Medicine and Health Sciences Commons^™

Intra-Accumbens Microinfusion Of The Dopamine D3 Receptor Partial Agonist (±)Vk4-40 Does Not Affect Basal Locomotion In Mice, Yeonwoo Sim, Nicole M. Hinds, Amy Hauck Newman, Daniel F. Manvich

Rowan-Virtua Research Day

The opioid epidemic remains a pressing public health crisis, prompting the search for alternative pharmacotherapies for Opioid Use Disorder (OUD). This study explores the potential of the dopamine D3 receptor (D3R) partial agonist, (±)VK4-40, as a novel treatment option. We investigated the impact of intra-nucleus accumbens (NAc) microinfusion of VK4-40 on basal locomotion in mice. Results indicate that VK4-40 did not significantly alter basal locomotion, suggesting that its therapeutic effects may not be mediated through disruptions in generalized motor function. Future research will focus on elucidating the neuropharmacological mechanisms underlying VK4-40's therapeutic actions and exploring its effects on psychostimulant-induced hyperlocomotion. …

Balancing The Mind: The Role Of Selective Serotonin Reuptake Inhibitors In Managing Anxiety, Olivia Mace

Best Integrated Writing

Olivia’s senior capstone review article focuses on the role of the selective serotonin reuptake inhibitor (SSRI) escitalopram in the management of anxiety. SSRIs have been successfully used to treat depression for decades, with fluoxetine (Prozac) being introduced to the US market in 1987. Recently it has been found that the SSRI escitalopram has efficacy in treating anxiety as well as depression. Olivia’s review is detailed and timely. Unmanaged anxiety and depression are common among students and this review will be of interest to students, parents and the university population in general.

Rapid Hepatomegaly From Ruxolitinib Discontinuation Syndrome, Ryan Jansen Van Rensburg, Shayna Hale, Anna Calara, Kulveer Dabb, Uday Dandamudi, Parth Desai

HCA Healthcare Journal of Medicine

Introduction

Ruxolitinib (RUX) is a Food and Drug Administration-approved Janus Kinase (JAK) inhibitor shown to be effective in improving hypercatabolic symptoms and splenomegaly in patients with myelofibrosis (MF). RUX therapy provides symptomatic benefits for MF patients but is often discontinued for various reasons including worsening cytopenias. Ruxolitinib Discontinuation Syndrome (RDS) involves an acute cytokine-storm rebound phenomenon that can manifest as an acute relapse of symptoms, worsening splenomegaly, respiratory distress, systemic inflammatory response syndrome, or disseminated intravascular coagulopathy.

Case Presentation

We present the case of a patient with JAK2-positive post-polycythemia vera MF, whose RUX therapy was discontinued due to an active …

Reducing Unnecessary Acid Suppression Use In Hospitalized Patients: A Description Of Targeted Strategies Implemented Across A Large Health System, Elizabeth H. Wiggins, L. Hayley Burgess, Joan Kramer

HCA Healthcare Journal of Medicine

Background

Ensuring the appropriate use of proton pump inhibitors (PPIs) and histamine type 2-receptor antagonists (H2RAs) is an important hospital patient safety and quality initiative because therapy may be inappropriately continued during transitions of care. In this article, we aim to describe the impact of targeted quality improvement strategies to reduce unnecessary acid suppression use in hospitalized patients across a large health system.

Methods

Beginning January 1, 2018, focused quality improvement strategies to prevent unnecessary initiation and continuation of proton pump inhibitors (PPIs) and histamine type 2-receptor antagonists (H2RAs) were implemented throughout a large health system. Targeted strategies were initially …

The Rubik's Cube Of Manufacturers' Coupons: Making The Case For Sneetches, Bruce Wolf

HCA Healthcare Journal of Medicine

Asthma maintenance inhalers are inordinately expensive, inhibiting patients from affording their medication and compromising compliance and adherence and optimal health outcomes. The objective of this article was to examine and highlight the competitive world and challenged opportunity of manufacturers' coupons discounting the inordinate cost of respiratory inhalers and asthma treatment. The cost of asthma treatment, in particular the cost of respiratory medicines, even with health insurance, can be prohibitive (upwards of $700 per month for one inhaler). Medication costs restrict medication access. Compliance and adherence suffer attested by monthly maintenance inhalers being filled less than 50% of the time. Pharmaceutical …

Major Publications In The Critical Care Pharmacotherapy Literature: 2020, Brittany D. Bissell, Jeannee Campbell, Reagan Collins, Charles Cook, Dharati Desai, Jessica Dewitt, Ifeoma Mary Eche, Ijeoma Julie Eche, Pansy Elsamadisi, Janelle Juul, Soyoung Kim, Courtney T. Makowski, Ruben J Mylvaganam, Adam Smith, Jennifer Stancati, Katherine Stonesifer, Justin Tawil, Melanie Smith Condeni

Pharmacy Practice and Science Faculty Publications

OBJECTIVES: To summarize selected meta-analyses and trials related to critical care pharmacotherapy published in 2020.

DATA SOURCES: The Clinical Pharmacy and Pharmacology Pharmacotherapy Literature Update group screened 36 journals monthly for impactful publications.

STUDY SELECTION: The group reviewed a total of 119 articles during 2020 according to relevance for practice.

DATA EXTRACTION: Articles were selected with consensus and importance to clinical practice from those included in the monthly Clinical Pharmacy and Pharmacology Pharmacotherapy Literature Update. The group reviewed articles according to Grading of Recommendations, Assessment, Development, and Evaluations criteria. Articles with a 1A grade were selected.

DATA SYNTHESIS: Several trials …

Evaluating The Biological Activities Of Novel Histone Deacetylase Inhibitors (Hdaci) In Adherent And Nonadherent Tumor Cell Lines, Samer Alanani

Theses and Dissertations

Epigenetic dysregulations are linked to many human diseases including neurodegenerative disorders, immunodeficiencies, cardiac disease, and most notably cancer. Changes in the mechanisms of histone modifications have been recognized as hallmarks of carcinogenesis. One of these modifications is histone acetylation which is regulated by the activities of histone acetyltransferases (HATs) and histone deacetylases (HDACs). The reversible actions of these enzymes govern the acetylome and maintain its balance allowing for activation and repression of gene transcription. However, aberrant overexpression of HDACs in certain tumors is associated with decreased levels of transcription leading to tumor progression and survival. Hence, small-molecule histone deacetylase inhibitors …

Effect Of Cftr Modulators On Respiratory Function In Adults With Cystic Fibrosis, Melissa Severson

Physician Assistant Scholarly Project Papers

Cystic Fibrosis (CF) is an autosomal recessive disorder that shortens one’s life due to its effect on the cystic fibrosis transmembrane regulator (CFTR) gene. CFTR modulator medications can correct the CFTR gene and consist of a potentiator (ivacaftor), and corrector (lumacaftor, tezacaftor and elexacaftor). This research and literature review sought to evaluate if lung function improved in an individual with genetically confirmed CF after being started on CFTR modulator medications. To complete the review, six databases were searched which included: CINAHL, PubMed, Clinical Key, Cochrane Library, Embase and Dynamed Plus. Both keyword and mesh terms were used to define a …

Efficacy Of Pharmacologic Treatment For Orthostatic Hypotension In The Elderly Population, Abigail Moeller

Physician Assistant Scholarly Project Papers

The purpose of this literature review is to determine the efficacy and safety of pharmacologic treatments for orthostatic hypotension (OH), with an emphasis on researching the elderly population. In this review, three electronic search databases were utilized including PubMed, Google Scholar, and Dynamed from the years 1997 to 2019. Several keywords were used during the search. Criteria for chosen articles included that the article must be peer-reviewed, the studied population must have a median age of at least 50 years-old, at least 20 subjects must be involved, and the study must be published after the year 1995. The specific pharmacologic …

Understanding The Role Of Ano1 In Oral Cancer, Mallary Forrest

UNLV Theses, Dissertations, Professional Papers, and Capstones

In 2008, the gene ANO1 was discovered to encode a calcium activated chloride channel. This gene is located on the 11q13 locus, a locus that is commonly amplified in many cancers including cancer of the head and neck. ANO1 is situated in close proximity to genes associated with growth and apoptosis. As rapid proliferation and lack of apoptosis are hallmark characteristics of cancer, growth factors and apoptosis mediators are expected to be altered in cancer. But what does a calcium activated chloride channel have to contribute to cancer’s pathogenesis? Is it an active gene in cancer progression or is it …

Comparative Research Of Effective Treatment Measures For Postpartum Depression, Aunica Novacek

Physician Assistant Scholarly Project Papers

Postpartum depression is a mood disorder that includes depressive symptoms during the time period following childbirth. There are various possibilities for what may cause this disorder, but the drastic change in hormones after delivery can play a role. With the chance this disorder may be fatal to both the mother and child, an appropriate, effective, and safe treatment is necessary to control depressive symptoms. The standard, first-line pharmacotherapeutic option is a selective serotonin reuptake inhibitor (SSRI) antidepressant. SSRI antidepressants are well understood, but these medications may take time to become effective. Knowing this, medical professionals can find a more rapid …

Targeting Parp-1 With Metronomic Therapy Modulates Mdsc Suppressive Function And Enhances Anti-Pd-1 Immunotherapy In Colon Cancer, Mohamed A. Ghonim, Salome V. Ibba, Abdelmetalab F. Tarhuni, Youssef Errami, Hanh H. Luu, Matthew J. Dean, Ali H. El-Bahrawy, Dorota Wyczechowska, Ilyes A. Benslimane, Luis Del Valle, Amir A. Al-Khami, Augusto C. Ochoa, A Hamid Boulares

School of Graduate Studies Faculty Publications

BACKGROUND: Poly(ADP-ribose) polymerase (PARP) inhibitors (eg, olaparib) are effective against BRCA-mutated cancers at/near maximum tolerated doses by trapping PARP-1 on damaged chromatin, benefitting only small patient proportions. The benefits of targeting non-DNA repair aspects of PARP with metronomic doses remain unexplored. METHODS: Colon epithelial cells or mouse or human bone marrow (BM)-derived-myeloid-derived suppressor cells (MDSCs) were stimulated to assess the effect of partial PARP-1 inhibition on inflammatory gene expression or immune suppression. Mice treated with azoxymethane/four dextran-sulfate-sodium cycles or mice bred into PARP-1 or treated with olaparib were used to examine the role of PARP-1 in colitis-induced or spontaneous colon …

Comparative Research Of Effective Treatment Measures For Postpartum Depression, Aunica Novacek

Physician Assistant Scholarly Project Posters

Postpartum depression is a mood disorder that includes depressive symptoms during the time period following childbirth. There are various possibilities for what may cause this disorder, but the drastic change in hormones after delivery can play a role. With the chance this disorder may be fatal to both the mother and child, an appropriate, effective, and safe treatment is necessary to control depressive symptoms. The standard, first line pharmacotherapeutic option is a selective serotonin reuptake inhibitor (SSRI) antidepressant. SSRI antidepressants are well understood, but these medications may take time to become effective. Knowing this, medical professionals can find a more …

Chronic Care And Arthritis: A Wrap Around Approach, Kayla Aliengena

Doctor of Nursing Practice (DNP) Projects

Background: Arthritis is a chronic concern for individuals and providers. It creates significant costs both directly and indirectly. Individuals with a diagnosis of any type of arthritis are more likely to follow a specialist in regard to their chronic, debilitating illness management. Evidence supports some complementary and alternative modalities (for example, diet adjustments, supplements, and exercise) to improve arthritis management in adjunct to the specialists plan of care. Purpose: The purpose of this project was to review current evidence regarding adjunct complementary and alternative modalities (CAM). Results were synthesized to develop educational materials titled “Wrap Around Care/Approach” to improve nursing …

Drug Therapy During Pregnancy., Dongmei Sun, Janine R. Hutson, Facundo Garcia-Bournissen Md Phd

Paediatrics Publications

No abstract provided.

Using Medical Claims Database To Develop A Population Disease Progression Model For Leuprorelin-Treated Subjects With Hormone-Sensitive Prostate Cancer, Yixuan Zou, Fei Tang, Jeffery C. Talbert, Chee M. Ng

Pharmacy Practice and Science Faculty Publications

Androgen deprivation therapy (ADT) is a widely used treatment for patients with hormone-sensitive prostate cancer (PCa). However, duration of treatment response varies, and most patients eventually experience disease progression despite treatment. Leuprorelin is a luteinizing hormone-releasing hormone (LHRH) agonist, a commonly used form of ADT. Prostate-specific antigen (PSA) is a biomarker for monitoring disease progression and predicting treatment response and survival in PCa. However, time-dependent profile of tumor regression and growth in patients with hormone-sensitive PCa on ADT has never been fully characterized. In this analysis, nationwide medical claims database provided by Humana from 2007 to 2011 was used to …

Developing Drug Therapies: Cognitive Damage In Mice Following Brain Radiation, Rachel Yuska

The Journal of Purdue Undergraduate Research

Pediatric brain cancer patients are at a high risk for radiation-induced cognitive impairment due to white matter changes in the brain. Half of six-month radiotherapy survivors develop significant changes in white matter. Previous research has shown that a mouse model can be used to show similar cognitive and behavioral deficits in human patients. The purpose of this work is to evaluate the effectiveness of two drug therapies, Donepezil and 3,3-Diindolylmethane (DIM), that could be used to either protect the brain from radiation injury or cure the cognitive injury and behavioral deficits that result from whole-brain irradiation. This project consisted of …

Health Literacy Screening To Increase Antihypertensive Medication Adherence, Boyann Bonjean

Evidence-Based Practice Project Reports

Hypertension contributes to the risk of developing cardiovascular disease (CVD), stroke, heart attack, and chronic kidney disease (CKD) (Abegaz et al., 2016; Weir, 2014; Whelton et al., 2017). Evidence indicates that 30 to 50% of people who are prescribed antihypertensive medication therapy are nonadherent (Hedna et al., 2015). Non-adherence to antihypertensive medications is a major contributor to hypertension treatment failure (Al Ghurair et al., 2012; Hu, 2016; Whelton et al., 2017). Evidence has shown that low health literacy may impact antihypertensive therapy (Slade, 2017). The purpose of this EBP project was to provide an organizational change by implementing a health …

Anxiety Is Something To Worry About: The Effects Of A Cognitive Behavioral Therapy And Selective Serotonin Reuptake Inhibitor Intervention Protocol On Generalized Anxiety Disorder, Alesha E. Mcclanahan

Evidence-Based Practice Project Reports

Generalized anxiety disorder (GAD) is highly prevalent in the United States with at least 12% of the population affected (Edmund & Sheppard, 2018). GAD can pose significant distress and debilitation throughout the lifespan (Bystritsky, Khalsa, Cameron, & Schiffman, 2013; Edmund & Sheppard, 2018). Barriers to treatment include adverse effects, inaccessibility, and expense. The purpose of this project was to implement an evidence-based protocol involving combination therapy with self-administered cognitive behavioral therapy (CBT) and selective serotonin reuptake inhibitor (SSRI) medication in order to improve patient outcomes through more accessible, affordable, and standardized treatment of GAD. The Neuman Systems Model and Stetler …

Anti-Tumor Activity Of Phenoxybenzamine And Its Inhibition Of Histone Deacetylases, Mario A. Inchiosa

NYMC Faculty Publications

The principal finding from this study was the recognition that the α-adrenergic antagonist, phenoxybenzamine, possesses histone deacetylase inhibitory activity. Phenoxybenzamine is approved by the United States Food and Drug Administration for the treatment of hypertensive crises associated with tumors of the adrenal medulla, pheochromocytomas. It has several "off label" indications relative to its capacity to relax vascular smooth muscle and smooth muscle of the urogenital tract. The drug also has a long history of apparent efficacy in ameliorating, and perhaps reversing, the severe symptoms of neuropathic pain syndromes. Our interest in this feature of the drug relates to the fact …

Effects Of Cetp Inhibition With Anacetrapib On Metabolism Of Vldl-Tg And Plasma Apolipoproteins C-Ii, C-Iii, And E, John S. Millar, Michael E. Lassman, Tiffany Thomas, Rajasekhar Ramakrishnan, Patricia Jumes, Richard L. Dunbar, Emil M. Degoma, Amanda L. Baer, Wahida Karmally, Daniel S. Donovan, Hashmi Rafeek, John A. Wagner, Stephen Holleran, Joseph Obunike, Yang Liu, Soumia Aoujil, Taylor Standiford, David E. Gutstein, Henry N. Ginsberg, Daniel J. Rader, Gissette Reyes-Soffer

Publications and Research

Cholesteryl ester transfer protein (CETP) mediates the transfer of HDL cholesteryl esters for triglyceride (TG) in VLDL/LDL. CETP inhibition, with anacetrapib, increases HDL-cholesterol, reduces LDL-cholesterol, and lowers TG levels. This study describes the mechanisms responsible for TG lowering by examining the kinetics of VLDL-TG, apoC-II, apoC-III, and apoE. Mildly hypercholesterolemic subjects were randomized to either placebo (N = 10) or atorvastatin 20 mg/qd (N = 29) for 4 weeks (period 1) followed by 8 weeks of anacetrapib, 100 mg/qd (period 2). Following each period, subjects underwent stable isotope metabolic studies to determine the fractional catabolic rates (FCRs) and production rates …

Health Care Resource Utilization And Costs Of California Medicaid Patients With Schizophrenia Treated With Paliperidone Palmitate Once Monthly Or Atypical Oral Antipsychotic Treatment, Jacqueline A. Pesa,, Dilesh Doshi, Li Wang, Huseyin Yuce, Onur Baser

Publications and Research

Objective: To compare all-cause health care utilization and costs between patients with schizophrenia treated with once monthly paliperidone palmitate (PP1M; Invega Sustenna1) and atypical oral antipsychotic therapy (OAT).

Methods: This was a retrospective claims-based analysis among adult California Medicaid (Medi-Cal) patients with schizophrenia having 2 claims for PP1M or OAT from 1 July 2009 to 31 December 2013 and continuous health plan enrollment for 1 year pre- and post-index date (PP1M or OAT initiation date). Baseline characteristics were reported descriptively. Propensity score matching with a 1:1 greedy match method was used to create two matched cohorts. Treatment patterns, all-cause health …

Pharmacotherapy And Pregnancy: Highlights From The Third International Conference For Individualized Pharmacotherapy In Pregnancy, David M. Haas, Beverly Gallauresi, Kristine Shields, Deborah S. Zeitlin, Shannon M. Clark, Mary F. Herbert, Zhaoxia Ren, Srikanth C. Nallani, Eric M. Meslin, Karen B. Feibus, Gideon Koren, W. Scott Goebel, Thomas Easterling, Scott C. Denne, David A. Flockhart, Jamie L. Renbarger

Deborah Zeitlin

To address provider struggles to provide evidence-based, rational drug therapy to pregnant women, this third Conference was convened to highlight the current progress and research in the field. Speakers from academic centers, industry, and governmental institutions spoke about: the Food and Drug Administration’s role in pregnancy pharmacology and the new labeling initiative; drug registries in pregnancy; the pharmacist’s role in medication use in pregnancy; therapeutic areas such as preterm labor, gestational diabetes, nausea and vomiting in pregnancy, and hypertension; breast-feeding and medications; ethical challenges for consent in pregnancy drug studies; the potential for cord blood banks; and concerns about the …

Medication Use In Pregnant Women With Chronic Medical Conditions, Deborah S. Zeitlin

Deborah Zeitlin

Dr. Deborah Zeitlin addresses medication options for pregnant women with chronic conditions such as: hypertension, asthma, diabetes, and depression. Risks of medication use to the fetus are addressed.

Pharmacotherapy And Pregnancy: Highlights From The Third International Conference For Individualized Pharmacotherapy In Pregnancy, David M. Haas, Beverly Gallauresi, Kristine Shields, Deborah S. Zeitlin, Shannon M. Clark, Mary F. Herbert, Zhaoxia Ren, Srikanth C. Nallani, Eric M. Meslin, Karen B. Feibus, Gideon Koren, W. Scott Goebel, Thomas Easterling, Scott C. Denne, David A. Flockhart, Jamie L. Renbarger

Deborah Zeitlin

To address provider struggles to provide evidence-based, rational drug therapy to pregnant women, this third Conference was convened to highlight the current progress and research in the field. Speakers from academic centers, industry, and governmental institutions spoke about: the Food and Drug Administration’s role in pregnancy pharmacology and the new labeling initiative; drug registries in pregnancy; the pharmacist’s role in medication use in pregnancy; therapeutic areas such as preterm labor, gestational diabetes, nausea and vomiting in pregnancy, and hypertension; breast-feeding and medications; ethical challenges for consent in pregnancy drug studies; the potential for cord blood banks; and concerns about the …

Medication Use In Pregnant Women With Chronic Medical Conditions, Deborah S. Zeitlin

Deborah Zeitlin

Dr. Deborah Zeitlin addresses medication options for pregnant women with chronic conditions such as: hypertension, asthma, diabetes, and depression. Risks of medication use to the fetus are addressed.

Identification Of Potential Drug Targets In Cancer Signaling Pathways Using Stochastic Logical Models, Peican Zhu, Hamidreza Montazeri Aliabadi, Hasan Uludag, Jie Han

Pharmacy Faculty Articles and Research

The investigation of vulnerable components in a signaling pathway can contribute to development of drug therapy addressing aberrations in that pathway. Here, an original signaling pathway is derived from the published literature on breast cancer models. New stochastic logical models are then developed to analyze the vulnerability of the components in multiple signalling sub-pathways involved in this signaling cascade. The computational results are consistent with the experimental results, where the selected proteins were silenced using specific siRNAs and the viability of the cells were analyzed 72 hours after silencing. The genes elF4E and NFkB are found to have nearly no …

Ten-Year Legacy Effects Of Baseline Blood Pressure ‘Treatment Naivety’ In The Second Australian National Blood Pressure Study, Mark Nelson, Enayet Chowdhury, Jenny Doust, Christopher Reid, Lindon Wing

Jenny Doust

Objectives: Current blood pressure (BP) management guidelines recommend that treatment thresholds for BP be based on absolute cardiovascular disease (CVD) risk rather than on elevated BP levels alone. Clinicians are concerned that delayed pharmacotherapy in individuals with high BP, but low CVD risk, may increase long-term CVD events. To investigate this, we examined differences in CVD events within the Second Australian National BP study (ANBP2) for those previously on pharmacotherapy and those who were not, as well as fatal events in the 6-year post-trial period. Methods: Population consisted of ANBP2 participants without a prior CVD event. Adjusted Cox-regression hazard models …

Maternal Psychiatric Disease And Epigenetic Evidence Suggest A Common Biology For Poor Fetal Growth, Timothy H. Ciesielski, Carmen J. Marsit, Scott M. Williams

Dartmouth Scholarship

We sought to identify and characterize predictors of poor fetal growth among variables extracted from perinatal medical records to gain insight into potential etiologic mechanisms. In this process we reevaluated a previously observed association between poor fetal growth and maternal psychiatric disease. We evaluated 449 deliveries of >36 weeks gestation that occurred between 9/2008 and 9/2010 at the Women and Infants Hospital in Providence Rhode Island. This study group was oversampled for Small-for-Gestational-Age (SGA) infants and excluded Large-for-Gestational-Age (LGA) infants. We assessed the associations between recorded clinical variables and impaired fetal growth: SGA or Intrauterine Growth Restriction (IUGR) diagnosis. After …

Haemophilus Influenzae Responds To Glucocorticoids Used In Asthma Therapy By Modulation Of Biofilm Formation And Antibiotic Resistance, Chris S. Earl, Tee Wooi Keong, Shi-Qi An, Sarah Murdoch, Yvonne Mccarthy, Junkal Garmendia, Joseph Ward, J Maxwell Dow, Liang Yang, George A. O'Toole, Robert P. Ryan

Dartmouth Scholarship

Glucocorticosteroids are used as a main treatment to reduce airway inflammation in people with asthma who suffer from neutrophilic airway inflammation, a condition frequently associ- ated with Haemophilus influenzae colonization. Here we show that glucocorticosteroids have a direct influence on the behavior of H. influenzae that may account for associated difficulties with therapy. Using a mouse model of infection, we show that cortico- steroid treatment promotes H. influenzae persistence. Transcrip- tomic analysis of bacteria either isolated from infected mouse airway or grown in laboratory medium identified a number of genes encoding regulatory factors whose expression responded to the presence of …