Developing and Managing a Clinical Practice

1. Demonstrate the steps to identify the need for and implement pharmacist-provided patient care services in the ambulatory care setting.
2. Summarize considerations for ongoing management of an ambulatory care service.
3. Design a robust and sustainable quality assessment program for pharmacist-provided patient care services in the ambulatory care setting.
4. Examine revenue-generating opportunities for pharmacist-provided patient care services in different ambulatory care settings.

Communication Strategies in Pharmacy 

1. Develop patient rapport, foster trust, and efficiently obtain accurate, comprehensive histories that overcome potential communication barriers.
2. Assess patients’ knowledge, health literacy, self-management skills, health beliefs, and attitudes toward medications to tailor educational interventions that will improve medication therapy adherence and self-efficacy.
3. Communicate medication-related information and pharmacist-directed patient care interventions effectively to other health care professionals both verbally and in writing through the medical record.
4. Discuss factors and methods used to assess and select age- and grade-level appropriate written educational materials intended for a variety of patient types.

Dermatologic and Eyes, Ears, Nose, and Throat, and Immunologic Disorders

1. Formulate an ophthalmologic drug therapy regimen for a patient presenting with macular degeneration, dry eye syndrome, or glaucoma.
2. Construct an individualized pharmacy care plan for a patient with allergic rhinitis.
3. Initiate, change, and modify topical and oral therapeutic regimens for acne using a treatment algorithm.
4. Recommend topical and systemic agents for treating plaque psoriasis given a patient’s disease presentation, severity, and prior therapies.
5. Effectively educate a patient presenting with a skin infestation or minor burn on the purpose, proper use, and potential adverse reactions of treatment.

 Bone/Joint and Rheumatology

1. Identify patients at risk of/presenting with osteoporosis (OP) for further screening and recommend an appropriate therapy plan to prevent future fractures.
2. Recommend therapy for patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), and systemic lupus erythematosus (SLE) on the basis of clinical practice guidelines and patient-specific factors.
3. Recommend screenings, laboratory tests, or immunizations at appropriate intervals for patients with RA, PsA, or SLE treated with disease-modifying antirheumatic drug (DMARD) or biologic DMARD therapies.
4. Choose appropriate drug therapy for osteoarthritis (OA) or fibromyalgia on the basis of drug efficacy and a patient’s comorbid conditions.
5. Formulate a care plan to help patients decrease their uric acid concentrations, gout symptoms, and gouty attacks using nonpharmacologic and pharmacologic interventions.

Psychiatric Disorders

1. Analyze the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Text Revision  (DSM-5-TR) criteria and disease course for anxiety disorders, sleep disorders, major depression, bipolar disorder, attention-deficit/hyperactivity disorder, schizophrenia, and substance use disorders.
2. Apply a working knowledge of common drug and nondrug therapies for psychiatric disorders, including drug, dose, frequency, adverse effects, drug interactions, and monitoring values.
3. Recommend appropriate treatments, including both lifestyle modification and specific drug therapy (medication dose, schedule, and delivery system), on the basis of relevant patient factors (pharmacodynamic, physiologic, pharmacokinetic, and socioeconomic parameters).
4. Develop a patient-specific monitoring plan including medication effectiveness, adverse drug reactions, and drug and disease state interactions.

 Neurology

1. Given a patient case, select an appropriate antiseizure medication (ASM) regimen for a patient with epilepsy on the basis of seizure type and ASM mechanism of action, common adverse effects, and drug interactions.
2. Provide a recommendation for an appropriate pharmacologic therapy for a patient with episodic or chronic migraine headache.
3. Select and manage appropriate disease-modifying therapy for a patient with multiple sclerosis (MS) on the basis of MS subtype and other patient-specific factors.
4. Recommend an appropriate pharmacologic therapy for a patient with Parkinson disease, neuropathic pain, or Alzheimer disease.

Cardiology I

1. Evaluate evidence-based strategies for primary prevention of cardiovascular events in adults, guided by clinical trial data and current practice guidelines.
2. Design an evidence-based treatment and monitoring strategy for patients with hypertension that considers goals of therapy, comorbid conditions, and compelling indications.
3. Create an evidence-based treatment and monitoring plan for patients receiving lipid-lowering therapies for primary and secondary prevention of atherosclerotic cardiovascular disease and hypertriglyceridemia.
4. Devise an evidence-based treatment plan for secondary prevention of acute coronary syndrome, chronic coronary disease, stroke and transient ischemic attack, and peripheral arterial disease.

Cardiology II

1. Formulate appropriate oral anticoagulant treatment strategies for patients who develop venous thromboembolism (deep venous thrombosis or pulmonary embolism) or atrial fibrillation (AF) without mitral stenosis or mechanical heart valves or who have mechanical heart valves consistent with available consensus panel guidelines, recent US Food and Drug Administration approvals, and randomized clinical trials.
2. Compare key differences in onset of action, dosing, administration, absorption, effects on common coagulation tests, and drug interactions between dabigatran, rivaroxaban, apixaban, edoxaban, and warfarin.
3. Design patient-specific, guideline-driven treatment, monitoring, and follow-up plans for patients with heart failure, AF, or ventricular tachycardia.
4. Analyze treatment goals, common adverse effects, clinically important drug interactions, monitoring, and Risk Evaluation and Mitigation Strategies requirements for oral pharmacotherapy of pulmonary arterial hypertension.

 Pulmonary Disorders

1. Compare and contrast common features of patients with asthma, chronic obstructive pulmonary disease (COPD), or both.
2. Select appropriate evidence-based treatment for patients with asthma, COPD, and/or nicotine dependence based on specific patient factors and comorbidities.
3. Develop a comprehensive education plan with monitoring parameters for patients on therapy for asthma, COPD, and/or smoking cessation.
4. Compare and contrast the different respiratory inhaler devices and holding chambers.
5. Integrate smoking cessation and behavioral counseling as a best practice when assisting a patient who is trying to quit smoking.

Diabetes

1. Identify differences between prediabetes, type 1 diabetes (T1D), type 2 diabetes (T2D), and gestational diabetes (GD), including differences in diagnostic criteria and clinical presentation.
2. Compare agents used in the treatment of diabetes, including their mechanisms of action, adverse effects, contraindications, advantages, and disadvantages.
3. Select appropriate insulin regimens on the basis of desired onset, peak, and duration of insulin effects.
4. Individualize a comprehensive glycemic treatment and monitoring plan for people with prediabetes, T1D, T2D, and GD.
5. Develop a treatment plan to address cardiorenal risk in a person with T2D.
6. Design a treatment plan to address the acute and chronic complications related to diabetes.

Endocrine Disorders

1. Design appropriate thyroid hormone replacement therapy dosing strategies for patients with hypothyroidism and hyperthyroidism.
2. Develop appropriate patient-specific pharmacotherapy for the treatment of polycystic ovary syndrome.
3. Medically manage a patient with hyperprolactinemia, acromegaly, and growth hormone deficiency.
4. Differentiate between available weight-loss medications, and design a patient-specific treatment plan.
5. Design a patient-specific treatment plan, for a patient with adrenal gland disorders and Cushing disease.
6. Formulate appropriate monitoring guidelines for hypogonadism.

Nephrology

1. Formulate an appropriate care plan to mitigate risk and slow progression in a patient at risk of developing, or presenting with, acute kidney injury, drug-induced kidney disease, or chronic kidney disease (CKD).
2. Using appropriate data, assess kidney function, dialysis regimen information, and pharmacokinetic/pharmacodynamic drug properties in a patient to inform clinical decision-making.
3. Apply evidence-based pharmacotherapy principles to prevent or slow the progression of CKD, including appropriate selection of guideline-directed medication therapy.
4. Construct an evidence-based treatment plan for managing the most common medical problems in patients with CKD, including anemia, CKD-related mineral and bone disorder, and hyperkalemia.
5. Interpret Medicare Part B and D policies related to end-stage renal disease (ESRD) and dialysis care (ie, ESRD Prospective Payment System, Quality Incentive Program, Conditions for Coverage, Centers for Medicare & Medicaid Services Comprehensive ESRD Care Model) and their respective effects on medication use.

Gastrointestinal Disorders

Gastrointestinal (GI) disorders within the objectives refer to the disorders covered in this chapter and include the following: gastroesophageal reflux disease, peptic ulcer disease, chronic liver disease manifestations, viral hepatitis, malabsorption syndrome, diarrhea, constipation, nausea and vomiting, irritable bowel syndrome, and inflammatory bowel disease.

1. Apply national guideline–based treatment strategies for GI disorders.
2. Assess the benefit-risk of drug therapy for patients with GI disorders.
3. Prepare appropriate nonpharmacologic and pharmacologic interventions for managing GI disorders.
4. Develop a patient-specific comprehensive therapeutic plan for managing GI disorders.
5. Initiate drug-related patient education and counseling for pharmacologic therapies used in managing GI disorders.

Infectious Diseases I

1. Design appropriate treatment regimens for sexually transmitted infections based on accurate identification of their clinical presentations.
2. Describe the classifications, adverse effects, and major drug interactions associated with antiretroviral agents.
3. Formulate treatment strategies for the management of HIV and commonly encountered opportunistic infections.
4. Design appropriate strategies for treatment and prevention of influenza and other viral infections.
5. Design treatment regimens for superficial and endemic fungal infections by assessing associated risk factors.

Infectious Diseases II

1. Use appropriate pharmacologic and nonpharmacologic treatment regimens for patients with urinary tract infections, prostatitis, community-acquired pneumonia, sinusitis, pharyngitis, acute otitis media, skin and soft tissue infections, latent tuberculosis infection, conjunctivitis, Lyme disease, antibiotic prophylaxis, infectious diarrhea, and Clostridioides difficile infections.
2. Interpret risk factors and clinical circumstances for the development of antimicrobial resistance.
3. Use an antimicrobial therapeutic regimen to treat resistant infections and prevent their future development.
4. Use evidence-based medicine and patient-specific factors to design antimicrobial regimens that are appropriate and cost-effective.

Obstetrics and Gynecology

1. Design a plan for contraception, infertility, menstrual disorders, and endometriosis on the basis of patient-specific information.
2. Design a plan for common acute and chronic conditions in pregnancy and lactation.
3. Design a plan for menopausal symptoms on the basis of patient-specific information.
4. Develop provider and patient education regarding medication use during pregnancy and lactation, contraception, infertility, menstrual disorders, endometriosis, and postmenopausal therapy.

Genitourinary, Electrolytes, and Nutritional Deficiencies/Supplementation in Older Adults

1. Assess common genitourinary diseases, electrolyte abnormalities, and nutritional deficiencies in ambulatory older adults.
2. Evaluate and manage drug-induced causes of benign prostatic hyperplasia (BPH), urinary incontinence, erectile dysfunction (ED), electrolyte abnormalities, and nutritional deficiencies in ambulatory older adults.
3. Compare and contrast pharmacologic interventions for BPH, urinary incontinence, ED, electrolyte abnormalities, and nutritional deficiencies.
4. Formulate treatment strategies for BPH, urinary incontinence, ED, electrolyte abnormalities, and nutritional deficiencies using patient-specific information.

Practices and Processes of Care

1. Illustrate a pharmacist’s role and resources regarding quality management, medication safety, and process improvement.
2. Assess the different types of patient care services within ambulatory care pharmacy practice, including any applicable scope or limitations of practice.
3. Use formulary management activities and other resources to improve the prescribing of and access to safe, effective, and affordable treatments.

Trial Design and Biostatistics

1. Describe hypothesis testing and state the meaning of and distinguish between P values, CIs, and measures of central tendency and data spread.
2. Define, compare, and contrast the concepts of internal and external validity, causation, association, bias, confounding, subgroup analysis, surrogate end points, and composite end points in trial design.
3. Compare and contrast the advantages and disadvantages of various study designs (e.g., prospective, retrospective, case-control, cohort, cross-sectional, randomized controlled clinical trials, systematic review, and meta-analysis).
4. Determine why a statistical test is appropriate or not appropriate, given the sample distribution, data type, and study design.
5. Interpret statistical and clinical significance for results from commonly used biostatistical estimation strategies (i.e., CIs) and statistical tests (i.e., P values).
6. Define and evaluate odds ratio, risk/incidence rate, relative risk, number needed to treat, number needed to harm, and other risk estimates.