Jean M. Nappi

Pharmacists in direct patient care settings are expanding their roles and responsibilities. These changes mandate a deeper and broader understanding of disease states, as well as influencing social, behavioral, and environmental factors. Existing guidelines and accreditation standards related to the training of graduate or cardiovascular pharmacist specialists (ie, Accreditation Council for Graduate Medical Education, American Society of Health‐System Pharmacists, American College of Clinical Pharmacy [ACCP]) provide some guidance on essential competencies. However, they stop short of providing recommendations for how to achieve all the objectives. The purpose of this paper is to build upon existing guidelines/standards, describing our recommendations for pharmacy residency training of a cardiovascular clinical specialist. The paper is broken down into the following sections: (1) Skills and Competencies (Building Clinical Skills, Application of Clinical Knowledge and Skills, Drug Information, Research and Scholarship, Teaching Skills, Interpersonal, Communication, and Presentation Skills), (2) Personal and Professional Growth (Growing Interpersonal Skills, Engaging with the Profession), (3) Program Design (Resident Selection, Preceptors and Mentoring, Expectations for Progress/Milestones, Program and Learning Experience Structure), and (4) Clinical and Therapeutic Content Expertise or Medical Knowledge. After each recommendation, specific details are provided to aid in conceptualizing how each can be achieved. Some recommendations are considered essential whereas others are designated as optional. This paper represents the opinion of the Cardiology Practice and Research Network of the American College of Clinical Pharmacy. It does not necessarily represent an official ACCP commentary, guideline, or statement of policy or position.

Pharmacy Practice is a free full-text journal with a scope on the practice of pharmacy. Pharmacy Practice covers pharmaceutical care, social pharmacy, pharmacy education, process and outcome research, health promotion and education, health informatics, pharmacoepidemiology

Heart failure is one of the leading causes of hospitalizations in the United States, with >1 million admissions yearly and a 25% risk of readmissions within 1 month. In order to assist clinicians, we provide an update of the heart failure bibliography that was published in Pharmacotherapy in 2008, which followed the original bibliography published in 2004. A significant number of clinical trials and observational studies have been conducted since the early 1980s to guide management of heart failure patients. Major advances have occurred in the past 10 years, and our understanding of the diagnosis, prevention, and management of heart failure has evolved substantially during this time period. Specific areas of this review include heart failure risk factors, management of comorbid conditions, acute heart failure management, chronic heart failure management, advanced heart failure, device therapy, lifestyle modification, and medication and therapy management, including medication adherence. Key consensus guidelines and statements are also included. This bibliography of key heart failure papers aims to provide clinicians and their trainees with a valuable clinical reference resource and teaching tool that may be used to optimize the care of patients with heart failure.

Purpose The use of a standardized knowledge test to assess postgraduate year 1 (PGY1) pharmacy residency training was evaluated. Methods This was a retrospective review of a prospectively administered exam. A bank of questions was developed by preceptors from each of the core rotation disciplines: general medicine (including ambulatory care and oncology), pediatrics, critical care (including transplantation), drug information, operations, practice management, and psychiatry. Board-certified pharmacy specialists at our institution were asked to submit 5–10 questions with answers that would likely be encountered by residents during rotation in their specific specialty area. The exam was administered at the beginning and the end of the resident’s PGY1 year. Results A total of 49 PGY1 residents completed the examination during the first and last months of their residency training. Residents’ overall scores improved 5–10% annually from baseline to completion of their residency. The mean overall exam score significantly improved from baseline after completion of a PGY1 residency at our institution for all four class years. All four residency classes demonstrated an increase from baseline scores in most core disciplines with the exception of practice management, which decreased every year of the examination. Conclusion Scores on a standardized exam developed to assess the baseline knowledge of incoming PGY1 residents and the effect of one year of residency training improved in the majority of practice areas at the end of the year compared to scores at the beginning of the year.

A Postgraduate Year One (PGY1) resident’s concerns, limitations, and strengths may be self-identified early in the residency year but are reliant on self-awareness and insight. Program directors commonly find difficulty in identifying a resident’s specific knowledge deficits at the beginning of the program. A standardized resident examination can identify limitations early in training and these results can be incorporated into a tailored resident development plan. A total of sixty-two PGY1 residents completed the examination pre- and post-training over a five-year timespan. Scores increased in most core disciplines in each of the five years, indicating an overall improvement in resident knowledge throughout their PGY1 year. The approach of utilizing the scores for the resident’s individualized plan allows for customization to ensure that the resident addresses knowledge gaps where necessary.

Objective: To review the pharmacology, efficacy, and safety of vorapaxar, a protease activator receptor-1 (PAR-1) antagonist, in the management of atherosclerotic diseases. Data Sources: Peer-reviewed clinical trials and review articles were identified from MEDLINE and Current Content database (both 1966 to December 31, 2014) using the search terms vorapaxar and protease activator receptor antagonist. Study Selection and Data Extraction: A total of 30 clinical studies were identified (16 clinical trials, including subanalyses, 14 related to pharmacology, pharmacokinetics, and pharmacodynamics and drug interactions). Data Synthesis: Two phase III clinical trials with vorapaxar have been published. In patients with non–ST segment elevation myocardial infarction (MI), vorapaxar failed to significantly reduce the primary efficacy end point (composite of cardiovascular death, MI, stroke, recurrent ischemia with hospitalization, and urgent coronary revascularization). Conversely, in a study of secondary prevention for patients with cardiovascular disease, the composite end point of cardiovascular death, MI, or stroke was significantly reduced. In both trials, the safety end points of major/minor bleeding were increased compared with placebo. In the secondary prevention trial, an increased incidence of intracranial hemorrhage led to the exclusion of patients with a prior history of stroke. Conclusion: Vorapaxar is approved for use with aspirin and/or clopidogrel in the secondary prevention of cardiovascular events in stable patients with peripheral arterial disease or a history of MI. However, the addition of vorapaxar to other antiplatelets can significantly increase the risk of bleeding. It is, therefore, essential to balance the need for further reduction of risk of thrombotic event with patient’s individual bleeding risk.

Background: Anticoagulation is standard practice for the prevention and treatment of thromboembolic events. Two of the newer agents, rivaroxaban (Xarelto) and dabigatran (Pradaxa) are being utilized frequently in the inpatient and outpatient settings. Prescribers may not appreciate the need for dose reduction in the setting of renal insufficiency. Objective: The objective of this study was to evaluate whether rivaroxaban and dabigatran were dosed according to recommendations in the package insert for patients with renal insufficiency. Methods: Eligible patients were those >18 years of age who received rivaroxaban or dabigatran as an inpatient or had a prescription filled from the outpatient pharmacy. The use of the Cockcroft–Gault equation was utilized to calculate creatinine clearance to evaluate whether patients had appropriate manufacturer recommended dose reductions based on their renal function. Results: There were very few patients (8 of 355, or 2.3%) who should have received a reduced dose when creatinine clearance was calculated utilizing actual body weight. In those patients with renal insufficiency, 3 of 6 (50.0%) patients receiving rivaroxaban and 1 of 2 (50%) patients receiving dabigatran were appropriately dosed. When ideal body weight was substituted for creatinine clearance calculation, there were 15 patients receiving rivaroxaban and 10 patients receiving dabigatran who fell below the creatinine clearance threshold for dose reduction. Conclusions: Based on this evaluation, very few patients required a dose reduction due to renal insufficiency. It is important for clinicians to always monitor renal function when utilizing these medications to optimize the benefits of the new oral anticoagulants while limiting potential deleterious effects. Furthermore, it is necessary to ensure that actual body weight is being utilized for creatinine clearance calculations with the new oral anticoagulants and not to base dosing on estimated glomerular filtration rate or other calculated creatinine clearance as this could lead to inappropriate dose reductions.

Objective. To assess the evolution and effectiveness of the Academician Preparation Program to provide knowledge and skills in teaching and evaluating to pharmacy residents, as well as generate interest in academic careers.Design. Participants attended seminars and participated in additional teaching, precepting, facilitating, and evaluating activities. Residents maintained a teaching portfolio and met with a faculty mentor quarterly to review their progress toward completion of the requirements for the Academician Preparation Program certificate.Assessment. Since the program was first offered in 2005, it has expanded to 7 sites throughout the state. As of June 2012, 155 residents had completed the program and 20 (13%) had accepted full-time academic positions. Many others were serving as adjunct faculty members or preceptors. The majority of those enrolled in pharmacy residencies completed the program.Conclusion. An optional, organized academic preparation program was of interest to residents, fostered a...