Medicine and Health Sciences Commons^™

Subanesthetic Iv Ketamine Reduces Acute Suicidal Ideation In Patients With Mood Disorders, Kimberly Jenko, Jack Anzilotti

Physician Assistant Capstones, 2016 to 2019

Background. Depression and suicide are common in the United States and present a significant problem in the healthcare landscape. Currently, there are few options that can rapidly reduce suicidal ideation in patients with depression. Ketamine, a glutamate N-methyl-D-aspartate (NMDA) receptor antagonist, has been shown to reduce acute suicidality in patients with depression. Previous studies have a reduction of suicidal ideation compared to saline placebo, but few studies have shown a significant effect compared to a similar psychoactive drug such as midazolam.

Method. A search of PubMed and PsychNET was performed in September 2018 using the terms “ketamine,” “suicide,” …

Gender Differences In Opioid Prescribing Patterns Among Adults In The Us, Salena Marie Preciado

Pharmaceutical Sciences (MS) Theses

This project aims to evaluate gender differences in opioid prescribing in ambulatory care and emergency department settings. The retrospective analysis of opioid prescribing rates in the US included all adult medical visits from 2006-2016. Data was collected from two nationally representative surveys, The National Ambulatory Medical Care Survey (NAMCS) and the National Hospital and Ambulatory Medical Care Survey (NHAMCS). Eligible patients were at least 18 years old on the date of the visit. Bivariate and multivariate analysis were used to identify factors associated with opioid prescribing.

Rates of opioid prescribing increased for both men and women over the study period. …

Impact Of Prevnar (Pcv13) Vaccine Recommendations In Pediatric And Immunocompetent Adults 65 Years And Older: What Are The Benefits And Risks?, James E. Watkins, Anne Marie Thibodeaux, John C. Darnell

Articles, Abstracts, and Reports

Background:

2000: PCV7 becomes the first FDA approved pneumococcal vaccine for pediatrics
2010: PCV13 recommended in pediatrics
2014: PCV13 recommended in immunocompetent adults 65+
2018: CDC looked at data since 2014 recommendation
2019: PCV13 now shared clinical decision-making

Non-Traditional Anti-Emetic Therapy For Cannabinoid Hyperemesis Syndrome: A Case Report, Sara Groome, Pharmd, Kelly Le, Pharmd, Christina Karalis, Pharmd, Eric Selvage, Pharmd, Brandi Thoma, Pharmd, Bcps, Bccp

Pharmacy Presentations, Posters, and Grand Rounds

• Marijuana is one of the most commonly utilized recreational drugs and is widely known for both its anti-emetic and appetite-stimulating properties
• Medicinal-grade marijuana has been available for patients suffering from various medical conditions, such as chemotherapy-induced nausea and vomiting, for example; it also has been utilized in patients with chronic pain, in addition to a number of other disease states
• While casual, intermittent use elucidates the aforementioned positive effects, chronic use of large quantities of marijuana may precipitate the contrary, such as extensive nausea and vomiting, a hallmark of Cannabinoid Hyperemesis Syndrome (CHS)
• CHS is hypothesized to result from alterations …

Does Dispensing Naloxone Kits To High-Risk Patients At The Time Of Emergency Department (Ed) Discharge Reduce The Burden Of Subsequent Overdose-Related Care?, Steven D. Perry, Charleen Gnisci, Rachel Beham

Emergency Medicine

Purpose: The rates of opioid-related overdose and death have remained at or near historically high levels despite reform in pharmaceutical opioid prescribing trends. This study will determine if a recently implemented protocol which aims to provide high-risk patients with naloxone emergency kits at the time of ED discharge has reduced the need for subsequent overdose-related care to a greater degree than providing the same patients with written outpatient naloxone prescriptions. Patients currently receive either intervention upon discharge from the ED based on a protocolized, criteria-based, provider-implemented decision-making tree that identifies patients at high risk for subsequent overdose.

Methods: This study …

Impact Of Required Antibiotic Stop Dates And Indications On Length Of Treatment In Hospitalized Patients With Pneumonia, Amanda Haddad, Kathryn Hernando, Kayihura Manigaba, Abigail Antigua

Infectious Disease

Purpose: The CDC Core Elements of Hospital Antibiotic Stewardship Programs recommends implementing policies to support optimal antibiotic prescribing including documentation of dose, duration and indication. On January 31, 2017, the study institution implemented new physician order entry screens in the electronic health record requiring the input of indication and duration on all antibiotic orders. The objective of this study is to determine if implementation of mandatory indication and duration for antibiotic orders decreases antibiotic duration of therapy in hospitalized patients with pneumonia.

Methods: This study was submitted to the Institutional Review Committee for approval. The clinical pharmacy surveillance platform, …

Pantoprazole Continuous Infusion Versus Intermittent Bolus For Gastrointestinal Bleed Prior To Esophagogastroduodenoscopy (Egd), Vy Dang Pharmd, Mickayla Clark Pharmd, Bcps, Kartika Shetty Md, James Hwang, Pinak Shah, Scott J. Anderson

Gastroenterology

Purpose: Practice guidelines recommend patients with non-variceal upper gastrointestinal (GI) bleeds who have a high risk of active bleeding, nonbleeding visible vessels, and adherent clots should be given proton pump inhibitors (PPIs) intravenous (IV) bolus followed by continuous infusion after esophagogastroduodenoscopy (EGD). The use of PPIs before EGD has shown to reduce the requirement for EGD, however, there are no studies evaluating the difference in outcomes of continuous infusion PPI versus intermittent IV bolus PPI prior to EGD. The objective of this study is to evaluate clinical outcomes of continuous infusion PPI versus intermittent IV bolus PPI prior to EGD. …

Utility Of Push Dose Vasopressor In The Emergency Department, Paul Nguyen, Daniel Giddings, Scott Dietrich, Kathryn Merkel

Emergency Medicine

Purpose: The purpose of this study is to evaluate push dose vasopressor (PDV) usage patterns, efficacy, and safety in a single community hospital emergency department when used for rapid sequence intubation (RSI). Pre-intubation hypotension is a positive correlator to incidences of cardiac arrest. Precautions should be in place to prevent and treat hypotension during emergent intubation. The emerging strategy of utilizing PDV in emergency department (ED) patients is an underexplored and potentially efficacious option.

Methods: This study will be submitted to the Institutional Review Board for approval. This retrospective evaluation will identify critically ill patients receiving phenylephrine or epinephrine PDV …

Retrospective Evaluation Of Hydromorphone Prescribing Patterns In The Emergency Department At A Community Hospital, Eduardo Martinez Sanchez, Winifred Pardo, Ada Jalice, James Adefisoye

All Publications

No abstract provided.

Evaluation Of Rasburicase Utilization For Hyperuricemia, Rachael Gerstein Pharmd, Arun Mancheril Pharmd, Bcps, Hope Kincaid Mph, Cph, Kristin M. Held Wheatley Pharmd, Bcop

Department of Pharmacy

No abstract provided.

Assessment Of Cytotoxic Activity Of Five Common Philippine Medicinal Plants Using Brine Shrimp Lethality Assay, Lloyd O. Balinado, Merab A. Chan

Biology Faculty Publications

A wide variety of plants in the Philippines are used to address several medical ailments; however, many of which have not yet undergone thorough pharmacological studies. The problem on the possible side effects caused by these medicinal preparations has, therefore, increased the interest in validating their safety for human use. The present study was conducted to determine the cytotoxicity of five common local medicinal plants. Annona muricata L., Cymbopogon citratus DC., Graptophyllum pictum (L.) Griff, Jatropha curcas L., and Piper betle L. were selected and subjected to crude aqueous leaf extraction. Extracts were then investigated for cytotoxicity potential using brine …

Ramucirumab: A New Agent For Advanced Or Metastatic Gastric Junction Adenocarcinoma, Adam Smith, Rebecca Worden, Jessica Hoffert, Brendon Rasor, Hannah Stewart, David Koh

Pharmacy and Wellness Review

Ramucirumab (Cyramza®), approved April 21, 2014, is a vascular endothelial growth factor receptor 2 (VEGFR2) antagonist with a U.S. Food and Drug Administration (FDA) indication for the treatment of advanced or metastatic gastric/gastroesophageal junction adenocarcinoma. Gastric cancer is a prevalent cancer in the United States with a poor prognosis. The phase 3 trial, REGARD, shows that ramucirumab, when used within four months after the last dose of first-line chemotherapy or six months after the last dose of adjuvant chemotherapy, increases overall survival. Also, ramucirumab has been included in combination therapy, such as in the RAINBOW trial, which demonstrated its effectiveness …

Memantine: Can It Be Used To Treat Children With Autism Spectrum Disorder?, Austin Brown, Katherine Liu, Pul Lee, Rachel Muhlenkamp, Manoranjan D'Souza

Pharmacy and Wellness Review

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by impairment in social, behavior and communicative skills. The current therapy for ASD only targets the associated symptoms such as aggression, self-harming acts or temper tantrums but not the core symptoms of social dysfunction. The pathology of ASD is not fully understood. Interestingly, imaging studies in ASD patients have reported abnormal high levels of glutamate in certain brain regions that play an important role in social interaction and communication. Thus, it has been hypothesized that medications attenuating glutamate transmission may be used as treatment for some of the core symptoms of …

Outbreak Of Ebola Virus Disease, Alexandra Dimit, Tiffany Kneuss, Joelle Farano, Haley Armstrong, Jodi Otte, Andrew M. Roecker

Pharmacy and Wellness Review

Ebola virus disease (EVD) has existed as a major health concern with devastating and, many times, fatal symptoms. The recent outbreaks of EVD in West Africa and the Democratic Republic of the Congo (DRC) have incited international concern. In this article, the implications of EVD will be discussed including the etiology, transmission, signs and symptoms, diagnosis and treatment of the disease. In addition to this discussion, the manner in which major health care organizations, including the World Health Organization (WHO), are dealing with treating infected patients and containing spread of the disease will be covered.

Cannabinoids For The Treatment Of Chronic Headaches, Kevin Krivanek, Lucy K. Wagala, Brian Heilbronner, Kimberly Loughlin, David Kinder

Pharmacy and Wellness Review

Species of the Cannabis plant genus were among the earliest medicinal plants cultivated by man, with historical accounts of their medicinal uses dating back before the Common Era. Despite its current legal status, Cannabis has garnered nationwide attention as a therapeutic agent for various disease states, including chronic headaches, due to its medical indications as an antispastic, analgesic, antiemetic, neuroprotective and anti-inflammatory agent. Since headaches have a high prevalence in the American population and greatly impair simple daily aspects of living, chronic headaches have become a particular point of interest in regard to the therapeutic potential of Cannabis. Clinical trials …

Marijuana And Its Cardiovascular Implications, Albert Bui, Daniel Powell, Victoria Cho, Kelsey Lindsley, Lindsey Peters

Pharmacy and Wellness Review

As marijuana becomes legalized for medical use, it is important for prescribers and pharmacists to be knowledgeable about the important aspects of marijuana such as mechanism of action, indications and abuse potential. Although marijuana's medicinal benefits are frequently reported, the risks, namely cardiovascular risks, associated with its utilization are often overlooked. Use of marijuana has been reported to increase the risk of myocardial infarction, tachycardia and hypotension, among others. Health care providers must determine if marijuana's benefits outweigh such risks when marijuana therapy is an option. It is also important for pharmacists to understand how to successfully counsel patients using …

Fda Approves New Inhaled Insulin: Afrezza® (Technosphere® Insulin), Benjamin Finley, Christina Ciccone, Kimberly Loughlin, Michelle Musser

Pharmacy and Wellness Review

Diabetes is an endocrine disease caused by deficiency or malfunction of insulin that results in high blood glucose levels and places patients at higher risk for a number of complications. This chronic disease is difficult to manage and affects millions of people in the United States, costing the health care system billions of dollars a year. Of a variety of antidiabetic agents used to control blood glucose, insulin is perhaps the most effective, but until recently it was only available in injectable form. As of June 27, 2014, a new inhaled insulin called Afrezza® (Technosphere® insulin) was approved by the …

Fentanyl: Abuse Potential And Prevention Strategies Tor Pharmacists, Margaret Rowland, Amanda Hoersten, Sarah Webb, H. Paige Stewart, Lindsey Hallman, Michael Milks

Pharmacy and Wellness Review

The abuse of fentanyl is becoming more prevalent, with patients devising new methods of extraction in order to abuse it. Fentanyl patches were originally intended for the opioid tolerant patients still requiring pain relief, but illicit use and drug diversion of this medication continues to grow at an alarming rate. Several cases of abuse have been documented in which patients were chewing patches for oral absorption, distilling the drug into liquid form for injection, or rectally inserting the patches. To discourage and prevent abuse, a keenly aware pharmacist can provide patients with important counseling points on proper use, disposal and …

Management Of Breakthrough Pain In Cancer Patients: Traditional And Novel Approaches, Courtney Porter, Nathaniel Hedrick, Katherine Salay, Lacey Shumate, Caitlin Swann, Kelly Reilly Kroustos

Pharmacy and Wellness Review

Approximately 80 percent of career patients experience breakthrough pain (BTP) characterized by acute onset, short duration, and moderate-to-severe intensity. Treatment of BTP using current available medications is often insufficient, leading to the development of various novel approaches that focus on rapid onset of action and short duration of action. Most of these products are still in clinical trials, and future studies are needed to compare the novel approaches to currently available treatments. Non-medication related issues, which arise from a lack of communication and understanding between the patient, physician and pharmacist, are also barriers to adequate BTP management. By educating patients …

Prevention Of Cytomegalovirus Lntection In Pregnant Mothers And Neonates, Aisha Oliver, Taylor Gauthier, Breanne Rizzo, Alison Huet, Natalie Dipietro

Pharmacy and Wellness Review

Congenital cytomegalovirus (CMV) is the most common virus spread in utero from mother to fetus, leading to more long-term problems and childhood deaths than other conditions such as Down syndrome, fetal alcohol syndrome, pediatric HIV/AIDS, or neural tube defects. The majority of congenital CMV infections are primary infections in which the mother acquires the infection during pregnancy. Current treatment options for CMV infection are available, but there is limited data on safety and effectiveness in pregnant mothers and neonates. Prevention by screening for CMV is associated with a high cost, and vaccines are currently unavailable. Studies show that education and …

Polycystic Ovarian Syndrome And Hyperinsulinemia: Overview And Treatment, Amanda M. Meyer, Lauren D. Bajbus, Sarah E. Drake, Kristen M. Quertinmont, Ashley Overy, Anne Gentry

Pharmacy and Wellness Review

Polycystic ovary syndrome is a prevalent issue in women's health that is associated with hyperinsulinemia and insulin resistance and can lead to long-term health problems. The most highly recommended treatments are diet and lifestyle changes. If these changes alone are not enough, pharmacologic treatments may be employed which include metformin, spironolactone or thiazolidinediones, although more research is needed to fully realize their role. The role of the pharmacist in this disease state includes counseling patients on healthy lifestyle changes, consulting with the physician about prescribing the best medication for each patient, and monitoring therapy adherence in the patient.

Role Of Non-Nutritive Sweeteners In Obesity And Diabetes, Erica Schoenberger, Ellen Hazelet, Kaitlin Sanders, Lindsey Hallman, David Bright, Amy Stockert

Pharmacy and Wellness Review

Artificial sweeteners have become a central component of the Western diet in order to facilitate weight loss and enhance glucose control. Despite their popularity, evidence supporting the benefits of artificial sweeteners remains contradictory; different trials have shown weight loss, weight gain or no change with artificial sweetener consumption. Multiple trials have correlated artificial sweetener usage, in the form of diet soda, with an increased risk of obesity, diabetes and/or metabolic syndrome. Hypotheses speculate that individuals who consume larger loads of artificial sweeteners may be more likely to make unhealthy lifestyle choices, putting them at an increased risk for the development …

Management Of Hypertensive Emergencies In Pediatrics, Jennifer L. Bauer, Jamie L. Amero, Amanda C. Mcdavid, Ryan A. Fischer, Alison L. Huet, Karen L. Kier

Pharmacy and Wellness Review

As hypertension becomes more prevalent in the pediatric population, clinicians are more likely to encounter hypertensive emergencies in children, which require pharmacists and physicians to be educated on the therapeutic options for these emergencies. However, the strict governmental requirements on the testing of these drugs in pediatric patients have limited the amount of available evidence on which to base clinical decisions. This review will highlight the available evidence and preferred treatment options for the management of pediatric hypertensive emergencies.

Genetic Variations In A Cytochrome P450 Enzyme And The Effects On Clopidogrel Bioactivation And Metabolism, Maryanne Ventura, Lauren Desko, Kimberly Gathers, Ashley Overy, David Kisor

Pharmacy and Wellness Review

Clopidogrel, the top prescribed antiplatelet medication for individuals who have experienced a myocardial infarction or cerebral vascular accident or who have peripheral arterial disease, is administered orally as a prodrug. It relies on hepatic metabolism through cytochrome P450 enzymes for conversion to its active form. Current research shows that allelic variation m the gene coding for CYP2C19 is the main factor contributing to the variability of response associated with clopidogrel treatment. Through the promotion of genetic testing for variability in the CYP2C19 gene and competently interpreting test results, pharmacists have the opportunity to use these findings to significantly impact clopidogrel …

Recent Advances Spark Significant Guideline Change: Antiretroviral Therapy (Art) At High Cd4+ Counts In The Treatment Naïve Patient, Joshua Ilenin, Kelly Fargo, Lisa Berni, Kristen Thatcher, Caitlin Swann, Andrew Roecker

Pharmacy and Wellness Review

Human immunodeficiency virus (HIV) targets CD4+ lymphocytes, a critical component to proper functioning of the human immune system. HIV is a significant public health concern, having resulted in over 27 million deaths since its discovery. Currently, several different treatment options exist, with combination antiretroviral therapy (ART) at the forefront. Despite the success of ART therapy, there are number of problems, including poor patient compliance. Due to this, the appropriate time to initiate therapy in the treatment naïve patient is under continuous scrutiny. Recently, several trials have demonstrated evidence suggesting that initiating ART at high CD4+ counts in the treatment naïve …

The Haunting Of Medical Literature, Brieann Miller, Tana Peterman

Pharmacy and Wellness Review

Ghostwriting, or using the names of academic researchers to validate studies commissioned by pharmaceutical companies, has become a growing concern within medical literature. Omission from authorship of the names of individuals making considerable contributions to a paper is one of the most significant aspects of ghostwriting. Policy prohibiting medical ghostwriting is lacking, and it is nearly impossible to prevent the practice without strict and thorough guidelines. More strict guidelines banning ghostwriting, denying government funds to organizations without such policies, and development of databases to track offending authors and organizations could decrease the impact of ghostwriting in medical literature.

Medication Use Evaluation Of Vaccines In Patients With Asplenia, Clarence Kyle Walker Pharmd, Jarrod W. Kile Rphd

Department of Pharmacy

No abstract provided.

A Dual Inhibitor Of The Proteasome Catalytic Subunits Lmp2 And Y Attenuates Disease Progression In Mouse Models Of Alzheimer's Disease, In Jun Yeo, Min Jae Lee, Ahruem Baek, Zachary Miller, Deepak Bhattarai, Yu Mi Baek, Hyun Jung Jeong, Yun Kyung Kim, Dong-Eun Kim, Jin Tae Hong, Kyung Bo Kim

Pharmaceutical Sciences Faculty Publications

The immunoproteasome (iP) is a variant of the constitutive proteasome (cP) that is abundantly expressed in immune cells which can also be induced in somatic cells by cytokines such as TNF-α or IFN-γ. Accumulating evidence support that the iP is closely linked to multiple facets of inflammatory response, eventually leading to the development of several iP inhibitors as potential therapeutic agents for autoimmune diseases. Recent studies also found that the iP is upregulated in reactive glial cells surrounding amyloid β (Aβ) deposits in brains of Alzheimer's disease (AD) patients, but the role it plays in the pathogenesis of AD remains …

The Hiv Vaccine: Learning From Failure And Building On Success, Lindsey Mcclish, Kimberly Gathers, Katie Salay, Lisa Vranekovic, Kristin Seaman, Kelly M. Shields

Pharmacy and Wellness Review

An effective vaccine for acquired immune deficiency syndrome (AIDS) has eluded researchers since the identification of the HIV virus. There are many challenges in developing an effective HIV vaccine, including the lack of knowledge regarding the immune response to the virus and its diverse nature. Ethical concerns further complicate research. A recent phase III trial was performed in Thailand and showed that a significant reduction in HIV infection is possible. Pharmacists need to stay informed of these important breakthroughs in AIDS research in order to provide quality health information to patients in their community. This paper aims to evaluate the …

The Use Of Propranolol In The Treatment Of Posttraumatic Stress Disorder, Tana M. Peterman, Alison L. Huet, Sarah E. Drake, Jamie L. Drees, Robert D. Raiff, B. Shane Martin

Pharmacy and Wellness Review

This article examines the rising issue of post-traumatic stress disorder (PTSD) and possible treatment options. PTSD is a behavioral disorder resulting from memory formation and association with a traumatic event. A search of the published literature reveals several positive studies and case reports suggesting that propranolol, a beta adrenergic receptor antagonist, may be useful for both treatment and prevention of PTSD. Additionally, current studies are being completed in different population groups to determine the overall effectiveness and mechanism by which propranolol is able to provide relief from certain symptoms common to the disorder. This article discusses the medical evidence and …