Pharmacy and Pharmaceutical Sciences Commons^™

Beta-Blockers Act Through Clathrin-Dependent Internalization And Egfr Transactivation To Promote Erk Phosphorylation, Taiwo Ajumobi

Graduate Thesis Collection

For cardiovascular diseases such as high blood pressure, angina pectoris, and left ventricle hypertrophy; long-term activation of beta-adrenergic receptors is strongly linked to the progression of these diseases. A class of antagonistic drugs that target betaadrenergic receptors are collectively called beta-blockers. These drugs are commonly used to reduce the inotropic and chronotropic effects of beta-adrenergic receptor activation. This past decade has revealed that beta-blockers and other ligands are capable of functional selectivity at receptors. Functional selectivity describes the ability of ligands acting at 0 protein-coupled receptors (OPCRs) to preferentially activate or inhibit different signal transduction pathways. The studies on beta-adrenergic …

Teaching Residents To Teach: Preparing Faculty And Clinical Educators, Sarah Nisly, Tracy Sprunger, Alison Walton, Tracy Costello, Jane M. Gervasio, Mary H. Andritz

Scholarship and Professional Work – COPHS

Abstract from the 114th Annual Meeting of the American Association of Colleges of Pharmacy, Chicago, IL, July 13-17, 2013.

Changes In Student Attitudes Towards The Elderly Following A Hypertension Education And Screening Event, David William Martin

Undergraduate Honors Thesis Collection

Objective: To assess student comfort levels and perceptions toward geriatric care after participation in a hypertension screening and education event, and to assess knowledge retention in the elderly participants.

Methods: This multiphase, survey based study evaluated pharmacy and physician assistant students' comfort levels and perceptions of the elderly. The study also used questionnaires to assess knowledge retention in the elderly at immediate, one-month, and three-month intervals.

Results: Student comfort levels significantly increased and perceptions remained unchanged after participation in the education and screening event. Elderly participant knowledge retention remained at around a 90% correct response rate.

Conclusion: Increasing student interactions …

A Randomized, Controlled Trial Of Catheter-Related Infectious Event Rates Using Antibiotic-Impregnated Catheters Versus Conventional Catheters In Pediatric Cardiovascular Surgery Patients, Elaine G. Cox, Chad A. Knoderer, Aimee Jennings, John W. Brown, Mark D. Rodefeld, Scott G. Walker, Mark W. Turrentine

Scholarship and Professional Work – COPHS

We conducted a randomized, controlled clinical trial to determine whether a difference in catheter-associated blood stream infection (CABSI) incidence existed between children who underwent cardiac surgery and had a central venous catheter impregnated with minocycline and rifampin versus those who had a conventional, nonimpregnated catheter after cardiac surgery. Due to a lower number of infections than expected, the study was terminated early. Among 288 evaluable patients, the rates of CABSI and line-related complications were similar between the 2 groups.

Medication Utilization Evaluation Of Dabigatran And Rivaroxaban Within A Large, Multicenter Health System., Sarah A. Nisly, Alex N. Issacs, Meagan Doolin, Courtney Morse, Erin Shiltz

Scholarship and Professional Work – COPHS

Objective. The objective of this medication utilization evaluation (MUE) was to determine the appropriateness of dabigatran and rivaroxaban while also reviewing outcomes for safety and effectiveness within a large, multi-center health system.

Methods. A retrospective chart review was performed using the system’s electronic medical record. A data inquiry was requested and generated for dabigatran usage from July 28, 2011 through July 28, 2012 and for rivaroxaban from March 1, 2012 to July 31, 2012 at eight health system hospitals. All patients receiving at least one dose were eligible for inclusion in the MUE.

Results. For dabigatran, 78 of 390 unique …

Use Of A Subcutaneous Insulin Computerized Glucostabilizer™ Program On Glycemic Control In The Intensive Care Setting: A Retrospective Data Analysis., Sarah A. Nisly, Serena Harris, Laura Aykroyd, Joni Carrol, Brian Ulmer, Michael Waddell, Samuel Flanders, Rattan Juneja

Scholarship and Professional Work – COPHS

Background: Despite guidelines that recommend strongly against Sliding Scale Insulin (SSI) it continues to be the most commonly insulin regimen used in hospitals to treat hyperglycemia. In addition to being reactionary to a glucose that has already increased, SSI offers practical challenges in the randomness of the doses of insulin prescribed and often a disconnect with glucose testing that should be occurring in congruence to the insulin dosing. While many clinical trials have shown improved glycemic control in critical care patients receiving intravenous insulin; few studies have demonstrated the efficacy of subcutaneous (SQ) insulin in this setting. In this study, …

Lipid Goals: Update On Their Status, Katie Axford, Eliza Dy, Sarah A. Nisly

Scholarship and Professional Work – COPHS

Goal: The goal of this lesson is to discuss current medical management of dyslipidemias, including available agents and goals of therapy, as well as potential future treatment strategies based on recently published literature.

Simvastatin: A Risk Factor For Angioedema?, Sarah A. Nisly, Areeba Kara, Tamara B. Knight

Scholarship and Professional Work – COPHS

Objective. To report a case of simvastatin-induced angioedema in a patient with near nightly episodes of orofacial angioedema.

Case Summary. A 75-year-old African American female presented to the emergency department with recurrent face, lip, and tongue swelling. The patient described frequent episodes of orofacial edema, with 4 emergency department visits over the previous 6 months. Her home medications were reviewed and simvastatin was identified as a possible contributing medication. Simvastatin was discontinued with resolution of the symptoms during hospitalization and a significant reduction in episodes.

Discussion. Drug-induced angioedema has been documented with several agents, most commonly angiotensin-converting enzyme inhibitors. …

Canagliflozin, A New Sodium-Glucose Co-Transporter 2 Inhibitor, In The Treatment Of Diabetes, Sarah A. Nisly, Denise M. Kolanczyk, Alison M. Walton

Scholarship and Professional Work – COPHS

Purpose. The published evidence on the pharmacology, pharmacodynamics, pharmacokinetics, safety, and efficacy of a promising investigational agent for managing type 2 diabetes is evaluated.

Summary. Canagliflozin belongs to a class of agents—the sodium–glucose cotransporter 2 (SGLT2) inhibitors—whose novel mechanism of action offers potential advantages over other antihyperglycemic agents, including a relatively low hypoglycemia risk and weight loss-promoting effects. Canagliflozin has dose-dependent pharmacokinetics, and research in laboratory animals demonstrated high oral bioavailability (85%) and rapid effects in lowering glycosylated hemoglobin (HbA1c) values. In four early-stage clinical trials involving a total of over 500 patients, the use of canagliflozin for varying periods …

Outcomes Of Extended-Infusion Piperacillin/Tazobactam In Pediatric Patients., Kristen R. Nichols, Katie Andricopulos, Ashley S. Crumby, Elaine G. Cox, Chad A. Knoderer

Scholarship and Professional Work – COPHS

Poster presented at: ID Week 2013, October 2013, San Francisco, California.

Linezolid-Associated Thrombocytopenia In Children With Renal Impairment, Chad A. Knoderer, Kristen R. Nichols, Heather L. Deyoung, Sara J. Jones, Elaine G. Cox

Scholarship and Professional Work – COPHS

Poster presented at ID Week, October 2013, San Francisco, California.

Analysis Of Anti-Xa Concentrations In Patients On Treatment Dose Enoxaparin: A Retrospective Chart Review, Lauren Levine, Nicole Pallme, Erik Angelotti, Dane L. Shiltz

Scholarship and Professional Work – COPHS

The purpose of this retrospective chart review was to determine the correlation between full weight-based enoxaparin use and the frequency of anti-Xa concentrations within the defined therapeutic range; to ascertain if anti-Xa monitoring is being appropriately ordered in relation to the timing of enoxaparin dose (after 3 consistent therapeutic doses and 3-5 hours post-dose); to establish if the evidence-based recommended dose adjustment protocol that was studied in the pediatric population was utilized; and if this yielded anti-Xa concentrations within the target range (0.6 – 1.1 IU/mL) for an adult population. The data may suggest a lack of correlation between BMI …

Vancomycin And Gentamicin Pharmacokinetic Alterations In An Adolescent Amputee, Kristen R. Nichols, Kari M. Edison, Michelle D. Rosenbaum, Chad A. Knoderer

Scholarship and Professional Work – COPHS

A 14-year-old male with bilateral above-the-knee amputations presented to our hospital for treatment of a skin and soft-tissue infection. We report the experience of vancomycin and gentamicin therapy in this patient. Because these medications require weight-based dosages and pharmacokinetic monitoring of serum levels, it was necessary to obtain peak and trough levels of the two drugs in order to determine the pharmacokinetic differences in this patient compared to those in an adolescent male without amputations. To our knowledge, this is the first report describing pharmacokinetic differences in an adolescent amputee.

We Can Do More Than Just Sell The Test: Pharmacist Perspectives About Over-The-Counter Rapid Hiv Tests, Beth Meyerson, Priscilla T. Ryder, Christiana Van Hippel, Kelsey Coy

Scholarship and Professional Work – COPHS

Pharmacist attitudes about the over-the-counter (OTC) sale of HIV rapid tests in pharmacies were explored through interviews conducted among 17 licensed community pharmacists in a Midwestern, moderate HIV incidence state between May and September 2012. Participants recognized that OTC rapid HIV tests would increase the number of people aware of their HIV status. Concerns included linkage to care and results consultation for those who test HIV-positive. Point of sale was identified as an opportunity for consultation about the test and to establish a relationship for future discussion about results and linkage to care. Pharmacists could provide initial test consultation or …

Survey Of Pharmacist-Managed Primary Care Clinics Using Healthcare Failure Mode And Effect Analysis (Hfmea), Ashley H. Vincent, Jasmine D. Gonzolvo, Darin C. Ramsey, Alison M. Walton, Zachary A. Weber, Jessica E. Wilhoite

Scholarship and Professional Work – COPHS

Objectives: The primary objective was to expand upon results of a previously piloted patient perception survey with Healthcare Failure Mode and Effect Analysis (HFMEA), to identify areas within pharmacist-managed clinics needing improvement.

Methods: The survey was adapted for use in pharmacist-managed clinics. Patients completed the survey following regularly scheduled pharmacist appointments. Data were analyzed with a method adapted from HFMEA. Product scores could range from five to 25. A product of five indicates that pharmacists are doing a good job on the items that patients place the most value on, while a product score of 25 indicates that pharmacists are …

Geriatric Medication Therapy: Weighing The Evidence Versus Best Practice, Lindsay M. Saum, Cathy Ramey

Scholarship and Professional Work – COPHS

Goals: The goal of this article is to provide a review of available evidence for safe prescribing in older adults and recommend medication therapies based on anticipated pharmacokinetic/physiologic changes in this population.

Assessing The Accuracy And Quality Of Medication History Collection: Effect Of Implementation Of Electronic Health Record, Kena Lanham, Lindsay Saum, David J. Reeves, Colleen Scherer, Beth Johnson, Anthony Antonopoulos, Suellyn Sorenson

Scholarship and Professional Work – COPHS

Abstract from 2013 ACCP Annual Meeting, Alburquerque, New Mexico.

Appropriate Management Of Migraines, Dane L. Shiltz

Scholarship and Professional Work – COPHS

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

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 …

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 …

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 …

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.

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 …

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 …

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. …

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 …

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 …

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 …