Medicine and Health Sciences Commons^™

Overview Of Stevens-Johnson Syndrome And Toxic Epidermal Necrolysis, Christina Spinaris, Sarah Kradel, Tara Tokar, Zachary Crawford, Michael M. Milks

Pharmacy and Wellness Review

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are immunologic reactions that typically present due to drug hypersensitivity. These reactions present with serious mucocutaneous manifestations that can lead to significant morbidity and mortality. The pathogeneses of SJS and TEN have yet to be clearly elucidated, but three potential immunologic mechanisms have been defined in literature: granulysin, Fas-FasL, and perforin and granzyme B. Medications have been immunologically linked as the primary causative agents of SJS/TEN. Corticosteroids, intravenous immunoglobulin administration (IVIG) and cyclosporine have been employed as treatments; however, none have resulted in consistent positive outcomes. Pharmacists have a significant role in …

E-Prescribing: Benefits And Challenges In Enhancing Patient Safety, Kayla Durkin, Rebecca Airel, Lauren Desko, Jamie Amero, Natalie Dipietro

Pharmacy and Wellness Review

As technology is becoming ever more prevalent in the delivery of health care, implementation of electronic prescribing (e-prescribing) has proven to be beneficial in many aspects. However, new challenges have arisen which may be problematic for pharmacy workflow and patient safety. Pharmacists must recognize potential medical errors due to e-prescribing and take the lead on identifying and preventing such errors to enhance patient safety.

The Impact Of Pharmacogenomics On Chemotherapeutic Drug Development And Use, Lara Long, Amy Pasternak, Ellen Hazelet, David Kisor

Pharmacy and Wellness Review

Cancer therapy is largely dependent on general treatment guidelines, and patients undergoing chemotherapy often experience treatment failure with standard drugs. The development of individualized drug therapy through pharmacogenomics has the potential to enhance chemotherapy regimen selection and improve patient outcomes. Antineoplastic agents such as cetuximab and trastuzumab are effective in treating cancers possessing specific genetic biomarker characteristics. Patients need to undergo genetic testing before these agents are administered to ensure appropriate use. Cetuximab has been shown to improve outcomes in metastatic colorectal cancers and head and neck squamous cell carcinomas positive for EGFR. Trastuzumab has shown benefit in human epidermal …

Emerging Therapies For The Treatment Of Multiple Sclerosis, Sara Swick, Amy Gillman, Lauren Bajbus, Jennifer Bauer, Jeffery Talbot

Pharmacy and Wellness Review

Multiple sclerosis is a neurological disease that affects millions of people worldwide, yet is not entirely understood. Symptoms of multiple sclerosis most frequently include muscle spasms and extreme fatigue, but patients can experience a wide variety of issues. There are four categories in which patients with multiple sclerosis are typically classified: relapse-remitting, primary-progressive, secondary-progressive and progressive-relapsing. The pathophysiology of the disease is largely unknown, but many theories are being researched. Currently, there are treatments that can alleviate symptoms and halt disease progression, but no cure is known at this time. Most symptomatic relief medications focus on anti-inflammatory mechanisms of action, …

Improving Maternal And Fetal Health: A Look At Thyroid Function During Pregnancy, Sarah Ginty, Jessica Beck, Taylor Gauthier, Amanda Meyer, Michelle R. Musser

Pharmacy and Wellness Review

Maintenance of thyroid function during pregnancy is critical for both maternal and fetal health and development; therefore, knowledge regarding the relationship between thyroid hormones and pregnancy is essential. The American Thyroid Association task force has developed clinical guidelines on the diagnosis and treatment of thyroid disease during pregnancy. Gestational thyroid diseases are divided into two classifications, hypothyroidism and hyperthyroidism, which are further divided into more specific classifications based on clinical presentation. Differentiation, diagnosis, and monitoring of thyroid diseases throughout pregnancy require assessing symptoms, as well as obtaining levels of thyroid-stimulating hormone (TSH) and free thyroxine (FT4) concentration by a simple …

Dronedarone: An Update To A Controversial Therapy For Atrial Fibrillation, Zachary Crawford, Sara Mcallister, Amanda Hoersten, Jennifer Bauer, Megan Keller, David Bright

Pharmacy and Wellness Review

As of 2004, it was estimated that 2.2 million Americans were diagnosed with paroxysmal or persistent atrial fibrillation (AF) resulting in one out of every six strokes in the United States. AF leads to a reduction in pumping efficiency of the heart increasing the risk of several serious sequelae such as thromboembolic stroke and congestive heart failure (CHF). It also results in a reduced quality of life for the patients suffering from the disease. Patients with AF require appropriate antiarrhythmic therapy to control symptoms and prevent adverse effects of the condition. Multaq® (dronedarone), an antiarrhythmic drug approved for AF in …

Laboratory Mutations Of H5n1 Confer Efficient Transmission In Animal Models And Generate International Debate Regarding Publication Of Dual Use Research, Morgan A. Belling, Kelly Dye, Joshua Ilenin, Jamie Amero, Andrew M. Roecker

Pharmacy and Wellness Review

H5N1, a subtype of influenza A virus that originated in Hong Kong in 1997 and has since spread across Asia and Africa, features a reported case fatality rate of nearly 60 percent in humans. Although naturally-occurring H5N1 has not developed the ability to be efficiently transmitted from human to human, two independent research teams have recently mutated strains of the virus, resulting in facile transmission among laboratory ferrets, which are considered the most accurate models for humans in viral studies. As a consequence of the security and public health risks of such information, the U.S. National Science Advisory Board for …

Lysteda® For Heavy Menstrual Bleeding, Erica B. Schoenberger, Todd A. Tucker Jr., Justin W. Steele, Amanda Meyer, Sandra L. Hrometz

Pharmacy and Wellness Review

Lysteda®, a novel formulation of tranexamic acid, is an antifibrinolytic medication recently approved by the Food and Drug Administration (FDA) for the treatment of heavy menstrual bleeding. Tranexamic acid has been shown to significantly reduce menstrual blood loss while simultaneously allowing a woman to safely become pregnant. The major advantage of Lysteda® (an oral modified-release formulation of tranexamic acid) compared to oral immediate-release tranexamic acid, is the decreased occurrence of gastrointestinal side effects. As there are no therapeutic equivalents to Lysteda® for heavy menstrual bleeding, it is important for pharmacists to be able to counsel patients appropriately on the specific …

Impact Of Community Pharmacists On Management Of Cancer Chemotherapy And The Resulting Side Effects, Jacquline M. Nunner, Jessica Stemen, Courtney Porter, Ellen Hazelet, Mark E. Olah

Pharmacy and Wellness Review

The severe side effects of chemotherapy negatively affect quality of life and may limit the amount of life-saving drug delivered to patients with cancer. These adverse events can be difficult to manage and evidence-based guidelines are lacking. Insufficient supportive care can amplify common side effects, such as chemotherapy-induced nausea and vomiting (CINV), myelosuppression, alopecia, gastrointestinal effects and neuropathy. Therefore, it is important to recognize the most commonly dispensed chemotherapy agents and the side effects that accompany them. Community pharmacists, as easily accessible health care professionals, can provide valuable supportive care to help manage potentially debilitating side effects. However, a major …

Pharmacogenetic Implications Regarding Second Generation Antipsychotics Clozapine And Risperidone, Sarah E. Ginty, Amy Pasternak, Lauren Desko, Jamie Amero, David Kisor

Pharmacy and Wellness Review

Pharmacogenomics is a growing area of pharmacy that has the potential to improve individualization of medication choices, dosing and predictability of side effects. Clozapine and risperidone are atypical antipsychotics whose metabolism, efficacy and side effects are influenced by single nucleotide polymorphisms (SNPs) in a patient's genetic makeup. It has been shown that a polymorphism in the D3 dopamine receptor is associated with an increased risk in developing tardive dyskinesia as an adverse event while taking risperidone. Also, there is evidence that a patient with a homogenous C genotype in the gene coding for the 5-HTzc receptor has a higher risk …

Effects Of Hormone Therapy On Cognition In Post-Menopausal Women, Jessica Langhals, Megan Meyer, Erica Schoenberger, Amanda Meyer, Kristen Finley Sobota

Pharmacy and Wellness Review

Menopause occurs as a result of decreased natural estrogen production by the body. A variety of short-term and long-term symptoms can occur during menopause, which may significantly impact a woman's daily life. Hormone therapy (HT) is commonly employed to alleviate these unwanted symptoms and to regain balance of hormone levels. Options include estrogen-only or estrogen-progestin combination therapy. While HT may help relieve symptoms such as cognitive decline caused by menopause, it also carries potential side effects. Although HT has shown a potential benefit in women with Alzheimer's disease (AD), overall outcomes measuring cognitive function improvement are inconclusive. Therefore, HT should …

The Use Of Crizotinib In Late Stage Lung Cancer Patients With An Abnormal Alk Gene, Lara Long, Kelly Dye, Courtney Porter, Ellen Hazelet, Karen L. Kier

Pharmacy and Wellness Review

The relatively new anti-cancer drug, crizotinib (Xalkori®, Pfizer), has created excitement in the research community. This drug has exhibited dramatic clinical benefits for select non-small cell lung cancer patients showing evidence of a mutation in the EML4-ALK gene. This gene mutation is present in 4 to 5 percent of non-small cell lung cancer patients. Crizotinib acts through a tyrosine kinase inhibition pathway, targeting the ALK and MET tyrosine kinases, to inhibit phosphorylation of activated ALK, which halts the ALK gene mutation and impedes metastasis. In phase I clinical trials, a 57 percent overall response rate was shown, and researchers calculated …

Lithium Therapy In Alzheimer's Disease, Ross Robison, Sara Swick, Lauren Bajbus, Jennifer Bauer, B. Shane Martin

Pharmacy and Wellness Review

Alzheimer's disease (AD) is a neurodegenerative disorder with no known cure which has a strong impact on patients and their caregivers. Current treatments for AD can slow the disease progression, but cannot reverse the damage that has already been done, resulting in some level of lifelong disability for affected patients. The use of lithium has shown promising results in mice models of AD. While animal models have produced positive results, additional human trials need to be conducted in order to determine a place for lithium in Alzheimer's disease therapy. Pharmacists should be aware of this potential new use of lithium …

Safety And Efficacy Of Human Chorionic Gonadotropin (Hcg) In Weight Loss, Todd A. Tucker Jr., Justin W. Steele, Amanda Hoersten, Amanda Meyer, Sandra L. Hrometz

Pharmacy and Wellness Review

Human Chorionic Gonadotropin (hCG) has recently experienced a resurgence in popular media. Late night television commercials and Internet advertisements have suggested that it is an essential, unequivocal means to losing weight fast. ls hCG really a miracle cure to help patients shed unwanted pounds? In 1954, A.T.W. Simeons claimed that hCG impacts weight loss by decreasing hunger, increasing fat redistribution, and increasing overall mood. Knowing that weight loss cannot be directly attributed to hCG use, Simeons developed a very low calorie diet (VLCD) to which the success of the therapy can be attributed. He saw hCG as a means to …

An Update On Acetaminophen Labeling Changes: A Pharmacist's Call To Action, Rebecca Airel, Kayla Durkin, Taylor Gauthier, Jamie Amero, Natalie A. Dipietro

Pharmacy and Wellness Review

Due to the number of acetaminophen overdoses each year, the Food and Drug Administration and the National Center for Prescription Drug Programs made changes and recommendations regarding the labeling of acetaminophen-containing products. It is important for pharmacists to understand these changes and to educate patients on the correct use of these products.

Fidaxomicin (Dificid®): New Antibiotic Approved For The Treatment Of Clostridium Difficile Infections, Sara M. Mcallister, Zachary Crawford, Joshua Ilenin, Ellen Hazelet, Andrew M. Roecker

Pharmacy and Wellness Review

Clostridium difficile is a gram-positive, spore forming bacteria normally transmitted by the fecal-oral route. Infection develops in patients with decreased normal gut flora and is typically associated with recent antibiotic use. Other risk factors include bowel surgery, compromised immune system function, extended hospital stays, and other underlying diseases. C. difficile bacteria produce two toxins, which cause increased intestinal fluid secretion and inflammation. Patients commonly present with diarrhea, abdominal discomfort, loss of appetite, and nausea. Current treatment guidelines are to discontinue antimicrobial agents and increase hydration. Less severe C. difficile associated diarrhea (CDAD) cases are treated with metronidazole 500 mg three …

The Emerging Role Of Ticagrelor In Acute Coronary Syndromes, Jennifer Bauer, Brittany Dye, Kimberly Baucher, Megan Keller, David Bright, Karen L. Kier

Pharmacy and Wellness Review

Antiplatelet therapy has become a mainstay in the treatment of acute coronary syndromes (ACS). Until recently, options were somewhat limited when it came to individualizing drug selection. Plavix® (clopidogrel) has been successfully used for many years but requires activation by CYP enzymes. Depending on an individual patient's genetic makeup, function of these CYP enzymes may be altered, which may increase the risk for clots. The recent approval of Effient® (prasugrel) and Brilinta® (ticagrelor) has provided physicians and pharmacists with more options and may hopefully lead to improved clinical outcomes. Ticagrelor specifically exhibits clinically different pharmacologic characteristics that require twice daily …

Rems: Risk Management Strategies, Current Issues, And The Pharmacist's Role, Kristen Thatcher, Megan Stojic

Pharmacy and Wellness Review

Risk Evaluation and Mitigation Strategies (REMS) are the most recent risk management initiative put forth by the Food and Drug Administration (FDA) that decreases the risk associated with certain medications. They may be mandatory by the FDA or can be produced voluntarily by the manufacturer in order for a drug associated with significant risk to be approved. REMS may include one or multiple elements, including a Medication Guide (MedGuide), Communication Plan, Elements to Assure Safe Use (ETASU), Implementation Plan, and Timetable for Submission of Assessments. Although REMS enhance patient care by reducing risk and maintaining patient safety, an unbalanced burden …

Letter From The Editors, Kelly Fargo, Maryanne Ventura

Pharmacy and Wellness Review

No abstract provided.

Beta-Blockers In Cardiovascular Therapy: A Review, Camelia C. Diaconu, Dragos R. Marcu, Ovidiu G. Bratu, Ana Maria A. Stanescu, Gina Gheorghe, Andreea A. Hlescu, Dan L. Mischianu, Maria Manea

Journal of Mind and Medical Sciences

The role of beta-adrenergic receptor antagonists in cardiovascular therapy has been the subject of various studies over time, these agents representing one of the oldest class of drugs used for the treatment of cardiovascular diseases. Although beta-blockers have been excluded from guidelines as the first-line therapy in essential hypertension, they remain the first choice in patients with heart failure, coronary artery disease, and atrial fibrillation. In this article, we review the major clinical evidence for the use of beta-blockers in cardiovascular diseases. Several trials have demonstrated that beta-blockers reduce mortality in patients with heart failure with a reduced ejection fraction. …

Characterizing Cdk8/19 Inhibitors Through A Nfκb-Dependent Cell-Based Assay, Jng Li, Donald C. Porter, Eugenia Broude, Igor Roninson, Mengqian Chen

Faculty Publications

Cell-based assays for CDK8/19 inhibition are not easily defined, since there are no known cellular functions unique to these kinases. To solve this problem, we generated derivatives of 293 cells with CRISPR knockout of one or both of CDK8 and CDK19. Double knockout (dKO) of CDK8 and CDK19 together (but not individually) decreased the induction of transcription by NFκB (a CDK8/19-potentiated transcription factor) and abrogated the effect of CDK8/19 inhibitors on such induction. We generated wild type (WT) and dKO cell lines expressing luciferase from an NFκB-dependent promoter. Inhibitors selective for CDK8/19 over other CDKs decreased TNFα-induced luciferase expression in …

Changes In Body Mass Index And Atherosclerotic Disease Risk Score After Switching From Tenofovir Disoproxil Fumarate To Tenofovir Alafenamide., Jason J. Schafer, Kaitlin N. Sassa, Jaclyn R. O'Connor, Ayako Shimada, Scott W. Keith, Joseph A. Desimone

College of Pharmacy Faculty Papers

Background: Switching from tenofovir disoproxil fumarate (TDF) to tenofovir alafenamide (TAF)-containing antiretroviral therapy (ART) can improve renal function and bone mineral density in people with human immunodeficiency virus (PWH). The switch can also negatively influence cholesterol, but changes in body mass index (BMI) and atherosclerotic cardiovascular disease (ASCVD) risk are unknown.

Methods: This retrospective observational study evaluated BMI and ASCVD risk score changes in virologically suppressed PWH who switched from TDF to TAF without switching other ART regimen components. Adults on TDF for ≥1 year with 2 consecutive HIV ribonucleic acid values/mL before a TAF switch were included. Body weight, …

Joint Annual Wellness Visit Scheduling, Rob Chamberlin, Jennifer Bliss, Andrea Lai, Paula Dougherty, Deb Swett, Logan Merrithew, Pam Stevens, Scott Williams

MaineHealth Maine Medical Center

Problem/Impact Statement: The pharmacists in Scarborough & Westbrook Primary Care conduct Medicare Annual Wellness Visits (AWVs) with a physician. The pharmacist and physician see the patient individually. The practices achieved and sustained FY18 Joint AWV volume goals through a new process to reschedule physician-only AWVs to Joints AWVs with a pharmacist. This leads to reschedule rework and reduced time practice staff have for patient care.

A Community-Based Survey To Assess Knowledge, Attitudes, Beliefs And Practices Regarding Herpes Zoster In An Urban Setting, Nour A. Baalbaki, Joseph P. Fava, Melanie Ng, Ezinwanne Okorafor, Asad Nawaz, Wesley Chiu, Abdulbaset Salim, Raymond Cha, Paul E. Kilgore

Department of Pharmacy Practice

Introduction: In the USA, nearly one in three people will experience herpes zoster (HZ) in their lifetime. Underserved communities may be at even higher risk due to several factors, including access to healthcare, education, and co-morbid conditions. The purpose of this study was to investigate current knowledge, attitudes, beliefs and practices (KABP) relative to HZ and HZ vaccines in a large urban city.

Methods: A cross-sectional KABP survey was conducted via in-person interview among 381 participants aged ≥ 50 years in Detroit, MI, USA, from June to August 2018. Survey results were stratified into two groups [< 60 and ≥ 60 years of age (YO)] for comparison.

Results: Of the …

Patients Living With Hiv Infection Are Less Likely To Receive The Correct Statin Intensity For Cardiovascular Disease Risk Reduction, Jason J. Schafer, Pharmd, Mph, Roshni Emmons, Pharmd, Bcps, Nick V. Hastain, Pharmd, Todd Miano, Pharmd, Phd

College of Pharmacy Posters

• Patients living with HIV (PLWH) are at high risk for atherosclerotic cardiovascular disease (ASCVD)
• Eligible PLWH should receive statins for ASCVD risk reduction according to current guidelines
• Studies suggest that statins are underprescribed in PLWH, but comparisons to uninfected patients and assessments of statin intensity have not occurred

Objective

To determine the influence of HIV infection on appropriate statin prescribing for ASCVD risk reduction

Exploring The Prevalence And Characteristics Associated With Weight Gain And Metabolic Changes In Plwh Who Are Virologically Suppressed On Antiretroviral Therapy And Switch To Integrase Inhibitor Containing Regimens, Matty Zimmerman, Joseph Desimone Jr., Md, Jason J. Schafer, Pharmd, Mph, Bcps-Aq Id, Bcidp, Aahivp

College of Pharmacy Posters

Objectives

• To determine the prevalence, extent and characteristics of weight gain among virologically suppressed PLWH whose ART has been switched to an INSTI-containing regimen
• To examine the presence of metabolic changes in PLWH who have been switched to INSTI-containing ART

Spring 2019 College Of Health Studies Research Symposium Abstracts, Susan Lacey

Journal of Interprofessional Practice and Collaboration

No abstract provided.

Mentorship And Evidence Based Practice With Athletic Trainer Preceptors: An Overview, John Roberts Jr, Jessica R. Dolecheck Dr

Journal of Interprofessional Practice and Collaboration

Evidence-based practice is often acknowledged as important and has an understood value by health professional students and practitioners. The Commission for Accreditation of Athletic Training Education (CAATE) adopted and integrated five core competencies into the new 2020 accreditation standards for Athletic Training education programs which strongly advocate for the inclusion of EBP. Hence, athletic training educators should work to embed EBP into curricula and clinical experiences through strategic planning and assessment to ensure educational goals and patient outcomes support the vision put forth by the CAATE. Furthermore, training preceptors to provide appropriate mentorship to athletic training students related to EBP …

An Interdisciplinary Approach For Treating Children With Cerebral Palsy, Magen Keys, Connie Lewis

Journal of Interprofessional Practice and Collaboration

Cerebral Palsy (CP) is a neurological disorder that affects the brain and muscles, often causing motor and social delays. Children diagnosed with CP often require interdisciplinary care to promote quality of life and improved development of motor and social skills. Interdisciplinary teams made up of families, the patient, nurses and therapists allow for ongoing goal setting and communication of treatment plans. Each member of the team plays a significant role as they offer specialized services to enhance not only the patient’s physical development but also

the child’s ability to build social relationships, promote autonomy, and encourage independence.

An interdisciplinary approach …

Student Led Interprofessional Activities: A Case Of Collaboration Between Student National Pharmaceutical Association, Student Nursing Association, And The National Kidney Foundation, Alexis Horace, Roxie Stewart, Craig Lavespere

Journal of Interprofessional Practice and Collaboration

Purpose:

The purpose of this project is to describe the implementation of a student led Interprofessional education (IPE) event in collaboration with a national organization, and to describe the perception of interprofessional growth by student volunteers. This even was hosted by the Student National Pharmaceutical Association (SNPhA) and the Student Nursing Association (SNA) in collaboration with the National Kidney Foundation (NKF) Louisiana.

Methods:

SNPhA and the SNA collaborated with the NKF Louisiana to create an IPE event which took place September 29th, 2018 at the College of Pharmacy. A total of 16 student pharmacists and 16 nursing students participated in …