Assignment #4 – Responding to a Clinician’s DI Request

Responding to a Clinician’s DI Request – Respond to the following scenario using the structured drug information approach. Be sure to do the background research so that you understand the true information need. The maximum length of the response is 500 words. The bibliography, salutation and signature are not included in the word count. Write in formal narrative using the AMA Style Guide as a writing and citation reference and use the IMRAD format (i.e. scientific paper). Follow the example I provided below.

Responding to a Clinician’s DI Request Scenario:

ML is a 57-year-old patient presenting for a 2 month follow up visit with with Dr.West. ML has a past medical history significant for obesity (BMI = 35), diabetes, hypertension and hypercholesterolemia He had a heart attack 2 months ago.ML’s father passed away after having a heart attack when he was 49 years old. ML does not smoke and has implemented life style modifications along with medications to improve his health due to his very high risk for another cardiovascular (CV) event such as a heart attack or stroke. His labs at his last visit 2 months ago were within expected range except for his LDL of 185mg/dl (goal < 70 mg/dl). High intensity atorvastation 80 mg once daily was started 2 months ago to lower his LDL and reduce his CV risk. Current medications include: metformin 850 mg twice daily, lisinopril 40 mg once daily, aspirin 81 mg once daily, carvedilol 6.25 mg twice daily, and atorvastatin 80 mg once daily. ML states he takes his medications as directed and rarely misses any doses. His BMI at today’s visit is 32 after modifying his diet and exercising more frequently. The patient had labs drawn 1 week before this visit (basic metabolic panel, complete blood count, lipid panel). The lipid panel was the only lab outside of normal limits with an LDL-C of 140 mg/dl. Although his LDL has improved with atorvastatin therapy, Dr. West is still concerned the patient’s LDL has not reached a goal of < 70 mg/dl. She calls you to ask if there is any evidence that adding non-statin therapy (i.e., niacin, ezetimibe, fenofibrate or evolocumab) to atorvastatin would be beneficial for this patient to reduce his risk of having another CV event (secondary prevention). Based on the evidence you find she would like to know what you recommend as next steps for this patient. It is okay to leave a message on her voicemail.

For this scenario, since the non-statin therapy has 4 different drugs provided, make sure you pick specific one, and state in the essay why you rule out other 3 drugs and why do you think the one you pick is the best one for the patient
Also, include the drug’s efficacy, route of Administration, cost that are benefit this patient.
Follow the example format and use AMA style for reference.

Responding to a Clinician’s DI Request Grading Rubric

Students must show competency in responding accurately and completely to a drug information request.

Domain	Description	Below Expectations /No Pass 3 points	Meets Expectations 4.5 points	Exceeds Expectations 6 points
Primary Question	Appropriate details are included in the query.	No attempt or limited success to identify and summarize the question.	Identifies and prioritizes most of the details.	Completely and accurately prioritizes all of the details .
Literature Search	Appropriate search, evidence selection and documentation of source material.	Material inappropriate for question.	Source material specified but some supporting sources omitted.	Sources are appropriate for question and primary literature search is efficiently researched.
Synthesis	Presents and assesses appropriate supporting data/evidence/sources. Appropriate study design is referenced and correctly identified (case report/series, case-control, observational cohort or randomized controlled trial).	Makes limited distinctions among fact, opinion, and value judgments. Chosen study is not relevant to scenario. No attempt is made to evaluate the study against any others identified with similar relevance using the evidence hierarchy.	Use of evidence is appropriate, but lacking sufficient comparative documentation. Rationale for choosing specific evidence is discussed.	Examines evidence and its source; questions its accuracy, relevance, and completeness. Makes appropriate distinctions in evidence types and frames synthesis accordingly (e.g. highlights strongest, most direct evidence prominently)
Response	Clinically accurate, cohesive, and concise response. Response is well written and appropriate to requestor using IMRaD (Introduction, Methods, Results, Discussion)format	Information presented is mostly inaccurate AND/OR It does not relate to the question	Information presented is mostly accurate and relates to the question. Response may lack cohesiveness.	Response is accurate, cohesive, and concise.
Clarity and format	References are appropriately cited and formatted using AMA style.	Response has many grammatical errors or inconsistencies References not cited appropriately.	One or two grammatical errors or examples of inappropriate language Minimal issues with reference citations.	Response is free of grammatical errors, inappropriate language, or incorrect reference citations

Responding to a Clinician’s DI Request Example from 2017:

Responding to a Clinician’s DI Request Scenario:

You are an ambulatory care pharmacist. The provider you work with, Dr. Caring, has a 52 year old patient that was given a diagnosis of type 2 diabetes mellitus 6 months ago when she was hospitalized for an emergency appendectomy. She is obese and weighs 250 lbs. She started lifestyle modifications including diet and exercise along with metformin 1000mg po BID after discharge from the hospital. She presents to the clinic today and denies any symptoms of hyperglycemia. Her laboratory studies show a hemoglobin A1C of 8.5%, serum creatinine of 1.0 mg/dL, low density lipoprotein cholesterol concentration of 120 mg/dL, high-density lipoprotein cholesterol of 35 mg/dL and triglyceride concentration of 150 mg/dL. Her doctor wants to start her on a glucagon-like peptide 1 agonist (GLP-1 agonist) because she has read that these drugs can assist with weight loss and effectively lower hemoglobin A1C. The patient’s private insurance will provide coverage for twice daily exenatide, once a week exenatide or once daily liraglutide. Which of the GLP-1 agonists would be the best fit for this patient? Be sure to evaluate efficacy, dosing, and side effects in your answer. You may cite randomized controlled trials, case reports, and systematic reviews as part of your written response.

Assignment #4 – Responding to a Clinician’s DI Request