Contemporary Pharmacotherapy: Collaborative Clinical Explorations

There are multiple controversial topics in anticoagulation reversal without clear data supporting the best approach. These topics include fixed dose vs package insert dosing of prothrombin complex concentrates (PCC) for warfarin reversal, the choice of reversal (andexanet alfa) or replacement product (PCC) for oral Xa inhibitor reversal especially in the setting of urgent/emergent surgery, and the role of laboratory monitoring and differentiation of clinical characteristics (bleed size and location) to drive institution prescribing guidelines and reversal order sets.

This presentation will outline the data available on these topics and review the strengths and limitations associated with the different options. The presentation style will include a dialogue with a hematologist and pharmacist at a large academic medical center in Boston, MA and will bring into the conversation typical cases and discussions with front line providers that will make this topic very relatable to other providers who manage these complicated patient cases.

Clinical pharmacists are often challenged with antibiotic selection for patients infected with multi-drug resistant organisms. There have been numerous new and novel antibiotics that have received FDA approval over the last decade. Many of these agents are not included on routine antibiotic susceptibility testing panels in hospital-based microbiology labs. Collaboration between the clinical microbiology lab and pharmacy is integral to developing processes and pathways for performing susceptibility testing of novel antibiotics.

This session will attempt to focus mainly on the core aspects of sepsis and septic shock. The pertinent pathophysiology will be reviewed to highlight how to optimize management. The most recent guidelines for the management of sepsis and septic shock will be discussed, as well as the literature that supports those guidelines, and the literature that has come out since they were published. Controversial aspects of sepsis and septic shock management (i.e. corticosteroids, vitamin C, vasopressin, angiotensin II, and balanced fluids) will be explored in the form of patient cases. New data will be discussed in depth to determine the potential benefits of these therapies and if they should be implemented in patients with sepsis or septic shock. This session will try to explore not only the possible benefits of balanced fluids, but new techniques of fluid assessment in patients in the early (and late) stages of sepsis and septic shock to help determine fluid responsiveness.

This presentation will focus on management strategies for acute ischemic stroke including initial evaluation and treatment strategies such as mechanical thrombectomy and systemic fibrinolysis as well as complications of specific interventions (alteplase administration). Early identification of stroke symptoms and presentation to a hospital is critical to improved patient outcomes. This presentation will highlight several aspects of acute stroke management that are of interest to most healthcare providers including pharmacists, physicians, nurses, nurse practitioners and physician assistants.

Many recent initiatives have designed care models that incorporate pharmacists into the initiation, titration and monitoring of drug therapy. In this presentation, we will describe current approaches to pharmacist and physician collaborative practices and their effect on care optimization using a cardiovascular-renal-metabolic collaborative clinic as an example. This information will assist pharmacists with designing and implementing their own care models to improve update of novel therapies.

Pharmacogenomics is a growing area of precision medicine that is increasingly being used in clinical practice. By using pharmacogenomic data alongside other clinical variables to inform medication selection and dosing, clinicians can make personalized medication recommendations that will maximize the likelihood of drug efficacy and minimize the likelihood of adverse drug reactions. In this session, the co-founders of the Brigham and Women’s Hospital Pharmacogenomics Clinic – a clinical pharmacist, genetic counselor, and medical geneticist – reflect on lessons learned from launching this innovative clinical service. Key points are illustrated using patient case examples from their clinic experience.