Active learning is an important component of pharmacy education. By engaging students in the learning process, they are better able to apply the knowledge they gain. This paper describes evidence supporting the use of active-learning strategies in pharmacy education and also offers strategies for implementing active learning in pharmacy curricula in the classroom and during pharmacy practice experiences.

The 2007 Accreditation Council for Pharmacy Education (ACPE) Accreditation Standards and Guidelines for the Professional Program in Pharmacy delineate new expectations for experiential education within curricula and include guidance on the development and conduct of Pharmacy Practice Experiences. The American College of Clinical Pharmacy (ACCP) Educational Affairs Subcommittee C developed a position statement to further delineate the views of ACCP on factors necessary to meet contemporary standards for doctoral education in pharmacy and to provide guidance to our membership on how to implement the new standards. This White Paper provides explanation and supporting documentation for positions on quantitative and qualitative aspects of experiential education, as well as requirements for practice sites, preceptor roles, qualification, credentialing, and development and assessment of student performance.

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Background:Food and Drug Administration–approved daptomycin dosing uses actual body weight, despite limited dosing information for obese patients. Studies report alterations in daptomycin pharmacokinetics and creatine phosphokinase elevations associated with higher weight-based doses required for obese patients. Limited information regarding clinical outcomes with alternative daptomycin dosing strategies in obesity exists.Objective:This study evaluates equivalency of clinical and safety outcomes in obese patients with daptomycin dosed on adjusted body weight versus a historical cohort using actual body weight.Methods:This retrospective, single center study compared equivalency of outcomes with two one-sided tests in patients with body mass index ⩾30 kg/m2 who received daptomycin dosed on actual body weight versus adjusted body weight. The primary outcome was clinical failure. Secondary outcomes included 90-day readmission and 90-day mortality. A combined safety endpoint included creatine phosphokinase elevation, patient-reported myopathy, and rhabdomyolysis.Results:A total of 667 patients were screened for inclusion; 101 patients were analyzed with 50 in the actual body weight cohort and 51 in the adjusted body weight cohort. The two regimens were statistically equivalent for clinical failure (2% actual body weight versus 4% adjusted body weight; p < 0.001 for equivalency). The two regimens were also statistically equivalent for 90-day mortality (6% actual body weight versus 4% adjusted body weight; p = 0.0014 for equivalency). Limitations include single center, retrospective design, and sample size. Daptomycin dosing intensified throughout the study period.Conclusion:The two daptomycin dosing cohorts were statistically equivalent for both clinical failure and 90-day mortality. More data are needed to assess outcomes with higher (⩾8 mg/kg/day) daptomycin doses in this patient population.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are extensively used worldwide. However, associated adverse gastrointestinal effects (NSAID gastropathy) such as bleeding, perforation and obstruction result in considerable morbidity, mortality, and expense. Although it is essential to employ gastroprotective strategies to minimize these complications in patients at risk, controversy remains on whether celecoxib alone or a non-selective NSAID in conjunction with a proton-pump inhibitor (PPI) is a superior choice. Recent concerns regarding potential cardiovascular toxicities associated with cox-2 selective inhibitors may favor non-selective NSAID/PPI co-therapy as the preferred choice. Concomitant use of low-dose aspirin with any NSAID increases the risk of gastrointestinal complications and diminishes the improved gastrointestinal safety profile of celecoxib; whereas use of ibuprofen plus PPI regimens may negate aspirin's antiplatelet benefits. Evidence shows that concurrent use of a non-selective NSAID (such as naproxen) plus a PPI is as effective in preventing NSAID gastropathy as celecoxib, and may be more cost-effective. Patients failing or intolerant to this therapy would be candidates for celecoxib at the lowest effective dose for the shortest duration of time. Potential benefits from using low-dose celecoxib with a PPI in patients previously experiencing bleeding ulcers while taking NSAIDs remains to be proven. An evidence-based debate is presented to assist clinicians with the difficult decision-making process of preventing NSAID gastropathy while minimizing other complications.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are extensively used worldwide. However, associated adverse gastrointestinal effects (NSAID gastropathy) such as bleeding, perforation and obstruction result in considerable morbidity, mortality, and expense. Although it is essential to employ gastroprotective strategies to minimize these complications in patients at risk, controversy remains on whether celecoxib alone or a non-selective NSAID in conjunction with a proton-pump inhibitor (PPI) is a superior choice. Recent concerns regarding potential cardiovascular toxicities associated with cox-2 selective inhibitors may favor non-selective NSAID/PPI co-therapy as the preferred choice. Concomitant use of low-dose aspirin with any NSAID increases the risk of gastrointestinal complications and diminishes the improved gastrointestinal safety profile of celecoxib; whereas use of ibuprofen plus PPI regimens may negate aspirin's antiplatelet benefits. Evidence shows that concurrent use of a non-selective NSAID (such as naproxen) plus a PPI is as effective in preventing NSAID gastropathy as celecoxib, and may be more cost-effective. Patients failing or intolerant to this therapy would be candidates for celecoxib at the lowest effective dose for the shortest duration of time. Potential benefits from using low-dose celecoxib with a PPI in patients previously experiencing bleeding ulcers while taking NSAIDs remains to be proven. An evidence-based debate is presented to assist clinicians with the difficult decision-making process of preventing NSAID gastropathy while minimizing other complications.

Studies have demonstrated that early treatment of RA and rapid suppression of inflammation are extremely important as they provide long-term benefits and improve the overall prognosis for patients with the disease.

P harmacists are valuable members of multidisciplinary teams caring for patients with rheumatic diseases, serving as clinicians, educators, and researchers. As pharmacotherapy specialists, pharmacists are essential in providing evidence-based clinical care and drug information and serving as patient care advocates to ensure safe and cost-effective drug therapy.The need for clinical pharmacy services in the practice of rheumatology has expanded over the past 40 years and continues to evolve as new therapeutic targets are identified and novel technologies and pharmacologic approaches become available. Prior to this time, nonsteroidal antiinflammatory drugs (NSAIDs), colchicine, antimalarial drugs, corticosteroids, penicillamine, and sulfasalazine were available for clinical use. 1-3 In 1971, Nobel Prize winner John R Vane demonstrated that the mechanism of acetylsalicylic acid effects was inhibition of cyclooxygenase (COX)-mediated production of prostaglandins and thromboxanes. This research subsequently led to the development of additional NSAIDs, including selective COX-2 inhibitors, 4 with wide variability in therapeutic 5 and toxic 6 responses associated with these agents. However, since NSAIDs provided only symptomatic relief, there was a need for the use of disease-modifying antirheumatic drugs (DMARDs) that could affect the progression of disabling diseases such as rheumatoid arthritis.By 1987, the effectiveness of methotrexate in the management of rheumatoid arthritis was so impressive that the Health and Public Policy Committee of the American College of Physicians developed guidelines for its use prior to Food and Drug Administration (FDA) approval for this indication. 7 Oral gold, azathioprine, cyclosporine, cyclophosphamide, leflunomide, mycophenolate, and biological response modifiers (tumor necrosis factor [TNF] blockers, and interleukin-1 [IL-1] receptor antagonists) were also being used to manage an array of rheumatologic conditions during the 1980s into the 21st century. 1,8 During that time, it was recognized that combination therapy with several of those DMARDs achieved an additive or synergistic response, 9 and that early and aggressive intervention in patients with newly diagnosed rheumatoid arthritis could slow radiographic progression of joint damage, limit disability, increase the likelihood of remission, and decrease mortality. 10-12 Most recently, a recombinant form of urate oxidase (rasburicase) 13,14 and agents that inhibit T-cell activation (abatacept)12 or deplete B lymphocytes (rituximab) 12 are being used in rheumatology.As we look toward the future, new biologic therapies that deplete or inhibit the activation of other inflammatory cells, proinflammatory/regulatory cytokines, chemokineinduced migration of inflammatory cells into the synovi-