming a nonabsorbable complex that imparts a reddish color to the stool. We describe a 9-month-old infant with failure to thrive and acute otitis media who developed an erythematous maculopapular rash during treatment with amoxicillin-clavulanate.

An advanced pharmacy practice experience in academia.

Objectives: To create an advanced pharmacy practice experience (APPE) that would encourage students to consider a career in academia.

Design: A 6-week, 6-credit elective APPE was created that offered students the opportunity to observe and participate in activities consistent with a full-time faculty appointment.

Assessment: A 9-question survey instrument was administered to 27 students who completed the APPE between 2000 and 2004 to determine the impact of the APPE on the student's career choice.