Introduction The American College of Clinical Pharmacy (ACCP) Pharmacotherapy Didactic Curriculum Toolkit was created by the 2008 ACCP Educational Affairs Committee to provide guidance to schools and colleges of pharmacy for didactic pharmacotherapy curricular development. The toolkit was revised and updated by the 2016 ACCP Educational Affairs Committee. Objectives In accordance with the ACCP Board of Regents decision to update the toolkit every 3 years, the 2019 ACCP Publications Committee was charged with updating the 2016 toolkit to guide adequate disease state inclusion and depth of pharmacotherapy coverage in pharmacy curricula. Methods The committee retained the competency‐based tier definitions and organization of the 2016 toolkit. Multiple literature resources were reviewed to assess medical conditions responsive to drug therapy for inclusion in the 2019 toolkit. The committee also reviewed the tier designation for all toolkit entries for appropriateness, given recent advances in medical care and evolving patient care responsibilities of clinical pharmacists. Updates to the toolkit were made by consensus with electronic voting when required. Results The 2019 toolkit contains 302 topics, including 94 (31%) tier 1, 133 (44%) tier 2, and 75 (25%) tier 3 entries. There are 26 additional topics in the updated toolkit, including 12 new tier 1 topics that are generally treated with nonprescription medications. Eleven new topics were added to tier 2, and 20 topics were added to tier 3 (including 11 topics in the Oncologic Disorders section). The tier classification of some conditions was changed to reflect current pharmacy practice expectations. Conclusion As with the 2016 toolkit, the large number of tier 1 topics will require schools and colleges to employ creative teaching strategies to achieve practice competence in all graduates. The large number of tier 2 topics highlights the importance of postgraduate training and experience for pharmacy graduates desiring to provide direct patient care.

BackgroundAdenosine cardiovascular magnetic resonance (CMR) can accurately quantify myocardial perfusion reserve. While regadenoson is increasingly employed due to ease of use, imaging protocols have not been standardized. We sought to determine the optimal regadenoson CMR protocol for quantifying myocardial perfusion reserve index (MPRi) – more specifically, whether regadenoson stress imaging should be performed before or after rest imaging.MethodsTwenty healthy subjects underwent CMR perfusion imaging during resting conditions, during regadenoson-induced hyperemia (0.4 mg), and after 15 min of recovery. In 10/20 subjects, recovery was facilitated with aminophylline (125 mg). Myocardial time-intensity curves were used to obtain left ventricular cavity-normalized myocardial up-slopes. MPRi was calculated in two different ways: as the up-slope ratio of stress to rest (MPRi-rest), and the up-slope ratio of stress to recovery (MPRi-recov).ResultsIn all 20 subjects, MPRi-rest was 1.78 ± 0.60. Recovery up-slope did not return to resting levels, regardless of aminophylline use. Among patients not receiving aminophylline, MPRi-recov was 36 ± 16% lower than MPRi-rest (1.13 ± 0.38 vs. 1.82 ± 0.73, P = 0.001). In the 10 patients whose recovery was facilitated with aminophylline, MPRi-recov was 20 ± 24% lower than MPRi-rest (1.40 ± 0.35 vs. 1.73 ± 0.43, P = 0.04), indicating incomplete reversal. In 3 subjects not receiving aminophylline and 4 subjects receiving aminophylline, up-slope at recovery was greater than at stress, suggesting delayed maximal hyperemia.ConclusionsMPRi measurements from regadenoson CMR are underestimated if recovery perfusion is used as a substitute for resting perfusion, even when recovery is facilitated with aminophylline. True resting images should be used to allow accurate MPRi quantification. The delayed maximal hyperemia observed in some subjects deserves further study.Trial registrationClinicalTrials.gov NCT00871260

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A US Food and Drug Administration (FDA) drug safety communication was released in March 2013, warning prescribers of the risk of QT prolongation associated with azithromycin. Overall azithromycin utilization and adherence to an inpatient QTc monitoring guideline during 8-month time periods before and after the warning were assessed to evaluate the impact of this warning on inpatient azithromycin utilization and QTc monitoring. Fifty-five patients were included in the prewarning time period and 50 were included in the postwarning period. A significant reduction in utilization in days of therapy per 1,000 patient days was observed (31.2 prewarning vs 17.5 postwarning, p < .001) in these groups. No changes in QTc monitoring among patients receiving azithromycin were identified. FDA warnings of severe, life-threatening toxicities can have a profound impact on utilization and prescribing of medications, however they may not necessarily change monitoring practices.