ArcMesa Educators - Primary Care CME Courses

Generic Substitution and Therapeutic Equivalence of Antiepileptic Drugs: Clinical and Pharmacoeconomic Issues in Epilepsy Management
A Priority Report
Faculty: John M. Pellock, MD | Andrew J. Pultz, Jr, PharmD, RPh
CME / CE credit hour: 1.0
The issue of generic drug substitution is complex and often poorly understood by physicians and pharmacists. Although the FDA requires that two drugs are similar as demonstrated by bioequivalence data, therapeutic equivalence (or therapeutic effectiveness) and bioequivalence are not necessarily the same. In the case of antiepileptic drugs (AEDs), the therapeutic range over which they are effective may be narrow and, although generic substitution of AEDs may be appropriate for some patients with epilepsy, it may represent suboptimal care for others. This program will give an overview of these and other important issues associated with generic substitution of AEDs.

Inflammatory Aspects and Detection of Vulnerable Plaque: Clinical Impact of Assessement
(Accreditation Expired)
Faculty: Peter Libby, MD | John Cooke, MD, PhD | Antonius F. W. van der Steen, PhD
CME / CE credit hours: 2.0
Rupture-prone (i.e. "vulnerable") plaques are a primary cause of acute coronary syndromes and myocardial infarction. Though the features of rupture-prone atherosclerotic plaques have been described by pathologists, the identification of high-risk plaque in vivo remains a challenge. While coronary angiography is the gold standard for diagnosis of a plaque, alternative detection methods that rely upon physical, optical, and mechanical parameters may help to direct treatment decisions and improve clinical outcomes.

Generic Substitution and Therapeutic Equivalence of Antiepileptic Drugs: Clinical and Pharmacoeconomic Issues in Epilepsy Management
Faculty: John M. Pellock, MD | Andrew J. Pultz, Jr, PharmD, RPh | Michael C. Smith, MD
CME / CE credit hour: 1.0
The issue of generic drug substitution is complex and often poorly understood by physicians and pharmacists. Although the FDA requires that two drugs are similar as demonstrated by bioequivalence data, therapeutic equivalence (or therapeutic effectiveness) and bioequivalence are not necessarily the same. In the case of antiepileptic drugs (AEDs), the therapeutic range over which they are effective may be narrow and, although generic substitution of AEDs may be appropriate for some patients with epilepsy, it may represent suboptimal care for others. This program will give an overview of these and other important issues associated with generic substitution of AEDs.

Novel Therapies in the Treatment of Rheumatoid Arthritis (Accreditation Expired)
Faculty: Roy Fleischmann, MD | Kathryn Hobbs, MD | Philip Mease, MD | Alan J. Bridges, MD
CME credit hours: 1.5
Recent developments in the treatment of rheumatoid arthritis include the approval of two new biologic agents (abatacept and rituximab), earlier initiation of treatment, and a move toward tight control of therapy with consistent monitoring of disease activity. Data from clinical trials of abatacept and rituximab in patients with rheumatoid arthritis suggest these agents are relatively effective and safe. Our panel of rheumatology experts discusses these issues within the context of recent clinical trial results and the implications for treating patients with rheumatoid arthritis. CME Credit hours: 1.5

Addressing Safety Concerns in the Treatment of Atopic Dermatitis (Accreditation Expired)
Faculty: Jon Hanifin, MD | Mark Boguniewicz, MD | Adelaide Hebert, MD | Jonathan Spergel, MD, PhD
CME / CE credit hour: 1.0
In this CME activity, four distinguished members of the medical community review and discuss current clinical trial data focusing on safety issues surrounding the use of topical corticosteroid and TCIs. Panel members review the potential short- and long-term adverse effects of each drug class and then place this information into context by evaluating the risk-benefit ratio associated with each treatment.

Interpreting Important Clinical Trials in Schizophrenia: Evaluating the Effectiveness of Antipsychotics (Accreditation Expired)
Faculty: Scott Stroup, MD, MPH | Joseph McEvoy, MD | Leslie Citrome, MD, MPH
CME credit hour: 1.0
Schizophrenia is a major mental illness, affecting approximately 2.4 million American adults. It is also among the world’s top ten causes of long-term disability. The availability of antipsychotic drugs to treat schizophrenia has greatly expanded with the addition of several newer agents, and it is therefore important for clinicians to be able to compare these agents with regard to long-term efficacy and safety. This program focuses on several recent clinical trials in hopes of providing doctors with information to help guide the selection of anti-psychotic medications for patients with schizophrenia. This educational activity is designed to help interpret the findings of these trials and assist physicians faced with the common and confusing dilemma of choosing an antipsychotic agent that will produce the most positive outcomes for their patients with schizophrenia.

Benefits and Risks of Antipsychotic Medication: A Focus on Sedation (Accreditation Expired)
Faculty: John M. Kane, MD | Christoph U. Correll, MD | Del D. Miller, PharmD, MD
CME credit hour: 1.0
In the management of psychotic episodes, the implications of sedation differ depending upon the intervention stage. Sedation that is advantageous in acute intervention may interfere with therapy in later stages. Historically, the sedation associated with older antipsychotic agents was considered a sign of efficacy. Recent studies, however, show that newer antipsychotic agents effectively control both psychosis and acute agitation with minimal sedation. Use of these agents may achieve acute control while allowing the patient to participate in therapeutic and normal daily activities. In this program, our experts will review the role of sedation in the management of psychotic episodes, from acute stabilization through maintenance.

A Global Look at Second Generation Anti-Epileptic Drug Treatment (Accreditation Expired)
Faculty: Blaise F. D. Bourgeois, MD | Edward P. Sloan, MD, MPH | Barry E. Gidal, PharmD, RPh | Andres M. Kanner, MD
CME credit hours: 1.5
Physicians face unique diagnostic and treatment challenges when treating patients with seizures. Primary care physicians may not be familiar with current treatment options and clinical trial evidence supporting newer first-line agents. In the emergency setting, the evaluation and treatment of a patient with seizures depends upon whether the patient has a history of epilepsy or is presenting with his or her first seizure. Emergency health physicians must decide what level of treatment. This program features a distinguished panel of experts sharing clinical experiences and suggesting strategies for treating patients with epilepsy with a focus on primary care and emergency treatment.

Current Perspectives in Epilepsy Treatment: Focus on Monotherapy
(Accreditation Expired)
Faculty: John M. Pellock, MD | Michael D. Privitera, MD
CME credit hour: 1.0
Combination therapy with antiepileptic drugs is associated with a variety of complications, including toxicity and the potential for drug interactions. In addition, many patients who do not respond to sequential monotherapy, will not become seizure-free with polytherapy. Monotherapy has several advantages over polytherapy, including a reduced risk of side effects and complications due to drug interactions, lower cost, and better compliance. hts issues relating to the use of newer antiepileptic drugs as monotherapy in the treatment of adults and children with epilepsy.

Chemotherapy-Induced Neutropenia Prevention: Implications of New Clinical Data and Guidelines
Faculty: Jeffrey C. Crawford, MD | David C. Dale, MD | Gary H. Lyman, MD, MPH, FRCP (Edin) | Christopher R. Friese, RN, PhD, AOCN^®
CME / CE credit hour: 1.0
Chemotherapy-induced neutropenia has very serious and important clinical consequences in terms of medical care, quality of life, and economic factors for cancer treatment. Chemotherapy patients who develop neutropenia are at risk of developing febrile neutropenia, which is a medical emergency that requires immediate medical management. Febrile neutropenia has historically been treated through the use of prophylactic antibiotics, but their usefulness continues to be controversial and the incidence of febrile neutropenia continues to be high. The use of hematopoetic colony stimulating factors (CSFs) has improved the outcomes for patients who experience febrile neutropenia.

The Conundrum of Rash in Management of EGFR Inhibitors (Accreditation Expired)
Faculty: Roy S. Herbst, MD, PhD | Mario Lacouture, MD | Roman Perez-Soler, MD | Sandy Kurtin, RN, MS, AOCN^®, NP
CME / CE credit hour: 1.0
New therapies targeting the epidermal growth factor receptor (EGFR) have been used in the treatment of a variety of cancers. Although generally well tolerated, EGFR inhibitors are associated with the development of dermatologic reactions (e.g., papulopustular rash, xerosis, pruritus, periungual inflammation, and alopecia) in most patients. At present, little is known about the etiology of these reactions, and no evidence-based management guidelines have been set forth in the dermatologic literature.

Esophageal Capsule Endoscopy in Evaluating Esophageal Varices in Cirrhosis: Current Perspectives on Screening (Accreditation Expired)
Faculty: Fredric D. Gordon, MD | Hugo E. Vargas, MD
CME credit hours: 2.0
Portal hypertension and esophageal varices are two of the main complications of liver cirrhosis. Bleeding from esophageal varices causes death in about 20% of cases. Current international guidelines recommend conventional endoscopic screening (esophagogastroduodenoscopy) for patients with cirrhosis every few years to detect esophageal varices. Recent innovations in capsule endoscopy show promise that it can be an accurate diagnostic tool in screening these patients.

Real World Best Practices for DVT Prophylaxis
(Accreditation Expired)
Faculty: Paul E. Marik, MD, FCCP, FCCM | Arthur P. Wheeler, MD, FCCP | Jamie E. Siegel, MD | Sandra L. Kane-Gill, PharmD, MSc.
CME Credit hours: 1.5
Venous thromboembolism (VTE) is a major cause of morbidity and mortality in the United States. There exists a gap in knowledge for the treatment of VTE with secondary prophylaxis, acute PE, as well as a special consideration for the critically ill (e.g. volume overloaded) or patients with comorbidities (e.g. renal insufficiency). Furthermore, the existing clinical data needs to be discussed and interpreted in order to be applied, as well as a discussion surrounding current issues and controversies in VTE treatment and prophylaxis. This program provides concise and contemporary insight addressing concerns practitioners have regarding the management of patients with VTE.

Role of PPARs in the Treatment of Insulin Resistance & Cardiovascular Disease
Faculty: Lawrence Blonde, MD, FACP, FACE | James R Gavin III, MD, PhD
CME Credit hour: 1.0
This CME initiative provides primary care providers, endocrinologists and cardiologists, who are the forefront in preventing and treating diabetes and CVD, with up-to-date information on the role of PPARs in the treatment of insulin-resistant diabetes and CVD. Topics of discussion include the interrelationship and impact of diabetes, metabolic syndrome, and CVD; current treatment strategies and unmet needs; safety and efficacy data on PPAR activators; and the potential clinical application of dual alpha-gamma PPAR activators.