Check out CSHP’s website for employment opportunities at www.cshp.org Free CE: Peroxisome Proliferator- Activated Receptor Agonists: Scratching the Surface of Gene Expression in Cardiovascular Disease Clinical Pearls of Practice: Aspirin and Clopidogrel Resistance: Is there a Role for Platelet Function Tests? Proceedings of the 2007 House of Delegates Seminar 2007 Highlights CSHP President Bill Yee Installed January/February 2008 Volume 20, Number 1 California Journal of Health-System Pharmacy Editor The Official Journal of the California Society of Health-System Pharmacists Dawn Benton 725 30th Street, Suite 208 Sacramento, CA 95816-3842 (916) 447-1033 FAX (916) 447-2396 Managing Editor www.cshp.org E-Mail [email protected] Cynthia Hespe Assistant Editor Vol. 20 No. 1 Sunny Garbutt January/February 2008 Design Consultant Continuing Education: Peroxisome Proliferator-Activated Receptor Agonists: HareLine Graphics Scratching the Surface of Gene Expression in Cardiovascular Disease ............4 Clinical Pearls: Aspirin and Clopidogrel Resistance: Editorial Advisory Board Is there a Role for Platelet Function Tests? .....................................................16 Angie Graham, Deborah Hass Chair Marcus Ravnan CSHP President William Yee ................................................................................22 Ronald Floyd, Cathlene Richmond Chair-elect CSHP Practitioner Recognition Program ...............................................................24 Dan Ross Gary Besinque Kathy Yang New Practitioner Career Profile Wendi Carroll Mirta Millares, Clinical Pharmacist in a Bone and Marrow Jack Chen Board Liaison Transplantation Satellite Pharmacy ................................................................26 Emily Cooper Cynthia Hespe, Kathy Daly Consultant Seminar 2007 Highlights .....................................................................................28 Proceedings of the 2007 House of Delegates Officers Minutes .........................................................................................................33 William Yee (209) 467-6518 Delegates ......................................................................................................36 President and Board Liaison Open Forum Attendance ...............................................................................39 to CVSHP and SSHP President’s Report ..........................................................................................40 Alan Endo (626) 961-8331 Treasurer’s Report ..........................................................................................42 Chair, Board of Directors and Interim Executive Vice President/CEO Report ................................................46 Board Liaison to GESHP and SFVSHP Scott Takahashi (323) 783-1911 Legislative Update President-Elect and Board Liaison to SGVSHP Lights, Camera, Political Action! ...................................................................50 Kelli Haase (209) 467-6369 Chair, House of Delegates Tech Talk ...........................................................................................................52 Lisa Gunther Lum (323) 857-2140 Treasurer, Board Liaison to SCSHP News You Can Use ..............................................................................................53 CSHP News Directors New Members ..............................................................................................13 Janice Akashi (818) 719-3548 Dates to Remember ......................................................................................20 Board Liaison to CISHP and SFVSHP Celebration of a Life: Anne A Erickson ..........................................................51 Christine Antczak (619) 265-5955 Board Liaison to SDSHP PTCB Exam Schedule ....................................................................................52 Julianna Burton (916) 734-1426 Call for Nominations – Officers ....................................................................56 Board Liaison to NCSHP Call for Nominations – Pharmacist of the Year ..............................................56 Victoria Ferraresi (408) 773-4247 Call for Nominations – Distinguished Service Award ....................................56 Board Liaison to QCSHP Call for Nominations – Student Leadership Award ........................................57 Jeannette Hanni (650) 949-2959 CSHP Board of Directors Meeting Highlights, October 2007 ........................57 Board Liaison to DSHP Kenneth Horowitz (323) 953-4507 Cover photo: CSHP President Bill Yee and Family Board Liaison to SB/LBSHP Brian Kawahara (909) 825-7084 CJHP (ISSN 1097-6337) is published bimonthly by the California Society of Health-System Pharmacists, 725 30th Street, Suite 208, Board Liaison to ISHP X6039 Sacramento, CA 95816-3842, under the guidance of the Editorial Advisory Board. 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Peroxisome Proliferator-Activated Receptor Agonists: Scratching the Surface of Gene Expression in Cardiovascular Disease Gary Besinque, PharmD, FCSHP Formulary Pharmacist Drug Information Services — California Regions, Kaiser Permanente Medical Care Program Adjunct Assistant Professor of Pharmacy Practice, University of Southern California School of Pharmacy [email protected] Learning Objectives Considerable energy has been devoted to understanding the function of peroxisome proliferator-activated receptors (PPAR) and After reading this article, the reader should be their role in human disease. An explosion of publications in the last able to: 2 decades has revealed that PPAR functions underlie a multitude of physiologic processes, among them glucose homeostasis, lipid 1. Describe the process of PPAR-mediated metabolism, inflammation, endothelial function, vascular remodeling, cell signaling. and coagulation. Two commercially successful synthetic PPAR agonist classes, the thiazolidinediones and the fibrates, exert their therapeutic 2. List the PPAR isotypes and their natural benefits via their PPAR effects. A growing body of evidence has also and synthetic ligands. shown that, while PPAR agonists provide considerable therapeutic 3. Identify the locations and functions of PPAR benefit, they are not without risk. This article will describe how PPAR function, the PPAR-active agents, and their place in the pharmaco- activation. therapy of cardiovascular disease (CVD). 4. Explain the relationship between PPAR, inflammation, atherosclerosis, and PPAR and Cell Signaling cardiovascular disease. Recent explorations into the above-mentioned pathologic pro- cesses have identified PPAR as central players in the development of 5. Outline the laboratory and clinical evidence CVD. A sub-family of nuclear transcription factors, PPAR respond to underlying the concepts of PPAR pleiotropism. endogenous molecules, or ligands, in processes that ultimately lead to 6. Explain the nature and extent of cardiovascular the expression of hundreds of target gene products. Briefly, these signaling events are initiated by ligand binding to the risk with the clinical use of the PPAR-g agonist PPAR, allowing its dimerization with another ligand-activated nuclear thiazolidinediones. receptor, retinoid X receptor (RXR). Influenced by the presence of an RXR ligand, various co-repressor and co-activator molecules, the PPAR/RXR complex arrives at sequence-specific DNA promoter oxidation product, 13-hydroxy-9,11-octadecadienoic acid (13-HODE), regions — called PPAR response elements (PPRE)-to begin the tran- eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and scription process at the target gene. In a complementary fashion, alpha-linolenic acid (ALA). Notably, the last 3 ligands — capable PPAR can also repress gene expression by interfering either with the of activating both PPAR-a and PPAR-g — belong to the omega-3 function