Pharmaceutical Preparations Commons^™

Doxazosin Immediate Release As Alternative Treatment For Nightmares In Post-Traumatic Stress Disorder: A Case Report, Danyaal Khan, Christie Richardson, Martin Forsberg

Rowan-Virtua Research Day

Nightmares and flashbacks are common debilitating symptoms of post-traumatic stress disorder (PTSD) that can disrupt daily functioning in patients. Prazosin, an alpha-1 adrenergic antagonist, has been commonly used off-label for the treatment of PTSD intrusion symptoms, although its short half-life is limiting. Doxazosin, another alpha-1 antagonist, is starting to be investigated in the treatment of PTSD-related nightmares due to its smaller side effect profile and longer half-life. In our case report, we present a case of a patient with PTSD-related nightmares who was successfully treated with doxazosin following relapse of symptoms after discontinuation of prazosin. The success of doxazosin immediate …

Pseudogout, A Case Of Rejection-Associated Pain, Emily Clark, Ziqian Wang

Rowan-Virtua Research Day

Pseudogout, known as calcium pyrophosphate deposition disease (CPPD), is an arthritis caused by the deposition of calcium pyrophosphate dihydrate crystals within the joint space. Certain medications have been implicated in the development of pseudogout. This case report examines a patient who developed pseudogout thought to be caused by the use of the immunosuppressant medication tacrolimus.

Quincke’S Phenomenon – The Ace Inhibitor Culprit, Mohammad A. Rattu, Eric A. Maddock

Rowan-Virtua Research Day

Angioedema is defined as a non-pitting edema that involves the subcutaneous layer and additionally may include submucosal layers of tissue which pertain to the face, oral cavity, larynx, lips, extremities and gastrointestinal tract; this becomes a life-threatening situation particularly when there is involvement of the larynx. Angioedema may be classified as either histamine-mediated or bradykinin-mediated. Histamine-mediated, associated with mast-cell and basophil activation, is the most common. Bradykinin-mediated (secondary to hereditary, acquired C1-inhibitor deficiency, ACEI-associated angioedema) occur when an allergic reaction and hives will not trigger this reaction. The C1-inhibitor is a regular of the complement system and either dysfunction or …

Evaluation Of The Efficacy Of Novel Drugs And Combinations Against Extensively- And Pan-Drug Resistant Acinetobacter Baumannii Isolates, Keertana Jonnalagadda, Rachel Carr, Valerie Carabetta

Rowan-Virtua Research Day

Acinetobacter baumannii, a Gram-negative, nosocomial, opportunistic pathogen is commonly infectious in immunocompromised patients. More specifically patients develop healthcare-associated infections (HAI) spanning beyond sepsis, pneumonia, meningitis, and urinary tract infections. Due to its rapid ability to acquire antibiotic resistance, it has raised the necessity to discern a novel therapeutic treatment that can be effectively used against the multidrug resistant (MDR) A. baumannii. Cooper University Hospital (CUH) faced an increased case load of patients that were infected with MDR A. baumannii. The patient isolates obtained from CUH were highly resistant to the 22 standard-of-care antibiotics. With the recent introduction …

Effects Of Sex And Estrous Cycle On Intravenous Oxycodone Self-Administration And The Reinstatement Of Oxycodone-Seeking Behavior In Rats, Nicole M. Hinds, Ireneusz D. Wojtas, Corinne A. Gallagher, Claire M. Corbett, Daniel F. Manvich

Rowan-Virtua School of Osteopathic Medicine Departmental Research

The increasing misuse of both prescription and illicit opioids has culminated in a national healthcare crisis in the United States. Oxycodone is among the most widely prescribed and misused opioid pain relievers and has been associated with a high risk for transition to compulsive opioid use. Here, we sought to examine potential sex differences and estrous cycle-dependent effects on the reinforcing efficacy of oxycodone, as well as on stress-induced or cue-induced oxycodone-seeking behavior, using intravenous (IV) oxycodone self-administration and reinstatement procedures. In experiment 1, adult male and female Long-Evans rats were trained to self-administer 0.03 mg/kg/inf oxycodone according to a …

The Effects Of Prenatal Buprenorphine Exposure On The Neurobehavioral Development Of The Child, Zaineb Zubair, Maryam Zubair, Juan Alonso, Abdullah Zubair

Rowan-Virtua Research Day

Background: Current guidelines for pregnant women with substance use disorder advise prenatal maintenance of opioid agonist therapy with either buprenorphine or methadone. Despite this rise in prenatal opioid agonist therapy, little is known about the effect of prenatal buprenorphine on the neurobehavioral development of the child. This poses the question: does buprenorphine have a long-lasting effect on the central and peripheral nervous system development and behavior of children who were exposed prenatally?

Methods: A comprehensive literature review identified articles relating to prenatal buprenorphine and neurobehavioral outcomes. Article searches were conducted on PubMed and Dynamed. Publications from 2002 through November 2021 …

Case Report: Epinephrine-Containing Topical Anesthetic Gel Inducing Systemic Epinephrine Toxicity, Md Fateha, Philip Willsie

Rowan-Virtua Research Day

Systemic epinephrine toxicity is a rare complication following inadvertent or excessively large or rapid subcutaneous, intramuscular or intravenous administration. Signs and symptoms of epinephrine toxicity include rapid onset of transient agitation, hypertension, tachycardia, lactic acidosis, and dysrhythmias with potentially fatal consequences. In this case report, we present a 33-year-old female who experienced epinephrine toxicity following the use of a topical anesthetic cream containing lidocaine and epinephrine. The patient had multiple applications to her chest before and during tattoo placement which led to tachycardia, elevated blood pressure, headache, chest pain, nausea, vomiting, and anxiety. The patient was brought into the ED …

Characterization Of Antibiotic Susceptibility Profiles Of Extensively- And Pan-Drug Resistant Acinetobacter Baumannii Clinical Isolates, Rachel Carr, Justin Halim, Rebecca Fliorent, Henry Fraimow, Dejan Nikolic, Valerie Carabetta

Rowan-Virtua Research Day

Acinetobacter baumannii is an opportunistic pathogen common in intensive care units (ICUs), particularly among immunocompromised individuals. Nosocomial A. baumannii infections have become increasingly problematic in recent years, as these bacteria rapidly acquire antibiotic resistance, leading to the emergence of multidrug, extensively drug and pan drug-resistant (MDR, XDR, and PDR, respectively) isolates. Recently, Cooper University Hospital (CUH) experienced a large increase in highly drug-resistant A. baumannii infections, which had a mortality rate of 60%. Oftentimes, physicians had to turn to combinations of drugs with no experimental verification or historically shelved antibiotics, such as the polymyxins, in a desperate attempt to save …

Chemical Restraints In The Emergency Department, Nicholas Noffsinger

Rowan-Virtua Research Day

Chemical restraint is a critical intervention used in emergency departments to manage acutely agitated or violent patients. It involves the administration of medication to induce sedation and control behavior, with the goal of ensuring patient and staff safety while allowing necessary medical interventions to be performed. However, the use of chemical restraints necessitates close observation of vital signs and any potential side effects, as well as careful consideration of patient-specific considerations.

Brash Syndrome Case Report And Brief Review, Kelly Schuitema

Rowan-Virtua Research Day

BRASH syndrome is an acronym that stands for bradycardia, renal failure, AV node blocker, shock and hyperkalemia. The syndrome is precipitated by synergism from AV nodal blocking agents and hyperkalemia. The combination of the AV nodal blockade and renal failure leads to a cycle of severe bradycardia and hyperkalemia. We will discuss a case of BRASH syndrome with a 68 year old female who presented with generalized weakness and was found to be hypotensive, bradycardia, in acute renal failure with hyperkalemia likely related to metoprolol and amlodipine use.

Comparative Analysis Of The Effects Of Actual Versus Assumed Opioid Experience On The Regulation Of Ventral Striatal Opioid Receptor Gene Expression, Indu Mithra Madhuranthakam, Martin Job

Rowan-Virtua Research Day

Rationale: We conducted experiments to assess the effect of prior opioid experience on gene expression changes. We compared the current experimenter-imposed short versus extended-access conditions of opioid self-administration and developed a new quantitative method to determine their effectiveness in identifying the role of opioid experience in regulating opioid receptor expression levels in the ventral striatum (VS) using an oxycodone self-administration/abstinence model.

Methods: In this study, male Sprague-Dawley rats (n=36) were trained for 20 days to self-administer oxycodone at 0.1 mg/kg/infusion under short access (n=15, or saline as controls n=3, for 3h/day) or extended access (n=15, or saline as controls n=3, …

Maldi-Tof Ms Based Proteomic Fingerprinting Of Total Serum Plasma For Somatic Pain Syndromes, Isaiah Pinkerton, Venkateswar Venkataraman

Rowan-Virtua Research Day

There are racial and ethnic disparities regarding pain management within the United States, and that disproportionately affects women of color. There is also a fundamental lack of information regarding the biological mechanism by which pain sensitization and perception occurs, and how it could be affected by both neurologic and somatic pain syndromes.

Methods: Research was performed on principal electronic scientific databases including Google Scholar, PubMed, and Embase with search terms “MALDI-TOF”, “ESI-MS”, “Pain”, and “Biomarkers”, as well as other modifiers to narrow the literature search.

Results: Studies on comparison between MALDI-TOF and other traditional analysis platforms, including Electrospray Ionization (ESI-MS), …

Brief Review: Patient Pill Splitting. What Is The Appropriate Advice To Provide Patients In The Emergency Department?, Mohammad Rattu, James Espinosa, Gabriel Meister, Alan Lucerna

Rowan-Virtua Research Day

A number of patients have inquired about the practice of pill splitting. Cutting or splitting of pills can be used by patients to create an intermediate dose or to save on money where a higher dose is priced at relatively the same cost as a lower dose. In this review we discuss a number of issues related to medication safety and table splitting.

Case Report And Review: Promethazine ("Purple Drank") Abuse, Riya Tandra, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

A 23 year old female was brought to the Emergency Department by EMS for confusion and aggressive behavior. The friends told EMS that the patient had been ingesting "purple drank" and that she had told her friends that she made the concoction with promethazine and opiate cough syrup with some vodka added. She mixed it in a carbonated soda. “Purple Drank” or “Lean” is a combination of codeine promethazine hydrochloride and soda or alcohol that has frequently been misused since the 1990s. This paper aims to highlight the recent resurgence of promethazine abuse occurring in the United States as well …

Brief Review: Iv Fluid Choice In The Emergency Department, Kaywan Saed, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Normal saline and balanced crystalloids, such as lactated Ringer's (LR) and Plasma-Lyte A, are commonly used in the emergency setting for fluid resuscitation. However, there has been growing interest in recent years in whether balanced crystalloids may be superior to normal saline, particularly in critically ill patients.

Normal saline has been the traditional fluid of choice for decades due to its widespread availability, low cost, and presumed safety. However, normal saline has a high chloride concentration (154 mmol/L), which can lead to hyperchloremic metabolic acidosis and other adverse effects, such as renal vasoconstriction and reduced renal blood flow.

In contrast, …

Perioperative Ketamine Use For Post Mastectomy Pain, Alessia Cooney, Jaylyn Thompson, Naomi Watkins-Granville

Rowan-Virtua Research Day

PMPS is defined as chronic neuropathic pain following breast cancer procedures in the ipsilateral arm, chest wall, axilla or shoulder.1-3 Approximately 20 to 50% of post mastectomy patients suffer from Post Mastectomy Pain Syndrome (PMPS).1 With more than 3.8 million breast cancer survivors, due to advances in treatment, there is increased importance in findings ways to better manage the quality of life of breast cancer survivors.1,4 Ketamine induces analgesic effects through its non-competitive antagonism of NDMA receptors.5 Low doses of ketamine infusion (20–30 mg x h−1) have been shown to produce analgesia in neuropathic pain states with benefits lasting up …

Prazosin Dosed 3 Times A Day To Treat Flashbacks Related To Ptsd: A Case Report, Christie Richardson, Alexander Swartz, Martin Forsberg

Rowan-Virtua School of Osteopathic Medicine Departmental Research

Prazosin is an alpha-1 adrenergic receptor antagonist widely known by mental health providers for its off-label use for nightmares in patients with PTSD. Prazosin is lipophilic and crosses the blood-brain barrier to antagonize alpha-1 receptors in the central nervous system, potentially reducing autonomic arousal caused by PTSD. There have been numerous case reports describing the reduction of nightmares and daytime flashbacks due to PTSD with prazosin dosed at night and during the day, respectively. This case report illustrates the resolution of flashbacks related to chronic PTSD with prazosin dosed 3 times a day. As the half-life of prazosin is only …

A Conserved Mechanism For Hormesis In Molecular Systems, Sharon N. Greenwood, Regina G. Belz, Brian P. Weiser

Rowan-Virtua School of Osteopathic Medicine Departmental Research

Hormesis refers to dose-response phenomena where low dose treatments elicit a response that is opposite the response observed at higher doses. Hormetic dose-response relationships have been observed throughout all of biology, but the underlying determinants of many reported hormetic dose-responses have not been identified. In this report, we describe a conserved mechanism for hormesis on the molecular level where low dose treatments enhance a response that becomes reduced at higher doses. The hormetic mechanism relies on the ability of protein homo-multimers to simultaneously interact with a substrate and a competitor on different subunits at low doses of competitor. In this …

Case Report: Covid Arm (Covid Vaccine Arm), Joseph Pagano, James Espinosa, Alan Lucerna, Henry Schuitema

Rowan-Virtua Research Day

We report the case of a 38-year-old male physician who was vaccinated with the Pfizer vaccine. He experienced arm pain and swelling on the vaccinated arm as well as systemic symptoms, including fever, chills, headache and weakness. The systemic symptoms improved after the use of oral prednisone. A review of the literature on the COVID vaccine is presented.

Digoxin Toxicity And Acute Renal Failure In A 75 Year-Old Female, Daniel Zaayenga, Andrew Caravello, Nicholas Tomasello

Rowan-Virtua Research Day

Digoxin toxicity can present with varying manifestations. While pathognomonic symptoms such as xanthopsia (object appearing yellow) are a board favorite it is not a required finding and is in fact not seen with most patients. Rather digoxin toxicity presents with more non-specific symptoms such as GI distress (anorexia, N/V) neurological distress (lethargy, fatigue, delirium, confusion, disorientation, weakness. EKG findings are varied and include premature ventricular contractions, bradycardia, atrial tachyarrhythmias with AV block, ventricular bigeminy, junctional rhythms, various degrees of AV nodal blockade, ventricular tachycardia, and ventricular fibrillation. Although rarely seen, digoxin is one of the only causes of bidirectional ventricular …

Seizure To Drug Induced Schizophrenia: A Rare Case Of Keppra-Induced Psychosis, Shadi Shams, Riddhima Issar, Nardin El-Shammaa, Munaza Khan

Rowan-Virtua Research Day

Levetiracetam is a broad-spectrum antiseizure medication and is approved as adjunctive therapy to treat focal-onset seizures in children and adults with epilepsy. Levetiracetam has a wide margin of safety and patient-friendly pharmacokinetics that distinguish it from other currently available antiepileptic drugs.

Most common side effects are fatigue, somnolence, dizziness, and upper respiratory infection. Neuropsychiatric symptoms are reported. Psychotic symptoms, paranoid ideation, hallucinations, and behavioral problems may occur in adult and pediatric patients. Among all adverse effects, the rate of psychosis is very low and ranges from less than 1% to 1.4%. A retrospective study showed that this rate is higher …

A Systematic Review Of The Barriers Of Opioid Addiction Treatment For Young Adult Males (Ages 18-26) Living In Low Income Areas In The United States Of America, Atish Gandhi, Asim Shafique, Jillian Baker

Rowan-Virtua Research Day

NOTE: This is a broad literature review, not a systematic review.

This systematic review aims to analyze the reasons behind reduced access to opioid addiction treatment for individuals of low socioeconomic standing. Understanding these barriers may allow communities to build a more comprehensive plan to lower addiction rates. In addition, this review will be examining further developments of theopioid crisis due to the recent COVID-19 pandemic. The literature search used publications from the following databases: PubMed, Google Scholar, and NCBI. The keywords searched were “opioid addiction”, “substance abuse”, “low-income area”, “barriers to treatment”, “young male addiction”, “opioid treatment”, “Narcan”. There …

Implementing Best Practices For Co-Prescribing Naloxone In Your Agency: A Guide For Healthcare Professions, Michael Anyanwu, Emmanuel Asenso Jr., Ahmad Hussein, Jessica Baaklini, Michael Sunderhauf

Rowan-Virtua Research Day

From April 2020 to April 2021, it has been recorded that there have been 75,673 opioid overdose-related deaths in the United States. This number is up almost 20,000 more from the last period that deaths were recorded, coming in at 56,064 from April 2019 to April 2020. The use of naloxone, has been proven to save the lives of overdose patients on opioids by reversing its effects. It has already shown significant reduction in opioid overdose related mortality. Pharmacists are now able to prescribe naloxone with opioid prescriptions without a script from a doctor. EMS units are active in communities …

Riluzole For Pediatric Patients With Treatment-Refractory Obsessive-Compulsive Disorder, Maheen Mohammad, Stuti Parikh

Rowan-Virtua Research Day

Obsessive-compulsive disorder (OCD) occurs in about 1-3% of the pediatric population, but many do not respond to standard therapies. Riluzole, a glutamate antagonist, has shown to be an effective treatment for refractory OCD in adults, however few trials have been conducted to show the effectiveness of Riluzole in children to treat refractory OCD. The study investigates the potential use of riluzole in children to treat refractory OCD.

What Motivates Patients To Enroll In A Naloxone Co-Prescribing Program?, Christina Kanagawa, David Aloisio, Eshani Choksi, Manasa Gowda, Tyler Klecha, Charles M. Defendorf

Rowan-Virtua Research Day

Patients were contacted via phone call to establish knowledge of and prescription status regarding naloxone. They were then invited to enroll in a research study consisting of two online surveys.

The patients who had been prescribed naloxone by the time the study had started ranked being persuaded by a medical professional as being the most important reason for accepting the naloxone prescription.

Insufficient data collected during the six-week time frame to draw statistically significant conclusions about what motivates patients to receive naloxone co-prescriptions.

Correlations seen in this study are interesting and warrant further investigation.

Too Much Of A Good Thing: Case Of Fluoride Toxicity, Swet Patel, John Polunin, James Espinosa, Alan Lucerna, Trent Malcolm

Rowan-Virtua Research Day

Overall, the beneficial role of fluoride for the maintenance of proper dental hygiene has been known for many decades which has been corroborated by a plethora of research. Media and culture have further highlighted how using fluoride supplementation can help with dental cavities. It is clear that just as there are benefits to fluoride usage, there also risks. Further awareness needs to be made that showcases the downfalls of excess fluoride use. Labels need to be placed on fluoride products that emphasizes the dosing. It is imperative that people are educated on the toxicity of fluoride as too much of …

The Role Of Physiologic Vision Deficits In Elderly Self Dispensing Medication Errors, Harrison Patrizio

Rowan-Virtua Research Day

Elderly populations are more prone to self-dispensing medication errors. Although some of these errors can be attributed to a patient’s disease, many errors are preventable with behavioral modification. As we age, the lens of the eye becomes yellow. This tints all light that passes through it causing deficits in color distinguishability.(Andreasen, 1980) Additionally, the lens of the eye hardens over time. This results in presbyopia, an inability to focus close objects.(Wolffsohn, 2018) These changes can cause elderly patients to misread labels or dispensed incorrect medication due to color shade similarities.(Cardarelli, 2011) Although these visual changes are well documented, current research …

Case Study Of Metformin-Induced Lactic Acidosis, Kajel Patel, Kishan B. Patel

Rowan-Virtua Research Day

Metformin induced lactic acidosis is when high levels of metformin cause dangerously high levels of lactic acid. Here is a case report of a 72-year-old female who came in for nausea, vomiting, and diarrhea found to have a high suspicion for metformin induced lactic acidosis. She stabilized in the emergency department, nephrology and ICU was contacted, and she went for emergent dialysis. For many patients the prognosis of metformin induced lactic acidosis is poor. This patient was made comfort care by her family.

Long-Term Lithium Use In The Younger Population: Do The Benefits Outweigh The Risks? - A Case Report, Seema Shekar, Alexander Garcia, Rachel Shmuts

Rowan-Virtua Research Day

For decades lithium has been the mainstay treatment for bipolar disorder. While its side effect profile is extensive and varied its most notable adverse effect, and one most feared by treating clinicians, is nephrotoxicity/ end-stage renal disease (ESRD). While the link between long-term lithium use and ESRD has been accepted by the medical community at large for many years, more recent scientific studies call the association into question. In fact, newer studies on the association between Li use and ESRD have shown a negative/inconclusive correlation. Despite this controversy the consensus still remains that ESRD secondary to long-term Li use is …

Robotripping: The Dangers Of Abusing Dextromethorphan, Tiffany Sin, James Espinosa, Dana Fichter

Rowan-Virtua Research Day

Dextromethorphan (3-methoxy-N-methylmorphinan), also known as “DXM,” is a synthetically produced drug available in many over-the- counter (OTC) cough and cold medications as a centrally acting cough suppressant that binds to NMDA receptors. In a 2006 national survey of 50,000 students, 4, 5, and 7% of 8, 10, and 12th graders reported DXM abuse in the past year. In high doses, DXM can cause euphoria, hallucinations, dissociations, and distortion of cognition and perception. DXM abuse is also known as “Robotripping,” “Robodosing,” “Dexing,” “Tussin,” or “Triple Cs” because Robitussin® and Coricidin® Cough and Cold are most frequently abused. DXM has replaced codeine …