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Pharmdigest Volume 2, Issue 3, Philadelphia College Of Osteopathic Medicine, School Of Pharmacy

PharmDigest

This issue of the Pharmacy Student Council newsletter includes the following articles:

• A Year in Review
• Impacting Patient Care
• Getting Your Voice Heard
• 10 Reasons to Counsel
• The Daily Dose: Residency
• AMCP Out West
• Dinner with a Pharmacist
• Introducing... [2016-2017 Pharmacy Student Council]

Prediction Of Fluoroquinolone Resistance In Gram-Negative Bacteria Causing Bloodstream Infections, Seejil Dan, Ansal Shah, Julie Ann Justo, P Brandon Bookstaver, Joseph Kohn, Helmut Albrecht, Majdi N. Al-Hasan

Faculty Publications

Increasing rates of fluoroquinolone resistance (FQ-R) have limited empirical treatment options for Gram-negative infections, particularly in patients with severe beta-lactam allergy. This case-control study aims to develop a clinical risk score to predict the probability of FQ-R in Gram-negative bloodstream isolates. Adult patients with Gram-negative bloodstream infections (BSI) hospitalized at Palmetto Health System in Columbia, South Carolina, from 2010 to 2013 were identified. Multivariate logistic regression was used to identify independent risk factors for FQ-R. Point allocation in the fluoroquinolone resistance score (FQRS) was based on regression coefficients. Model discrimination was assessed by the area under receiver operating characteristic curve …

Nsu Sharks Rx-Spring, 2016, College Of Pharmacy

NSU Sharks Rx

Volume 2, Number 1

A Community Hospital Antimicrobial Stewardship Program’S Assessment Of Prolonged Infusion Piperacillin-Tazobactam For Pseudomonas Aeruginosa Pneumonia, Lee Nguyen, Paul Gavaza, Amy Y. Kang, An Nguyen, Liem Hoang, Nguyen Ta

Pharmacy Faculty Articles and Research

Background: The study aim was to determine and compare the length of hospitalization, mortality, clinical stability, and time to clinical stability of a standard infusion (SI) and prolonged infusion (PI) piperacillin-tazobactam (TZP) in Pseudomonas aeruginosa ( PA) pneumonia patients.

Methods: This retrospective study evaluated length of hospitalization, mortality, clinical stability, and time to clinical stability with either SI-TZP or PI-TZP therapy in hospitalized patients diagnosed with PA pneumonia between January 01, 2008 and June 30, 2014. Patients were included in the study if they received ≥2 days of TZP, were diagnosed with PA pneumonia, and had TZP therapy …

Respiratory Muscle Paralysis Associated With Colistin, Polymyxin B, And Muscle Relaxants Drugs: A Case Report, Thein Myint, Martin E. Evans, Donna R. Burgess, Richard N. Greenberg

Internal Medicine Faculty Publications

Polymyxins B and E (colistin) exert a bactericidal effect on the gram-negative bacterial cell wall, causing permeability changes in the cytoplasmic membrane, leading to cell death. Their use was substantially decreased in clinical practice from the 1970s to 2000s due to their significant nephrotoxicity and neurotoxicity compared to the newly introduced antibiotics. The increasing prevalence of multidrug-resistant gram-negative bacteria infections in this century has led to an upsurge in the use of these “older” drugs. Respiratory paralysis caused by neuromuscular blockage associated with the use of polymyxin B and E was reported mostly in literature published in the 1960s to …

Micro- And Nanoparticulate Cancer Vaccines: A Vision For The Future, Lipika Chablani

Pharmacy Faculty/Staff Publications

In lieu of an abstract, here is the article's first paragraph:

Formulation scientists are constantly challenged with unique opportunities to deliver chemotherapeutic drug molecules to cancer patients. With the growing rate of cancer diagnoses, new therapies are being introduced to pave their way to the market. Along with drug delivery, these formulation approaches are being screened for formulation, design, and development of cancer vaccines. Can a vaccine be formulated to obtain a protective or therapeutic immune response against cancer?

Optimizing Guideline-Recommended Antibiotic Doses For Pediatric Infective Endocarditis, Chad A. Knoderer, Kristen R. Nichols, Emily N. Israel, Christopher A. Thomas

Scholarship and Professional Work – COPHS

The American Heart Association recently published an updated scientific statement on the management of infective endocarditis in childhood. The recommendations included for vancomycin, aminoglycoside, and β-lactam dosing and monitoring are based primarily on expert opinion and do not consider available evidence for dose optimization based on pharmacokinetic and pharmacodynamic principles in pediatric patients. This is concerning because even when clinically necessary, some practitioners may be hesitant to deviate from guideline-recommended doses. In this perspective, we highlight potential areas for improvement in the statement-recommended doses and summarize evidence supporting antibiotic dosing optimization. The addition of a pediatric clinical pharmacist with expertise …

Treatment Modalities And Antimicrobial Stewardship Initiatives In The Management Of Intra-Abdominal Infections, Charles Hoffmann, Matthew Zak, Lisa M. Avery, Jack Brown

Pharmacy Faculty/Staff Publications

Antimicrobial stewardship programs (ASPs) focus on improving the utilization of broad spectrum antibiotics to decrease the incidence of multidrug-resistant Gram positive and Gram negative pathogens. Hospital admission for both medical and surgical intra-abdominal infections (IAIs) commonly results in the empiric use of broad spectrum antibiotics such as fluoroquinolones, beta-lactam beta-lactamase inhibitors, and carbapenems that can select for resistant organisms. This review will discuss the management of uncomplicated and complicated IAIs as well as highlight stewardship initiatives focusing on the proper use of broad spectrum antibiotics.

Targeting An Essential Gtpase Obg For The Development Of Broad-Spectrum Antibiotics, Josephine A. Bonventre, Ryszard A. Zielke, Konstantin V. Korotkov, Aleksandra E. Sikora

Molecular and Cellular Biochemistry Faculty Publications

A promising new drug target for the development of novel broad-spectrum antibiotics is the highly conserved small GTPase Obg (YhbZ, CgtA), a protein essential for the survival of all bacteria including Neisseria gonorrhoeae (GC). GC is the agent of gonorrhea, a prevalent sexually transmitted disease resulting in serious consequences on reproductive and neonatal health. A preventive anti-gonorrhea vaccine does not exist, and options for effective antibiotic treatments are increasingly limited. To address the dire need for alternative antimicrobial strategies, we have designed and optimized a 384-well GTPase assay to identify inhibitors of Obg using as a model Obg protein from …

Chao Yuanfang: Imperial Physician Of The Sui Dynasty And An Early Pertussis Observer?, Yan Liang, Abdulbaset M. Salim, Wendy Wu, Paul E. Kilgore

Department of Pharmacy Practice

Early Chinese texts contain extensive disease descriptions, including various texts that contain descriptions of modernday conditions. During the Sui Dynasty, a leading scholar, Chao Yuanfang, may have authored a leading treatise 1400 years ago. Although these texts are the subject of ongoing research, evidence suggests that a clinical syndrome consistent with pertussis was observed in ancient China.

A Novel Loop-Mediated Isothermal Amplification Assay For Serogroup Identification Of Neisseria Meningitidis In Cerebrospinal Fluid, Dokyung Lee, Eun Jin Kim, Paul E. Kilgore, Hideyuki Takahashi, Jun Tomono, Shigehiko Miyamoto, Daisuke Omagari, Dong Wook Kim, Mitsuko Seki

Department of Pharmacy Practice

We have developed a novel Neisseria meningitidis serogroup-specific loop-mediated isothermal amplification (LAMP) assay for six of the most common meningococcal serogroups (A, B, C, W, X, and Y). The assay was evaluated using a set of 31 meningococcal LAMP assay positive cerebrospinal fluid (CSF) specimens from 1574 children with suspected meningitis identified in prospective surveillance between 1998 and 2002 in Vietnam, China, and Korea. Primer specificity was validated using 15 N. meningitidis strains (including serogroups A, B, C, E, W, X, Y, and Z) and 19 non-N. meningitidis species. The N. meningitidis serogroup LAMP detected down to ten copies …

A Rare Case Report Of Probable Indigotindisulfonate Sodium-Induced Cardiac Arrest, Andrew P. Smith, Catherine A. Millares-Sipin, Henry Cohen, William Lois

Touro College of Pharmacy (New York) Publications and Research

Background: Indigotindisulfonate (Indigo Carmine, American Regent, Shirely, NY) is a blue dye that is commonly used for localizing ureteral orifices during surgery. In general, it is safe and biologically inactive, with the package insert citing only rare idiosyncratic reactions and mild pressor effects in some patients. We report a case of a severe life-threatening anaphylactoid reaction due to indigotindisulfonate following intravenous administration.

Case Report: We describe a case of a 42-year-old female admitted for a total abdominal hysterectomy. Upon arrival to the operating room, her heart rate (HR) was 80/min, blood pressure (BP) was 135/75 mm Hg, and …

Cyclophosphamide For Suspected Primary Angiitis Of The Central Nervous System In A Patient With Human Immunodeficiency Virus: A Case Report, Martha M. Rumore, Samantha Su, Jake Pellinen

Touro College of Pharmacy (New York) Publications and Research

Introduction: Central nervous system (CNS) vasculitis is rare, including in human immunodeficiency virus (HIV), occurring in less than 1% of patients. Systemic vasculitis affecting the CNS is termed secondary CNS vasculitis, whereas primary CNS vasculitis, referred to as primary angiitis of the CNS (PACNS) refers to an extremely rare disease specifically confined to the CNS. Only some cases of PACNS in HIV patients have been reported in literature.

Case Report: We report a case of a 46-year-old female with HIV who developed probable primary CNS vasculitis, which was treated with intravenous cyclophosphamide and glucocorticoids for both induction and …

Phenotyping And Genotyping Of Cyp2c19 Using Comparative Metabolism Of Proguanil In Sickle‐Cell Disease Patients And Healthy Controls In Nigeria, O. E. Adejumo, T. R. Kotila, A. G. Falusi, B. O. Silva, J. N. Nwogu, P. S. Fasinu, C. P. Babalola

Pharmaceutical Sciences

No abstract provided.

Doctor Of Pharmacy-Philosophy Of Pharmacy 2016, Nova Southeastern University

Health Professions Divisions Course Catalogs and Course Descriptions

No abstract provided.

Development And Implementation Of A Pharmacist-Managed Outpatient Parenteral Antimicrobial Therapy Program, Eun Kyoung Chung, Cole B. Beeler, Eva W. Muloma, Danielle Osterholzer, Kendra M. Damer, Sharon M. Erdman

Scholarship and Professional Work – COPHS

Purpose The development and implementation of a pharmacist-managed outpatient parenteral antimicrobial therapy (OPAT) program in a county teaching hospital are described.

Summary A pharmacist-managed OPAT program was developed and implemented at a county teaching hospital to provide consistent evaluation, approval, and monitoring of patients requiring OPAT for the treatment of infection. The developmental and implementation stages of the OPAT program included (1) a needs assessment, (2) the identification of resources necessary for program operation, (3) delineation of general OPAT program operations and activities of individual OPAT clinicians, (4) the development of patient selection criteria, including a plan of care algorithm, …

Role Of Microglial Α7 Nicotinic Acetylcholine Receptor Positive Allosteric Modulator In Neuroinflammatory Pain Models In Mice, Muzaffar Abbas

Electronic Theses and Dissertations

Neuroinflammatory pain affects about 1.5% of the United States population. Around 20-40% patients having neurological disorders are affected with neuroinflammatory pain. As a part of the limbic system, hippocampus is known to play a critical role in pain perception and processing, and is densely populated with microglial cells and α7 nicotinic acetylcholine receptors (nAChRs). Given the role of microglial α7 nAChRs in neuroinflammation, the α7 nAChRs have emerged as potential target for neuroinflammatory pain treatment. We hypothesized that microglial α7 nAChRs positive allosteric modulation in the hippocampus will decrease neuroinflammatory pain at behavioral, cellular, biochemical, and molecular level. The primary …

Acute Kidney Injury In Patients Treated With Vancomycin And Piperacillin-Tazobactam: A Retrospective Cohort Analysis, Wilbur Cliff Rutter

Theses and Dissertations--Pharmacy

Empiric antimicrobial therapy often consists of the combination of Gram-positive coverage with vancomycin (VAN) and Gram-negative coverage, specifically an anti-pseudomonal beta-lactam, such as piperacillin-tazobactam (PTZ). Nephrotoxicity is commonly associated with VAN therapy; however, recent reports demonstrate increasing nephrotoxicity rates among patients treated with the combination of VAN and PTZ. This study evaluated the effect of the VAN/PTZ combination on acute kidney injury (AKI), as defined by the RIFLE criteria, compared to VAN and PTZ monotherapies.

Overall, 11,650 patients were analyzed, with 1,647 (14.1%) AKI cases occurring. AKI was significantly more frequent in the VAN/PTZ group (21%) compared to either monotherapy …

Clinical Outcomes Associated With Time To Antimicrobial Therapy Change From Vancomycin To Daptomycin In Staphylococcal Bacteremia, Sarah J. Tennant

Theses and Dissertations--Pharmacy

Background: Staphylococcus aureus is an aerobic, Gram positive commensal organism that is capable of causing a wide spectrum of disease. This study contributes to previously published literature regarding daptomycin versus vancomycin use in S. aureus bacteremia (SAB).

Methods: Adult patients admitted between 2010 and 2014, billed for ICD-9 code V09.0, 038.11, 038.12, 041.11, or 041.12, and received vancomycin and daptomycin were included in this retrospective analysis. Patients were stratified by time to change in antibiotics from vancomycin to daptomycin to the early switch (1-3 days), intermediate switch (4-7 days), or late switch (8 days or later) group. The primary outcome …

Exploring New Chemical Entities From Traditional Medicine: Docking, Synthesis And Specific Bioactivities, Chinni Yalamanchili

Electronic Theses and Dissertations

Traditional medical systems contributed significantly to medicine with a number of their phytochemicals found to possess good biological properties. Recently, Dr. Youyou Tu was awarded the Nobel Prize (2015) for her discovery/isolation of Artemisinin from the TCM plant Artemisia annua. Our first aim is to identify active phytochemicals against botulinum neurotoxin A (BoNT/A), and diabetes from Ayurveda and TCM, respectively, by using in silico, in vitro and in vivo approaches. In our second aim, we wanted to enantioselectively synthesize scalable quantities of phytoestrogenic isoflavans such as equol and sativan. The following three chapters summarize results of the three research goals. …

Curcumin/Melatonin Hybrids As Neuroprotective Agents For Alzheimer's Disease, John Saathoff

Theses and Dissertations

Alzheimer's disease (AD) is a progressive neurodegenerative disorder and the leading cause of dementia, affecting ~5.2 million Americans. Current FDA approved medications provide mainly symptomatic relief and there are no agents available to delay or cure this disease. Multiple factors such as amyloid-β aggregates, dyshomeostasis of biometals, oxidative stress, and neuroinflammation have been implicated in the development of AD. Even though significant advances have been made in understanding the mechanisms leading to AD, the exact etiology still remains elusive. Given AD’s multifactorial nature, a multifunctional strategy of small molecule design would help to identify novel chemical templates. Recently our lab …

Variability In Antibacterial Chemical Defenses In Caribbean Sponges Of The Genus Aplysina, Savannah Stockton

Honors Theses

Coral reefs represent one of the most diverse ecosystems on earth, providing habitat for at least 25% of all marine species. Coral ecosystems are faced with many stressors, both physical and biological, that are causing their continuing decline. Understanding the impacts of these stressors, and the resilience of coral reefs, is important to the long-term survival of these critical ecosystems. As a major constituent of marine communities, sponges are an important phylum contributing to the ecology of coral reefs. Like other components of coral reef habitats, sponges also face a wide variety of biological stressors including pathogens, predators, and competitors. …

The Impact Of The Sentinel Initiative And Faers Surveillance System On Consumer Safety, Sonia Batra

Walden Dissertations and Doctoral Studies

The U.S. Food and Drug Administration (FDA) uses the FDA Adverse Event Reporting System (FAERS) to monitor adverse events resulting from pharmaceutical drug use. However, this system has limitations such as not allowing real-time data collection. To address these limitations, the FDA launched the Sentinel Initiative in 2008. This comparative case study was conducted to describe perceptions of investigating the efficacy of the Sentinel Initiative compared with the FAERS. The study was based on the theory of preemption as it emphasized the need for efficient means for providing unquestionable proof that consumers suffered adverse drug effects. The sample included interivews …

Antiviral Peptide Nanocomplexes As Potential Therapeutics For The Treatment Of Infectious Diseases, Jinjin Zhang

Theses & Dissertations

Hepatitis C Virus (HCV) is recognized as a major burden in global public health, which can be further exacerbated by several cofactors such as human immunodeficiency virus (HIV). Currently, there is no vaccine for HCV. The emergence of potent and highly specific direct-acting antivirals (DAA) has marked a new era in HCV therapy, however, the remaining issues like affordability, genotype dependency, and potential resistance still necessitate the development of additional therapeutic approaches to be used instead or in combination with DAA.

Recently, the antiviral peptide C5A (in our studies designated as p1) and its cationic derivative p41 have been identified …

Comparison Of Pediatric Outpatient Antibiotic Prescribing Patterns For Specified Indications In Primary Care Practices, Samantha Spishock Pharmd, Kristen Held Wheatley Pharmd, Bcop, Tibisay Villalobos Md, Faap

Department of Pharmacy

No abstract provided.

Utilizing Monte Carlo Simulations To Optimize Institutional Empiric Antipseudomonal Therapy, Sarah J. Tennant, Donna R. Burgess, Jeffrey M. Rybak, Craig A. Martin, David S. Burgess

Pharmacy Practice and Science Faculty Publications

Pseudomonas aeruginosa is a common pathogen implicated in nosocomial infections with increasing resistance to a limited arsenal of antibiotics. Monte Carlo simulation provides antimicrobial stewardship teams with an additional tool to guide empiric therapy. We modeled empiric therapies with antipseudomonal β-lactam antibiotic regimens to determine which were most likely to achieve probability of target attainment (PTA) of ≥90%. Microbiological data for P. aeruginosa was reviewed for 2012. Antibiotics modeled for intermittent and prolonged infusion were aztreonam, cefepime, meropenem, and piperacillin/tazobactam. Using minimum inhibitory concentrations (MICs) from institution-specific isolates, and pharmacokinetic and pharmacodynamic parameters from previously published studies, a 10,000-subject Monte …

Synthesis Of Medicinally Relevant Thiazolyl Aryl Ketones Under Mild Conditions, Danielle M. Gardner

Health, Human Performance and Recreation Undergraduate Honors Theses

Purpose: The growing amount of clinical resistance observed in current antifungal drugs and in anti-HIV pharmaceuticals is a concern in the medical community. The purpose of this study is to develop a mild synthetic process for biomedically relevant thiazolyl aryl ketones that can be used to develop antifungal and anti-HIV drugs. We hypothesized that the proposed synthetic technique would be more efficient, produce fewer unwanted byproducts, and be more tolerant of functional groups than existing methods.

Methods: Prior to each of the ketone reactions, the necessary salt was synthesized by mixing thiazole and 9-bromofluorene neat in a reaction tube heated …

Development And Evaluation Of Amphotericin B Loaded Iron Oxide Nanoparticles For Targeted Drug Delivery To Systemic Fungal Infections, Pavan Balabathula

Theses and Dissertations (ETD)

A targeted nanotheronostic drug delivery system to diagnose and treat life threatening invasive fungal infections (IFIs) such as cryptococcal meningitis was designed, developed, characterized, and evaluated. To address the development processes, first, iron oxide nanoparticles (IONP) (34-40 nm) coated with bovine serum albumin (BSA), loaded and targeted with amphotericin B (AMB) (AMB-IONP) was formulated by applying a layer by layer approach. Several designs (A, B, C, D, & E) of AMB-IONP were developed and their physicochemical properties such as drug loading with HPLC method, particle size, poly dispersity index (PDI), and ζ-potential using dynamic light scattering (DLS) technique, morphology with …

Development Of Oral Vaccines Against Lyme Disease, Rita Raquel Dos Anjos De Carvalho E Melo

Theses and Dissertations (ETD)

Lyme Disease, caused by the spirochete Borrelia burgdorferi, is the most common vector-borne disease in the United States and Europe. If left untreated, it can lead to permanent damage to the nervous and musculoskeletal systems. In some cases, patients that receive the recommended antibiotic therapy develop a debilitating health condition associated with substantial health care costs. Despite current preventive measures, the incidence and the geographic distribution of Lyme Disease continues to increase. Recent estimates from CDC suggest that the true number of cases of Lyme Disease in the US is approximately 300,000 per year. Yet, there is currently no vaccine …

Antibiotic Resistance And The White House Forum On Antibiotic Stewardship, Mary Lou Manning Phd, Crnp, Cic, Faan

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.