Objective: Discuss the literature and describe strategies to overcome barriers of inpatient initiation of sacubitril/valsartan in patients with heart failure with reduced ejection fraction (HFrEF). Data Sources: A PubMed, EMBASE, and Google Scholar literature search (January 2014 to June 2020) limited to English language articles was conducted with the following terms: sacubitril/valsartan, initiation, inpatient, hospitalized, B-type natriuretic peptide (BNP), N-terminal pro-B-type natriuretic peptide (NT-proBNP), diuretic, cost, and cost-effectiveness. Study Selection and Data Extraction: Included articles described inpatient initiation of sacubitril/valsartan or described its impact on BNP, NT-proBNP, diuretic dosing, or cost of care. Data Synthesis: A total of 20 studies were identified based on included search terms. Conclusions: Sacubitril/valsartan should be considered for hemodynamically stable patients with HFrEF (New York Heart Association class II or III), potassium <5.2 mmol/L, without a history of angioedema, and after a 36-hour washout from angiotensin-converting enzyme (ACE) inhibitor or aliskiren, if applicable. An appropriate dose can be determined based on the patient’s previous ACE inhibitor or angiotensin receptor blocker dose and/or blood pressure along with patient-specific factors. To overcome barriers of use, the following are recommended: NT-proBNP or BNP with establishment of a new baseline 1 month after initiation may be used for prognosis or diagnosis; careful monitoring of diuretic requirements; utilization of multiple strategies to overcome cost barriers; and use of interdisciplinary care.

The choice of contraceptive method should be based on patient specific factors, patient preference, and method-specific properties. In this article, we review opportunities for an inpatient clinical pharmacist to assist in the selection and counseling of contraceptives in hospitalized patients. An inpatient pharmacist has the opportunity to discuss various contraceptive methods with the patient, ensuring an appropriate method is used after discharge, which is especially important after the occurrence of a contraception-related adverse effect or contraindication to certain contraceptive methods. Barriers, such as formulary restrictions, can limit inpatient initiation of contraceptive therapy while hospitalized, but pharmacists can provide education on appropriate alternatives. Inpatient clinical pharmacists can also make recommendations for contraceptive methods in special populations. It is crucial to select an appropriate therapy in patients with an underlying medical condition, such as those with active or history of breast cancer, psychiatric disorder, or thrombophilia, as inappropriate therapy can cause an increased risk of harm. Pharmacists can assist in contraceptive counseling, evaluating for drug-drug and drug-disease interactions, and recommending the most appropriate therapy in special populations. An inpatient pharmacist has the opportunity to interact with the medical team and assist in navigation of teratogenic medication use and Risk Evaluation and Mitigation Strategies.