4th Annual Meeting

SPRING SENIOR SUMMIT

Saturday, April 14, 2018

8:00 am to 3:30 pm

Workforce Alliance

Wichita, KS

Friday, April 13th 6:30pm Happy Hour

Scotch & Sirloin, 5325 E. Kellogg Drive, Wichita, Kansas 67218

7:00pm Dinner Scotch & Sirloin, 5325 E. Kellogg Drive, Wichita, Kansas 67218 Hosted by Sunovion

Saturday, April 14th 7:30am-8:00am Registration

7:45am-9:20am Continental Breakfast

8:00am-8:10am Opening Statements and Introductions

8:10am-9:10am

Addiction Curtis Prichard, PharmD

9:10am-9:20am Break

9:20am-10:20am Meet the CYP’s: Review of Cytochrome P450 Janell Mayer, PharmD, BCPS, BCGP

10:20am-10:30am Break

10:30am-12:00pm Antibiotic Stewardship John W. Millard, PharmD, BCPS, BCGP

12:00pm-1:30pm Lunch and Product Theatre

1:30pm-3:00pm Geri-Jeopardy: An Active Learning Challenge of Geriatric Pharmacy Knowledge Jennifer Warren, PharmD, BCGP, FASCP & Jenny Cole, PharmD, BCPS, BCPP, BCGP

3:00pm-3:30pm Closing Remarks and Awards

Special thanks to our 2017-2018 Board Members and Committee Volunteers 2017-2018 Kansas ASCP Board Members: Lindsey Votaw PharmD, BCPS, BCGP Immediate Past-President, Board Member Jennifer Warren, PharmD, BCGP, FASCP President, Board Member Bradley J. Newell, PharmD, BCACP, BCGP President-Elect, Board Member Chair of Student Engagement Committee Chair of Meetings Committee John W. Millard, PharmD, BCPS, BCGP Secretary/Treasurer, Board Member Chair of Education Committee Mike Coast, RPh, BCGP Board Member Co-Chair of Membership Committee

Kendra Strum, PharmD, BCGP Board Member Co-Chair of Membership Committee Marwa Buser, PharmD, BCPS, BCGP Board Member Chair of Legal Committee Whitney Zentgrapf, PharmD, BCGP Board Member Chair of Community Outreach Brandon Blehm Non-Voting Board Member KU-ASCP Student Liaison

2017-2018 Kansas ASCP Committee Members: Meetings Committee: Chair: Bradley Newell Jennifer Warren John Millard Jenny Cole Lindsey Votaw Brandon Blehm Membership Committee: Co-Chair: Mike Coast Co-Chair: Kendra Strum Community Outreach Committee: Chair: Whitney Zentgrapf Marwa Buser

Education Committee Chair: John Millard Jennifer Warren Janell Mayer Student Engagement Committee Chair: Bradley J. Newell Marwa Buser Brandon Blehm Legal Committee Chair: Marwa Buser LaTonyua Rice

Kansas Chapter

Speaker Biographies: Dr. Curtis L Prichard, Pharm.D. – Opioid Addiction, The Disease Process, Neurobiological Changes and Treatment Options. Dr. Prichard earned his Doctor of Pharmacy degree from Creighton University School of Pharmacy and Health Professions. He is currently employed by Indivior Pharma PLC as a Regional Medical Scientist. He is trained in opioid addiction and utilizes his expertise as an educator for key opinion leaders in the field of addiction. Dr. Prichard directly educates physician providers on the pathophysiology of addiction and treatment options. Dr. Prichard also identifies novel molecules in early stages of development for strategic partnering in coordination with academia to bring new addiction treatment options to market. Dr. Prichard actively consults with Indivior’s Research and Development team on feasibility, study design, and viability of these new treatment modalities. Dr. Prichard performed similar roles over the past 20 years during his time in the pharmaceutical industry. Other companies include Bristol Meyer Squibb’s cardiovascular division (New Oral Anticoagulants), and Teva Pharmaceuticals Respiratory & Immunology division focusing in airway disease. Dr. John W. Millard, Pharm.D., BCPS, BCGP – Antimicrobial Stewardship – A Opportunity for All Dr. Millard earned his Doctor of Pharmacy degree from Creighton University School of Pharmacy and Health Professions. Shortly after graduation Dr. Millard co-founded Recalcitrant Sciences LLC a biotechnology company focusing on meningitis and neurological diagnostic modalities. Dr. Millard is employed by the Robert J. Dole VA Medical Center as a Clinical Pharmacy Specialist with focus practice areas in Internal Medicine, Critical Care, and Infectious Disease. Dr. Millard has a collaboration agreement with an infectious disease physician including a very broad scope of practice with prescription authority. During his tenure Dr. Millard has obtained several advanced Antimicrobial Stewardship Certifications. Including Making a Difference in Infectious Diseases as well as from the Society of Infectious Diseases Pharmacists. Dr. Millard is associated with several infectious disease case reports and poster publications most recently at the American College of Physicians via KU School of Medicine. Dr. Millard serves as a Kansas University Medical Center community faculty member as a pharmacotherapy content expert for their Quality Grand Rounds. Dr. Millard created and acts as the Robert J. Dole VA Medical Center Program Manager for the Clinical Pharmacy In-Service Educational Series. Teaching responsibilities include training KU medical residents on Antimicrobial Stewardship, annual Medical Grand Rounds, and monthly Quality Grand Rounds. He also serves as a preceptor for APPE students in internal medicine and infectious diseases.

Dr. Janell Mayer, Pharm.D. BCGP, BCPS – Meet the Cyps

Dr. Janell Mayer, Pharm.D., BCGP, BCPS is a clinical educator at Wichita State University in the School of Nursing and has an appointment at the University of Kansas as an Adjunct Clinical Assistant Professor in the Department of Pharmacy Practice. She received her BS in Pharmacy from Southwestern Oklahoma State University and her Pharm.D. from the University of Kansas. She has 12 years of geriatric practice in long term care and is a Board Certified Geriatric Pharmacist. She also is a Board Certified Pharmacotherapy Specialist. Dr. Mayer served as President of the Kansas Chapter of the American Society of Consultant Pharmacists.

Dr. Jenny Cole, Pharm.D., BCPS, BCGP, BCPP – Geri-Jeopardy Dr. Jenny Cole is currently a pharmacist at Wesley Rehabilitation Hospital in Wichita, KS. She graduated from the University of Kansas in 2000. Before moving back to Wichita in 2014, Jenny worked for Stormont Vail Hospital where she was the Senior Diagnostic Unit pharmacist. She then went on to manage Genoa Psychiatric Pharmacy, where she was instrumental in starting an indigent fund to help people obtain their medications when they could not afford to pay for them on their own. Jenny is the owner of JLC Pharmacy Services, which focuses on helping community pharmacies manage their MTMs and immunization services. At the 2017 annual KPHA convention she was awarded the MTM Champion Award in 2017 from Sunflower, for having completed the most MTMs in the state of KS. Jenny is a past board member of the KS chapter of ASCP and is board certified in pharmacotherapy, geriatrics, and psychiatric pharmacy.

Dr. Jennifer Warren, PharmD, BCGP, FASCP – Geri-Jeopardy: An Active Learning Challenge of Geriatric Pharmacy Knowledge Dr. Jennifer Warren is the Director of Pharmacy at Wesley Rehabilitation Hospital in Wichita, Kansas. She received her Doctorate of Pharmacy from the University of Colorado Denver Skaggs School of Pharmacy and her Bachelor of Science in Pharmacy from Southwestern Oklahoma State University. She is a Board Certified Geriatric Pharmacist and became a Certified Pain Educator in 2012. Jennifer is the current president of the Kansas chapter of the American Society of Consultant Pharmacists (ASCP) and is also a Fellow of ASCP. She completed two ASCP Foundation Traineeships, one in Parkinson’s Disease and the other in pain management. She also enjoys serving as a preceptor for pharmacy students from the University of Kansas and Creighton University.

NOTES

NOTES

John

Mill

ard,

Pha

rm.D

., BC

PS, B

CG

PA

SCP-

KS

Cha

pter

Spr

ing

Seni

or S

umm

itA

pril

14, 2

018

Pres

ente

r has

no

actu

al c

onfli

cts

of in

tere

st in

rela

tion

to th

is a

ctiv

ityM

ay h

ave

pote

ntia

l con

flict

s of

inte

rest

in re

latio

n to

the

follo

win

g:In

vest

ed in

to th

e TS

P fu

nds

with

no

cont

rol o

ver i

ndiv

idua

l ass

ets

allo

catio

n an

d as

a re

sult

may

dir

ectly

ow

n po

rtio

ns o

f the

co

mpa

nies

whi

ch p

rodu

cts a

re h

erew

ith in

dis

cuss

edC

o-fo

unde

d bi

otec

hnol

ogy

com

pany

Rec

alci

tran

t Sci

ence

LLC

Are

a of

rese

arch

: neu

rolo

gica

l and

men

inge

al in

fect

ious

dia

gnos

tic

mod

aliti

es

Dis

clos

ure

The

view

s ex

pres

sed

in th

is p

rese

ntat

ion

refle

ct th

ose

of th

e pr

esen

ter,

and

not n

eces

sari

ly th

ose

of th

e D

epar

tmen

t of V

eter

an A

ffair

s

Dis

clai

mer

o o o o o o

oo

o o o o o

o o o o o o

o o o

o o o

Stew

ard

ship

Bal

ance

Nee

d fo

r tim

ely,

ap

prop

riate

antim

icro

bial

initi

atio

n in

se

rious

infe

ctio

ns

Nee

d to

avo

id

unne

cess

ary

antim

icro

bial

use

to

prev

ent r

esist

ance

and

ad

vers

e ef

fect

s

Ove

rvie

w –

Nur

sing

Hom

e D

ata

o4.

1 m

illion

pat

ient

s are

ad

mitt

ed to

or r

esid

e in

nur

sing

hom

es

annu

ally

oUp

to 7

0% o

f nur

sing

hom

e re

siden

ts re

ceiv

e an

tibio

tics a

nnua

lly

oUp

to 7

5% o

f ant

ibio

tics a

re p

resc

ribed

inco

rrect

ly

o50

% o

f nur

sing

hom

e re

siden

ts re

ceiv

e in

appr

opria

te a

ntib

iotic

d

urat

ion

Hec

kerM

T, e

t al.

Arc

h In

tern

Med

. 20

03; 1

63:9

72-9

78

Con

sequ

ence

s of A

ntib

iotic

M

isus

e

Adv

erse

Dru

g Ev

ents

and

To

xici

ty

C. d

iffic

ile

Infe

ctio

n

Ant

ibio

tic

Resi

stan

t Pa

thog

ens

Exce

ss M

orta

lity

and

Cos

ts

Inap

prop

riat

e A

ntib

iotic

Use

Clin

Infe

ct D

is

Patie

nt C

ase

176

yea

r old

pat

ient

rece

ntly

dis

char

ged

with

Bac

tere

mia

2/2

ESB

L K

. pne

umon

iae.

C

urre

nt tr

eatm

ent E

rtap

enem

500

mg

IV q

pm–

adm

itted

for f

amily

con

cern

of f

ailu

re

to th

rive

pos

t dis

char

ge

Day

4 o

f rea

dmis

sion

: spi

ke in

whi

te c

ount

, afe

brile

, no

qSO

FA o

r SIR

S cr

iteri

a

Any

que

stio

ns fo

r the

nur

se o

r pat

ient

?

C. D

iff p

ositi

ve

Mos

t Com

mon

Adv

erse

Eve

nts

Alle

rgic

reac

tions

(80%

)A

dver

se e

ffect

s (1

8%)

Dia

rrhe

a, h

eada

che,

diz

zine

ss

Uni

nten

tiona

l ove

rdos

e (1

%)

Mos

t Com

mon

Ant

ibio

tics

Penc

illin

s(3

7%)

Fluo

roqu

inol

ones

(14%

)C

epha

losp

orin

s(1

2%)

Trim

etho

prim

-sul

fam

etho

xazo

le (1

1%)

Ant

ibio

tic A

dver

se E

vent

s

Clin

Infe

ct D

is. 2

008

Sep

15;4

7(6)

:735

-43.

ht

tps:

//w

ww

.cdc

.gov

/dru

gres

ista

nce/

thre

at-r

epor

t-201

3/[A

cces

sed

2017

Sep

tem

ber 0

9]

Ant

ibio

tic e

xpos

ure

is th

e fo

r the

de

velo

pmen

t of C

DI

Clos

trid

ium

diff

icile

Infe

ctio

n (C

DI)

Uni

ted

Stat

es C

ente

rs fo

r Dis

ease

Con

trol

and

Pre

vent

ion.

Ant

ibio

tic R

esis

tanc

e Th

reat

s in

the

Uni

ted

Stat

es, 2

013.

URL

: ht

tp:/

/ww

w.c

dc.g

ov/d

rugr

esis

tanc

e/th

reat

-rep

ort-2

013/

[Acc

esse

d 20

17 S

epte

mbe

r 09]

Frid

kin

S, e

t al.

Mor

bidi

ty a

nd M

orta

lity

Wee

kly

Repo

rt.

Uni

ted

Stat

es C

ente

r for

Dis

ease

Con

trol

and

Pre

vent

ion.

201

4; 6

3(09

):194

-200

.

C. d

iffic

ile

It is

a m

icro

biol

ogic

al d

iagn

osis

:10

cfu/

mL

in 2

con

secu

tive

urin

e sp

ecim

ens

Asy

mpt

omat

ic c

linic

ally

Freq

uent

ly a

ssoc

iate

d w

ith p

yuri

a35

% in

wom

en, 7

0% in

dia

betic

wom

en, 5

0% in

pre

gnan

t wom

en

90%

of i

nstit

utio

naliz

ed e

lder

ly p

atie

nts

100%

in p

atie

nt w

ith in

dwel

ling

cath

eter

s

Asy

mpt

omat

ic b

acte

riur

ia

Con

tam

inat

ion

Asy

mpt

omat

ic b

acte

riur

ia

Indi

catio

n fo

r tre

atm

ent:

Preg

nant

wom

enIn

crea

sed

risk

pye

lone

phri

tis (2

–3

fold

)In

crea

sed

prem

atur

ity a

nd lo

w b

irth

wei

ght

Patie

nts u

nder

goin

g in

vasi

ve G

U p

roce

dure

sPa

tient

with

bac

teri

uria

hav

e a

risk

of b

acte

rem

ia =

60%

Rena

l tra

nspl

ant r

ecip

ient

s

Asy

mpt

omat

ic b

acte

riur

ia

"Inf

ectio

us D

isea

ses

Soci

ety

of A

mer

ica

Gui

delin

es fo

r the

Dia

gnos

is a

nd T

reat

men

t of A

sym

ptom

atic

Bac

teri

uria

in A

dults

“-S

ee m

ore

at: h

ttp:/

/ww

w.id

soci

ety.

org/

Org

an_S

yste

m/#

Gen

itour

inar

y. 2

005

Cys

titis

Dys

uria

, Hem

atur

ia, F

requ

ency

, and

supr

apub

ic p

ain

Pyel

onep

hriti

sC

osto

vert

ebra

l ang

le te

nder

ness

, fev

er, u

rgen

cy,

dysu

ria,

chi

lls, n

ause

a, a

nd v

omiti

ng

Clin

ical

Pre

sent

atio

n

Loeb

Cri

teri

a

Empi

ric

trea

tmen

t bas

ed o

n yo

ur lo

cal a

ntib

iogr

amIn

gen

eral

ens

ure

you

have

E. c

oli c

over

age

To c

ultu

re o

r not

to c

ultu

reU

rine

cul

ture

is n

ot re

com

men

ded

for m

anag

ing

acut

e un

com

plic

ated

cy

stiti

s or t

hose

with

out U

TI sy

mpt

oms

Uri

ne c

ultu

re in

dica

ted

for

acut

e py

elon

ephr

itis

and

any

type

of c

ompl

icat

ed U

TIs

Trea

tmen

t

Trea

tmen

t

Clin

Infe

ct D

is 2

010;

5:62

5-63

; Clin

Infe

ct D

is 2

011;

5:e1

03-2

0D

iPir

oJT

,Tal

bert

RL,Y

eeG

C,e

tal,

eds.

Phar

mac

othe

rapy

:APa

thop

hysi

olog

icA

ppro

ach,

10th

ed.N

ewYo

rk:M

cGra

w-H

ill,2

017

CEL

LULI

TIS

FAST

FAC

TS

Infe

ctio

n of

epi

derm

is, d

erm

is, a

nd

supe

rfic

ial f

asci

a

http

s://w

ww

.aad

.org

/pub

lic/d

iseas

es/r

ashe

s/ce

llulit

is

Cel

lulit

is is

cons

ider

ed a

ser

ious

dise

ase

beca

use

of th

e pr

open

sity

of th

e in

fect

ion

to s

prea

d th

roug

h ly

mph

atic

tiss

ue a

nd to

th

e bl

oods

trea

m

http

s://w

ww

.may

oclin

ic.o

rg/d

iseas

es-c

ondi

tions

/cel

lulit

is/sy

mpt

oms-

caus

es/s

yc-2

0370

762

CLI

NIC

AL

PRES

ENTA

TIO

N

SIG

NS/

SYM

PTO

MS

Mal

aise

, Fev

er, C

hills

Alte

red

Men

tal S

tatu

s, H

ypot

ensio

n

Eryt

hem

a an

d ed

ema

Lesio

ns

Are

a w

arm

to to

uch

Infla

mm

atio

n

LABO

RATO

RY

FIN

DIN

GS

Leuk

ocyt

osis

Bact

erem

ia

DIA

GN

OSI

SC

BC

Clin

ical

Jud

gmen

t

LOEB

CRI

TERI

A

Mild

Typi

cal

Moderate

Syst

emic

Sig

ns o

f in

fect

ion

Mul

tiple

site

s of

infe

ctio

nC

ompl

icat

ing

fact

ors

–ag

e,

com

orbi

ditie

s, im

mun

osup

pres

sion

Abs

cess

es in

are

as d

iffic

ult t

o dr

ain

Severe

Faile

d an

tibio

tic tr

eatm

ent,

Imm

unoc

ompr

omise

d, C

linic

al s

igns

of

deep

er in

fect

ion

Empi

ric

Trea

tmen

t A

lgor

ithm

Man

dell,

Dou

glas

, and

Ben

nett’

s P

rinci

ples

and

Pra

ctic

e of

Infe

ctio

us D

isea

ses.

Phi

lade

lphi

a: C

hurc

hill

Livi

ngst

one

Els

evie

r,20

10:8

73-6

.R

espi

rMed

201

5;10

9:11

05-1

3.M

ande

ll, D

ougl

as, a

nd B

enne

tt’s

Prin

cipl

es a

nd P

ract

ice

of In

fect

ious

Dis

ease

s. P

hila

delp

hia:

Chu

rchi

ll Li

ving

ston

e E

lsev

ier,

2010

:877

-83

Cen

ter f

or D

isea

se C

ontro

l. G

et S

mar

t: K

now

Whe

n A

ntib

iotic

s W

ork

in D

octo

r’s O

ffice

s. h

ttps:

//ww

w.c

dc.g

ov/g

etsm

art/c

omm

unity

/abo

ut/in

dex.

htm

l. A

cces

sed

3/20

18A

nn In

tern

Med

200

1; 1

34(6

):518

-20.

; Am

Fam

Phy

sici

an 2

013;

88(

5):3

38-4

0.A

ntib

iotic

s fo

r acu

te b

ronc

hitis

. Coc

hran

e D

atab

ase

of S

yste

mat

ic R

evie

ws

2017

; Iss

ue 6

. Art.

No.

: CD

0002

45. D

OI:

10.1

002/

1465

1858

.CD

0002

45.p

ub4

Ann

Inte

rn M

ed 2

001;

134

(6):5

18-2

0.; A

m F

am P

hysi

cian

201

3; 8

8(5)

:338

-40.

; Ann

Inte

rn M

ed. 2

001;

134

(6):5

21-9

.; N

Eng

lJ M

ed. 2

006;

355

(20)

:212

5-30

.

Long

er d

urat

ions

may

be

nece

ssar

y if

bact

erem

ia

pres

ent

Men

,fol

eyca

thet

er, o

bstru

ctio

n

Long

er d

urat

ions

may

be

nece

ssar

y if

bact

erem

ia

pres

ent

IV to

PO

Equ

ival

ent C

hart

75 y

/o w

hite

mal

e w

ith a

PM

H D

M, C

KD

sta

ge 4

-5, a

nd N

KD

A p

rese

nts t

o ER

w

ith in

crea

sed

wea

knes

s, su

prap

ubic

tend

erne

ss, a

nd m

ore

SOB

with

any

ac

tivity

ove

r las

t 48

hour

s. H

e ha

d br

achi

ocep

halic

AV

fist

ula

plac

ed la

st w

eek

LUE

He

uses

oxy

gen

2 L

NC

at n

ight

and

prn

dur

ing

the

day.

UA

: WBC

s TN

TC,

RBC

s TN

TC, L

E m

oder

ate,

Nitr

ite n

egat

ive

WBC

s 16

,000

Tmax

: 100

.9F

all o

ther

vita

ls W

NLs

CXR

: Sm

all l

eft a

nd tr

ace

righ

t ple

ural

effu

sion

s w

ith a

djac

ent a

tele

ctas

is,

impr

oved

from

pri

or e

xam

. No

supe

rim

pose

d fo

cal c

onso

lidat

ive

infil

trat

e

Patie

nt C

ase

2

Patie

nt s

tart

ed o

n C

eftr

iaxo

ne 1

gm IV

q24

h 2/

2 U

TID

ay 3

of a

ntib

iotic

s pa

tient

’s W

BCs s

pike

and

bec

omes

febr

ileU

rine

cul

ture

: Gra

m n

egat

ive

rods

Bloo

d cu

lture

s: N

GTD

Wor

kup

for a

ltern

ativ

e so

urce

s of

infe

ctio

n ne

gativ

e

Cul

ture

resu

lts a

re re

port

ed o

ut in

the

afte

rnoo

n on

Day

3

Patie

nt C

ase

2

A.

Esca

late

ther

apy

to C

efep

ime

to a

ppro

pria

te re

nal d

ose

for 7

day

sB.

Con

tinue

cur

rent

ther

apy

(Cef

tria

xone

1gm

IV q

24hr

) to

com

plet

e 7

days

C.

Adj

ust C

eftr

iaxo

ne to

1gm

IV q

12hr

for 7

day

sD

.C

hang

e to

Lev

oflo

xaci

n to

app

ropr

iate

rena

l dos

e fo

r 14

days

Thou

ghts

?

Intr

insi

c re

sist

ance

to c

omm

on a

ntib

iotic

s 2/

2 A

mpC

-lact

amas

esRe

sist

ance

mec

hani

sms:

Enzy

mat

ic, E

fflux

pum

p(s)

, Por

inan

d M

embr

ane

perm

eabi

lity

alte

rnat

ions

Re

gard

less

of s

usce

ptib

ilitie

s D

OC

: Cef

epim

e or

Car

bape

nem

s

Ente

roba

cter

70 y

/o p

atie

nt p

rese

nted

to E

D fo

r 4 d

ays o

f dys

pnea

, sub

ject

ive

feve

r, pr

oduc

tive

coug

h, a

nd n

oted

flu

expo

sure

Adm

issi

on:

Acu

te h

ypox

emic

resp

irat

ory

failu

re 2

/2 C

AP

vs C

OPD

ex

acer

batio

n, a

nd in

fluen

zaTm

ax10

1, W

BCs 1

2.9,

Ban

ds 2

6%, R

R 28

, HR

111

Influ

enza

A p

ositi

ve

Empi

ric

trea

tmen

t: C

eftr

iaxo

ne, A

zith

rom

ycin

, Ose

ltam

ivir

, M

ethy

lpre

dnis

olon

e

Agr

ee o

r dis

agre

e w

ith e

mpi

ric

trea

tmen

t?

“To

be, o

r not

to b

e, th

at is

the q

uest

ion:

”

Day

3 o

f the

rapy

WBC

s 12

.9

15.1

0 14

.7Ba

nds

26

22

no d

iff o

n da

y 3

S. p

neum

onia

e ur

inar

y an

tigen

–po

sitiv

e G

roup

1 S

putu

m c

ultu

re:

3+ G

ram

-pos

itive

coc

ci; 1

+ G

ram

-neg

ativ

e co

cci;

1+ G

ram

-neg

ativ

e ro

dsD

ay 4

of t

hera

pyPa

tient

clin

ical

ly im

prov

ed

Sput

um c

ultu

re S

. pne

umon

iae

2+H

ospi

tal o

n di

vers

ion

requ

est f

or d

isch

arge

s

Patie

nt C

ase

3

Team

dis

cuss

ion

on ro

unds

: a te

am m

embe

r wan

ts to

de-

esca

late

th

erap

y to

Pen

VK

and

dis

char

ge

Com

plet

ed 3

day

s of C

eftr

iaxo

ne/A

zith

rom

ycin

……

……

……

….A

gree

or D

isag

ree…

……

……

……

……

……

….

Atte

ndin

g el

ects

to w

ait f

or s

usce

ptib

ilitie

s

Patie

nt C

ase

3Pa

tient

Cas

e 3

Mic

robi

olog

y Te

stin

go

Gra

m S

tain

sD

eter

min

e if

a ba

cter

ia is

gra

m p

ositi

ve o

r gra

m n

egat

ive

oSe

nsiti

vity

Rep

ort

Cul

ture

s sho

uld

be ta

ken

prio

r to

initi

atin

g an

tibio

tic

ther

apy;

oth

erw

ise

the

path

ogen

may

not

be

iden

tifia

ble

Det

erm

ines

whi

ch a

ntib

iotic

s are

sens

itive

to th

e or

gani

sm in

que

stio

n (S

, I, R

)O

nly

use

antib

iotic

s th

at th

e or

gani

sm is

sen

sitiv

e to

N

ever

use

an

antib

iotic

that

com

es b

ack

as R

or I

oBr

eakp

oint

s pu

blis

hed

by C

LSI o

r FD

Ao

Cla

ssify

MIC

s in

to S

usce

ptib

le (S

), In

term

edia

te (I

), Re

sist

ant (

R)

VIT

EK

Mul

tiple

upd

ates

to C

LSI b

reak

poin

tsC

urre

nt: C

LSI M

100

2017

In 2

010

CLS

I upd

ated

bre

ak p

oint

s for

Ent

erob

acte

riac

iae

Revi

sion

in b

reak

poin

ts o

ccur

due

toBa

cter

ial p

opul

atio

n di

stri

butio

nsBe

tter u

nder

stan

ding

of p

harm

acol

ogic

det

erm

inan

tsBa

cter

ial r

esis

tanc

e m

echa

nism

sPo

or o

utco

mes

from

ESB

L in

fect

ions

Why

Are

MIC

s im

port

ant?

73 y

/o p

atie

nt w

ith E

SRD

on

HD

MW

F is

set

to d

isch

arge

from

Hos

pita

l fo

r rig

ht h

eel O

steo

mye

litis

Ba

selin

e la

bs:

ESR

> 10

0; C

RP 1

4.9

Base

line

imag

ing

New

cor

tical

irre

gula

rity

of t

he c

alca

neus

with

ove

rlyi

ng so

ft tis

sue

defe

ct

is h

ighl

y co

ncer

ning

for o

steo

mye

litis

. Pa

tient

not

a c

andi

date

for M

RIBo

ne b

iops

y cx

: P. M

irab

ilis

3+

Patie

nt C

ase

4

Patie

nt d

isch

arge

d on

Cef

azol

in 2

gm to

be

give

n af

ter H

D o

n di

alys

is d

ays

Patie

nt C

ase

4

Patie

nt re

adm

itted

6 d

ays l

ater

for s

igni

fican

t wea

knes

s, h

ypot

ensi

on,

righ

t hee

l ulc

er re

open

ed a

nd in

nee

d of

wou

nd c

losu

reO

n ad

mis

sion

ther

apy

was

cha

nged

to P

iper

acill

in/T

azob

acta

m?

Patie

nt C

ase

4C

LSI M

100-

S20

(201

0)

FR is

a 7

1 y/

o w

hite

mal

e

Tran

sfer

red

from

a K

S M

edic

al C

ente

r dur

ing

sum

mer

of 2

017,

with

CC

of

seve

re h

eada

che,

exp

losi

ve d

iarr

hea,

nig

ht sw

eats

, chi

lls, a

nd d

ysur

ia.

Vita

ls: T

max

101.

8F,

RR

31, H

R 86

, BP

86/5

3

Star

ted

on IV

Cip

ro a

nd IV

Fla

gyl ,

on

arri

val a

dded

Zos

yn w

ith in

stru

ctio

ns to

co

ntin

ue F

lagy

l

Mic

robi

olog

y O

utsi

de H

ospi

tal:

urin

e cx

E. c

oli >

100

,000

CFU

/mL,

Day

3M

icro

biol

ogy

Robe

rt J.

Dol

e: a

ll cu

lture

s neg

ativ

e

Patie

nt C

ase

5C

ultu

re R

epor

t

Dia

gnos

is: S

epsi

s 2/2

E. c

oli U

TI

QTc

: Adm

issi

on: 4

14 m

sec

Day

3: 4

62 m

sec,

Cip

ro st

oppe

dD

ay 4

: 496

mse

c

No

know

n dr

ug a

llerg

ies

All

sym

ptom

s re

solv

ed a

nd p

atie

nt n

ow re

ady

for d

isch

arge

Wha

t is y

our a

ntib

acte

rial

PO

reco

mm

enda

tion?

Patie

nt C

ase

5C

ultu

re R

epor

t

CLS

I Bre

akpo

int R

evis

ions

Out

side

Hos

pita

l Mic

robi

olog

y la

b M

ICs,

app

ear t

o be

out

date

d

70 y

/o p

atie

nt p

rese

nts

to th

e ED

afte

r a n

on-V

A E

D s

ent h

im h

ome

last

ni

ght f

or in

crea

sing

SO

A, i

ncre

ased

sput

um p

rodu

ctio

n, a

nd c

hang

e in

pu

rule

nce

to a

bro

wni

sh c

olor

Chr

onic

resp

irat

ory

failu

re o

n 3

L O

2 at

hom

eV

ery-

seve

re C

OPD

1-vi

ew C

XR: T

here

is a

smal

l pat

chy

dens

ity a

t the

righ

t bas

e w

hich

pr

obab

ly is

sub

-seg

men

tal a

tele

ctas

is a

lthou

gh it

cou

ld re

pres

ent p

atch

y pn

eum

onia

Adm

issi

on d

x: A

cute

on

chro

nic

hypo

xic

hype

rcap

nic

resp

irat

ory

failu

re

2/2

CO

PD e

xace

rbat

ion

Star

ted

on L

evaq

uin

and

adm

itted

to th

e IC

U (f

loor

on

dive

rsio

n)

Patie

nt C

ase

6

WBC

s 18.

4 15

.0

12.7

Band

emia

12%

xx

xx

LAC

2.0

Patie

nt c

linic

ally

impr

ovin

g an

d tr

ansf

erre

d to

the

floor

pri

or to

the

wee

kend

Satu

rday

Day

3 –

4 Sp

utum

cx

orde

red

but n

ot c

olle

cted

Bloo

d cx

: 2/2

gra

m p

ositi

ve c

occi

Leva

quin

ther

apy

cont

inue

d ba

sed

on c

ultu

re re

port

Patie

nt C

ase

6

Earl

y M

onda

y m

orni

ng d

ay 4

–5i

shRR

incr

ease

s to

31, B

P dr

ops

64/4

1, a

nd p

atie

nt b

ecom

es fe

brile

for t

he fi

rst

time

Tmax

103.

1W

BCs

18.4

15

.0

12.7

19

.22

view

CXR

obt

aine

d:

Air

spac

e op

aciti

es in

the

righ

t low

er lo

be, r

ight

mid

dle

lobe

, and

righ

t up

per l

obe

conc

erni

ng fo

r mul

tifoc

al p

neum

onia

Sput

um c

x ob

tain

ed –

resu

lted

show

ed M

RSA

Patie

nt d

iagn

osed

with

CA

P w

ith b

acte

rem

ia 2

/2 M

RSA

Bloo

d &

Spu

tum

cul

ture

s sus

cept

ibili

ties a

re id

entic

al

Patie

nt C

ase

6“T

he C

hart

”

UpT

oDat

e

MRS

A is

kno

wn

to d

evel

op re

sist

ance

to q

uino

lone

s

Why

sho

uldn

’t I u

se th

e U

p-To

-Dat

e C

OPD

cha

rt

Why

?

Clin

Infe

ct D

is 2

006;

42:7

78-8

4J

Ant

imic

rob

Che

mot

her2

012;

67:

1010

-101

5

http

://w

ww

.fda.

gov/

dow

nloa

ds/D

rugs

/Dru

gSaf

ety/

UCM

5005

91.p

df

>32

mill

ion

pres

crip

tion

s in

2014

!

Der

esin

skiS

. ACH

med

ia 2

016;

Vol

35,

issu

e 9

Fluo

roqu

inol

one

Adv

erse

Effe

cts

CN

S ef

fect

s:H

allu

cina

tions

, con

fusi

on, r

are

chan

ce o

f sei

zure

Q

Tcpr

olon

gatio

n, c

ardi

ac a

rrhy

thm

ias,

dea

thPe

riph

eral

neu

ropa

thy

Tend

on in

flam

mat

ion/

rupt

ure

C. d

iffic

ilePh

otos

ensi

tivity

/ Ph

otot

oxic

ity

Hep

atot

oxic

ity

CLS

I Bre

akpo

ints

CLS

I Bre

akpo

ints

Fast

and

Fur

ious

Fast

and

Fur

ious

Fast

and

Fur

ious

1.M

erop

enem

/Vab

orba

ctam

(Vab

omer

e) –

CRE

2.

Cef

tazi

dim

e/A

viba

ctam

(Avy

caz)

–C

RE

3.Fo

sfom

ycin

in p

roce

ss la

bel e

xpan

sion

to H

AP,

VA

P, sk

in in

fect

ions

, co

mpl

icat

ed in

tra-

abdo

min

al in

fect

ion

4.D

elaf

loxa

cin

5.Le

fam

ulin

–M

DR

CA

P pa

thog

ens

6.C

efid

eroc

ol(s

ider

opho

rece

phal

ospo

rin)

–M

DR

Pseu

dom

onas

/Aci

neto

bact

er7.

Plaz

omic

in–

CRE

8.

Om

adac

yclin

e9.

Icla

prim

-St

aphy

loco

ccus

“no

evi

denc

e of

nep

hrot

oxic

ity”

10.E

rava

cycl

ine

–no

vel f

luor

ocyc

line

antib

iotic

for M

DRs

Que

stio

nsht

tps:

//w

ww

.med

scap

e.co

m/s

lides

how

/ten

-new

-ant

ibio

tics-

6009

164?

nlid

=118

667_

745&

src=

WN

L_m

dpls

feat

_171

024_

msc

pedi

t_ph

ar&

uac=

1510

84C

X&sp

on=3

0&im

pID

=146

4174

&fa

f=1

NOTES

NOTES

GERI-JEOPARDY SCORE SHEET

CAN’T CRUSH

THIS

HOME BREW

ALPHABET

SOUP

LAB RATS

A BEAUTIFUL

MIND

WITCH’S

BREW

$100 $100 $100 $100 $100 $100

$200 $200 $200 $200 $200 $200

$300 $300 $300 $300 $300 $300

$400 $400 $400 $400 $400 $400

$500 $500 $500 $500 $500 $500

TOTAL GERI-JEOPARDY SCORE: ___________

GERI-JEOPARDY SCORE SHEET

DOUBLE GERI-JEOPARDY Hit me

with your best shot

Can’t Touch This

Medicare Short Term Memory

$200 $200 $200 $200

$400 $400 $400 $400

$600 $600 $600 $600

$800 $800 $800 $800

$1000 $1000 $1000 $1000

TOTAL GERI-JEOPARDY SCORE

TOTAL DOUBLE GERI-JEOPARDY SCORE TOTAL

FINAL GERI-JEOPARDY WAGER

FINAL SCORE FINAL GERI-JEOPARDY QUESTION:

HOW TO OBTAIN CONTINUING EDUCATION CREDIT

FOR ASCP-KS SPRING SENIOR SUMMIT

Your CE certificate is the next page in this booklet

It is currently pending KS BOP approval for 4 CE hours

To receive CE Credit you MUST submit your completed copy of the CE certificate to the Kansas State Board of Pharmacy within 30 days of completion of the event.

Both Missouri and Oklahoma have agreed to reciprocate the Kansas CE but you will need to contact their respective Boards of Pharmacy for further instructions.

Certificates may be hand-delivered or submitted by mail to: Kansas State Board of Pharmacy

800 SW Jackson, Suite 1414 Topeka, KS 66612

or

Emailed to pharmacy@ks.gov

or

Faxed to 785-296-8420

This Certificate of Continuing Pharmaceutical Education Is awarded to

Name:_______________________ Address:_____________________ Pharmacist License #:__________

For Attending:

ASCP-KS CHAPTER SPRING SENIOR SUMMIT 2018 ON

APRIL 14, 2018 SPONSORED BY

KS Chapter American Society of Consultant Pharmacists

Pending approval by the KANSAS STATE BOARD OF PHARMACY

KBOP Course No. 18-014 4 hours of CPE credit

Kansas Board of Pharmacy 800 SW Jackson, Suite 1414

Topeka, KS 66612

Thank You to Our Sponsors

Thank you to our sponsors for empowering pharmacists to promote healthy aging through the appropriate use of medications.