Final for Thera (Digital Health, Venous Thromboembolism, Anticoagulation Reversal, Heparin Induced Thrombocytopenia, Stroke and Core Calcualtions = 26+1 bonus)

Recurrent VTE rates are highest in the ____ days following the initial event?

180

What is the age that causes risk factors in VTE?

Incidence in adults greater than 75 years is 7-10x higher then adults < 55 years (Risk increases in adults > 85 years old)

What vascular injury are risk factors for VTE?

1. Major orthopedic surgery (knee or hip replacement)

2. Trauma (espically fractures of the pelvis, hip, or leg)

3. Indwelling venous catheters

What are examples of blood stasis that causes risk factors of VTE?

1. Acute medical illness requiring hospitalization

2. Surgery (esp. general anesthesia > 30 min)

3. Paralysis ( status post stroke, spinal cord injury)

4. Immobility (plaster casts, status post stroke or spinal cord injury)

5. Polycythemia vera

6. Obesity

What are the risk factors of VTE as a summary?

1. Reduced Mobility

2. Obesity (BMI > 30)

3. Hypercoagulable state

4. Previous VTE

5. Elderly

6. Recent trauma and or surgery (< 1 month)

7. Heart/Respiratory Failure

8. AMI / Ischemic Stroke

9. Acute Infection

10. Hormonal Treatment

What DVT rarley cause significant emboli due to their smaller size and thus may not be clinically important?

Distal DVTs

What DVT is 20% of calf vein thrombi propagates to larger veins above the knee?

Proximal DVTs

Formed clots can ____ blood flow or _____

obstruct / embolize

Non-massive (low risk) PE

present in the absence of hypotension, RV dysfunction or myocardial injury (elevated troponin)

Sub-massive (intermediate risk) PE

present in the absence of hypotension, but positive for RV dysfunction or myocardial injury (elevated troponin)

Massive (high risk) PE

Is positive for hypotension, RV dysfunction or myocardial injury (elevated troponin)

What are symptoms of DVT?

1. Unilateral leg pain, swelling and/or warmth

2. If post-thrombotic syndrome develops -> skin, discoloration, chronic swelling, ulceration (in severe cases)

What are signs of DVT?

1. Superfical veins may be dilated

2. A "palpable cord" may be felt in the affected leg

3. Pain in the back of the knee when dorsiflexes the foot of the affected leg (Homan's sign)

What are symptoms of PE?

1. Dyspena, tachypnea, SOB, cough

- Hemoptysis occurs < 1/3 pts

2. Chest pain, chest tightness, palpitations, cardiovascular collapse (marked by cyanosis, shock and oliguria)

Whart are signs of PE?

1. Tachycardia

2. Tachypnea

3. Diaphoresis

4. Patient's neck veins are distended

5. Cyanosis, hypoxia and hypotension (with massive PE)

For DVT, what the the gold standard for imaging?

Contrast Venography

What is contrast venography

A radiographic contrast study that involves the injection of a dye into a foot vein (invasive, expensive and can cayse anaphylaxid and nephrotoxicity)

What is duplex ultrasonogrpahy for VTE?

Measures the rate and direction of blood flow, visualizes clot formation in proximal veins

What is the most common test used for imaging for VTE?

Duplex ultrasonography

What is a downfall of Duplex ultrasonography?

Can not detect small clots in distal veins

What is considered gold standard for PE diagnosis?

Pulmonary angiography

What is pulomary angiography?

an injection of radiopaque contrast dye into the pulmonary artery (associated with significant risk of mortality)

What is ventilation-perfusion scan?

Measures the distrbution of blood and airflow in one area of the lung

What is computerized tomographic scans?

Detects emboli in the pulmonary arteries

What are the two common imaging studies for PE?

Ventilation-perfusion scan & Computerized tomographic scans

When should you use non-pharmacologic treatment in VTE prevention?

Postoperative VTE prophylaxis, espically in patients with contraindications to pharmacologic therapies

What are the two non-pharmacologic treatments for VTE Prevention?

1. Compression Stockings

2. Intermittent pneumatic compression(IPC)

What are intermittent pneumoatic compression (IPC)

utilize a series of cuffs wrapped around the patient's legs that inflate in continouous 1 to 2 minute cycles from the ankles to the thighs

How long should intermittent pneumoatic compression (IPC) be worn for optimal effectiveness?

at least 18 hours/ day

Graduated compression stockings ___ ___ reliably reduce VTE in medically ill patients

do not

What is an interferior vena cava?

can provide short - term protection against PE in very-high-risk patients by blocking enbolization of thrombus formed below the filter

When can you use UFH in VTE prevention?

Acute medical illness and surgical prophylaxis?

What is the dose for UFH for VTE Prevention?

5000 units SC every 12 hours or 8 hours

When can you use Enoxaparin (Lovenox) in VTE prevention?

1. Acute medical illness

2. Knee replacement

3. Hip replacement

4. Abdominal Surgery

What is the dosing for acute medical illness with the use of Enoxaparin (Lovenox)?

40mg SC every 24 hours

What is the dosing for knee replacement with the use of Enoxaparin (Lovenox)?

30mg SC every 12 hours

What is the dosing for hip replacement with the use of Enoxaparin (Lovenox)?

30mg SC every 12 hours or 40mg SC every 24 hours

What is the dosing for abdominal surgery with the use of Enoxaparin (Lovenox)?

40mg SC every 24 hours

When do you have to renal/hapetic dose adjust for the use of Enoxaparin (Lovenox)

If CrCl < 30 mL/min -> 30mg SC every 24 hours

What is the dosing for acute medical illness with the use of Dalteparin (Fragmin)

5000 units SC every 24 hours

When can you use Fondaparinux (Arixtra) in VTE Prevention?

1. Acute medical illness

2. Surgical prophylaxis

What is the dosing for Fondaparinux (Arixtra)?

2.5mg SC every 24 hours (patients weight must be greater than or equal to 50kg

What is a Contraindication with the use of Fondaparinux (Arixtra)?

1. If CrCl < 30mL/min - CI (STOP USE)

2. if patients weight is less than 50kg

What statement best distinguishes digital therapueics (DTx) from wellness apps?

DTX deliver evidence-based therapuetic interventions for disease treatment

What DFA pathway is used when a device is novel with no predicate device?

De Novo pathway

What example best represents remote patient monitoring (RPM)

Home BP cugg transmitting readings to care team between visits

What statement correctly describes telethealth vs. telemedicine?

Telehealth is broader than telemedicine

What is a major patient-level barrier to adoption of digitial health technologies?

Low digital literacy

What is a key pharmacist role in digital pharmacotherapy

Interpret and verify outputs from digital healtht tools

What device classfication represents highest risk?

Class III

Smart inhalers primarily help clinicians identify

Medication adherence patterns

AI integration into infectious disease manageemnt helps primarily with?

Antibacterial dose / duration selection

What is digital health?

comprehensive concept of the ultization of information and communication technology (ICT) for all medical, nursing care, or healthcare support

What is digital medicine?

Digital health related to medical care and broadly supporting medicine practive

What is digital therapeutics?

Health softwares intended to treat or alleviate a disease, disorder, condition, or injury by generating and delivering medical intervention that has a demonstrable positive therapuetic impact on a patient's health

What are class I medical devices?

Low risk, general controls (EX : Elastic bandage)

What are class II medical devices?

Moderate risk, general controls and special controls (EX : automated external defibrillator)

What are class III medical devices?

High risk, general controls and premarket approval (EX : Pacemaker)

What is a wellness app?

App provides insight on sleep based on wearable device and helps user record the quality of sleep alongside advice on possible means to improve their sleep quality

What is a DTX app?

App tracks sleep quality via wearable and then gives CBT for patient over a course of a timeperiod to treat their insomnia. Data is collected and shared with their provider on how treatment is progessing

What is Telehealth?

broad term covering all digitial health services?

What is telemedicine?

refers to remote clinical care using technology like video,phone, or email

What is Remote Patient Monitoring (RPM)

uses digital tools (ex : weight scales, blood pressure cuff, wearables), to collect and transmit patient health dta to healthcare between visits - espically useful for magaing chronic conditions like heart failure or hypertension

True or False : Patients will increasingly interact with AI before the pharmacist does?

True

True or False : Regulation and oversight are still in development for AI?

True

True or False : Pharmacy roles will shift toward verification, interpretation, and system-level judgement

True

True or False : AI is becoming embedded in clinical workflow?

True

Why does surveillance matter?

helps detect trend sooner and support public-health response

What are example of surveillance ?

Internet-based surveillance systems for influenza, dengue, and COVID-19

Why does outbreak response matter?

improves speed and coordination during outbreaks

What are examples of outbreak response?

digital tools used for contact tracing, reporting, and centralized data systems

What is the importance for AI predicition?

aims to improve early warning before large outbreaks

What are examples of AI prediction?

New AI platforms for disease-threat prediction

What is the importance of Diagnostics?

Can speed disease-risk assessment and diagnosis

What are examples of Diagnostics?

Commerical digital diagnostics enabled by AI/ML

How is AI going to intergrate Infectious Disease into practice?

1. Integration of AI models into EHR to aid in ABX selection will increase

2. May help with selection of drugs and with dose calculation

3. Utilize the models/tools to help with making a clinical decision

4. Do not relay solely on the model alone, intergrate clinical decision making throughout

A mobile app tracks a patient's sleep duration using smartwatch data and suggests lifestyle changes like reducing caffeine and screen time. No clinical treatment is delivered. How should this app be classified?

Wellness product app

An app provides CBT modules to treat insomnia, tracks sleep data, and shares progress with a clinician. How should this be classified?

Digital therapuetic (DTx)

What product would MOST likely require FDA oversight?

Insulin titration recommendation software

A pharmacist conducts a video medication counseling visit after hospital discharge. This is:

telemedicine

A patient uses a Bluetooth BP cuff that automatically sends readings to their provider weekly. This is:

RPM : remote patient monitoring

A mobile app tracks asthma symptoms and inhaler adherence and sends reports for therapy adjustments. This is:

RTM

What development is MOST responsible for increased AI adoption in pharmacy workflows?

Integration into EHR documentation systems

Patients increasingly interact with AI tools before pharmacists primarily through

Patient portals and digital assistants

Which device BEST supports long-term arrhythmia detection?

Implantable cardiac monitor

Which pulmonary DHT helps optimize inhaler adherence and technique?

Smart inhaler sensor

A limitation of wearable cardiovascular monitoring devices is

patients usability and comfort concerns

A patient uploads home BP readings weekly. Their pharmacist adjusts lisinopril dosing remotely. This intervention demonstrates:

RPM - supported pharmacotherapy management

Primary pharmacist contribution to hypertension RPM programs includes:

Medication titration support

Which data point collected by smart inhalers MOST improves therapy optimization

Inahler technique timining + adherance

A patient's smart inhaler shows frequent nighttime rescue inhaler use. Best pharmacist action?

Increase ICS therapy consideration

Population-level digital infectious disease surveillance primarily helps:

Predict outbreaks earlier

Clinical decision support systems for infectious disease help pharmacists:

Select antibiotics and dosing strategies

Bayesian-guided dosing platforms (e.g., vancomycin tools) primarily improve:

Serum concentration prediction

Best pharmacist role when using AI dosing tools:

Integrate model output with clinical judgement

Which is a patient-level barrier to DHT adoption?

Limited digital literacy

Which represents a system-level adoption barrier?

Poor interoperability between platforms

Which barrier MOST affects healthcare organization adoption of DHTs?

Return on investment (ROI) uncertanity

A hospital implements an AI assistant that summarizes charts inside the EHR before pharmacist verification. Which key theme driving AI adoption does this example represent?

Integration into clinical workflow system

A patient with asthma uses a smart inhaler. Data show frequent nighttime rescue inhaler use and inconsistent controller inhaler timing. What is the BEST pharmacist intervention?

Evaluate adherence and consider controller therapy adjustment