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ASHP Re-certification Ambassador - New Practitioner: Dyslipidemia Module

By David Martin posted 05-31-2015 21:53

Good Evening Everyone!

I hope everyone is enjoying the spring weather and getting their summer plans in place as we head into June.  Like all of you, I have been extremely busy planning vacations and finishing projects for residency.  I also had the opportunity to attend the MAD-ID conference in Orlando earlier this month and recently visit the University of Iowa Hospitals and Clinics as well as the VA center in Iowa City as part of a trip my residency class took to learn about another institution.  It was a mutual sharing of ideas, and we plan to bring back things we learned to our own site in order to improve pharmacy practice.

One thing that both UIHC and the VA are very strong in is ambulatory care, and we learned a lot about how pharmacists manage patients independently in a variety of clinics.  One common disease state that these pharmacists are managing is dyslipidemia and hypertension.  The new 2013 ACC/AHA guidelines were published as I was graduating pharmacy school and beginning my first year of pharmacy residency.  Given the controversy surrounding the guidelines, they weren't really incorporated into clinical practice during my PGY-1 residency year.  As a PGY-2 specializing in infectious diseases in an acute care setting, I don't often think about a patient's lipid panel and what statin therapy (or lack thereof) the patient is receiving.  As such, I began the ASHP Intensive Study B: Evaluating Clinical Trials in Hypertension and Dyslipidemia: Applying Recent Guideline Changes to Patient Care with the hopes of learning a little more about the management of these issues.

So far, I have watched the first of a 3-part series of lectures on the topic of dyslipidemia and hypertension.  Dr. Kostoff provided a good review of the new ACC/AHA guideline recommendations and incorporated a patient case throughout the presentation in order to help the audience understand how to apply it.  He showed the clinical trial data that supports the guideline recommendations regarding using fix-dosed statin therapy (moderate to high intensity based on risk level).  The clinical trials did not use the LDL goals that we have traditionally thought of when treating a patient with dyslipidemia.

As pharmacists, I think it is in our nature to want a number to strive to achieve when treating a patient.  We like treating to numbers (either goals or drug levels) for hypertension, anticoagulation, antibiotics, anti-epileptics, etc.  To take away the goal LDL with statin therapy makes many of us nervous!  One of the unknowns that we face is the question of "how low is too low?"  As we are all aware, cholesterol plays an important role, and we don't know the adverse events that may result from bringing cholesterol levels down extremely low.  Nevertheless, I think it is reasonable to incorporate the new guidelines into our clinical practice when we are treating a patient with dyslipidemia.  Since I am practicing in an acute care setting and in a specialized area, I am curious to know if these guidelines are being used in clinical practice.  If you wouldn't mind sharing your experiences or thoughts, that would be great!

Until next month, take care!

- David

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