Chronic Obstructive Pulmonary Disease, Part 5: Clinical Pearls for Comorbid COPD.

Chronic obstructive pulmonary disease (COPD) is often diagnosed with other comorbid conditions. This can complicate therapy overall by contributing to adverse events leading to poor outcomes to not only COPD, but other comorbid conditions. This manuscript will discuss common comorbid conditions often seen with COPD, update vaccination recommendations for COPD patients, and provide information regarding smoking cessation in COPD. The senior care pharmacist has an important role where they can recommend medication adjustments to potentially avoid these adverse events, immunize their patients appropriately, and provide assistance with smoking cessation to improve not only COPD outcomes but outcomes associated with other comorbid conditions.

Assessment of Direct Oral Anticoagulant Use at a Community Teaching Hospital.

Direct oral anticoagulants (DOACs) have become popular choices for both the treatment and prevention of thromboembolic events. However, these agents pose additional risks to patients due to complex dosing, insufficient monitoring, and inconsistent patient compliance. This study evaluates the appropriateness of DOAC prescribing for patients who received an order for apixaban or rivaroxaban over a 6-month period. The primary outcome is percentage of inappropriately prescribed DOAC regimens. Secondary outcomes include an effectiveness endpoint of stroke or embolism and a safety endpoint of major bleeding documented during or within 60 days of the initial visit as well as number of pharmacist clinical interventions. DOAC orders were appropriate 73% of the time. Of the 27% of inappropriate orders, approximately half were apixaban and half were rivaroxaban. The most common reason for an inappropriate order for apixaban was due to atrial fibrillation dosing, and the most common reason for an inappropriate rivaroxaban order was due to dose-indication mismatch. There were 30 pharmacist clinical interventions on DOAC orders that were documented during the 6-month period, and the most common reason for a pharmacist intervention was duplication with another anticoagulant.