Medicine and Health Sciences Commons^™

Evaluation Of The Appropriate Weaning Of Neonatal Morphine Solution (Nms) In The Treatment Of Neonatal Abstinence Syndrome (Nas) And Its Effect On Length Of Stay (Los), Nicole Hollinger, Pharmd Candidate, Christopher Hvisdas, Pharmd Candidate, Maria Samohod, Md Candidate, Tara E. Decerbo, Pharmd, Janet Larson, Md, Kristin Mckenna, Md, Lindsey Roke, Pharmd

Pharmacy Presentations, Posters, and Grand Rounds

Purpose: Neonates suffering from NAS receive NMS to treat withdrawal symptoms associated with this disease. Frequent NMS dosing and close monitoring are required to ensure adequate symptom control and prevent adverse events. Maximum dose achieved, titration, severity of disease, and variance in in-utero exposure to addictive drugs all contribute to length of stay. The primary objective of this drug utilization evaluation is to assess adherence to current institutional guidelines for titrating neonates and infants off NMS and to identify opportunities for improvement to potentially decrease length of stay in this population.

Methods: A retrospective chart review of neonates …

An Institution Wide Interdisciplinary Protocol For Improving The Recognition And Treatment Of Sepsis In Patients Presenting To The Emergency Department, Glenn Oettinger, Pharmd, Bcps

Pharmacy Presentations, Posters, and Grand Rounds

Objectives of this presentation were to describe our severe sepsis protocol, tools for sepsis identification, management, and staff education, as well as results of our research demonstrating the impact of this initiative on mortality.

Presented at: UHC Annual Conference 2013 in Atlanta, GA

36 PowerPoint slides.

Clevidipine For Acute Blood Pressure Management In The Neurological Intensive Care Unit, Dorota K. Szarlej, Pharmd, Jessica L. Mckeon, Pharmd, Akta S. Patel, Pharmd, Bcps, Amber King

College of Pharmacy Faculty Papers

Clevidipine is a third generation intravenous dihydropyridine calcium channel antagonist approved for treatment of acute hypertension when oral therapy is not feasible or desirable. It is an arterial vasodilator that is metabolized by plasma esterases; therefore, it is eliminated independently of the liver and kidney.1 Clevidipine has been studied for the control of perioperative hypertension2-5 as well as for the management of hyper-tensive crises6 when immediate blood pressure control is clinically necessary. Benefits include its tolerability, rapid onset and offset, and easy titration with predictable response. Other continuously infused intravenous antihypertensives used in the neurocritical care patient population include nicardipine, …

The Impact Of Community Use Of Novel Oral Anticoagulants On An Academic Medical Center, Luis Eraso, Md, Taki Galanis, Md, Kristina Kipp, Pharm.D., Walter K. Kraft, Md, Michael Palladino, Pharm.D., Cacp, Alejandro Perez, Md, Kimberle Ferebee-Spruill, Crnp, Geno Merli, Md, Brian G. Swift, Pharm.D., Mba, Lynda Thomson, Brittany Vining

Department of Pharmacology and Experimental Therapeutics Faculty Papers

Warfarin has been a mainstay of therapy for treatment and prevention of venous thromboembolic disease (VTED) and prevention of stroke and systemic embolism for over 50 years. Recent FDA approval of several novel oral anticoagulants has offered more extensive treatment options for management of these disease states.

The availability of the novel anticoagulants offers an attractive alternative to warfarin therapy for patients due to their convenience of use. In comparison to warfarin, dabigatran, rivaroxaban and apixaban offer: - a fixed dosage regimen

- a relatively small potential drug interaction profile

- minimal laboratory monitoring

- little to no dietary restrictions. …

Rituximab Treatment For Antibody-Mediated Rejection (Amr) Following Heart And Kidney Transplant, Laura Falconieri, Ba, Pharmd, Cheryl A. Abbas, Pharmd

Pharmacy Presentations, Posters, and Grand Rounds

Background

Antibody Mediated Rejection (AMR)1,2

• Rejection that occurs due to antibodies against donor-specific antigen (DSA)

– Antibodies activate complement system

– Leads to cell death and tissue necrosis

• Risk Factors

– Pregnancy

– Blood transfusions

– Prior transplantation

• Types of AMR

– Hyperacute

• Occurs within minutes of graft transplantation causing death of the graft

• Due to pre-formed antibodies present in high titers

• Rarely occurs now due to universal cross-matching

– Acute

• Occurs within a few days of transplantation causing graft dysfunction

• Due to pre-formed antibodies or antibodies that develop de novo after …

What’S Your Line? Defining Pharmacists' Role In Jejunostomy Tube Medication Administration, Jamie M. Gomes, Pharmd, Gloria M. Espinosa, Pharmd, Brian P. Roslund, Pharmd, Bcps, Joanne Heil, Pharmd, Bcps

Pharmacy Presentations, Posters, and Grand Rounds

Enteral nutrition is preferred over parenteral nutrition in patients with inadequate oral intake for an extended period of time. Enteral feeding helps preserve the functioning of the gastrointestinal (GI) tract. 1 Feeding tubes provide access to the GI tract allowing administration of medication while unable to swallow. Drug therapy is complicated by drug formulation, absorption site, first-pass elimination, as well as the size and placement of the tube.1-3 Medication errors revolving around administration via enteral feeding tubes represent a need for education and implementation of hospital guidelines.

Increased Levels Of Plasma Soluble Sema4d In Patients With Heart Failure., Qiongyu Lu, Ningzheng Dong, Qi Wang, Wenxiu Yi, Yuxin Wang, Shengjie Zhang, Haibo Gu, Xin Zhao, Xiaorong Tang, Boquan Jin, Qingyu Wu, Lawrence F Brass, Li Zhu

Department of Pharmacology and Experimental Therapeutics Faculty Papers

Semaphorin 4D (Sema4D/CD100) is a 150-kDa transmembrane glycoprotein expressed by platelets and T-cells. When these cells are activated, Sema4D is cleaved proteolytically, generating a biologically active 120-kDa fragment (soluble Sema4D) capable of targeting receptors on platelets, B-cells, endothelial cells and tumor cells. However, its plasma levels and significance in heart failure (HF) have not been reported. In this study, we established an ELISA and detected soluble Sema4D in human plasma. In healthy controls, plasma Sema4D levels were higher in men than women (5.15±3.30 ng/mL, n = 63, vs. 4.19±2.39 ng/mL, n = 63, P

Identification Of Distant Drug Off-Targets By Direct Superposition Of Binding Pocket Surfaces., Marcel Schumann, Roger S Armen

College of Pharmacy Faculty Papers

Correctly predicting off-targets for a given molecular structure, which would have the ability to bind a large range of ligands, is both particularly difficult and important if they share no significant sequence or fold similarity with the respective molecular target ("distant off-targets"). A novel approach for identification of off-targets by direct superposition of protein binding pocket surfaces is presented and applied to a set of well-studied and highly relevant drug targets, including representative kinases and nuclear hormone receptors. The entire Protein Data Bank is searched for similar binding pockets and convincing distant off-target candidates were identified that share no significant …

Fibroblast Growth Factor-2 (Fgf2) And Syndecan-1 (Sdc1) Are Potential Biomarkers For Putative Circulating Cd15+/Cd30+ Cells In Poor Outcome Hodgkin Lymphoma Patients., Rajendra Gharbaran, Andre Goy, Takemi Tanaka, Jongwhan Park, Chris Kim, Nafis Hasan, Swathi Vemulapalli, Sreeja Sarojini, Madalina Tuluc, Kip Nalley, Pritish Bhattacharyya, Andrew Pecora, K Stephen Suh

College of Pharmacy Faculty Papers

BACKGROUND: High risk, unfavorable classical Hodgkin lymphoma (cHL) includes those patients with primary refractory or early relapse, and progressive disease. To improve the availability of biomarkers for this group of patients, we investigated both tumor biopsies and peripheral blood leukocytes (PBL) of untreated (chemo-naïve, CN) Nodular Sclerosis Classic Hodgkin Lymphoma (NS-cHL) patients for consistent biomarkers that can predict the outcome prior to frontline treatment.

METHODS AND MATERIALS: Bioinformatics data mining was used to generate 151 candidate biomarkers, which were screened against a library of 10 HL cell lines. Expression of FGF2 and SDC1 by CD30+ cells from HL patient samples …

Implementation Of Three Times Daily Small Volume Parenteral (Svp) Processing Using Lean Methodology, Phuoc Lynsey Le, Pharmd, Dominick Bulone, Pharmd, Akta S. Patel, Pharmd, Bcps, Glenn Oettinger, Pharmd, Bcps, Dennis Delisle, Mhsa, Pmp

Pharmacy Presentations, Posters, and Grand Rounds

Clinical Importance

• Small volume parenteral (SVP) medications are batch-processed once daily at a 900+ bed academic medical center
• Labels are printed 36 hours before medications are due and prepared and delivered for a 24-hour period
• Therapy changes, discontinuations or patient transfers lead to increased rework, missing doses, and ultimately waste
• Lean methodology was originally developed as a production philosophy and quality
• system with an emphasis on problem solving, partnership, and process improvement1-3
• The Lean philosophy emphasizes the continual identification and elimination of waste in order to maximize value1
• Lean has been used in healthcare with great success4-5

Use Of Apheresis And Insulin For Hypertriglyceridemia-Induced Pancreatitis And Diabetic Ketoacidosis, Drew Kirk, Pharmd, Cara Mcdaniel, Pharmd, Bcps, Rohit A. Moghe, Pharmd, Msph, Cde

Pharmacy Presentations, Posters, and Grand Rounds

CLINICAL RELEVANCE

• Acute pancreatitis (AP) is a common gastrointestinal disease that may result in multiple organ failure and death¹

– Gallstones & alcohol are the most common causes of AP¹

– Hypertriglyceridemia (HTG) causes 1-4% of cases, and should be suspected if triglycerides (TG) are > 1,000 mg/dL in the absence of gallstones or history of significant alcohol use¹

– Clinical management of hypertriglyceridemia-induced pancreatitis (HTGP) is based primarily on anecdotal evidence and case reports

• Concurrent diabetic ketoacidosis (DKA) and AP have been described in the literature

– DKA may be a risk factor for AP, but it …