D5 purge solution with heparin 50 units/mL may increase the risk of supratherapeutic aPTTs, leading to increased bleeding. Decreasing heparin to 25 units/mL as a standard in purge solution may decrease these risks; however, protection against thrombosis remains unknown.

The use of systemic bivalirudin and an anticoagulant-free purge solution in a percutaneous left ventricular assist device (pVAD) is described in a patient with a history of heparin-induced thrombocytopenia (HIT). An 80-year-old man with a past medical history of severe aortic stenosis and HIT was transferred to our facility for cardiogenic shock. The patient was emergently taken to the cardiac catheterization laboratory for balloon valvuloplasty and Impella pVAD (Abiomed, Inc) implantation. Due to the history of HIT, bivalirudin was chosen as an alternative anticoagulant. The device representative suggested adding bivalirudin 20 mg/500 mL to the Impella purge solution. However, due to the negligible amount of bivalirudin this would provide in comparison to patient’s systemic intravenous bivalirudin dose, we elected not to add bivalirudin to the purge solution. The patient remained on the Impella for 72 hours with intravenous bivalirudin without any evidence of pump thrombosis as evidenced by unchanging flows and stable purge pressures. Unfortunately, despite functional Impella pVAD support, care was withdrawn due to ongoing multi-organ failure. This patient case demonstrated the safe, effective, and practical use of an anticoagulant-free purge solution with systemic bivalirudin in a patient with 72 hours of Impella support.

The recent coronavirus disease 2019 (COVID‐19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) challenges pharmacists worldwide. Alongside other specialized pharmacists, we re‐evaluated daily processes and therapies used to treat COVID‐19 patients within our institutions from a cardiovascular perspective and share what we have learned. To develop a collaborative approach for cardiology issues and concerns in the care of confirmed or suspected COVID‐19 patients by drawing on the experiences of cardiology pharmacists across the country. On March 26, 2020, a conference call was convened composed of 24 cardiology residency‐trained pharmacists (23 actively practicing in cardiology and 1 in critical care) from 16 institutions across the United States to discuss cardiology issues each have encountered with COVID‐19 patients. Discussion centered around providing optimal pharmaceutical care while limiting staff exposure. The collaborative of pharmacists found for the ST‐elevation myocardial infarction patient, many institutions were diverting COVID‐19 rule‐out patients to their Emergency Department (ED). Thrombolytics are an alternative to percutaneous coronary intervention (PCI) allowing for timely treatment of patients and decreased staff exposure. An emergency response grab and go kit includes initial drugs and airway equipment so the patient can be treated and the cart can be left outside the room. Cardiology pharmacists have developed policies and procedures to address monitoring of QT prolonging medications, the use of inhaled prostacyclins, and national drug shortages. Technology has allowed us to practice social distancing, while staying in close contact with our teams, patients, and colleagues and continuing to teach. Residents are engaged in unique decision‐making processes with their preceptors and assist as pharmacist extenders. Cardiology pharmacists are in a unique position to work with other pharmacists and health care professionals to implement safe and effective practice changes during the COVID‐19 pandemic. Ongoing monitoring and adjustments are necessary in rapidly changing times.

What is known and objective Colchicine is a standard therapy for the treatment of acute pericarditis. It is metabolized by cytochrome P‐450 3A4 (CYP3A4) and is subject to potential drug interactions. Multiple case reports describe accumulation of colchicine with CYP3A4 inhibitors, but limited data exist for increased colchicine clearance with CYP3A4 inducers. We describe a case of idiopathic haemorrhagic pericarditis treated with colchicine but rendered ineffective given potential drug interaction with carbamazepine. Case summary A 61‐year‐old man with a history of seizures presented to the emergency department with severe chest pain radiating to the back and was found to have a large pericardial effusion. The patient underwent pericardiocentesis, which demonstrated a haemorrhagic pericardial effusion. After an extensive workup, he was treated for idiopathic pericarditis with anti‐inflammatories and colchicine but failed to improve despite adequate colchicine loading and maintenance dosing. A serum colchicine level was checked given a potential CYP3A4 drug interaction in the setting of chronic carbamazepine use and was found to be sub‐therapeutic. Concomitant use of CYP3A4 inducers in the setting of colchicine use can render anti‐inflammatory strategies ineffective and may result in treatment failure. What is new and conclusion Due to its hepatic and intestinal metabolism by CYP3A4 enzymes, colchicine is susceptible to drug‐drug interactions resulting in either toxicities or rendering it ineffective with concomitant CYP3A4 inhibitors or inducers, respectively. Carbamazepine, a common anti‐epileptic medication and known inducer of the CYP3A4 enzyme, may reduce levels of colchicine in the blood resulting in treatment failure. Further study is required to determine if dose adjustments may overcome this drug interaction.

BaCKground: The World Health Organisation (WHO) reports that about 314 million people are visually impaired worldwide, and in 153 million of them the impairment is due to uncorrected refractive errors. Hence, uncorrected refractive error is one of the leading causes of blindness around the globe. The aim of this study is to assess the prevalence and patterns of different types of refractive errors among the people attending the eye clinic in Northern Pakistan. Material and Methods: A hospital-based retrospective audit was done on patients who presented to the Ophthalmology Outpatients Department of Ayub Medical Complex Abbottabad between 1 st June 2017 and 31 st July 2017. The data of 662 patients were analysed using IBM SPSS Statistics v. 22.0. results: Refractive errors were found in 487 (73.5%) of the total participants. The crude prevalence of myopia, hyperopia, and astigmatism was found to be 33.5%, 21.9%, and 18.1%, respectively. The refractive error status was found to be independent of gender (p = 0.075), but it varied among different age groups (p = 0.000). ConClusion: Myopia seems to be the most common refractive error in northern Pakistan, followed by hyperopia. The results of our study can be useful for the planning of eye care services in our country so that we can achieve the goal of VISION 2020 with proper care and planning.