PSAP-VII • Cardiology i. Front Matter. Illustrations in This Book iv. PSAP-VII
Editorial Board v. Welcome vi. Acknowledgments vi. Faculty Potential COI
Disclosure.
Book 1 Table of Contents Illustrations in This Book PSAP-VII Editorial Board Welcome Acknowledgments Faculty Potential COI Disclosure Role of ACCP Role of BPS CE and Program Instructions Book 1 Post Test Directions Cardiology I Cardiology I Panel Cardiology I Subscriber Evaluation
iv v vi vi vii vii vii viii viii
Pediatric Screening and Treatment Quality Improvement—Pharmacist-Managed Programs Annotated Bibliography Self-Assessment Questions MANAGEMENT OF CHRONIC STABLE ANGINA By Paul P. Dobesh, Pharm.D., FCCP, BCPS (AQ Cardiology); and Zachary A. Stacy, Pharm.D., BCPS Introduction Pathophysiology Clinical Evaluation Clinical Presentation Physical Findings Diagnostic and Prognostic Testing Quality Patient Care Goals of Therapy Nonpharmacologic Treatments Pharmacologic Treatments Medical Therapy vs. PCI Pharmacotherapy with Elective PCI Monitoring Conclusion Annotated Bibliography Self-Assessment Questions
1 3 5
HYPERTENSION: cLINICAL pRACTICE uPDATES By Heath R. Jennings, Pharm.D., BCPS (AQ Cardiology); and Terri S. Cook, Pharm.D., BCPS Introduction 7 Overview 7 Evidence-Based Treatment 8 JNC 7 Guidelines 2003 8 AHA Scientific Statement 2007 8 ESC and ESH Guidelines 2007 12 CHEP 2008 and 2009 12 Changes Expected with the JNC 8 12 New Literature and Clinical Considerations 13 Special Patient Populations 13 Clinical Controversies 13 New Antihypertensive Therapies 14 Aliskiren 14 Nebivolol 14 Pipeline Agents 15 Additional Targets 15 Quality Improvement Programs 16 Home Blood Pressure Monitoring 16 The Pharmacist’s Role in Preventing Clinical Inertia 17 Annotated Bibliography 17 Self-Assessment Questions 21
43 43 44 44 44 44 45 45 45 46 48 49 57 57 57 61
VENOUS THROMBOEMBOLISM PREVENTION AND TREATMENT: eVIDENCE-bASED uPDATES By Nancy L. Shapiro, Pharm.D., BCPS; and Adam J. Bursua, Pharm.D., BCPS Introduction 65 VTE Prophylaxis 65 Formal Strategy to Address VTE Prevention 66 Risk Stratification 66 Moderate-Risk Groups 66 General Surgery 66 Acute Medical Illness 68 High-Risk Groups: Orthopedic Surgery 70 VTE Treatment 72 Initial Treatment Choices 72 Warfarin Intensity 73 Therapy Duration 74 Heparins in Special Populations 76 Malignancy 76 Obesity 76 Kidney Considerations 77 Heparin-Induced Thrombocytopenia 78 Diagnostic Controversies 78 Treatment Approach and Therapeutic Options 78 The Future of Anticoagulation 79 Genetic Screening/Warfarin Dosing 79 Emerging Therapies 79 The Role of the Pharmacist 82 Annotated Bibliography 82 Self-Assessment Questions 87
DYSLIPIDEMIAS: uPDATES AND nEW cONTROVERSIES By Evan Sisson, Pharm.D., MSHA, CDE; and Benjamin W. Van Tassell, Pharm.D., BCPS Introduction 25 Risk of Cardiovascular Disease 25 Novel and Emerging Risks 26 Risk Calculators 28 Risks and Benefits of Treatment 28 Nonprescription Therapy—Therapeutic Lifestyle Change 28 Prescription Therapy 29 Populations Deserving Special Risk Consideration 32 Acute Coronary Syndromes 32 Cardiometabolic Risk 32 Elderly and Stroke Prevention 34
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i
Front Matter
Cardiology II Cardiology II Panel Cardiology II Subscriber Evaluation
91 93 95
Perioperative Treatment of Patients Receiving VKAs Assessment of Bleeding Risk Assessment of Thromboembolic Risk During Interruption Recent ACCP Recommendations Emergency Reversal Management of Perioperative Bleeding Associated with VKAs Perioperative Treatment of Patients Receiving Antiplatelet Therapy Bleeding Risk Thromboembolic Risk During Antiplatelet Interruption ACCP and AHA/ACC Recommendations Management of Perioperative Bleeding Associated with Antiplatelet Agents Issues Unique to Cardiac Surgery Preoperative Considerations Intraoperative Anticoagulation Reversal of Anticoagulation After Separation from CPB Bleeding Associated with Cardiac Surgery Conclusion Annotated Bibliography Self-Assessment Questions
EVOLUTION OF ANTITHROMBOTIC THERAPY USED IN ACUTE CORONARY SYNDROMES By Sarah A. Spinler, Pharm.D., FCCP, FAHA, BCPS (AQ Cardiology) Introduction 97 Timeline for Antiplatelet Development 97 Timeline for Anticoagulant Development 98 General Overview of ACS Therapy 98 Newer Antiplatelet Therapies for ACS 98 Clopidogrel Loading Dose 98 Prasugrel 107 Other P2Y12 Antagonists 109 Newer Anticoagulants for ACS 111 Bivalirudin for STEMI 111 Rivaroxaban 111 Apixaban 112 Quality Patient Care 113 Quality Metrics vs. Quality Performance Measures 113 ACC/AHA 2008 STE and NSTE MI Performance Measures 113 Estimating Bleeding Risk: The CRUSADE Bleeding Risk Score 114 Conclusion 115 Annotated Bibliography 115 Self-Assessment Questions 121
Cardiology III Cardiology III Panel Cardiology III Subscriber Evaluation
ATRIAL AND VENTRICULAR ARRHYTHMIAS: eVOLVING PRACTICES By Cynthia A. Sanoski, Pharm.D., FCCP, BCPS Introduction 125 Atrial Fibrillation 125 Epidemiology 125 Pathophysiology 126 Therapeutic Goals 128 Pharmacologic Therapy 128 Nonpharmacologic Therapy 132 Treatment Plan 133 Ventricular Arrhythmias and Related Emergency Cardiovascular Care 135 Epidemiology 135 Therapeutic Goals 137 Pharmacologic Therapy 138 Nonpharmacologic Therapy 139 Treatment Plan 139 Annotated Bibliography 142 Self-Assessment Questions 147 PERIOPERATIVE MANAGEMENT OF ANTITHROMBOTIC THERAPY By Jeremy D. Flynn, Pharm.D., BCPS; and Kevin W. Hatton, M.D. Introduction Epidemiology Therapeutic Goals
Front Matter
154 154 155 155 156 157 159 159 159 160 161 162 162 162 163 165 165 165 169 173 175 177
CARDIOVASCULAR DISEASE IN WOMEN By Shannon W. Finks, Pharm.D., BCPS (AQ Cardiology) Introduction 179 Sex-Related Differences and Gender Bias 179 Sex-Related Risk of CVD 180 Risk Awareness 180 Risk Factors 180 Cardiovascular Risk Equations for Women 183 CVD Among Women 186 Disease Presentation 186 Disease Findings 186 Diagnostic Testing Challenges 187 Prognosis and Treatment Outcomes 187 Treatment Disparity Among Men and Women 188 Evidence-Based Treatment Guidelines 190 Sex-Specific Drug Therapy 191 Role of the Pharmacist 194 Conclusion 194 Annotated Bibliography 195 Self-Assessment Questions 201 ANTICOAGULATION MANAGEMENT IN PREGNANCY By Nathan P. Clark, Pharm.D., BCPS, CACP; and Mary Beth M. Dowd, Pharm.D., BCPS, CACP Introduction 205 Pathophysiology 205 Risk Factors for VTE During Pregnancy 206
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PSAP-VII • Cardiology
Thrombophilia Testing and Interpretation Presentation and Diagnosis of VTE Antithrombotic Drugs Pharmacokinetic Alterations in Antithrombotic Drugs During Pregnancy Risks Implications for Nursing Mothers Prevention of VTE Antenatal VTE Prophylaxis Postpartum VTE Prophylaxis Thromboprophylaxis for the Pregnant Patient with MHV Low-Molecular-Weight Heparin Unfractionated Heparin Warfarin Treatment Recommendations Treatment of VTE Recommended Antithrombotic Agents Thrombolysis and Vena Cava Interruption Obstetric Complications Treatment Recommendations Management of Antithrombotic Drugs at Delivery Role of the Pharmacist Conclusion Annotated Bibliography Self-Assessment Questions
206 206 208 208 208 209 209 210 211 212 212 213 213 213 213 213 214 214 214 215 216 216 216 221
Surrogate Outcomes Composite Outcomes Basic Data Interpretation Power and Sample Size Analysis Selection Survival Analyses Non-inferiority Trials Systematic Reviews and Meta-Analyses Annotated Bibliography Self-Assessment Questions
241 242 243 244 245 248 249 250 250 253
Reference Values for Common Laboratory Tests
258
EVALUATING DRUG-INDUCED Cardiovascular disease: A PHARMACOEPIDEMIOLOGIC PERSPECTIVE By Brian J. Quilliam, Ph.D., RPh; and Marilyn M. Barbour, Pharm.D., FCCP, BCPS Introduction 225 Epidemiology of Adverse Events 225 Necessity of Postmarketing Evaluation of Safety 226 Pharmacoepidemiology 226 Pharmacovigilance 226 History of Pharmacovigilance 226 Pharmacovigilance Methodology 227 Pharmacoepidemiology 230 Cohort Studies 230 Case-control Studies 230 Large, Simple Trials 231 Evaluating the Risk of MI Associated with TZDs: An Example of the Role of Observational Studies 232 Observational Studies Evaluating TZDs and MI 232 Causality: Weighing All Available Evidence 234 Conclusion 235 Annotated Bibliography 235 Self-Assessment Questions 237 Interpreting Data in Cardiovascular Disease Clinical Trials: A Biostatistical Toolbox By Ross T. Tsuyuki, BSPharm, Pharm.D., M.Sc., FCSHP, FACC; and Sipi Garg, M.Sc. Introduction 241 Types of Outcome Variables 241 Continuous and Discrete Variables 241
PSAP-VII • Cardiology
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Front Matter
