Dapagliflozin (Farxiga) has been FDA-approved for adults with chronic kidney disease to reduce the risk of eGFR decline, end-stage renal disease, cardiovascular death and hospitalization for heart failure.

The Infectious Diseases Society of America (IDSA) and the American College of Gastroenterologists (ACG) have both released updates for the treatment of Clostridioides difficile infection (CDI):

• First (initial) episode: preferred first-line treatment options remain the same (fidaxomicin or oral vancomycin).
• Second episode (first recurrence): can be treated with any of the following regardless of the antibiotic used for the initial episode (unless noted):
  • Fidaxomicin 200 mg PO BID x 10 days
  • Vancomycin tapered and pulsed regimen (e.g., vancomycin 125 mg PO QID for 10 days, then BID for one week, then once per day for one week, then every 2 or 3 days for 2-8 weeks)
  • Vancomycin 125 mg PO QID x 10 days (if metronidazole was used to treat the initial episode)
• Subsequent episodes: treatment options for the third episode or greater remain the same.
• Bezlotoxumab has a more defined role in the prevention of recurrent CDI. It can be considered in high risk patients (e.g., age ≥ 65, immunocompromised, severe presentation and/or a second episode within the past 6 months) and must be used in combination with antibiotics active against C. difficile (e.g., fidaxomicin or oral vancomycin). A labeled warning advises caution when used in patients with a history of heart failure.

The Sexually Transmitted Infections Treatment Guidelines, 2021 published by the Centers for Disease Control and Prevention contain an update for chlamydia treatment. The preferred regimens are:

• Non-pregnant adults: doxycycline 100 mg PO BID x 7 days
• Pregnant females: azithromycin 1 gram PO x 1 dose

Empagliflozin (Jardiance) has been FDA-approved to reduce the risk of cardiovascular death and hospitalization in patients with heart failure with reduced ejection fraction.

The American College of Chest Physicians (CHEST) released a second update to the Antithrombotic Therapy for the Treatment of Venous Thromboembolism (VTE) Disease guideline:

• In patients with cancer-associated thrombosis, oral factor Xa inhibitors (apixaban, edoxaban, rivaroxaban) are preferred over low molecular weight heparins (e.g., enoxaparin).

Semaglutide (Wegovy) injection has been FDA-approved for weight management in adults with obesity or who are overweight with at least one additional weight-related condition (e.g., hypertension, type 2 diabetes, dyslipidemia).

On the clipboard describing USP 797 cleaning requirements, the minimum frequency of cleaning the carts should be monthly.

In the section under Collecting Duct, the second to last sentence in the paragraph should say, “Potassium-sparing diuretics (including aldosterone antagonists) work in the distal convoluted tubule and collecting duct to decrease Na and water reabsorption and increase K reabsorption.

All controlled substances (schedule II – V) can be stored in a locked cabinet or dispersed among other drugs. Prior to this change, schedule II drugs needed to be stored in a securely locked cabinet or vault and could not be dispersed throughout the stock of non-controlled drugs.

The following update impacts the last sentence in the section under Biologics and Biosimilars.

The FDA approved two interchangeable biosimilar products in 2021. The following are interchangeable:

• Insulin glargine-ygfn (Semglee) for insulin glargine (Lantus)
• Adalimumab-adbm (Cyltezo) for adalimumab (Humira)

Regarding the prescription drugs that do not require child-resistant packaging, colesevelam powder should read ≤ 3.75 grams/package.

The 4th bullet in the Methadone Study Tip should read “(days 271 - 365).”

The following update impacts the last sentence of the second paragraph under the Substituting Biologics section.

The FDA approved two interchangeable biosimilar products in 2021. The approval allows for the substitution of the following biosimilars without the need for a separate prescription:

• Insulin glargine-ygfn (Semglee) for insulin glargine (Lantus)
• Adalimumab-adbm (Cyltezo) for adalimumab (Humira)

The following updates were made to secure prescription form requirements:

• In addition to the features noted on p. 120 and 121, security prescription forms must now contain a barcode and the prescriber's pre-printed address.
• The serial number formatting has also changed from 15 digits (3 letters followed by 12 numbers) to 12 digits (any combination of letters and numbers) that corresponds with the barcode.

As of January 1, 2022, exceptions to the mandatory electronic prescribing (e-prescribing) law include:

• Prescriptions issued by a veterinarian.
• Prescriptions issued in a hospital emergency department or urgent care clinic if the patient is homeless without a preferred pharmacy, the patient lives outside of California or the geographic area of the hospital/clinic, or the prescription is issued when the preferred pharmacy is closed.
• The prescription will be dispensed outside of California.
• Electronic data transmission is not available due to a temporary technological or electrical failure.

The last paragraph on the page should read: A pharmacy must contact the recipient (i.e., pharmacy, prescriber or patient) and board within 12 hours of the recall notice. An outsourcing facility must contact the recipient (i.e., pharmacy, prescriber or patient) and the board within 24 hours of the recall notice.

Under the second bullet that states “Six quantity check-off boxes,” the second sub-bullet should read “May be checked by the prescriber to correspond to the written quantity of the drug.”