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Selexipag is an oral prostacyclin IP receptor agonist approved for use as monotherapy or in combination with other therapies to slow PAH progression and reduce the risk of hospitalization in patients with FC II or III symptoms. Its stability and relatively long half-life offer conveniences over conventional prostanoid therapies.

New literature and recommendations for managing hypertensive emergencies in the setting of pregnancy, stroke, and heart failure have been published. Oral nifedipine is now considered an alternative first-line therapy, along with intravenous hydralazine and labetalol for women presenting with pre-eclampsia. Clevidipine is now endorsed by guidelines as a first-line treatment option for blood pressure reduction in acute ischemic stroke and may be considered for use in intracranial hemorrhage. Treatment of hypertensive heart failure remains challenging; clevidipine and enalaprilat can be considered for use in this population although data supporting their use remains limited.

As compared to the standard doses of oseltamivir, higher-dose (ie, double dose) oseltamivir was not associated with improvement in any clinical outcomes. Using higher doses empirically on all patients during influenza season may exacerbate local drug shortages.

Background: Direct oral anticoagulants (DOACs) are considered high-risk medications and pose a serious threat to patients if mismanaged. Furthermore, medication error rates involving DOACs in the acute care setting range from 25% to 40%. To reduce medication error rates at our institution, we implemented a pharmacist-driven DOAC protocol that permitted pharmacists to independently order and monitor DOACs pursuant to a consult order.Objective: To determine the impact of a pharmacist-to-dose DOAC protocol on medication errors at an academic medical center.Methods: This was a retrospective, single-center cohort study using a pre-post design to evaluate the impact of a pharmacist-to-dose DOAC protocol on rates of medication errors. Patient data were evaluated during a 6-month period before and after the implementation of the protocol. Patients were excluded if they were receiving a DOAC for an indication other than venous thromboembolism and/or atrial fibrillation.Results: A total of 502 patients (pre-phase = 256; post-phase = 246) admitted to the hospital and receiving a DOAC were included in the study. A total of 41 patients in the pre-phase received a medication error involving a DOAC compared with 22 patients in the post-phase (16% vs 8.9%; relative risk reduction 44%; P = .017).Rates of near misses were numerically higher in the post-phase group (7.4% vs 11.8%; P = .1), and rates of discharge DOAC errors were numerically lower (8.5% vs 4.9%; P = .1). The most common error was underdosing (N = 31). Conclusion:In this study, the implementation of a pharmacist-to-dose DOAC protocol was associated with a 44% reduction in DOAC-related medication errors. These findings underscore the impact of a protocolized approach to DOAC management, as well as the role of pharmacists in overseeing inpatient DOAC use and reducing medication errors.

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Acute care pharmacists play an integral role in identifying drug-drug interactions that may predispose patients to QT prolongation. Although most pharmacists are equipped with a baseline understanding of drug interactions and the risks of QTc prolongation, few understand the limitations of QTc calculation and interpretation. In this commentary, we put forth the notion that at times health care providers, including pharmacists, place an overemphasis on the QTc interval. In the context of using the QTc to guide pharmacotherapy decisions, unintended consequences may include a cascade of effects leading to delays in treatment, suboptimal medication selection, alert fatigue, and overutilization of resources.

Doctor of Pharmacy department heads are responsible for determining the breadth and depth of content within courses. While the Accreditation Council for Pharmacy Education (ACPE) provides standards for what content, skills, and abilities should be included in PharmD education, the process that schools and colleges use to determine the degree to which these measured outcomes are taught is variable. As new topics and content for instruction are identified, schools and colleges are faced with either extending the PharmD curriculum length, removing other content, or diminishing the depth that other content is covered to make room for new content. To assist with these decisions, the Ebel grid is a tool that can be used to identify the criticality and relevance of encountered topics as well as guide pre-APPE curriculum selection.