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Clinical Primer: Potential Hepatic Complications with Triazole Therapy

Target Audience and Scope of Practice

Statement of Need

Elements of Competence

Educational Reviewers

Disclosure Information

Accreditation Statement

Credit Designation Statement

To Obtain Credit for This Activity

This educational activity has been designed to meet the needs of clinicians and other health care professionals who manage invasive fungal infections.

Invasive fungal infections (IFIs) present a looming worldwide public health problem and a treatment challenge to physicians, pharmacists, and other clinicians. Over the past 2 decades, IFIs have become an increasing source of morbidity and mortality in the United States, particularly in immunocompromised and hospitalized patients with underlying diseases.

This US problem is mirrored in the European setting, which recently spurred international collaboration on the topic to better understand the epidemiology of these infections and move forward with more effective clinical trials on therapy and outcomes.

As newer agents are developed for IFIs, the troublesome effects of resistance and toxicity make the proper clinical selection of an antifungal agent and specific dosing and administration strategies increasingly important for assuring effectiveness and patient safety.

This CME activity has been designed for practice-based learning and improvement, one of the six competencies embraced by the American Board of Medical Specialties.

The University of Wisconsin-Madison, School of Medicine and Public Health, School of Nursing, School of Pharmacy and Fallon Medica.

This activity is supported by an educational grant from Pfizer.

There are no prerequisites to participate in this activity.

Upon completion of this activity, participants should be able to:

Identify risk factors for developing triazole toxicity
Implement a strategy to use therapeutic drug monitoring (TDM) for appropriate patients on triazole therapy in clinical practice
Adjust triazole therapy using TDM, based on the attributes of specific therapies as well as on patient factors

William Hope, MD, The University of Manchester, Manchester Academic Health Science Centre, NIHR Translational Research Facility in Respiratory Medicine, University Hospital of South Manchester NHS Foundation Trust, Manchester, United Kingdom

Russell Lewis, PharmD, FCCP, BCPS, Associate Professor, University of Houston College of Pharmacy, University of Texas MD Anderson Cancer Center, Houston, Texas

Jeannina Smith, MD, Division of Infectious Diseases, University of Michigan Medical School, Ann Arbor, Michigan

Reviewed by

David Andes, MD, Assistant Professor of Medicine, Clinical Science Center University of Wisconsin, Madison, Wisconsin

Harry A. Gallis, MD, Consulting Professor of Medicine, Internal Medicine/ID Duke University, Durham, North Carolina

Julia Greenleaf, MS, MPH, RN, University of Wisconsin-Madison School of Nursing Madison, Wisconsin

It is the policy of the University of Wisconsin School of Medicine and Public Health that the faculty, authors, planners, and other persons who may influence content of this CME activity disclose all relevant financial relationships with commercial interests* in order to allow CME staff to identify and resolve any potential conflicts of interest. Faculty must also disclose any planned discussions of unlabeled/ unapproved uses of drugs or devices during the educational activity. For this educational activity all conflicts of interest have been resolved and detailed disclosures are listed below:

David Andes, MD
Dr. Andes has disclosed that he has served as a Principle Investigator for Astellas Inc., Merck & Co, Inc., Pfizer, Schering-Plough, and Novartis.

Harry A. Gallis, MD
Dr. Gallis has no relevant relationships to disclose in regard to this activity.

Julia Greenleaf, MS, MPH, RN
Ms. Greenleaf has no relevant relationships to disclose in regard to this activity.

William Hope, MD
Dr. Hope has disclosed he has served as a Principal Investigator for Shering-Plough. He has also server as a Speaker for Pfizer Inc and Schering-Plough.

Russell Lewis, PharmD, FCCP, BCPS
Dr. Lewis has disclosed he has served as an Investigator for Astellas Inc., Enzon Inc., and Merck & Co, Inc. He has also served as a Speaker for Merck & Co, Inc.

Jeannina Smith, MD
Dr. Smith has no relevant relationships to disclose in regard to this activity.

This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the University of Wisconsin School of Medicine and Public Health and Fallon Medica. The University of Wisconsin School of Medicine and Public Health is accredited by the ACCME to provide continuing medical education for physicians.

The University of Wisconsin School of Medicine and Public Health designates this enduring material for a maximum of 1 AMA PRA Category 1 Credit(s)�.Physicians should only claim credit commensurate with the extent of their participation in the activity.

To obtain credit for this activity, you must read the monograph, complete an online registration on the respective website, and complete a posttest and evaluation.

This activity will be valid for credit through November 4, 2011. No credit will be given after that date.

Credit: 1 AMA PRA Category 1 Credit ™
Fee: FREE
Activity Original Release Date: November 4, 2009
Activity Reviewed and Renewed Date: November 4, 2010
Expiration Date: November 4, 2011

Office of Continuing Professional Development
University of Wisconsin School of Medicine and Public Health
2701 International Lane, #208
Madison, WI 53704-3126
Call for further information: 608-240-2145

Extension Services in Pharmacy at the University of Wisconsin-Madison School of Pharmacy is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. Participants successfully completing this knowledge-based program (documented participation based on a completed a program evaluation and post-test with a minimum score of 70%) will be eligible to receive a maximum of 1 hour (0.1 CEUs). A Statement of Credit will be issued online after completion of the activity.

Universal program #073-999-09-135-H01-P

For Pharmacy Credit:

Extension Services in Pharmacy
University of Wisconsin School of Pharmacy
777 Highland Avenue
Madison, WI 53705-2222
Call for further information: 608-262-3130

The University of Wisconsin-Madison School of Nursing,Continuing Education in Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

Iowa Provider Number:350

This activity has been planned and implemented using the educational design criteria of the American Nurses Credentialing Center's Commission on Accreditation through the joint providership of The University of Wisconsin-Madison Continuing Education in Nursing and the other providers. 1.0 ANCC Contact Hours (1.2 Iowa ) will be awarded for successful completion of this activity based on documented participation and attainment of minimum score of 70% on post-test. Awarding of contact hours does not imply product endorsement.

For Nursing CE Credit:

Continuing Education in Nursing
H6/160 Clinical Science Center;
600 Highland Avenue
Madison, WI 53792-2455
Call for further information: 608-262-0049

The estimated time to complete the activity and exam is 1 hour. To receive credit, a passing grade of 70% is required on a short multiple choice exam. You will have one opportunity to retake the quiz to achieve a passing score. After you have completed your exam and evaluation you will be able to automatically print your credit letter.