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OVERVIEW

Tumor lysis syndrome (TLS) is the most common disease-related emergency encountered during the treatment of patients with cancer and results in a release of large amounts of cellular contents into the blood stream leading to hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia. Electrolyte and metabolic dysregulation can progress to renal toxicity, cardiac arrhythmias, seizures, and death due to multiorgan failure. It is encountered most commonly in patients with a select few hematologic malignancies and is rare in others, particularly in patients with solid tumors. As a result, pharmacists may have limited experience in recognizing and managing patients at risk of TLS or experiencing TLS.

This enduring case-based activity will provide participants with up-to-date information regarding selecting an appropriate prophylaxis approach for patients at risk of TLS. This activity will also discuss care for patients with established TLS and highlight the pharmacist's critical role in educating patients and other healthcare professionals on medication usage in patients at risk for TLS and in those with established TLS.

GOAL

The goal of this activity is provide pharmacists with a current understanding of strategies to minimize the risk of TLS in cancer patients and manage patients with established TLS. Participants will be better able to relate the underlying pathophysiology of TLS to their peers, risk-stratify patients, develop individualized treatment strategies, anticipate and manage treatment-related adverse events, and select appropriate prophylaxis strategies.

TARGET AUDIENCE

This enduring case activity is designed for oncology pharmacy specialists, hospital pharmacists, specialty and managed-care pharmacists, all of whom are involved in the care of patients at risk for TLS. No prerequisites required.

LEARNING OBJECTIVES

The University of Tennessee College of Pharmacy takes responsibility for the content, quality, and scientific integrity of this CPE activity. At the conclusion of this activity, the participant should be able to:

• Describe the underlying pathophysiology and metabolic complications associated with tumor lysis syndrome.
• Identify patients most likely to develop tumor lysis syndrome, including risk stratification to direct preventative therapy.
• Summarize current clinical trial data and recommendations regarding the safety and efficacy of agents used to manage tumor lysis syndrome.
• Develop a drug therapy plan to prevent and manage tumor lysis syndrome.

CREDIT DESIGNATION STATEMENT

The University of Tennessee College of Pharmacy is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education. Successful completion of this knowledge-based program will provide a statement for 1.0 contact hour of credit (0.10 CEU) and will be available at the completion of the activity. Successfully completing the activity and receiving credit includes: 1) attending the session; 2) watching, listening to, and participating in the educational activity; 3) completing the self-assessment instrument  with a score of at least 70%. UAN:  0064-0000-16-229-H01-P. CE credit will be submitted to the NABP CPE Monitor within 30 days.  It is recommended that you check your NABP CPE Monitor e-profile database 30 days after the completion of any CE activity to ensure that your credits are posted.

NABP e-PROFILE ID NUMBER

Pharmacists or pharmacy technicians with questions regarding their NABP e-Profile or CPE Monitor should refer to the FAQ section on the NABP website: https://nabp.pharmacy/cpe-monitor-service/cpe-monitor-faqs/. To receive credit for your participation in this activity, all pharmacists must include their NABP e-Profile ID number, along with their month and date of birth. If incorrect information is provided, this will result in "rejected" status from the CPE Monitor. It is the responsibility of the participant to notify The University of Tennessee (within the 60 day submission timeframe) of their corrected information. Otherwise, the completed CE will not be accepted by the CPE Monitor.

Please allow up to 30 days for your credit to appear on CPE Monitor.

Type of Activity: Knowledge

Published:  December 31, 2016
Expires: December 31, 2017

Media: Internet
Fee Information: There is no fee for this educational activity.

Estimated time to complete activity: 60 minutes

HOW TO EARN CREDIT

Participants must complete the activity as described above in the Credit Designation Statement. To answer the questions, click on your selected choice for each answer then proceed to the next question. We recommend that you print a copy of your answers before you submit them to us. Once completed, click on Submit Post-test at the bottom of the page. Your post-test will automatically be graded. If you successfully complete the post-test (score of 70% or higher), your statement of CE credit will be made available immediately. Click on View Certificate and print the CE statement for your records. If you receive a score lower than 70%, you will receive a message notifying you that you did not pass the post-test. You will have 2 opportunities to pass the post-test.

FULL DISCLOSURE POLICY AFFECTING CPE ACTIVITIES

As an accredited provider by the Accreditation Council for Pharmacy Education (ACPE), it is the policy of The University of Tennessee College of Pharmacy to require the disclosure of the existence of any significant financial interest or any other relationship a faculty member or a sponsor has with the manufacturer(s) of any commercial product(s) discussed in an educational presentation. The Chair/Author reported the following:

PARTICIPATING FACULTY

LeAnne Kennedy, PharmD, BCOP, CPP (Chair/Author)
Hematology and Oncology Residency Program Director
Pharmaceutical Care Coordinator
Hematology and Oncology
Wake Forest Baptist Medical Center
Winston-Salem, North Carolina

Dr Kennedy reports having no relevant financial or advisory relationships with corporate organizations related to this activity.

OFF-LABEL PRODUCT DISCUSSION

In accordance with ACPE Criteria for Quality, the audience is advised that discussions in this CPE activity may include reference(s) to unlabeled, unapproved, or investigational uses of therapeutic agents or biomedical devices, including, but not limited to, the following:

• Rasburicase dosing

DISCLAIMER STATEMENT

The opinions and recommendations expressed by faculty and other experts whose input is included in this activity are their own. This activity is produced for educational purposes only. Use of The University of Tennessee College of Pharmacy name implies review of educational format, design, and approach. Please review the complete prescribing information of specific drugs or combinations of drugs, including indications, contraindications, warnings, and adverse effects, before administering pharmacologic therapy to patients.

GRIEVANCE POLICY

A participant, sponsor, faculty member, or other individual wanting to file a grievance with respect to any aspect of an activity sponsored or cosponsored by The University of Tennessee College of Pharmacy may contact the Associate Dean for Continuing Education in writing at gfarr@utasip.com. The grievance will be reviewed and a response will be returned within 45 days of receiving the written statement. If not satisfied, an appeal to the Dean of the College of Pharmacy can be made for a second level review.

ACTIVITY

The following is an interactive case simulation designed to help you gauge your basic knowledge of the topic and then direct you to areas you may need to focus on. It consists of 3 sections: an unaccredited pre-test, an interactive case study, and a CPE post-test, and evaluation. All 3 sections must be completed to receive CPE credit. A statement of credit will be available online immediately following successful completion of the activity.

REQUIRED COMPUTER HARDWARE/SOFTWARE

Please ensure the computer you plan to use meets the following minimum requirements:

• Operating System: Windows 98 or higher & Macintosh 2.2 or higher
• Internet Browser (Mac &/Windows): Internet Explorer 6.0 or higher, Google Chrome, Safari 5.0.6 or higher, Firefox 3.0.3 or higher & Opera 5 or higher
• Broadband Internet connection: Cable, High-speed DSL & any other medium that is internet accessible.
• Peripherals: Computer speakers or headphones
• Monitor Screen Resolution: 320 x 480 or higher
• Media Viewing Requirements: Adobe Reader, Microsoft Power Point, Flash Player & HTML5

TABLE OF CONTENTS

Preassessment

Lysis Crisis: Pharmacist's Role and Responsibility in the Management of Tumor Lysis Syndrome
LeAnne Kennedy, PharmD, BCOP, CPP

Postassessment and Evaluation