Smith ZR, Kelly B, Wu S
… +2 more, Raymond-Forde S, Coons JC
Am J Health Syst Pharm
· 2026 Apr · PMID 41949019
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PURPOSE: The purpose of this publication is to outline evidence-based approaches to the diagnosis, assessment, and treatment of pulmonary arterial hypertension (PAH) utilizing contemporary guidelines and clinical trials....PURPOSE: The purpose of this publication is to outline evidence-based approaches to the diagnosis, assessment, and treatment of pulmonary arterial hypertension (PAH) utilizing contemporary guidelines and clinical trials. SUMMARY: PAH is a rare, progressive cardiopulmonary disease hallmarked by elevations in pulmonary vascular resistance leading to right heart failure. PAH is distinct from other forms of pulmonary hypertension, which include 4 additional groups with different hemodynamic and pathophysiologic mechanisms. Diagnosis of PAH requires exclusion of common cardiac and pulmonary disorders and is confirmed by right heart catheterization with distinct hemodynamic criteria. Disease severity and prognosis in PAH are evaluated using multidimensional assessment tools, which guide evidence-based medication selections. The landscape for evidence-based PAH treatment has evolved over the past decade and includes agents within the nitric oxide, endothelin, prostacyclin, and activin signaling pathways. The standard of care includes initiating a dual oral combination or a 3-drug combination including a parenteral agent at diagnosis in patients with group 1 PAH in those with low- to intermediate- or high-risk status, respectively. Reassessment and modification of the PAH medication regimen includes adding agents from different pathways or switching within a treatment pathway for those agents with clinical trials demonstrating clinical improvements with these approaches. CONCLUSION: The management of PAH has progressed significantly over the past decade with the availability of new treatment approaches and novel therapeutics. It is imperative for healthcare professionals caring for patients with PAH to stay abreast of the current management approaches in this population to improve patient outcomes in this rare disease.
Howington GT, Luo D, Vu L
… +5 more, Trivedi R, Yang L, Hankinson WB, Barlow BT, Prisinzano TE
Am J Health Syst Pharm
· 2026 Apr · PMID 41935840
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PURPOSE: Meropenem is a broad-spectrum antimicrobial used to treat a wide variety of pathogens. In clinical practice, meropenem is frequently administered as an extended infusion. However, the stability of meropenem at r...PURPOSE: Meropenem is a broad-spectrum antimicrobial used to treat a wide variety of pathogens. In clinical practice, meropenem is frequently administered as an extended infusion. However, the stability of meropenem at room temperature when diluted in 0.9% sodium chloride injection ("normal saline" [NS]) is 1 hour per the package insert. Therefore, the concentration of meropenem during the extended infusion may decline to suboptimal levels due to degradation. The objective of this study was to determine the stability of meropenem diluted in bags of NS and stored at 23-25 °C. METHODS: Meropenem 1-g vials were used to prepare 13 mg/mL solutions via aseptic compounding that were stored at 23-25 °C. Samples at 0-, 2-, 4-, 6-, 12-, and 24-hour time points were collected and the meropenem concentration was determined using high-performance liquid chromatography. Data was presented in triplicate measurements of 3 independent drug preparations. Samples were considered stable when the percentage remaining concentration was maintained above the 90% threshold stated in the United States Pharmacopeia-National Formulary monograph. RESULTS: Chemical stability is typically defined as 90% or more of the drug remaining in the preparation. All sample solutions of meropenem remained above 90% of the initial drug concentration threshold through the 12-hour time point (mean concentration, 92.72%), with a linear decrease in concentration over time. At the 24-hour time point, the remaining concentration of meropenem fell below the 90% threshold (to a mean of 86.65%). CONCLUSION: Meropenem can remain stable for up to 12 hours when formulated in a polyvinyl chloride bag containing 100 mL of NS stored at 23-25 °C.
Alexander CS, Rao K, McKinzie CJ
… +5 more, Tinoco E, Deyo Z, Colmenares EW, Muluneh B, Valgus J
Am J Health Syst Pharm
· 2026 Apr · PMID 41935381
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PURPOSE: Relevant tools are lacking to assess health equity specifically related to pharmacy services; therefore, there is minimal guidance on how to objectively and strategically evaluate the impact clinic-based pharmac...PURPOSE: Relevant tools are lacking to assess health equity specifically related to pharmacy services; therefore, there is minimal guidance on how to objectively and strategically evaluate the impact clinic-based pharmacists have in health equity efforts. The overall aims of this project were to (1) identify health indicators for a health equity scorecard in ambulatory care pharmacy practice and (2) create and refine a reproducible process for identifying key health indicators for a health equity scorecard. METHODS: A modified Delphi methodology served as the primary framework for health indicator selection. This approach included gathering subject matter expert (SME) insights regarding the importance, usability, and validity of potential health indicators identified via an environmental scan. RESULTS: The primary objective for this project was to identify health indicators, with 8 selected at the end of the modified Delphi survey process. The process consisted of 2 iterative rounds and a final consensus meeting. Twenty SMEs were recruited to participate, with 90% (n = 18), 85% (n = 17), and 70% (n = 14) participating in the first and second rounds of the survey and the final consensus meeting, respectively. CONCLUSION: Through this project's use of a modified Delphi methodology, a standardized and reproducible process was successfully developed for the identification of health indicators for a health equity scorecard to evaluate clinic-based pharmacists' impact on closing health equity gaps. This process has the potential to fill a significant gap in the literature, and the future health equity scorecard will further demonstrate the value of pharmacists in the pursuit of health equity.
Gandhi K, Molineros CN, Akture E
… +2 more, Crossman A, Khan A
Am J Health Syst Pharm
· 2026 Apr · PMID 41934629
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PURPOSE: A case in which cefiderocol was used for the treatment of ventriculitis caused by difficult-to-treat resistance in Pseudomonas aeruginosa (DTR-PA) is reported. SUMMARY: A 56-year-old female with a relevant past...PURPOSE: A case in which cefiderocol was used for the treatment of ventriculitis caused by difficult-to-treat resistance in Pseudomonas aeruginosa (DTR-PA) is reported. SUMMARY: A 56-year-old female with a relevant past medical history significant for type 2 diabetes mellitus was admitted to the intensive care unit for an acute large intraparenchymal hemorrhage. Despite numerous attempts at neurosurgical interventions and procedures (eg, hematoma evacuation, external ventricular drain placement, ventriculoperitoneal shunt placement), the patient developed worsening hydrocephalus. While dependent on mechanical ventilation, she developed multiple episodes of ventilator-associated pneumonia (VAP) secondary to pansusceptible Pseudomonas aeruginosa infection treated with courses of cefepime and meropenem. Eventually, the patient developed DTR-PA VAP and was treated with ceftolozane/tazobactam. On day 124, she was unresponsive and febrile, and cerebrospinal fluid (CSF) culture grew DTR-PA. Although susceptibility testing indicated that the cultured P. aeruginosa isolate was susceptible to ceftolozane/tazobactam at a minimum inhibitory concentration of 4 µg/mL, the clinical decision to utilize cefiderocol instead was made. Despite use of cefiderocol for a 3-week course, neurologic examination findings remained poor. After multiple repeat CSF cultures suggesting no growth, 3 weeks after completion of therapy CSF culture grew DTR-PA again, with a similar susceptibility pattern. Thus, the patient was restarted on an additional 9 weeks of cefiderocol. After completion of a total of 12 weeks of cefiderocol therapy, repeat CSF cultures demonstrated microbiological eradication and the patient remained clinically stable. CONCLUSION: This patient case demonstrates cefiderocol's potential clinical utility for the treatment of DTR-PA ventriculitis, providing real-world context in an area with limited clinical data.
Am J Health Syst Pharm
· 2026 Mar · PMID 41885169
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PURPOSE: The purpose of this manuscript is to provide an up-to-date overview of the emerging pharmacotherapy options for the treatment and management of metabolic dysfunction-associated steatotic liver disease (MASLD) wh...PURPOSE: The purpose of this manuscript is to provide an up-to-date overview of the emerging pharmacotherapy options for the treatment and management of metabolic dysfunction-associated steatotic liver disease (MASLD) while also highlighting pathophysiology, diagnostic criteria, risk factors, management of comorbidities, and implications for pharmacist practice. SUMMARY: MASLD, formerly known as nonalcoholic fatty liver disease (NAFLD), affects approximately 80 million adults in the US and disproportionately impacts individuals with diabetes and obesity. Recent guidance from the AASLD, ADA, and AACE provides a framework for screening, diagnosis, and pharmacological management aimed at reducing fibrosis, hepatic steatosis, and inflammation. Updated recommendations emphasize risk stratification through noninvasive testing, such as the FIB-4 score, followed by noninvasive imaging when clinically indicated. Fibrosis staging informs subsequent treatment decisions, which may include pharmacological agents such as PPAR agonists (pioglitazone), antioxidants (vitamin E), thyroid hormone receptor-β agonists (resmetirom), and GLP-1 or GLP-1/GIP receptor agonists. While pharmacotherapy plays an essential role in management, lifestyle interventions and comprehensive patient education remain fundamental components of care. CONCLUSION: As treatment options for MASLD continue to emerge, it is crucial for pharmacists across all practice settings to optimize patient care. Optimization should occur through early recognition and management of comorbidities and disease, as well as by ensuring access to medications. Effective management of MASLD involves collaboration among all members of the healthcare team to enhance patient outcomes and maintain safety.
Kortokrax A, Rush M, Beatty S
… +2 more, Kier KL, Salameh L
Am J Health Syst Pharm
· 2026 Mar · PMID 41873715
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PURPOSE: Medicare annual wellness visits (AWVs) focus on overall patient wellness and disease prevention, increasing preventative care utilization. Despite being a counterpart, there are no Medicaid AWVs. The purpose of...PURPOSE: Medicare annual wellness visits (AWVs) focus on overall patient wellness and disease prevention, increasing preventative care utilization. Despite being a counterpart, there are no Medicaid AWVs. The purpose of this study was to evaluate the feasibility of Medicaid AWVs in an independent pharmacy within an academic institution. METHODS: This was a prospective exploratory research study. The primary objective of this study was to identify the number of Medicaid patients who participate in a Medicaid AWV. Secondary objectives included quantifying the number of interventions and provider recommendations made by pharmacists, identifying the percentage of visits billable for reimbursement, performing economic analysis, and evaluating patient satisfaction. Between February 1 and April 30, 2025, patients were contacted to schedule an appointment. During Medicaid AWVs, point-of-care testing was performed, health risks and social determinants of health documented, and recommendations provided. Patient satisfaction following visits was evaluated. Pharmacists are becoming more involved in primary care and conducted these novel appointments to further expand the scope of practice. RESULTS: Twelve appointments were scheduled, and 6 Medicaid AWVs were completed during the 3-month period. The mean number of risks or conditions identified per patient was 9 (SD, 1.67). The mean number of interventions per patient and mean number of recommendations per patient were 9 (SD, 1.67) and 4 (SD, 1.26), respectively. The number of billable visits was 4 (67% of completed visits). Economic analysis revealed that allocating 1 pharmacist full-time equivalent (FTE) to perform Medicaid AWVs could be feasible, depending on the population. In the satisfaction survey, 5 patients rated the service at the highest level (a mean [SD] score of 79.67 [0.82] points out of a total possible score of 80 points). CONCLUSION: Pharmacists are uniquely poised to conduct Medicaid AWVs due to their accessibility and primary care scope. Pharmacists could utilize the forms and workflow developed in this study to impact patient health, decrease long-term healthcare costs for Medicaid patients, and receive reimbursement through billing as Medicaid providers.
Am J Health Syst Pharm
· 2026 Mar · PMID 41870191
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PURPOSE: The purpose of this study was to review the accuracy of 4 different artificial intelligence (AI) tools in providing dosing recommendations for initiation and missed doses of long-acting injectable antipsychotics...PURPOSE: The purpose of this study was to review the accuracy of 4 different artificial intelligence (AI) tools in providing dosing recommendations for initiation and missed doses of long-acting injectable antipsychotics (LAIAs). SUMMARY: The increasing number of LAIAs provides a valuable treatment option for individuals with schizophrenia and bipolar disorder who struggle with adherence. Currently, there are over 10 second-generation LAIA formulations available in the United States; however, dosing and administration can be complex, leading to the possibility of errors. As the use of AI continues to expand in healthcare, clinicians may utilize AI for guidance in dosing LAIAs. Our study evaluated the accuracy of 4 generative AI tools (ChatGPT, Microsoft Copilot Chat, Perplexity, and OpenEvidence) in providing dosing recommendations for both initiation and missed-dosing scenarios for LAIAs. Accuracy rates among the models varied significantly. OpenEvidence was the most accurate, providing an inacurate response to only one query (a 95% accuracy rate). ChatGPT was the least accurate, with a 40% accuracy rate. Most of the inaccuracies (62%) occurred when the AI tools provided recommendations related to missed-dose scenarios. CONCLUSION: This study highlights the importance of providers using caution when relying on AI tools to provide dosing recommendations for patients prescribed LAIAs. Tools that are rooted in more scientific data, like OpenEvidence, may be more useful in providing accurate information quickly than conversation-based tools, like ChatGPT. If utilizing AI tools for guidance on medication dosing and recommendations, providers should be sure to also review recommendations from package inserts or other reliable drug information sources.
Am J Health Syst Pharm
· 2026 Mar · PMID 41870190
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PURPOSE: Sugammadex rapidly and effectively reverses aminosteroidal neuromuscular blocking agents and has largely replaced neostigmine in perioperative practice. Although its use is associated with faster recovery and a...PURPOSE: Sugammadex rapidly and effectively reverses aminosteroidal neuromuscular blocking agents and has largely replaced neostigmine in perioperative practice. Although its use is associated with faster recovery and a lower rate of residual neuromuscular blockade, clinically important limitations exist. This review summarizes the literature describing incomplete reversal, recurrence of neuromuscular blockade, adverse effects, drug interactions, and challenges in special populations, with a focus on the role of quantitative neuromuscular monitoring and pharmacist-led activities to optimize sugammadex use. SUMMARY: While sugammadex substantially reduces the risk of residual neuromuscular blockade compared to neostigmine, incomplete reversal and recurrence of neuromuscular blockade continue to occur, particularly when dosing is not guided by quantitative neuromuscular monitoring. Underdosing, redistribution of neuromuscular blocking agents, and altered pharmacokinetics can all contribute to inconsistent responses. Quantitative neuromuscular monitoring, rather than choice of reversal agent, is the main determinant of reliable neuromuscular recovery and reduced occurrence of postoperative complications. Sugammadex is associated with rare but potentially serious adverse effects, including hypersensitivity reactions and cardiovascular instability, highlighting the need for careful monitoring. Patent expiration and generic availability may expand access to sugammadex, and these limitations warrant continued attention. CONCLUSION: Sugammadex represents a major advance in neuromuscular blockade reversal but remains an imperfect agent. Safe and effective use requires individualized dosing guided by quantitative neuromuscular monitoring and vigilance for adverse effects. Pharmacists are well positioned to lead education, dosing protocol development, and monitoring strategies that optimize patient safety while supporting adoption of quantitative neuromuscular monitoring.
Am J Health Syst Pharm
· 2026 Mar · PMID 41870187
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PURPOSE: The purpose of this study is to evaluate the impact of pharmacist-led management of GLP-1 and GIP/GLP-1 receptor agonists in patients with type 2 diabetes mellitus (T2DM), as compared to usual care by a physicia...PURPOSE: The purpose of this study is to evaluate the impact of pharmacist-led management of GLP-1 and GIP/GLP-1 receptor agonists in patients with type 2 diabetes mellitus (T2DM), as compared to usual care by a physician. METHODS: This was a retrospective study conducted at an outpatient clinic. Adult patients with T2DM who received an initial prescription for dulaglutide, liraglutide, oral or injectable semaglutide, or tirzepatide during the study period of January 1, 2019, to March 31, 2024, were included. Patients were stratified into 2 groups based on the care they received: management by a clinical pharmacist (pharmacist-managed care) or by a resident physician (usual care). Data was collected from the initiation of the GLP-1 receptor agonist (RA) or GIP/GLP-1 RA to 6 months after initial or treatment discontinuation. The primary outcome was the net change in glycated hemoglobin (HbA1c) from baseline to the end of the study period. RESULTS: This study included 128 patients: 24 pharmacist-managed and 104 usual care patients. The pharmacist-managed group had a mean 19.9% (SD, 13%) reduction in HbA1c from baseline, compared to a 10.2% (SD, 20.9%) reduction in the usual care group (P = 0.03). The pharmacist-managed group also saw greater improvements in de-escalation of insulin and average number of GLP-1 RA and GIP/GLP-1 RA dose titrations. CONCLUSION: Pharmacist-led management of GLP-1 RA or GIP/GLP-1 RA therapy resulted in a greater improvement in HbA1c when compared to usual care.
Johnson K, Kaveh M, Livezey S
… +4 more, Moore R, Choi L, Zuckerman AD, Cruchelow K
Am J Health Syst Pharm
· 2026 Mar · PMID 41861049
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PURPOSE: To examine interventions, recommendations, and direct cost avoidance from integrated outpatient specialty neurology pharmacists in the non-multiple sclerosis (MS) setting. METHODS: A single-center, retrospective...PURPOSE: To examine interventions, recommendations, and direct cost avoidance from integrated outpatient specialty neurology pharmacists in the non-multiple sclerosis (MS) setting. METHODS: A single-center, retrospective cohort study was performed, including patients prescribed specialty medications from non-MS neurology clinics with at least one pharmacist intervention from January to March 2023. Outcomes included pharmacist intervention types, intervention recommendations to patients and providers, and direct cost avoidance from interventions. Cost avoidance was calculated by summing the total costs (average wholesale price minus 20%) of one fill of medications that were discontinued or had a dose change as a result of an intervention or refill deferral. Patients who used excess supply on hand from a previous fill were accounted for during the calculation. The cost per unit of each medication/dosage was multiplied by the quantity of the last medication fill to calculate the cost avoided. RESULTS: The study included 741 patients with a median age of 60 (interquartile range, 22-72) years; 83% were White; 55% were male; and 69% used the integrated health-system specialty pharmacy (IHSSP) for medication fulfillment. Pharmacists performed 2,244 interventions, generating 392 recommendations, with a 98% acceptance rate. The most common recommendation outcomes were medication changes (34%, n = 129) and financial assistance referrals (17%, n = 64). During the 3-month study period, discontinuations and dose changes resulted in $172,757 in direct cost avoidance for IHSSP patients. CONCLUSION: IHSSP neurology pharmacists in the non-MS setting frequently perform interventions that result in therapy changes and direct cost avoidance. IHSSP pharmacist interventions benefit patients, providers, the healthcare system, and insurers.
Thai V, Garofalo J, Donnelly A
… +1 more, Thambi M
Am J Health Syst Pharm
· 2026 Mar · PMID 41841628
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PURPOSE: The accuracy of medication histories is critical for patient safety, especially during transitions of care. Although pharmacy-led medication history services have demonstrated clinical value, evaluation of their...PURPOSE: The accuracy of medication histories is critical for patient safety, especially during transitions of care. Although pharmacy-led medication history services have demonstrated clinical value, evaluation of their effectiveness typically relies on manual chart review, which is an unsustainable approach for large-scale quality improvement. This initiative aimed to validate an automated reporting tool embedded in the electronic health record that can be used to evaluate the performance of a pharmacy-led medication history service in the emergency department. SUMMARY: An automated reporting tool was developed using native reporting functionality within the health system's electronic health record. The tool was designed to capture key performance metrics of the service, including the timeliness of medication history review, staff involvement, medication counts, and patient outcomes such as length of stay as well as readmission and revisit rates. Retrospective validation was conducted using a stratified random sample of 121 emergency department admissions between July and December 2024. Data from the automated report were compared to manual chart review results. Most inpatient variables showed 100% agreement, while discrepancies were observed in the number of medications documented (72% accuracy), 30-day readmissions (81%), and 90-day readmissions (68%). CONCLUSION: The automated report demonstrated strong accuracy for most metrics, particularly for those related to the hospital admission. Variability in postdischarge data and medication counts highlights the need for refinement of the data extraction logic. Once optimized, the tool offers a scalable solution for continuous performance monitoring and pharmacy service evaluation.
Am J Health Syst Pharm
· 2026 Mar · PMID 41825900
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PURPOSE: Professional identity formation (PIF) is the internal process of identifying with one's profession by developing the knowledge, values, and beliefs held by those in the field. Despite the growth of pharmacy resi...PURPOSE: Professional identity formation (PIF) is the internal process of identifying with one's profession by developing the knowledge, values, and beliefs held by those in the field. Despite the growth of pharmacy residency programs, limited research exists on PIF in this group. We conducted a scoping review to explore the current understanding of PIF in pharmacy residents and identify gaps in this area. SUMMARY: In January 2025, databases were searched for relevant publications that addressed pharmacy resident PIF in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews methodology. Seven publications were included in this review. The final synthesis was organized around 4 major themes identified in the literature: (1) the role of preceptors; (2) facilitators of PIF; (3) barriers to PIF; and (4) program initiatives. CONCLUSION: This scoping review provides an initial overview of PIF in pharmacy residents, much of which overlaps with what is known about pharmacy students. Given the limited familiarity with PIF and the critical role of preceptors in this process, faculty development and preceptor training remain key areas for growth. Future research focusing specifically on pharmacy residents and their process of PIF is needed.
Knight JM, Hawkins B, Anderson E
… +5 more, Brown S, Brown B, Yates JR, Tuttle J, Walker S
Am J Health Syst Pharm
· 2026 Mar · PMID 41822974
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PURPOSE: Suppression of unnecessary allergy alerts for β-lactams with dissimilar side chains may reduce prescribing of alternative agents. This study sought to determine whether selective suppression of β-lactam allergy...PURPOSE: Suppression of unnecessary allergy alerts for β-lactams with dissimilar side chains may reduce prescribing of alternative agents. This study sought to determine whether selective suppression of β-lactam allergy alerts solely by side chain cross-reactivity could safely decrease prescribing of alternative (carbapenem, monobactam, and non-β-lactam) antibiotics. METHODS: This retrospective quasi-experimental study was conducted at a 710-bed academic medical center. In total, 819 encounters between August 2020 and October 2024 were screened. Encounters from August 1, 2020, to September 20, 2022, were assigned to the pre-alert suppression group, while the post-alert suppression group included encounters from October 1, 2022, through March 31, 2024. Adults with a documented β-lactam allergy receiving at least one dose of antibiotic were included. Patients were excluded if they had a nonsuppressible class allergy or received a one-time antibiotic dose for surgical prophylaxis. The primary composite outcome was defined as receipt of a carbapenem, monobactam, or non-β-lactam antibiotic for initial therapy. Secondary outcomes included the percentage of patients initially prescribed an alternative antibiotic by agent, receiving an empiric antibiotic with side chains identical or similar to those of their reported β-lactam allergy, with allergy-related pharmacist interventions, and with documentation of a new β-lactam allergy during the current admission. An interrupted time series analysis was performed for the primary composite outcome. RESULTS: Individual rates of initial carbapenem, fluoroquinolone, and aztreonam prescription were not significantly different between the groups, although composite prescribing of these agents was significantly lower in the post-alert suppression group (25.4% vs 15.0%; P = 0.016). Initial prescribing of alternative agents per quarter did not significantly change in level or trend after implementation of alert suppression. Documentation of new β-lactam allergies was comparable between the groups. CONCLUSION: β-lactam allergy alert suppression yielded a significant reduction in initial composite prescribing of alternative agents. These findings, and the comparable rates of new allergies recorded in the postimplementation group, suggest that alert suppression may be safe and clinically meaningful in antibiotic selection.