Pharmacy and Pharmaceutical Sciences Commons^™

Understanding The Pharmacokinetic Interaction Between Alcohol And Long-Acting Opioids, Emily Blum, Brittany Crowe, Tanya Wilsmann, Heather Helsel, David Kisor

Pharmacy and Wellness Review

In response to the fatal interaction of alcohol with extended-release hydromorphone, the U.S. Food and Drug Administration (FDA) approved a class-wide Risk Evaluation and Mitigation Strategy (REMS) for extended-release (ER) and long-acting (LA) opioid analgesics in July 2012. Due to the rising concern of dose-dumping effects, it is important for pharmacists to understand the pharmacokinetic interaction between two of the most commonly prescribed LA opioids (oxycodone and morphine) and alcohol. Clinical trials have looked at the pharmacokinetic profile of these long-acting formulations in conjunction with alcohol, and the results have varied depending on the formulation. For this reason, it is …

Antidepressant Therapy: A Review Of Current Treatment Options And A Glance At The Future, Brittany Dye, Stacy Henthorne, Molly Kulp, Tristan Maiers, Zachary Crawford, Erin Petersen

Pharmacy and Wellness Review

Depression and anxiety disorders are two of the most common mental illnesses experienced by people within the United States, affecting 6.7 percent of the adult population per year. This article will focus on one specific type of depression, major depressive disorder (MDD), characterized by two or more weeks of depressed mood and/or decreased interest in normally enjoyed activities. Depression complicates treatment of other disease state(s), making successful treatment of depression essential in the management of a patient's overall health. This review will evaluate the pathophysiology, antidepressant treatment, and new approaches to treatment, specifically vortioxetine, for MDD.

Fda Approves New Tuberculosis Drug: Bedaquiline (Sirturo®), Megan Ruffner, Kent Wilin, Charles Hay, Zachary Crawford, Andrew Roecker

Pharmacy and Wellness Review

Tuberculosis (TB), caused by the acid-fast bacilli (AFB) Mycobacterium tuberculosis, is an infectious disease that continues to greatly impact morbidity and mortality worldwide; in 2011 it caused 1.4 million deaths. Some strains of the bacteria have become resistant to current treatment regimens, resulting in multidrug-resistant (MOR) and extensively drugresistant (XOR) TB. The emergence of these resistant strains of bacteria calls for new treatment regimens that can quickly and effectively eradicate the organism. The U.S. Food and Drug Administration (FDA) recently approved Sirturo® (bedaquiline) with the indication of MDR pulmonary TB. Bedaquiline introduces a novel mechanism of action via the inhibition …

Endometriosis: The Etiology And Recommended Treatment, Amanda Lovell, Kasie Bellmann, Kelsey Fink, Jessica Beck, Michelle Musser

Pharmacy and Wellness Review

Endometriosis is a gynecological condition that occurs in women between the ages of 15 and 49 years, in which endometrial cells grow outside the uterus. Normally, endometrial cells form the endometrium and respond to hormones throughout the menstrual cycle, but when endometrial cells are located outside the endometrium, painful bleeding and other side effects may occur. Treatment of endometriosis is usually symptomatic relief, including the use of oral contraceptives and other hormone replacement options, as well as non-steroidal anti-inflammatory drugs. To ensure that patients receive the appropriate treatment for this condition, pharmacists should be able to recognize the signs and …

Truvada® Recommended By Fda Committee For Pre-Exposure Prophylaxis In High-Risk Hiv-Negative Individuals, Justin Steele, Emily Blum, Alison Steinbrunner, Lara Long, Andrew M. Roecker

Pharmacy and Wellness Review

Once-daily combination tenofofovir disoproxil fumarate (TDF) and emtricitabine (FTC) has received Food and Drug Administration (FDA) approval for use in pre-exposure prophylaxis (PrEP) against Human Immunodeficiency Virus (HIV) infection in high-risk individuals. In clinical trials, FTC/TDF has been shown to reduce the risk of HIV acquisition by 62 percent in sexually active heterosexual men and women. Similarly, use of FTC/TDF demonstrated a 44 percent reduction in HIV infection within the men who have sex with men population.⁷ When used compliantly and in conjunction with safe sex practices, it appears that FTC/TDF can play an important role in reducing the …

Comparing The Glp-1 Receptor Agonists: Byetta®, Victoza® And Once-Weekly Bydureon™, Todd A. Tucker Jr., Sarah Turley, Kaila Bollinger, Jessica Beck, Sandra L. Hrometz

Pharmacy and Wellness Review

Type 2 diabetes mellitus (T2DM) has traditionally been managed with oral medications. However, in the last few years, subcutaneous glucagon-like peptide-1 (GLP-1) receptor agonists have risen to fame. These agents serve as a reliable addition to current monotherapy. GLP-1 receptor agonists offer a significant reduction in hemoglobin AlC (HbAlc), fasting plasma glucose, and have the added benefit of weight loss. They work primarily by enhancing glucose-dependent insulin secretion while inhibiting glucagon secretion. The available GLP-1 agonists are Byetta® (exenatide), Victoza® (liraglutide), and Bydureon™ (exenatide extended-release). Studies suggest that they are similar in safety and efficacy, with the longer acting GLP-1 …

Sildenafil As An Appropriate Monotherapy Option In The Treatment Of Pulmonary Arterial Hypertension (Pah), Kaitlin Horton, Kent Wilin, Sarah Ginty, Lara Long, David Bright

Pharmacy and Wellness Review

Pulmonary arterial hypertension (PAH) is a debilitating disease characterized by constriction in the diameter of the pulmonary arterial lumen.1,2 This leads to increased pressure and stress on the right ventricle of the heart, which may lead to heart failure and death.2,3 Currently there are only a few treatment options for patients with PAH. Sildenafil, a phosphodiesterase type 5 (PDE-5) inhibitor, can be used to treat PAH. Sildenafil inhibits the degradation of cyclic guanosine monophosphate (cGMP). Increased cGMP concentration results in pulmonary vasculature relaxation. Current clinical trials have indicated that sildenafil can significantly improve many of the symptoms of PAH. The …

Use Of Pharmacogenomics In Mtm Services, Molly Kulp, Halle Orlinski, Zachary R. Jones, Zachary Crawford, David Kisor

Pharmacy and Wellness Review

Incorporation of pharmacogenomic data into Medication Therapy Management (MTM) allows pharmacists to optimize treatment regimens for patients leading to better overall outcomes. Utilizing pharmacogenomics makes it easier for health care professionals to initiate medication regimens with reduced adverse reactions, improves outcomes due to specialized dosing and therapies and allows the treatment process to be as cost-effective as possible for the patient. Pharmacists have an opportunity to educate the rest of the health care team on issues such as: which ethnicities possess higher odds of carrying certain genetic variants, the most common or most relevant medications that can have variable effects …

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 …

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 …

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 …

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 …

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 …

Sipuleucel-T (Provenge®): Therapeutic Use And Financial Implications, Courtney Porter, Joshua Ilenin, Lisa Berni, Ashley Overy, Karen L. Kier

Pharmacy and Wellness Review

Although mortality rates have been declining, prostate cancer accounts for a large percentage of cancer diagnoses around the world. Sipuleucel-T (Provenge®), an autologous cellular immunotherapy targeted against the antigen expressed in most prostate cancers, has been shown to increase the median survival rate of castration-resistant prostate cancer. Even so, the therapeutic risks and benefits, as well as financial implications, all currently play a role in the governmental decision to reimburse for this new therapy.

Pediatric Poisoning: Overview, Treatment, And Prevention, Margaret Rowland, Taylor Gauthier, Kaitlin Sanders, Caitlin Swann, David Bright

Pharmacy and Wellness Review

Pediatric poisoning remains a common and preventable occurrence in the United States. Every year, prescription and over-the-counter medications account for a significant portion of documented poison exposures. Frequent causes of overdose in children include improper medication storage and caregiver or physician dosing error. As easily accessible medication experts, pharmacists have an opportunity to counsel patients in an effort to decrease these preventable poisoning cases. Because children frequently ingest products prescribed for adult use, pharmacist should relay safety considerations to all patients, regardless of age. This article provides a general review of toxicity concerns, discusses clinical implications of common medications resulting …

Will New Mrsa Guidelines Make A Difference In Clinical Outcomes? A Comparison Of United States And United Kingdom Guidelines And Outcomes, Kelly Fargo, Erica Schoenberger, Kristen Thatcher, Lindsey Hallman, Andrew Roecker, Tarek Mahfouz

Pharmacy and Wellness Review

As of February 2011, the Infectious Disease Society of America (IDSA) published the first guidelines assessing the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections. S. aureus is present in the environment and is also located on the skin's surface. MRSA can cause a variety of clinical syndromes presenting with different symptoms that vary with the type and stage of the infection. MRSA is also classified into community-acquired MRSA (CA-MRSA) and hospital-acquired (HA-MRSA), both of which possess different treatment options and strategies. Due to the complex treatment of MRSA, as well the concern over the development of resistance, suggested treatment guidelines …

No Meaningful Drug Interactions With Doravirine, Lamivudine And Tenofovir Disoproxil Fumarate Co-Administration., Matt S. Anderson, Jocelyn Gilmartin, Li Fan, Ka Lai Yee, Walter K. Kraft, Ilias Triantafyllou, Christina Reitmann, Ying Guo, Rachael Liu, Marian Iwamoto

Department of Pharmacology and Experimental Therapeutics Faculty Papers

BACKGROUND: Doravirine (DOR) is a novel non-nucleoside reverse transcriptase inhibitor available as a single tablet and a three-drug combination with lamivudine (3TC) and tenofovir disoproxil fumarate (TDF) to treat HIV-1 infection. These analyses assessed pharmacokinetic (PK) interactions with co-administration.

METHODS: Two trials were conducted. Study 1: two-period, fixed-sequence; 8 healthy participants; Period 1, DOR 100 mg followed by ≥7-day washout; Period 2, TDF 300 mg once daily for 18 days, co-administration of DOR 100 mg on day 14. Study 2: three-period, crossover, 15 healthy participants; Treatment A, DOR 100 mg; Treatment B, 3TC 300 mg + TDF 300 mg; Treatment …

Investigating Trail Sensitivity In Platinum-Resistant Ovarian Cancer, Nicholas Pathoulas

All College Thesis Program, 2016-2019

Ovarian cancer is the deadliest gynecologic malignancy in the United States. While these tumors may have a promising initial response to platinum-based chemotherapies, the patient’s prognosis is commonly hindered by the development of platinum resistant cancer. Tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) has been implicated as a potential treatment for many cancers based on its tumor selective nature. Combination therapies with TRAIL and platinum drugs have been shown to increase apoptosis and have been used in a variety of clinical trials, which have thus far failed to pass phase II.1 Researchers have not yet elucidated the complex mechanism(s) of TRAIL …

Predictive Performance Of Existing Population Pharmacokinetic Models Of Tacrolimus In Pediatric Kidney Transplant Recipients, Alenka Chapron

Research Days

No abstract provided.

The Pharmabiotic For Phenylketonuria: Development Of A Novel Therapeutic, Chloé Elizabeth Lebegue

Senior Theses

Phenylketonuria, now known as phenylalanine hydroxylase (PAH) deficiency, is a genetic disorder of metabolism affecting approximately one in every 15,000 infants born in the United States. Patients have nonfunctional PAH enzyme secondary to one or more genetic mutations. The enzyme deficit results in destructive supraphysiologic blood phenylalanine levels upon consumption of the essential dietary amino acid phenylalanine. Current standards of care mitigate signs and symptoms of the disorder, but do not approach a cure. The methods for creating a prototype pharmabiotic as an innovative treatment strategy for PAH deficiency are described herein.

DNA molecular cloning techniques were utilized to engineer …

Pharmacokinetics Of Ketamine At Dissociative Doses In An Adult Patient With Refractory Status Asthmaticus Receiving Extracorporeal Membrane Oxygenation Therapy., Edwin Lam, Ankit K. Rochani, Gagan Kaushal, Brandi N. Thoma, Julian Tanjuakio, Frances Mae West, Hitoshi Hirose

Department of Pharmacology and Experimental Therapeutics Faculty Papers

PURPOSE: First-line management of severe asthma exacerbations include the use of inhaled short-acting β-agonists, anticholinergics, and systemic corticosteroids. Continuous intravenous ketamine given at dissociative doses may be a pharmacologic option in patients who are intubated with life-threatening severe bronchospasm unresponsive to standard therapy. We describe the case of a 44-year-old man admitted to the intensive care unit for status asthmaticus requiring intubation and mechanical ventilation.

METHODS: The patient developed severe refractory hypercapnic respiratory failure necessitating additional respiratory support with veno-venous extracorporeal membrane oxygenation (ECMO) therapy. Ketamine treatment was initiated at 0.5 mg/kg/h continuous infusion on the day of admission for …

Mass Caffeination, Michael J. Leach

The Transdisciplinary STEAM+ Journal

This poem reflects on caffeine intake in modern society from the perspective of a pharmacologist. It is a free verse, concrete poem that communicates the science of caffeine through both words and visual images.