Pharmacy and Pharmaceutical Sciences Commons^™

Impact Of Outpatient Vs Inpatient Absssi Treatment On Outcomes: A Retrospective Observational Analysis Of Medical Charts Across Us Emergency Departments, P. Brandon Bookstaver, Timothy C. Jenkins, Edward Stenehjem, Shira Doron, Jack Brown, Shannon H. Goldwater, Carlos Lopes, Angela Haynes, Chuka Udeze, Yifan Mo, Patrick Gllard, Yan Liu, Katelyn Keyloun

Pharmacy Faculty/Staff Publications

Background

The objective of this study was to characterize treatment of patients with acute bacterial skin and skin structure infections (ABSSSIs) and describe the association between hospital admission and emergency department (ED) visits or readmissions within 30 days after initial episode of care (IEC).

Methods

This was a retrospective, observational, cohort study of adults with ABSSSI who presented to an ED between July 1, 2012, and June 30, 2013. Patient, health care facility, and treatment characteristics, including unplanned ED visits or readmissions, were obtained through manual chart review and abstraction. Adjusted logistic regression analysis examined likelihood of all-cause unplanned ED …

The Relationship Between Prior Experiences In Mathematics And Pharmacy School Success, Kelly M. Conn, Christine R. Birnie, David Mccaffrey, Jack Brown

Pharmacy Faculty/Staff Publications

Objective. To assess students’ pre-pharmacy math experiences, confidence in math ability, and relationship between experiences, confidence, and grades in math-based pharmacy courses.

Methods. A cross-sectional survey of first year to third year pharmacy students was conducted. Students reported type of pre-pharmacy math courses taken, when they were taken [high school (HS) vs. college] and year of HS and college graduation. Students rated their confidence in math ability using the previously validated 11-item Fogerty Math Confidence Scale (Cronbach alpha=0.92). Math grade point average (GPA), Pharmacy College Admission Test quantitative (PCAT quant) scores, and grades (calculations and kinetics) were obtained from transcripts …

Stability Of Extemporaneously Prepared Ophthalmic Solutions For Mydriasis, Nicole A. Camp, Jennifer T. Nadra, Susan E. Hughes, Justine M. Gilbert, Fang Zhao

Doctoral External Publications

Purpose Results of an evaluation of the physical and chemical stability of extemporaneously prepared adult and pediatric ophthalmic solutions containing combinations of phenylephrine, tropicamide, and cyclopentolate are reported.

Methods A stability study was conducted to help determine the feasibility of innovative formulations to meet an unmet clinical need for combination mydriatic ophthalmic eyedrops. An adult mydriatic ophthalmic solution containing phenylephrine hydrochloride 2.5% and tropicamide 1.0% and a pediatric formulation containing phenylephrine hydrochloride 2.5%, tropicamide 0.5%, and cyclopentolate hydrochloride 0.5% were prepared using proper aseptic techniques. Triplicate samples of each formulation were stored for 60 days at refrigeration temperatures (2–8 °C) …

Administration Of Long-Acting Injections, Christopher Noel, Karl Williams

Pharmacy Faculty/Staff Publications

Expanding the scope of pharmacy practice demonstrates that the profession has been successful at improving public health. Despite being a late adopter, New York's limited experience with vaccines has improved immunization rates and lowered rates of disease. During emergencies, the 2017-2018 flu season for example, the state has turned to pharmacists to go beyond what the pharmacy practice law permits, in this case enabling immunizations in pediatric patients.¹ This illustrates recognition of untapped potential within the profession to contribute to the public health. Another opportunity for pharmacists to enhance the public health is embodied in a Bill introduced in …

Variation Between Point-Of-Care And Laboratory Hba1ctesting In Clinical Practice, Shawn E. Fellows, Gabriela Cipriano

Pharmacy Faculty/Staff Publications

Aims: The aim of this study was to identify potential disparities between Point-Of-Care Testing (POCT) and laboratory hemoglobinH bA1c reporting at a Federally Qualified Health Center (FQHC).
Methods: The electronic medical record was reviewed to identify POCT HbA1c done at a FQHC and centralized laboratory HbA1c performed on the same day. Manual data extraction was used to identify potential variables that could account for disparities between POCT and laboratory testing.
Results: A total of 42 samples in 40 patients were identified. The median HbA1c difference was 1.5mmol/mol (0.15%) and ranged from -26-52 mmol/mol (-2.4 to 4.8%). Of the patients in …

Correlation Of Solid Dosage Porosity And Tensile Strength With Acoustically Extracted Mechanical Properties, Xiaochi Xu, Connor Mack, Zachary J. Cleland, Chaitanya Krishna Prasad Vallabh, Vivek S. Dave, Centin Cetinkaya

Doctoral External Publications

Currently, the compressed tablet and its oral administration is the most popular drug delivery modality in medicine. The accurate porosity and tensile strength characterization of a tablet design is vital for predicting its performance such as disintegration, dissolution, and drug-release efficiency upon administration as well as ensuring its mechanical integrity. In current work, a non-destructive contact ultrasonic approach and an associated testing procedure are presented and employed to quantify and relate the acoustically extracted mechanical properties of pharmaceutical compacts to direct porosity and tensile strength measurements. Based on a comprehensive set of experimental data, it is demonstrated how strongly the …

Ciprofloxacin For The Treatment Of Cardiobacterium Hominis Prosthetic Valve Endocarditis, Lisa M. Avery, Catherine B. Felberbaum, Muhammad Hasan

Pharmacy Faculty/Staff Publications

Prosthetic valve endocarditis due to Cardiobacterium hominis is rare and recommended therapy includes a third generation cephalosporin. We report a case of Cardiobacterium hominis endocarditis post transcatheter aortic valve replacement in a patient with significant beta-lactam antimicrobial sensitivities who was successfully treated with ciprofloxacin monotherapy in conjunction with surgery.

Telepharmacy And The Law, Hailey Button, Karl Williams

Doctoral External Publications

Recently, an "Advisory Notice" was placed on the website of the New York State Board of Pharmacy entitled "Automated Dispensing Machines" that provide "drugs for sale to customers outside of their respective registered pharmacy areas", and that it "considers this to be a violation of state law"¹. In support, the Notice cited the Education Law relating to the profession of pharmacy² and Regulations of the Commissioner of Education³. Finally, ownership of the pharmacy and the Supervising Pharmacist are responsible for compliance and "may be subject to disciplinary and unprofessional conduct action". The Notice did not …

Hydrochloric Acid Infusion For The Treatment Of Metabolic Alkalosis In Surgical Intensive Care Unit Patients, Jason D. Guffey, Curtis E. Haas, Amber Crowley, Kathryn A. Connor, David C. Kaufman

Pharmacy Faculty/Staff Publications

Background: Older reports of use of hydrochloric acid (HCl) infusions for treatment of metabolic alkalosis document variable dosing strategies and risk. Objectives: This study sought to characterize use of HCl infusions in surgical intensive care unit patients for the treatment of metabolic alkalosis. Methods: This retrospective review included patients who received a HCl infusion for >8 hours. The primary end point was to evaluate the utility of common acid-base equations for predicting HCl dose requirements. Secondary end points evaluated adverse effects, efficacy, duration of therapy, and total HCl dose needed to correct metabolic alkalosis. Data on demographics, potential causes of …

The Prevention And Control Of Cancer By Metformin In Patients With Type 2 Diabetes: A Systematic Mapping Review Protocol, Michelle Price, Gabriela Cipriano, Albania Mitchell

Lavery Library Faculty/Staff Publications

No abstract provided.

Identifying Patterns In Health Care Disparities And Barriers To Health Care In Rural Tanzania, Karlee Platts, Christina Sanborn, Melinda E. Lull

Pharmacy Faculty/Staff Publications

Tanzania is a country in East Africa with a population of 55 million people. HIV/AIDs, malaria and nutritional deficiencies claim the lives of many each year across Tanzania. The World Health Organization (WHO) reported in 2013 that approximately 70 percent of the population of Tanzania live in more rural areas where access to healthcare, health education, and medications for these diseases may be limited. The objective of this study was to illuminate significant health disparities in rural Tanzania based on literature and direct observations to identify barriers to quality health care.

A comprehensive literature evaluation was completed on reports published …

The Report Of The 2016-2017 Professional Affairs Standing Committee: Formally Embracing And Engaging Preceptors In The Academy — The Time Has Come, Karen Whalen, Daniel S. Aistrope, Jason Ausili, Kathleen H. Besinque, Elizabeth A. Cardello, Philip M. Hritcko, George E. Mackinnon Iii, Eric Maroyka, Elizabeth Sutton Burke, I. Shane Trent, Lynette R. Bradley-Baker

Pharmacy Faculty/Staff Publications

EXECUTIVE SUMMARY

The 2016-2017 AACP Professional Affairs Committee (PAC) was charged to examine strategies to include adjunct/affiliate preceptors as AACP members and to determine the value proposition of AACP membership for this group of educators. The PAC defined adjunct/affiliate preceptors as preceptors who are neither full-time employees nor have a primary employment commitment (≥50% of the preceptor’s work salary) at a school/college of pharmacy. Specific charges to the PAC included: recommend an approach to increase the number of adjunct/affiliate preceptors as AACP members, examine AACP membership from an adjunct/affiliate preceptor value perspective, and prepare a concise summary of available literature …

In Vitro Evaluation Of Eslicarbazepine Delivery Via Enteral Feeding Tubes, Kristin Reindel, Fang Zhao, Susan Hughes, Vivek S. Dave

Doctoral External Publications

Purpose: The feasibility of preparing an eslicarbazepine acetate suspension using Aptiom tablets for administration via enteral feeding tubes was evaluated. Methods: Eslicarbazepine acetate suspension (40 mg/mL) was prepared using Aptiom tablets after optimizing the tablet crushing methods and the vehicle composition. A stability-indicating high-performance liquid chromatography (HPLC) method was developed to monitor the eslicarbazepine stability in the prepared suspension. Three enteric feeding tubes of various composition and dimensions were evaluated for the delivery of the suspensions. The suspension was evaluated for the physical and chemical stability for 48 hours. Results: The reproducibility and consistency of particle size reduction was found …

Influence Of Carrier (Polymer) Type And Drug-Carrier Ratio In The Development Of Amorphous Dispersions For Solubility And Permeability Enhancement Of Ritonavir., Pradip W. Dhore, Vivek S. Dave, Suprit D. Saoji, Deepak Gupta, Nishikant A. Raut

Pharmacy Faculty/Staff Publications

The influence of the ratio of Eudragit® L100-55 or Kolliphor® P188 on the solubility, dissolution, and permeability of ritonavir was studied with a goal of preparing solid dispersions (SDs) of ritonavir. SDs were formulated using solvent evaporation or lyophilization techniques, and evaluated for their physical-chemical properties. The dissolution and permeability assessments of the functionality of the SDs were carried out. The preliminary functional stability of these formulations was assessed at accelerated storage conditions for a period of six months. Ritonavir: Eudragit® L100-55 (RE, 1:3) SD showed a 36-fold higher solubility of compared with pure ritonavir. Similarly, ritonavir:Kolliphor® P188 (RP, 1:2) …

Emerging Technologies For The Non-Invasive Characterization Of Physical-Mechanical Properties Of Tablets, Vivek S. Dave, Hend I. Shahin, Susanne R. Youngren-Ortiz, Mahavir B. Chougule, Rahul V. Haware

Pharmacy Faculty/Staff Publications

The density, porosity, breaking force, viscoelastic properties, and the presence or absence of any structural defects or irregularities are important physical-mechanical quality attributes of popular solid dosage forms like tablets. The irregularities associated with these attributes may influence the drug product functionality. Thus, an accurate and efficient characterization of these properties is critical for successful development and manufacturing of a robust tablets. These properties are mainly analyzed and monitored with traditional pharmacopeial and non-pharmacopeial methods. Such methods are associated with several challenges such as lack of spatial resolution, efficiency, or sample-sparing attributes.

Recent advances in technology, design, instrumentation, and software …

Sertraline And Phenytoin Drug Interaction In A Geriatric Patient, Kobi T. Nathan, Heather A. Hopkins, Stefanie E. Diloreto, Nhon A. Ta, Thomas V. Caprio

Pharmacy Faculty/Staff Publications

This report presents the case of a 78-year-old man residing in a nursing home who presented with a 2-month history of increasing lethargy and confusion. These symptoms coincided with the initiation of sertraline in the patient. Among other medications, he was also taking phenytoin. The medical team concluded that the cause of the patient’s lethargy and confusion was a drug interaction between sertraline and phenytoin. Phenytoin was held, while the sertraline was slowly tapered to discontinuation. The patient’s symptoms resolved soon thereafter. Future research is needed to better guide clinicians in appropriate selection, dosing, and monitoring of selective serotonin reuptake …

Comprehensive Medication Management: Implications For The Patient And Pharmacist, Alexander Delucenay, Barry Bunting, Hayden Brayer, Karl Williams

Pharmacy Faculty/Staff Publications

Since 1979, state pharmacy practice laws have begun to allow pharmacists to provide advanced levels of care in collaboration with prescribers. These might be termed medication therapy management, collaborative practice, comprehensive medication management and other variations. Invariably, pharmacists working closely with prescribers and patients in care of chronic disease have achieved dramatic results including improvement in surrogate markers, decreased rates of secondary large organ disease, decreased mortality, decreased hospitalizations, and as a result decreased spending.^1-28

This paper will discuss the profound impact of advanced practice models on patient care and the health care system, the current status of New …

Compounded Apixaban Suspensions For Enteral Feeding Tubes, Maria Caraballo, Seda Donmez, Kobi T. Nathan, Fang Zhao

Doctoral External Publications

Objective: There is limited information on compounded apixaban formulations for administration via enteral feeding tubes. This study was designed to identify a suitable apixaban suspension formulation that is easy to prepare in a pharmacy setting, is compatible with commonly used feeding tubes, and has a beyond-use date of seven days.

Methods: Apixaban suspensions were prepared from commercially available 5 mg Eliquis® tablets. Several vehicles and compounding methods were screened for ease of preparation, dosage accuracy, and tube compatibility. Two tubing types, polyurethane and polyvinyl chloride (PVC), with varying lengths and diameters, were included in the study. They were mounted on …

Practical Use Of Blactchford Score, Shawn E. Fellows, Jamie M. Rosini

Pharmacy Faculty/Staff Publications

Aim: To retrospectively evaluate the use of proton pump inhibitor infusions.

Methods: A retrospective chart review was conducted of all patients who received an 80 mg bolus of esomeprazole follow by an infusion at 8 mg/hr. An analysis was performed to determine if a Blatchford Score of > 5 was a predictor of upper gastrointestinal ulcers.

Results: 300 patients received high dose esomeprazole over a 15 month period. 32% had an ulcer identified on endoscopy. Gastritis and esophagitis were the second most common diagnosis accounting for 16% of patients. A Blatchford Score of >5 as a predictor of upper gastrointestinal ulcers …

Methadone And Corrected Qt Prolongation In Pain And Palliative Care Patients: A Case–Control Study, Katherine Juba, Tina M. Khadem, David Hutchinson, Jack Brown

Pharmacy Faculty/Staff Publications

Background: Methadone (ME) is commonly used in pain and palliative care (PPC) patients with refractory pain or intolerable opioid adverse effects (AEs). A unique ME AE is its corrected QT (QTc) interval prolongation risk, but most evidence exists in methadone maintenance therapy patients.

Objective: Our goal was to identify QTc interval prolongation risk factors in PPC patients receiving ME and other medications known to prolong the QTc interval and develop a risk stratification tool.

Design: We performed a case–control study of adult inpatients receiving ME for pain management.

Settings/Subjects: Adult inpatients receiving ME with a QTc >470 msec (males) and …

A Pilot Stability Study Of Dehydroepiandrosterone Rapid-Dissolving Tablets Prepared By Extemporaneous Compounding, Steven D. Rush, Charlene Vernak, Fang Zhao

Pharmacy Faculty/Staff Publications

Dehydroepiandrosterone supplementation is used to treat a variety of conditions. Rapid-dissolving tablets are a relatively novel choice for compounded dehydroepiandrosterone dosage forms. While rapid-dissolving tablets offer ease of administration, there are uncertainties about the physical and chemical stability of the drug and dosage form during preparation and over long-term storage. This study was designed to evaluate the stability of dehydroepiandrosterone rapid-dissolving tablets just after preparation and over six months of storage. The Professional Compounding Centers of America rapid-dissolving tablet mold and base formula were used to prepare 10-mg strength dehydroepiandrosterone rapid-dissolving tablets. The formulation was heated at 100°C to 110°C …

Assessing Student Perceptions Of The Pharm.D. Degree At A Private Tertiary Medical University In India, Kobi T. Nathan, Kelly Conn, Christine R. Birnie

Pharmacy Faculty/Staff Publications

Background: Pharmacy education in India has expanded to include the Doctorate of Pharmacy degree (Pharm.D.). With clinical practice in early development, job opportunities in India are limited. Graduates often consider pharmacy opportunities abroad.

Aims: This study compares Indian students’ career aspirations related to the Pharm.D. degree before and after beginning their programmes.

Methods: A 5-point Likert scale paper survey with open ended questions was distributed to all Pharm.D. students (Year 1- 6) at a medical university in India.

Results: With a response rate of 83% (144/173), over half of the students’ primary goal was to pursue careers abroad post-graduation (54.2% …

Evidence For The Use Of ‘‘Medical Marijuana’’ In Psychiatric And Neurologic Disorders, Christopher Noel

Pharmacy Faculty/Staff Publications

Introduction: Cannabis is listed as a Schedule I substance under the Controlled Substances Act of 1970, meaning the US federal government defines it as an illegal drug that has high potential for abuse and no established medical use; however, half of the states in the nation have enacted “medical marijuana” (MM) laws. Clinicians must be aware of the evidence for and against the use of MM in their patients who may consider using this substance.

Methods: A PubMed database search was performed using the text string: “Cannabis”[Mesh] OR “Marijuana Abuse”[Mesh] OR “Medical Marijuana”[Mesh] OR “Marijuana Smoking”[Mesh] OR “cannabi*” OR “tetrahydrocannabinol.” …

An Evaluation Of The Impact Of Immediate Compared To Delayed Feedback On The Development Of Counselling Skills In Pharmacy Students, Alexander Delucenay, Kelly Conn, Anthony Corigliano

Pharmacy Faculty/Staff Publications

Background: Simulation-based counselling using standardised patients (SPs) provide pharmacy students an authentic approach to training; limited data exists regarding student performance using immediate feedback approaches.

Aims: To compare grades of students receiving immediate feedback verses (vs.) delayed feedback.

Methods: A pre-trial assessment of student perceptions and an unblinded randomised trial comparing immediate and delayed feedback. Third year pharmacy students (n=153) counselled SPs in four clinical “experiences”; student grades were the primary outcome. Student t-test and repeated measures were used to compare grades between groups and grades over time.

Results: During pre-trial surveys 50% of students preferred immediate feedback, 22% …

Current And Evolving Approaches For Improving The Oral Permeability Of Bcs Class Iii Or Analogous Molecules, Vivek S. Dave, Deepak Gupta, Monica Yu, Phong Nguyen, Sheeba Varghese Gupta

Pharmacy Faculty/Staff Publications

The Biopharmaceutics Classification System (BCS) classifies pharmaceutical compounds based on their aqueous solubility and intestinal permeability. The BCS Class III compounds are hydrophilic molecules (high aqueous solubility) with low permeability across the biological membranes. While these compounds are pharmacologically effective, poor absorption due to low permeability becomes the rate-limiting step in achieving adequate bioavailability. Several approaches have been explored and utilized for improving the permeability profiles of these compounds. The approaches include traditional methods such as prodrugs, permeation enhancers, ion-pairing, etc., as well as relatively modern approaches such as nanoencapsulation and nanosizing. The most recent approaches include a combination/hybridization of …

Kaempferol-Phospholipid Complex: Formulation, And Evaluation Of Improved Solubility, In Vivo Bioavailability, And Antioxidant Potential Of Kaempferol, Darshan R. Telange, Arun T. Patil, Anil M. Pethe, Amol A. Tatode, Sridhar Anand, Vivek S. Dave

Pharmacy Faculty/Staff Publications

The current work describes the formulation and evaluation of a phospholipid complex of kaempferol toenhance the latter’s aqueous solubility, in vitro dissolution rate, in vivo antioxidant and hepatoprotectiveactivities, and oral bioavailability. The kaempferol-phospholipid complex was synthesized using a freeze-drying method with the formulation being optimized using a full factorial design (32) approach. The resultsinclude the validation of the mathematical model in order to ascertain the role of specific formulation andprocess variables that contribute favorably to the formulation’s development. The final product wascharacterized and confirmed by Differential Scanning Calorimetry (DSC), Fourier Transform InfraredSpectroscopy (FTIR), Proton Nuclear Magnetic Resonance Spectroscopy (1H-NMR), and …

Formulation And Characterization Of An Apigenin-Phospholipid Phytosome (Aplc) For Improved Solubility, In Vivo Bioavailability, And Antioxidant Potential, Darshan R. Telange, Arun T. Patin, Anil M. Pethe, Harshal Fegade, Sridhar Anand, Vivek S. Dave

Pharmacy Faculty/Staff Publications

The apigenin-phospholipid phytosome (APLC) was developed to improve the aqueous solubility, dissolution, in vivo bioavailability, and antioxidant activity of apigenin. The APLC synthesis was guided by a full factorial design strategy, incorporating specific formulation and process variables to deliver an optimized product. The design-optimized formulation was assayed for aqueous solubility, in vitro dissolution, pharmacokinetics, and antioxidant activity. The pharmacological evaluation was carried out by assessing its effects on carbon tetrachloride-induced elevation of liver function marker enzymes in a rat model. The antioxidant activity was assessed by studying its effects on the liver antioxidant marker enzymes. The developed model was validated …

Medication Adherence In Patients With Myotonic Dystrophy And Facioscapulohumeral Muscular Dystrophy, Bryan Fitzgerald, Kelly Conn, Joanne Smith, Andrew Walker, Amy L. Parkhill, James E. Hilbert, Elizabeth A. Luebbe, Richard T. Moxley Iii

Doctoral External Publications

Myotonic dystrophy (DM) and facioscapulohumeral muscular dystrophy (FSHD) are the two most common adult muscular dystrophies and have progressive and often disabling manifestations. Higher levels of medication adherence lead to better health outcomes, especially important to patients with DM and FSHD because of their multisystem manifestations and complexity of care. However, medication adherence has not previously been studied in a large cohort of DM type 1 (DM1), DM type 2 (DM2), and FSHD patients. The purpose of our study was to survey medication adherence and disease manifestations in patients enrolled in the NIH-supported National DM and FSHD Registry. The study …

Evaluation Of Over The Counter Medication Knowledge And Literacy In Middle School And High School Students, Tessa Kelly, Kelly M. Conn, Allison Bosworth, Matthew Zak

Doctoral External Publications

Over the counter (OTC) medications are commonly utilized by the public, including adolescents, to self-treat many conditions. Unfortunately, these products can be dangerous if not used safely and appropriately. Adolescents between 13 and 19 years old composed 7.32 percent of the human exposure cases reported to U.S. poison control centers in 2014. Among these cases, there were 53 fatalities involving pharmaceuticals. This is an age range where medication use becomes more independent and the education they receive throughout the school curriculum is unknown. This study was designed to evaluate OTC medication knowledge and literacy among middle and high school students.

Fructose Alters Cell Survival And Gene Expression In Microglia And Neuronal Cells Lines, Drew P. Seidel, Susan Denapoli, Thomas S. Maciulewicz, Melinda E. Lull

Pharmacy Faculty/Staff Publications

Purpose: Microglia are macrophages that are found primarily in the CNS and play a crucial role in maintaining a healthy brain by engulfing invading microorganisms, releasing inflammatory mediators, and pruning dead cells. Microglia can become activated in response to certain stimuli which causes them to transition into a pro-inflammatory state, and can sometimes become chronically activated which can result in neuronal damage. Studies have shown a causal relationship between this activation and sugars such as fructose and glucose. We sought to understand the role of sugars in microglial activation and the subsequent effects on neuron health.

Methods: Rat microglia (HAPI) …