Pharmacy and Pharmaceutical Sciences Commons^™

Appropriate Management Of Migraines, Dane L. Shiltz

Scholarship and Professional Work – COPHS

Presenation to pharmacists at Butler CE Symposium, June 2012, Indianapolis, Indiana.

P-Glycoprotein Functional Studies To Evaluate The Effect Of Cyclosporine Emulsion Formulations On Reversal Of Resistance In The Multidrug Resistant Cancer Cell Line Mes-Sa-Dx5, Katherine E. Cich

Undergraduate Honors Thesis Collection

Background: The overexpression of an efflux protein, p-glycoprotein (P-gp), is a leading cause of multi drug resistance (MDR). This research project is based on designing emulsions containing optimal doses of cyclosporine (CyA) and Pluronic® P-85 (P85), two agents found to be effective in inhibiting P-gp. Study

Objective: To investigate whether CyA exposure affects the quantity or functionality of P-gp in vitro.

Methods: To study the functionality of P-gp, MDR cells were incubated with CyA solutions containing the P-gp substrate and fluorescent dye Rhodamine 123 (RI23). P-gp inhibition was measured by fluorescence spectrophotometry, which indicates the accumulation of R123 inside the …

Pharmacy And Empathy: Evaluating The Impact Of A Pharmacy Student's Project In A Service-Learning Course, Carly D'Agostino

Undergraduate Honors Thesis Collection

Background: Empathy is taking on a larger role in the pharmaceutical field as pharmacists place emphasis on patient centered care. Service-learning courses can expose pharmacy students to future patients, allowing them to interact and develop empathy. While this study suggests service-leaming can foster empathy, further research is needed to assess the specific outcome of empathy as a result of incorporating a project in a service-learning course for pre-pharmacy students.

Objective: To evaluate the effect on a pharmacy student's empathy after completing a one-on-one patient interview project during a service-learning experience. A secondary objective is to assess tile validity of a …

Safety Of Saccharomyces Boulardii (Florastor) In Solid Organ Transplant Patients, Nicole Marie Dores

Undergraduate Honors Thesis Collection

Probiotics have been promoted for use in many gastrointestinal ailments. Most studies find probiotics safe for human use, reporting no severe adverse effects. However, probiotics are live microorganisms and thus have the potential to cause infection. Transplant recipients are considered at high risk for infectious complications from probiotics due to the immunosuppressive medications used to prevent organ rejection. Nonetheless, clinicians are currently utilizing probiotics in the transplant population, due to their benefit in gastrointestinal disorders, particularly recurrent Clostridium difficile. Limited knowledge and paucity of prospective trials in this patient population demands the need for completion of studies to identify the …

Over-The-Counter Non-Steroidal Anti-Anflammatory Drugs In Adolescent Athletes, Anna Christine Parada

Undergraduate Honors Thesis Collection

Non-steroidal anti-inflammatory drugs (NSAIDs) are common medications used by the general population due their anti-inflammatory and analgesic properties. These are especially popular in athletes since they are not prohibited in many rules of athletic competition. Over-the-counter (OTC) NSAIDs comprise several drugs that may be purchased without a prescription. These are often over-utilized by the general population due to their accessibility and relatively low cost. The unsuspecting victims are the children, especially adolescent athletes, who deem OTC NSAIDs safe without realizing the potential adverse effects of inappropriate consumption of these medications. This article reviews the approved indications and side effects of …

Medications Use And Patient Outcomes At Two Indianapolis Area Skilled Nursing Facilities: A Retrospective Chart Review, Christine Brockett, Priscilla T. Ryder

Scholarship and Professional Work – COPHS

Background: Residential health care has changed over time. Skilled nursing facilities (SNF) as an alternative to standard long-term care are understudied. Objective: To describe current prescribing patterns of medication use in two Indianapolis SNFs.

Method: Chart review to examine associations between medication use and outcomes such as weight changes, falls and re-hospitalization. Discharged patients had to be residents for at least 14 days.

Results: 35 charts were reviewed. 17 (48.6%) patients were male, 22 (62.9%) were Caucasian, 15 (42.9%) had Medicaid, 6 subjects (17%) visited the emergency department, 5 (14.3%) visited the hospital during their stay at the selected facilities, …

Compounding Vs Standardized Commercial Parenteral Nutrition Product: Pros And Cons, Jane M. Gervasio

Scholarship and Professional Work – COPHS

Standardized commercial parenteral nutrition (PN) formulations have advantages and disadvantages as compared with PN formulations compounded using an automated compounding device. These advantages and disadvantages are discussed along with the supporting available research.

Nonsteroidal Anti-Inflammatory Drugs Are An Important Cause Of Acute Kidney Injury In Children, Jason M. Misurac, Chad A. Knoderer, Jeffrey D. Leiser, Corina Nilescu, Amy C. Wilson, Sharon P. Andreoli

Scholarship and Professional Work – COPHS

Objective

To characterize nonsteroidal anti-inflammatory drug (NSAID)-associated acute kidney injury (AKI) in children.

Study design

We conducted a retrospective chart review of children diagnosed with AKI through the use of International Classification of Diseases, Ninth Revision diagnosis code 584.5 or 584.9 from January 1999 to June 2010. Medical records were reviewed to confirm the diagnosis of AKI and to quantify NSAID administration. Pediatric RIFLE criteria were used to codify AKI. Patients were not classified as having NSAID-associated AKI if they had a diagnosis explaining AKI or comorbid clinical conditions predisposing to AKI development.

Results

Patients (N = 1015) were identified …

System-Wide Implementation Of The Use Of An Extended-Infusion Piperacillin/Tazobactam Dosing Strategy: Feasibility Of Utilization From A Children's Hospital Perspective, Kristen R. Nichols, Chad A. Knoderer, Elaine G. Cox

Scholarship and Professional Work – COPHS

Background

Use of extended infusions of piperacillin/tazobactam (PT) in adult patients has been described, but data in children are limited.

Objective

The goal of this study was to determine the feasibility of using an extended-infusion PT dosing strategy as the standard of care in a children's hospital.

Methods

This was a prospective observational study of patients aged >30 days who received PT after admission to a freestanding, tertiary care children's hospital. After institution of an extended-infusion PT dosing protocol as the standard dosing option, patients receiving PT were prospectively assessed for presence of and reasons for changes in dosing regimen. …

Hemopericardium And Cardiac Tamponade Associated With Dabigatran Use, Eliza A. Dy, Dane L. Shiltz

Scholarship and Professional Work – COPHS

OBJECTIVE: To describe 2 cases of hemopericardium following treatment with dabigatran.

CASE SUMMARIES: A 70-year-old male with a history of dabigatran use presented with cough, fatigue, and bloody stools. The patient had a large hyperdense pericardial effusion caused by accumulation of bloody fluid, leading to hypotension and shock. Approximately 1000 mL of hemorrhagic fluid was drained from the pericardial space. A 77-year-old female was admitted for treatment of pneumonia and atrial fibrillation. Dabigatran was initiated and, after 6 doses, the patient developed abdominal pain, respiratory distress, and shock. She was diagnosed with pericardial effusion leading to cardiac tamponade. Pericardiocentesis and …

Use Of Cilostazol For Secondary Stroke Prevention: An Old Dog With New Tricks?, Alex J. Ansara, Dane L. Shiltz, Jennifer B. Slavens

Scholarship and Professional Work – COPHS

OBJECTIVE: To evaluate the safety and efficacy of cilostazol for secondary prevention of non-cardioembolic ischemic stroke.

DATA SOURCES: PubMed and MEDLINE searches were performed (January 1970-September 2011) using the key words cilostazol, antiplatelet, aspirin, acetylsalicylic acid, secondary stroke prevention, ischemic stroke, intracerebral hemorrhage, intracranial, cerebrovascular accident, and transient ischemic attack. Additionally, reference citations from publications identified were reviewed.

STUDY SELECTION AND DATA EXTRACTION: Articles published in English and relevant primary literature evaluating the efficacy and safety of cilostazol in the secondary prevention of atherosclerotic ischemic stroke were included.

DATA SYNTHESIS: Antiplatelet therapy plays a vital role in the multifaceted approach …

Tissue-Specific Alterations Of Prl-1 And Prl-2 Expression In Cancer, Carmen M. Dumaual, George E. Sandusky, Han Weng Soo, Sean R. Werner, Pamela L. Crowell, Stephen K. Randall

Scholarship and Professional Work – COPHS

The PRL-1 and PRL-2 phosphatases have been implicated as oncogenic, however the involvement of these molecules in human neoplasms is not well understood. To increase understanding of the role PRL-1 and PRL-2 play in the neoplastic process, in situ hybridization was used to examine PRL-1 and PRL-2 mRNA expression in 285 normal, benign, and malignant human tissues of diverse origin. Immunohistochemical analysis was performed on a subset of these. PRL-1 and PRL-2 mRNA expression was also assessed in a small set of samples from a variety of diseases other than cancer. Where possible, associations with clinicopathological characteristics were evaluated. Alterations …

Rocuronium And Malignant Hyperthermia, Jennifer Quinn Mccann, Ashton E. Beggs

Scholarship and Professional Work – COPHS

Authors response to a comment on: Beggs A, McCann J, Powers J. “Delayed-onset malignant hyperthermia in association with rocuronium use ” Am J Health-Syst Pharm 2012; 69:1128-34.

Delayed-Onset Malignant Hyperthermia In Association With Rocuronium Use, Ashton E. Beggs, Jennifer Quinn Mccann, Jan M. Powers

Scholarship and Professional Work – COPHS

Purpose Two cases of malignant hyperthermia suspected to be related to the use of a nondepolarizing neuromuscular blocker are reported.

Summary A pharmacogenetic disorder that may occur in as many as 1 in 3000 anesthesia procedures, malignant hyperthermia has been linked to the use of certain anesthetic gases and depolarizing neuromuscular blocking agents (e.g., succinylcholine). Although nondepolarizing neuromuscular blockers were cited as contributing to the development of malignant hyperthermia in a small number of published reports, the agents are generally considered safe for use in at-risk patients. Here investigators report two cases in which the nondepolarizing agent rocuronium is thought …

Do Antibiotics Improve Outcomes For Patients Hospitalized With Copd Exacerbations?, Sagi Mathew, Deborah S. Zeitlin, Katherine Rickett

Scholarship and Professional Work – COPHS

EVIDENCE-BASED ANSWER

YES. Antibiotic use reduced mortality and treatment failure in patients hospitalized with acute exacerbations of chronic obstructive pulmonary disease (COPD) (strength of recommendation [SOR]: A, systematic reviews of randomized controlled trials [RCTs]).

Giving antibiotics early to hospitalized patients decreased the need for later ventilation and readmission within 30 days for exacerbation of COPD (SOR: B, a retrospective cohort study).

Successful Desensitization To Docetaxel After Severe Hypersensitivity Reactions In Two Patients, David J. Reeves, Michael J. Callahan, Gregory P. Sutton

Scholarship and Professional Work – COPHS

Purpose Two cases of successful desensitization to docetaxel after severe hypersensitivity reactions are reported.

Summary Two patients with gynecological malignancies (uterine leiomyosarcoma and ovarian adenocarcinoma) experienced severe hypersensitivity reactions with docetaxel, including flushing, numbness, sharp radiating pain, severe nausea and vomiting, apnea, and unresponsiveness. Both patients received ondansetron before docetaxel. One patient received dexamethasone, diphenhydramine, and famotidine premedication before docetaxel, as she had previously reacted to paclitaxel. Docetaxel infusions were stopped, and the reactions were treated with diphenhydramine and dexamethasone (one patient also received famotidine). After resolution of symptoms, the docetaxel was not reinitiated due to the nature of the …

Leukopenia Associated With Long-Term Colchicine Adminsitration, Ashton E. Beggs, David J. Reeves, Nancy S. Noel

Scholarship and Professional Work – COPHS

Purpose A case of leukopenia in a patient receiving colchicine for calcium pyrophosphate dihydrate deposition disease, or pseudogout, is reported.

Summary An 85-year-old man experienced leukopenia likely due to colchicine. His medical history included chronic lymphocytic leukemia (CLL), pseudogout, osteoarthritis, and hypertension. In February 2011, his white blood cell (WBC) count was 2700 cells/μL, and his absolute neutrophil count (ANC) was 2200 cells/μL. Colchicine 0.6 mg orally daily was initiated in March for the prophylaxis of pseudogout. His WBC count decreased, and his colchicine dosage was reduced to 0.6 mg every other day. Despite this decreased dosage, his WBC count …

Bone Health Management In Prostate Cancer Patients Receiving Androgen Deprivation Therapy, Vishnuprabha Dhanapal, David J. Reeves

Scholarship and Professional Work – COPHS

Purpose. Patients receiving androgen deprivation therapy undergo a rapid decline in bone mineral density during the first 6 to 12 months of initiating therapy. The World Health Organization has developed and implemented the Fracture Risk Assessment Tool (FRAX) to predict the ten year risk of a major fracture & hip fracture. Additionally, the National Comprehensive Cancer Network and the National Osteoporosis Foundation have developed osteoporosis guidelines. This study aims to characterize the fracture risk (based on the FRAX tool) and the current management of bone health based on national guidelines compliance.

Methods. A retrospective chart review of patients receiving a …