Objective: To review the pharmacology, pharmacokinetics, safety, and efficacy of baricitinib, a recently approved selective Janus Kinase (JAK) inhibitor for the treatment of rheumatoid arthritis (RA), and explore its potential role in therapy. Data Sources: Articles were identified using a PubMed search from inception through January 2019 using the terms rheumatoid arthritis, Olumiant, baricitinib, and LY3009104, its molecular name. Study Selection and Data Extraction: Articles relating to randomized clinical trials, pharmacology, pharmacokinetics, efficacy, and safety of baricitinib were evaluated. Data Synthesis: Baricitinib exerts its effects by inhibiting JAK1 and JAK2 enzymes, targeting cytokine and growth factor receptor stimulation, thus reducing downstream immune cell function. Four trials have demonstrated the efficacy of baricitinib with or without methotrexate in patients naïve to disease-modifying antirheumatic drugs (DMARDs) and those who had an inadequate response to or intolerance to both conventional and biological DMARDs. Furthermore, baricitinib was associated with delayed radiographic progression. Despite baricitinib 4 mg often demonstrating greater efficacy compared with the 2 mg dose, only the 2 mg dose is Food and Drug Administration approved because of safety concerns with the 4 mg dose, primarily thromboembolism. Relevance to Patient Care and Clinical Practice: Baricitinib provides an oral treatment option for patients failing tumor necrosis factor inhibitors (TNFis). Safety, cost, and comparative effectiveness to tofacitinib should be considered prior to prescribing baricitinib. Conclusion: Baricitinib is the second medication in its class and has been proven efficacious for the treatment of RA. Given concerns for adverse effects associated with baricitinib, it should be reserved for patients who have failed one or more TNFis.

Background: Secondary prevention medications are often not prescribed to frail, older adults following acute myocardial infarction (AMI), potentially due to the absence of data to support use, perceived lack of benefit, and concern over possible harms. We examined the effect of using more guideline-recommended medications post-AMI on mortality, rehospitalization, and functional decline in the frailest and oldest segment of the U.S. population-long-stay nursing home (NH) residents. Methods and Results: We conducted a retrospective cohort study of NH residents aged ≥65 years using 2007-2010 national U.S. Minimum Data Set clinical assessment data and Medicare claims. Exposure was the number of secondary prevention medications (antiplatelets, beta

To develop, implement and evaluate a 'Shark Tank' style co-curricular activity focusing on creating a new clinical pharmacy service, including assessing student performance and determining the effect of the activity on students' perceptions of innovation as it applies to their own future practice and pharmacy practice in general. Methods. Second year pharmacy students participated in an optional 'Shark Tank' style co-curricular activity and worked in teams to develop a clinical service. A team of faculty graded students according to a CAPE-mapped rubric to determine the winning team. A pre-and post-survey was administered to gather information about changes in perceptions of innovation and entrepreneurship. Results. Student groups received higher scores on their ability to present the background and need for their clinical service, and lower scores in areas such as tracking outcomes and predicting challenges. After completing the activity, 96.7% of responding students agreed that the activity gave them a better understanding of pharmacists' roles in establishing new clinical services and 86.7% stated they intend to actively seek out new clinical pharmacy service opportunities in their future career. Conclusion. Survey results demonstrate that students understand the importance of innovation and entrepreneurship in pharmacy practice, and almost all students felt that the activity gave them an even better understanding of the pharmacist's role in clinical service development. This activity can serve as a blueprint for schools of pharmacy looking to incorporate creative and fun methods of exposing students to innovation and entrepreneurship activities.