Pharmacy and Pharmaceutical Sciences Commons^™

Is The 340b Hospitals Battle At The Supreme Court Over?, Casey W.. Baker, Susan W. Lanham, Alberto Coustasse

Accounting Faculty Research

Under the Federal 340B Program, hospitals and eligible health care clinics that serve low income or rural populations can qualify for federally negotiated manufacturer discounts on purchases of prescription drugs. Approximately 50,000 entities participate in the 340B program, where pharmaceutical manufacturers are instructed to supply outpatient medications to participating providers at discounted rates of 20% to 50%. Participating hospitals depend on profits from the differential between their reimbursement for these drugs and the discounted rates they disburse to finance affordable patient care in underserved communities. On June 15, 2022, the US Supreme Court ruled that major cuts to 340B payments …

Radio Frequency Identification Enhances Patient Safety, Craig Kimble, Alberto Coustasse, Ken Maxik

Pharmacy Practice & Administration

Radio Frequency Identification (RFID) is a technology that uses tags and readers to identify and collect asset information. In pharmacies, this usually means RFID is used for high cost equipment or pharmaceuticals. RFID applications have been in use for many years but recently gained traction in health systems. RFID is becoming particularly effective in drug inventory and automation applications, such as medication carousels and pick-to-light systems.

Evaluate 503b Facilities For Outsourced Compounds, Sarah Clemente, Brittany Riley, Alberto Coustasse

Pharmacy Practice & Administration

The US health care system has encountered long-standing, complex challenges, including growing costs, overuse of care, staffing shortages and supply chain weaknesses. COVID-19 revived these pressures, transforming the health care landscape. Medication and staffing shortages plague hospital systems, and pharmacies are not exempt. Most health systems have experienced high levels of pharmacy technician turnover, with most reporting a minimum turnover rate of 21% last year. In addition, medication shortages of critical medications and infusions create significant workflow barriers that hospitals must address to ensure patient safety. In the face of these obstacles, health systems are turning to 503B compounding facilities …

Gabapentin Presents High Potential For Misuse, Alberto Coustasse, Stacie Deslich, Susan W. Lanham, Brittany Riley

Management Faculty Research

The FDA Approved Gabapentin in 1993 as a non-controlled substance and it has remained a non-controlled substance at the federal level. The drug was created as an anticonvulsant and used to treat seizure disorders. The medication has also been used to treat hot flashes, neuropathic pain, pain, postoperative nausea, substance abuse issues, and vomiting. It is estimated that approximately 1% of people in the United States misuse gabapentin. This fact has compelled certain states to generate legislative initiatives designed to monitor the use and/or reclassify gabapentin. In 2019, US pharmacies dispensed 69 million prescriptions for gabapentin.

Prescribing Controlled Substances Goes Electronic, Alberto Coustasse, Craig Kimble, Ken Maxik

Management Faculty Research

With the Affordable Care Act in 2010 came interoperability and meaningful use requirements. Part of these requirements included the implementation of electronic medical records (EMRs), which was a crucial part of achieving these standards. With EMRs, prescribers began sending electronic prescriptions. EMRs can provide advanced decision support when writing prescriptions, and they include features such as auto populating the quantity prescribed, formulary information, therapeutic duplications, warnings about interactions, or other potential clinical or regulatory issues. This system results in enhanced patient care and a more streamlined dispensing process. In addition, electronic prescriptions for controlled substances (EPCS) has become more widely …

Treatment Of Tardive Dyskinesia With High Dose Vitamin B6 Associated With Depression, Marjorie Mccoy, Adam Schindzielorz, Suzanne Holroyd

Marshall Journal of Medicine

Tardive dyskinesia (TD) is a movement disorder associated with dopamine receptor blocking medications. Recommended treatments for TD include discontinuing the causative agent, adding vesicular monoamine transporter 2 (VMAT2) inhibitors, or adding vitamin B6. We present a 66-year-old Caucasian male with bipolar I disorder who developed TD while on lithium and quetiapine having been euthymic on this regimen for three years. He was initially treated with 1200 mg B6 daily. This failed to improve his TD and was associated with a depressive episode. He switched to valbenazine 40 mg daily which improved his TD and concurrently his mood, but months later …

Association Of Electronic Medical Records And Opioid Prescription, Archana Suwal, Jemimah Okonjo, Stacie Deslich, Alberto Coustasse

Management Faculty Research

A Prescription Drug Monitoring Program (PDMP) is an electronic database that tracks controlled substance prescriptions in a state. PDMPs can provide health authorities timely information about prescribing and patient behaviors that contribute to the epidemic and facilitate an agile and directed response. Electronic Prescribing for Controlled Substances (EPCS) aimed to eliminate paper prescriptions by allowing clinical prescribers to write prescriptions electronically, making them digital and trackable for both the prescriber and the pharmacist and has been an essential part of any health information technology system, as well as a requirement for 'meaningful use' (Blumenthal & Tavenner, 2010). However, one of …

Race And Sex Associations With Tacrolimus Pharmacokinetics In Stable Kidney Transplant Recipients, Kathleen M. Tornatore, Calvin J. Meaney, Kristopher Attwood, Daniel A. Brazeau, Gregory E. Wilding, Joseph D. Consiglio, Aijaz Gundroo, Shrley S. Chang, Vanessa Gray, Louise M. Cooper, Rocco C. Venuto

Pharmaceutical Science and Research

Study Objective: This study investigated race and sex differences in tacrolimus pharmacokinetics and pharmacodynamics in stable kidney transplant recipients.

Design and Setting: A cross-sectional, open-label, single center, 12-h pharmacokinetic-pharmacodynamic study was conducted. Tacrolimus pharmacokinetic parameters included area under the concentration-time curve (AUC_0–12), AUC_0–4, 12-h troughs (C_{12 h}), maximum concentrations (C_max), oral clearance (Cl), with dose-normalized AUC_0–12, troughs, and C_max with standardized adverse effect scores. Statistical models were used to analyze end points with individual covariate-adjustment including clinical factors, genotypic variants CYP3A5*3, CYP3A5*6, CYP3A5*7(CYP3A5*3*6*7 …

Store, Handle, And Administer Vaccines Safely To Prevent Errors, Craig Kimble, Kenneth Maxik, Alberto Coustasse

Management Faculty Research

Insufficient training, multiple manufacturers, and noninterchangeable products increase the risk of vaccine-related errors. Increasing the complexity are the addition of boosters with different doses, personnel new to the vaccine administration process, changes in dosing, easily misidentified labeling or products, vaccines given together, and the interchanging of booster products.2,3 As a result, there is an increased need to be alert in safety efforts with vaccine administration and storage. Pharmacy staff members must work together to improve safety and prevent vaccine-related errors.

Prenatal Exposure To Methamphetamine Causes Vascular Dysfunction In Adult Male Offspring, Hasitha Chavva, Adam M. Belcher, Daniel A. Brazeau, Boyd Rorabaugh

Pharmaceutical Science and Research

Methamphetamine use during pregnancy can have negative consequences on the offspring. However, most studies investigating the impact of prenatal exposure to methamphetamine have focused on behavioral and neurological outcomes. Relatively little is known regarding the impact of prenatal methamphetamine on the adult cardiovascular system. This study investigated the impact of chronic fetal exposure to methamphetamine on vascular function in adult offspring. Pregnant female rats received daily saline or methamphetamine (5 mg/kg) injections starting on gestational day 1 and continuing until the pups were born. Vascular function was assessed in 5 month old offspring. Prenatal methamphetamine significantly decreased both the efficacy …

Help Patients Safely Handle Medications To Improve Adherence, Kenneth Maxik, Craig Kimble, Alberto Coustasse

Management Faculty Research

Medication nonadherence can cause many drug-related adverse effects (AEs), and pharmacists are in a prime position to use every patient interaction as an opportunity to address barriers, improve adherence, and increase the safe management of medications.

Law Helps Ensure Safety Of The Supply Chain, Kenneth Maxik, Craig Kimble, Alberto Coustasse

Management Faculty Research

The Drug Quality and Security Act was signed into law on November 27, 2013, and included the Title 2 Drug Supply Chain and Security Act (DSCSA). This legislation was introduced to enact a federal prescription drug safety standard to decrease contamination, counterfeiting, diversion, and otherwise harmful illicit activities. It also improves the detection and elimination of potentially unsafe drugs from the drug supply chain to protect US consumers.

Detect Adverse Events And Medication Errors Using Technology, Kenneth Maxik, Craig Kimble, Alberto Coustasse

Pharmacy Practice & Administration

Technology has changed the practice of pharmacy. Many systems are now part of an ever increasingly interfaced or integrated health care system allowing the electronic exchange of prescriptions from electronic health records (EHRs) to the pharmacy information system and bidirectional data exchange for many items, such as lab results and test information. With meaningful use of automated distribution cabinet databases, EHR efforts, electronic data exchange, and smart pump technology, the availability of data to use for addressing and preventing adverse medication events has grown. Use of these systems has allowed a data-rich environment to store and retrieve reporting. Mining data …

Methamphetamine-Induced Changes In Myocardial Gene Transcription Are Sex-Dependent, Hasitha Chavva, Daniel A. Brazeau, James Denvir, Donald A. Primerano, Jun Fan, Sarah L. Seeley, Boyd R. Rorabaugh

Pharmaceutical Science and Research

Background: Prior work demonstrated that female rats (but not their male littermates) exposed to methamphetamine become hypersensitive to myocardial ischemic injury. Importantly, this sex-dependent effect persists following 30 days of subsequent abstinence from the drug, suggesting that it may be mediated by long term changes in gene expression that are not rapidly reversed following discontinuation of methamphetamine use. The goal of the present study was to determine whether methamphetamine induces sex-dependent changes in myocardial gene expression and whether these changes persist following subsequent abstinence from methamphetamine.

Results: Methamphetamine induced changes in the myocardial transcriptome were significantly greater in female hearts …

Change Management Is A Consideration Beyond The Pandemic, Kenneth Maxik, Craig Kimble, Alberto Coustasse

Pharmacy Practice & Administration

Change management (CM) is a well-organized framework for managing the people side of change. It includes practices, processes, and planned activities designed to facilitate and lead organizations to move from the present state to a desired state. The goal of CM is not to eliminate resistance but to anticipate it, proactively plan for it, continuously manage it, and mitigate the consequences.

Drug Delivery Systems: Exploring Rheological Properties And Therapeutic Effect Of 5-Fu Chitosan Gel For Topical Wound Healing, Samuel Tetteh-Quarshie

Theses, Dissertations and Capstones

Diabetic skin wound is a common complication of diabetes that occurs in about 15% of diabetic patients and often requires prolonged hospitalization for its management and treatment. Natural polymers are used for wound dressing due to their biological adhesiveness, non-toxicity, and biodegradable nature. 5-Fluorouracil (FU) has been shown to alter adipokine expression which is implicated in cutaneous wound repair. Thus, our overall objective was to investigate the utility of chitosan (CS) gel for topical delivery of 5-FU to treat diabetic wounds. We prepared chitosan gel (2% w/w) in serial dilutions of 5-FU (25μg/mL, 2.5μg/mL, 0.25μg/mL, and 0.025μg/mL) and evaluated their …

Association Of Electronic Prescription In Controlled Substances Used, Archana Suwal, Jemima Akinyi Okonjo

Theses, Dissertations and Capstones

Introduction: Controlled substances have been described as pharmaceuticals or illegal medicines that act primarily on the central nervous system and could cause physical and mental dependence, eventually leading to addiction. Prescription opioids were a significant contributor to the opioid epidemic, accounting for more than 70,000 opioid-related overdose deaths, including illicit and prescription opioids, between 2018 and 2019. The Electronic Prescriptions for Controlled Substances (EPCS) initiative recently aimed to reduce rates of prescription opioid addiction, abuse, diversion, and death. The system for controlled substances had become more widely used as providers and governments trying to combat the opioid problem. Because …

Characterization Of Cardiovascular Function In Adult Offspring Following Prenatal Exposure To Methamphetamine, Hasitha Chavva

Theses, Dissertations and Capstones

Methamphetamine (meth) is a synthetic stimulant, and its abuse is a significant public health concern in the United States and all over the world. Methamphetamine is a highly addictive drug, and its abuse is widespread among women of child-bearing age. The consequences of methamphetamine abuse are not only of relevance to pregnant women, but also their unborn children, as amphetamine type substances can cross the placental barrier and effect the fetus during gestation. Most previous studies investigating the impact of prenatal methamphetamine exposure on the offspring have focused on neurological and behavioral effects. The goal of this study was to …

Mechanisms Of Apoptosis Induced By Actinomycin D In Aerodigestive Tract Cancers, Adeoluwa Ayodeji Adeluola

Theses, Dissertations and Capstones

Upper aerodigestive tract cancers including cancers of the oral cavity, pharynx, larynx, esophagus, and lungs are the most prevalent cancers and leading causes of cancer-related deaths. Collectively, over 300,000 new cases and 146,500 deaths are projected within the US in the year 2021. Drug-associated toxicities, as well as resistance to therapy (intrinsic and acquired), are big challenges for successfully treating these cancers. Recent studies have shown that combining low-dose actinomycin D with existing therapies is a promising strategy to reduce toxicity (cyclotherapy) and to overcome resistance. The development of these treatment strategies however requires an understanding of the molecular mechanisms …

Consider Real Costs Before Implementing A 340b Program, Kenneth Maxik, Craig Kimble, Alberto Coustasse

Pharmacy Practice & Administration

The 340B drug pricing program was created to improve access to outpatient medications for low-income and underinsured r uninsured patients. It has exponentially grown with the expansion of the definition of a covered entity and the change to allow multiple contract pharmacies. Still, there are debates about the program’s financial impact and whether the discounts are passed along to enough underinsured or uninsured patients.

Beyond Single Nucleotide Polymorphisms: Cyp3a5∗3 ∗6 ∗7 Composite And Abcb1 Haplotype Associations To Tacrolimus Pharmacokinetics In Black And White Renal Transplant Recipients, Daniel A. Brazeau, Kristopher Attwood, Calvin J. Meaney, Gregory E. Wilding, Joseph D. Consiglio, Shirley S. Chang, Aijaz Gundroo, Rocco C. Venuto, Louise Cooper, Kathleen M. Tornatore

Pharmaceutical Science and Research

Interpatient variability in tacrolimus pharmacokinetics is attributed to metabolism by cytochrome P-450 3A5 (CYP3A5) isoenzymes and membrane transport by P-glycoprotein. Interpatient pharmacokinetic variability has been associated with genotypic variants for both CYP3A5 or ABCB1. Tacrolimus pharmacokinetics was investigated in 65 stable Black and Caucasian post-renal transplant patients by assessing the effects of multiple alleles in both CYP3A5 and ABCB1. A metabolic composite based upon the CYP3A5 polymorphisms: ^∗3(rs776746), ^∗6(10264272), and ^∗7(41303343), each independently responsible for loss of protein expression was used to classify patients as extensive, intermediate and poor metabolizers. In addition, the …

Hyperkalemia Secondary To Prophylactic Heparin Use In A Trauma Patient: Case Report, Marco Custodio, Errington C. Thompson

Marshall Journal of Medicine

This case report describes a complex trauma patient who develops hyperkalemia secondary to heparin. Heparin is a commonly used drug in trauma patients. Physicians need to be aware of this potentially harmful adverse reaction in these high-risk patients.

Prepare The Pharmacy For The Next Crisis: A Well-Drafted Business Continuity Plan Enables Continued Operations, Mitigates Potential Risks., Kenneth Maxik, Craig Kimble, Alberto Coustasse

Pharmacy Practice & Administration

The purpose of continuity planning is to ensure that dispensing operations continue, that pharmacy information systems’ data remain protected and accessible, and that telecommunications to support critical organization function during and after business interruption. Interruptions can occur for various reasons, such as earthquakes, fires, flooding, hurricanes, pandemics, power loss, tornadoes, and wildfires. Devising a crisis continuity plan can enable pharmacies to continue to provide patient care, ensure staff safety, and maintain financial viability after a disaster. The coronavirus disease 2019 (COVID-19) pandemic and the resulting business closures brought about by the shutdown have highlighted this need to plan for all …

Leadership Challenges And Collaborative Opportunities Unveiled Through Covid-19, Gayle Brazeau

Marshall Journal of Medicine

No abstract provided.

How Do Pharmacies Evaluate Cleanroom Automation Systems?, Kenneth Maxik, Craig Kimble, Alberto Coustasse, Chris Booth

Pharmacy Practice & Administration

Many pharmacies have implemented or considered implementing cleanroom automation or compounding systems. Intravenous (IV) admixture automation is one of the newest areas of technology that has been applied to pharmacy workflow. Manufacturers tout systems for reducing errors reaching patients. Clinical literature supports that cleanroom technology can aid in patient safety.

United States Medicaid And Pharmacy Fraud: An Unintended Consequence Of The Affordable Care Act, Sean Mcdaniel, Drew Blakely

Theses, Dissertations and Capstones

Introduction: The Affordable Care Act (ACA) increased access to health insurance throughout the United States. To date, an estimated 20 million previously uninsured individuals have gained access to coverage since the expansion. As a result, the number of fraudulent schemes reported has been on the rise. Among the many fraudulent activities in the healthcare sector, abuse of pharmacy benefits has been the most prevalent. The misuse and abuse of opioids, and opioid related overdoses has created a widespread epidemic throughout the country, thus extending opportunities for potential fraud within the pharmaceutical industry.

Purpose of the Study: The purpose …

Faculty Perceptions And Teaching Practices For Transformative Change: Culturally Responsive Teaching In Pharmacy Education, Nicole Rockich Winston

Theses, Dissertations and Capstones

Cultural diversity training in pharmacy education has evolved from standalone lectures to longitudinal courses, service-learning initiatives, rotation experiences, and global health opportunities. This mixed methods study explored the perceptions, attitudes, and pedagogies of pharmacy educators who have incorporated culture diversity into their classrooms and clinic sites. First, 91 online surveys incorporating items from the Teaching Multicultural Attitudes Survey and the Multicultural Competency Teaching Scale were distributed to a random sample of pharmacy faculty who interface with cultural diversity. In total, 36 completed surveys were analyzed using descriptive statistics, Pearson correlations, and stepwise linear regressions. Following the survey, seven pharmacy faculty …

Mechanisms Of Dopamine-Induced Methamphetamine Neurotoxicity, Melinda L. Asbury

Theses, Dissertations and Capstones

Methamphetamine (MA) neurotoxicity is particularly evident in the striatum where it causes extensive dopamine (DA) release and results in neurodegeneration. To identify specific signaling pathways and macromolecules involved in postsynaptic DA-induced striatal toxicity we used a SK-N-MC cell model that mimics postsynaptic D1 receptor-expressing striatal neurons. The cells were treated for 6-24 h with 0-50 µM DA. The concentration was chosen to impart physiological relevance to the study as it mirrors [DA] found within the striatum following MA exposure. We show that 25-50 µM DA resulted in protein changes consistent with nitro(oxidative) stress as well as enhanced cleavage of caspase …

340b Program Utilization In Rural Us Clinics, William Finley, Heather M. Kruel

Theses, Dissertations and Capstones

Introduction: The 340B program was an effective strategy in reaching more potential patients, providing more comprehensive services, and limiting the gap between affordability and healthcare. The uninsured and underprivileged often are unable to receive medications at the high market price due to the financial situation they face and inflation. The 340B program seeked to mend this issue to help the public and healthcare organizations. The main purpose of this research was to search and evaluate if the 340B program lived up to its purpose of decreasing the cost of medications in rural based clinics.

Methodology: The research strategy developed …

Post-Implementation Analysis Of The Impact Of Intravenous Automation Systems On Health-System Pharmacy Operations, Craig Kimble, Ken Maxik, Chris Booth, Michael Rudolph, Kim Broedel-Zaugg

Faculty Research Day

We have all seen the reports on the news about issues related to IV rooms and IV room compounding. Many health-system pharmacies have implemented, or are considering some form of intravenous (IV) automation and/ or compounding system in their clean rooms to reduce pharmacy errors and improve accuracy, productivity, and workflow. Manufacturers tout that automated systems, used appropriately, aid in reducing errors from reaching patients. Additionally, IV admixture automation is one of the most recent areas where technology has been added to pharmacy workflow.