Pharmacy and Pharmaceutical Sciences Commons^™

A Systematic Review On The Efficacy Of Iontophoresis As A Treatment For Lateral Epicondylitis, James M. Mckivigan, Brent Yamashita, Derek Smith

College of Health & Human Services (TUN) Publications and Research

Background and purpose: It is still inconclusive which method of iontophoresis delivers the most medication deepest through the skin, and therefore most effective in treating lateral epicondylitis. The purpose of this systematic review is to analyze the efficacy of treatments for lateral epicondylitis using iontophoresis.

Method: The review included articles from peer-reviewed journals with sufficient data related to the purpose and focus of the study. Inclusion criteria included randomized control trials, cohort studies, case studies, systematic reviews, meta-analyses, and pilot studies published since 2000.

Results: Fourteen relevant studies were identified. Twelve were experimental in vivo studies, two …

2017 Pharmacy Yearbook Top Notch, Touro College Of Pharmacy

Touro Yearbooks

Top Notch, the 2017 yearbook for the Touro College of Pharmacy

Benzylideneoxymorphone: A New Lead For Development Of Bifunctional Mu/Delta Opioid Receptor Ligands, Jason R. Healy, Padmavani Bezawada, Nicholas W. Griggs, Andrea L. Devereaux, Rae Reiko Matsumoto, John R. Traynor, Christopher W. Cunningham

Faculty Publications & Research of the TUC College of Pharmacy

Opioid analgesic tolerance remains a considerable drawback to chronic pain management. The finding that concomitant administration of delta opioid receptor (DOR) antagonists attenuates the development of tolerance to mu opioid receptor (MOR) agonists has led to interest in producing bifunctional MOR agonist/DOR antagonist ligands. Herein, we present 7-benzylideneoxymorphone (6, UMB 246) displaying MOR partial agonist/DOR antagonist activity, representing a new lead for designing bifunctional MOR/DOR ligands.

Components Of A Measure To Describe Organizational Culture In Academic Pharmacy, Shane P. Desselle, Meagen Rosenthal, Erin R. Holmes, Brienna Andrews, Julia Lui, Leela Raja

Faculty Publications & Research of the TUC College of Pharmacy

Objective. To develop a measure of organizational culture in academic pharmacy and identify characteristics of an academic pharmacy program that would be impactful for internal (eg, students, employees) and external (eg, preceptors, practitioners) clients of the program.

Methods. A three-round Delphi procedure of 24 panelists from pharmacy schools in the U.S. and Canada generated items based on the Organizational Culture Profile (OCP), which were then evaluated and refined for inclusion in subsequent rounds. Items were assessed for appropriateness and impact.

Results. The panel produced 35 items across six domains that measured organizational culture in academic pharmacy: competitiveness, …

2016 Touro College Of Pharmacy Senior Yearbook, College Of Pharmacy

Touro Yearbooks

2016 College of Pharmacy Senior Yearbook

A Rare Case Report Of Probable Indigotindisulfonate Sodium-Induced Cardiac Arrest, Andrew P. Smith, Catherine A. Millares-Sipin, Henry Cohen, William Lois

Touro College of Pharmacy (New York) Publications and Research

Background: Indigotindisulfonate (Indigo Carmine, American Regent, Shirely, NY) is a blue dye that is commonly used for localizing ureteral orifices during surgery. In general, it is safe and biologically inactive, with the package insert citing only rare idiosyncratic reactions and mild pressor effects in some patients. We report a case of a severe life-threatening anaphylactoid reaction due to indigotindisulfonate following intravenous administration.

Case Report: We describe a case of a 42-year-old female admitted for a total abdominal hysterectomy. Upon arrival to the operating room, her heart rate (HR) was 80/min, blood pressure (BP) was 135/75 mm Hg, and …

Benzocaine-Induced Methemoglobinemia: A Case Report, Keith Veltri, Ellen Rudnick

Touro College of Pharmacy (New York) Publications and Research

The authors present introductions to local anesthetics and methemoglobinemia, and detail a case report of a patient with benzocaine-induced methemoglobinemia.

Overcoming Cancer Multidrug Resistance Through Inhibition Of Microparticles, Sora Vysotski, Rivka Winzelberg, Mariana Babayeva

Touro College of Pharmacy (New York) Publications and Research

One of the main obstacles to success of chemotherapy agents is the development of cancer resistance. Cancer multidrug resistance (MDR) is thought to arise from over-expression of efflux transporters on cancer cells’ plasma membranes. Recently, microparticles (MP) were found to play a major role in mediating the resistance to antineoplastic agents. Microparticles can confer MDR phenotype to cancer cells though 3 complimentary pathways: 1) Intercellular transfer of P-gp and MRP1; 2) Intercellular transfer of regulatory nucleic acids that ensure acquisition of MDR phenotype; and 3) Internal sequestration of anticancer drugs to reduce the amount of free active drug. Compounds that …

Cyclophosphamide For Suspected Primary Angiitis Of The Central Nervous System In A Patient With Human Immunodeficiency Virus: A Case Report, Martha M. Rumore, Samantha Su, Jake Pellinen

Touro College of Pharmacy (New York) Publications and Research

Introduction: Central nervous system (CNS) vasculitis is rare, including in human immunodeficiency virus (HIV), occurring in less than 1% of patients. Systemic vasculitis affecting the CNS is termed secondary CNS vasculitis, whereas primary CNS vasculitis, referred to as primary angiitis of the CNS (PACNS) refers to an extremely rare disease specifically confined to the CNS. Only some cases of PACNS in HIV patients have been reported in literature.

Case Report: We report a case of a 46-year-old female with HIV who developed probable primary CNS vasculitis, which was treated with intravenous cyclophosphamide and glucocorticoids for both induction and …

Perspectives On Transdermal Electroporation, Kevin B. Ita

Faculty Publications & Research of the TUC College of Pharmacy

Transdermal drug delivery offers several advantages, including avoidance of erratic absorption, absence of gastric irritation, painlessness, noninvasiveness, as well as improvement in patient compliance. With this mode of drug administration, there is no pre-systemic metabolism and it is possible to increase drug bioavailability and half-life. However, only a few molecules can be delivered across the skin in therapeutic quantities. This is because of the hindrance provided by the stratum corneum. Several techniques have been developed and used over the last few decades for transdermal drug delivery enhancement. These include sonophoresis, iontophoresis, microneedles, and electroporation. Electroporation, which refers to the temporary …

A Single Dose Tmv-Ha Vaccine Protects Mice From H5n1 Influenza Challenge, Jyothi K. Mallajosyula, Trushar Jeevan, Rachel Chikwamba, Richard J. Webby, Alison A. Mccormick

Faculty Publications & Research of the TUC College of Pharmacy

Recombinant subunit vaccines are an efficient strategy to meet the demands of a possible influenza pandemic, because of rapid and scalable production. However, vaccines made from recombinant Hemagglutinin (HA) subunit protein are often of low potency, requiring repeated boosting to generate a sustained immune response. Previously, we demonstrated improved immunogenicity of a plant-made H1 Hemagglutinin (HA) vaccine by chemical conjugation to the surface of the Tobacco Mosaic Virus (TMV) which is non infectious in mammals. Antigen coated TMV is taken up by mammalian dendritic cells and is a highly effective antigen carrier for subunit protein vaccines. In this work, we …

The Influence Of Solid Microneedles On The Transdermal Delivery Of Selected Antiepileptic Drugs, Julia Nguyen, Kevin B. Ita, Matthew J. Morra, Inna E. Popova

Faculty Publications & Research of the TUC College of Pharmacy

The aim of this project was to examine the effect of microneedle rollers on the percutaneous penetration of tiagabine hydrochloride and carbamazepine across porcine skin in vitro. Liquid chromatography-mass spectrometric analysis was carried out using an Agilent 1200 Series HPLC system coupled to an Agilent G1969A TOF-MS system. Transdermal flux values of the drugs were determined from the steady-state portion of the cumulative amount versus time curves. Following twelve hours of microneedle roller application, there was a 6.74-fold increase in the percutaneous penetration of tiagabine hydrochloride (86.42 ± 25.66 µg/cm²/h) compared to passive delivery (12.83 ± 6.30 µg/cm …

Motivations And Predictors Of Cheating In Pharmacy School, Eric J. Ip, Kathy Nguyen, Bijal M. Shah, Shadi Doroudgar, Monica K. Bidwal

Faculty Publications & Research of the TUC College of Pharmacy

Objective. To assess the prevalence, methods, and motivations for didactic cheating among pharmacy students and to determine predictive factors for cheating in pharmacy colleges and schools.

Methods. A 45-item cross-sectional survey was conducted at all four doctor of pharmacy programs in Northern California. For data analysis, t test, Fisher exact test, and logistic regression were used.

Results. Overall, 11.8% of students admitted to cheating in pharmacy school. Primary motivations for cheating included fear of failure, procrastination, and stress. In multivariate analysis, the only predictor for cheating in pharmacy school was a history of cheating in undergraduate studies.

Conclusion. Cheating occurs …

Obesity Management: Clinical Review And Update Of The Pharmacologic Treatment Options, Raymond A. Plodkowski, Megan E. Mcgarvey, Keith Reisinger-Kindle, Bradley Kramer, Erik Nelson, Jennifer Lee, Quang T. Nguyen

College of Osteopathic Medicine (TUN) Publications and Research

The toolbox of medications available for medical weight management is more robust than ever and includes a wide variety of mechanisms of actions and options for patients.

Treatment Of Pasireotide Lar-Associated Hyperglycemia In A Patient With Acromegaly, Cheryl Rosenfeld

Touro College of Osteopathic Medicine (Middletown) Publications and Research

Objective: Hyperglycemia was noted in pasireotide long-acting release (PAS LAR}-treated patients with acromegaly during clinical trials. We describe a clinical approach to hyperglycemia in a patient with acromegaly and diabetes mellitus type 2 (DM2) during PAS LAR initiation and treatment.

Methods: Clinical response to PAS LAR, including self­ monitored blood glucose (SMBG) levels, HbA1c, IGF-1, and adverse effects, was reported. Case Presentation: A 44-year-old male was referred for consultation in 2007 owing to uncontrolled DM2 despite maximum metformin (MET) dose. Testing led to a biochemical diagnosis of acromegaly. An 8-mm pituitary adenoma was seen on MRI. Transsphenoidal pituitary adenoma …

Evaluating The Effects Of An Interdisciplinary Practice Model With Pharmacist Collaboration On Hiv Patient Co-Morbidities, Rebecca Cope, Leonard Berkowitz, Rebecca Arcebido, Jun-Yen Yeh, Nathan Trustman, Agnes Cha

Touro College of Pharmacy (New York) Publications and Research

Treatment of HIV now occurs largely within the primary care setting, and the principal focus of most visits has become the management of chronic disease states. The clinical pharmacist’s potential role in improving chronic disease outcomes for HIV patients is unknown. A retrospective cohort study was performed for HIV-positive patients also diagnosed with diabetes, hypertension, or hyperlipidemia. Characteristics and outcomes in 96 patients treated by an interdisciplinary team which included a clinical pharmacist (i.e., the intervention group) were compared to those in 50 patients treated by an individual healthcare provider (i.e., the control group). Primary outcomes were changes from baseline …

Customized Order-Entry Sets Can Prevent Antiretroviral Prescribing Errors: A Novel Opportunity For Antimicrobial Stewardship, Yi Guo, Philip Chung, Caryn Weiss, Keith Veltri, Grace Y. Minamoto

Touro College of Pharmacy (New York) Publications and Research

Background: Patients with human immunodeficiency virus (HIV) infection on antiretroviral (ARV) therapy are at increased risk for medication errors during transitions of care between the outpatient and inpatient settings. This can lead to treatment failure or toxicity. Previous studies have emphasized the prevalence of medication errors in such patients, but few have reported initiatives to prevent errors from occurring.

Methods: The study was conducted in a 1,400-bed health care center with a state-designated Acquired Immunodeficiency Syndrome (AIDS) Center in the Bronx, New York. The antimicrobial stewardship team and HIV specialists developed customized order-entry sets (COES) to guide ARV …

Majority Of Hiv/Hcv Patients Need To Switch Antiretroviral Therapy To Accommodate Direct Acting Antivirals, Rebecca Cope, Aaron Pickering, Thomas Glowa, Samantha Faulds, Peter Veldkamp, Ramakrishna Prasad

Touro College of Pharmacy (New York) Publications and Research

The impact of drug–drug interactions (DDIs) between interferon-free direct acting antiviral (DAA) regimens and antiretrovirals (ART) among HIV/HCV co-infected individuals in clinical practice settings is unknown. A singlecenter, retrospective chart review of co-infected patients was conducted from June 2014 to February 2015. Significant interactions between simeprevir (SMV), ledipasvir (LDV), and paritaprevir/ritonavir/ombitasvir plus dasabuvir (3D regimen) with ART were identified based on available literature. SMV had the largest number of DDIs and was further investigated to determine the feasibility of ART switch to allow for DAA use. Of 127 subjects, 23% had advanced liver disease; 86% of those with known HCV …

Treatment Outcomes For Infections Caused By “Spice” (S–Serratia, P–Pseudomonas Aeruginosa, I–Indole Positive Proteus, C–Citrobacter, E– Enterobacter) Organisms: Carbapenem Versus Non-Carbapenem Regimens, Stanley Moy, Roopali Sharma

Touro College of Pharmacy (New York) Publications and Research

Background. Techniques to identify AmpC β-lactamases in SPICE organisms are not yet optimized for the clinical laboratory and are not routinely done. Clinicians are often left with an uncertainty on the choice of antibiotic when a SPICE organism is isolated. The purpose of this study is to evaluate the outcomes of carbapenem versus non-carbapenem regimens in treating bacteremia or urinary tract infection (UTI) from a SPICE organism in a “real-world” setting.

Methods. This was a single-center, retrospective, case-cohort study consisting of adult patients who had clinical infection with a SPICE organism isolated from blood or urine cultures. Patients …

Improving A Curriculum Through Incremental Changes Based On Programmatic Assessment Results, Batoul Senhaji-Tomza, Suzanne R. Soliman, Paramita Basu

Touro College of Pharmacy (New York) Publications and Research

Objectives: To describe implementation of incremental curriculum changes aimed at addressing identified gaps via subjective and objective programmatic assessment in a 2 + 2 curriculum.

Method: After low first-time NAPLEX pass rates for two consecutive class years, subjective and objective assessment of a 2 + 2 curriculum was conducted. The curriculum was benchmarked to the other existing 2 + 2 program. Other assessments that occurred include: intensive course content review, course credit number versus instructional time audit, vertical and horizontal topical sequence revision in the clinical, basic sciences and social and behavioral course sequences, faculty/student feedback and focus groups; outside …

Evaluate To Learn: Integrating Assessment Data To Improve Outcome Of A Didactic Biomedical Science Course, Paramita Basu, John Fisher, Batoul Senhaji-Tomza, Suzanne R. Soliman

Touro College of Pharmacy (New York) Publications and Research

Objectives: To describe the evaluation system used to identify curricular issues within a pre-clinical biomedical science course in a Pharm.D program and report the difference in outcome after implementation of the resulting changes.

Method: Course content, sequence of delivery and integration of topics with other courses in the relevant tracks were reviewed to identify discrepancies. Evaluation feedback from students and faculty were obtained from E-value online course evaluation system, and end of course discussion reports. Student performance in the course before and after implementing the recommended changes were compared to assess their effectiveness.

Results: Content duplications and …

Medication-Induced Hypokalemia, Keith Veltri, Carly Mason

Touro College of Pharmacy (New York) Publications and Research

The authors present an introduction to hypokalemia and then discuss a case report on a patient with medication-induced hypokalemia.

Geographic Variation In Antidiabetic Agent Adherence And Glycemic Control Among Patients With Type 2 Diabetes, Eleanora Tan, Wenya Yang, Bo Pang, Mingliang Dai, F. Ellen Loh, Paul Hogan

Touro College of Pharmacy (New York) Publications and Research

BACKGROUND: Medication nonadherence is an imperative public health concern. Among patients with type 2 diabetes mellitus (T2DM), poor adherence to antidiabetic agents is strongly associated with suboptimal glycemic control. Poor adherence and hyperglycemia greatly increase diabetes-related morbidity and mortality. At a national level, diabetes drug adherence using average proportion of days covered (PDC) is estimated to range between 36% and 81%, with an estimated range for diabetes control between 38% and 47%. At a state level no such studies exist.

OBJECTIVE: To estimate the level of medication adherence to antidiabetic agents and of diabetes control, and their association among patients …

Transdermal Delivery Of Drugs With Microneedles—Potential And Challenges, Kevin B. Ita

Faculty Publications & Research of the TUC College of Pharmacy

Transdermal drug delivery offers a number of advantages including improved patient compliance, sustained release, avoidance of gastric irritation, as well as elimination of pre-systemic first-pass effect. However, only few medications can be delivered through the transdermal route in therapeutic amounts. Microneedles can be used to enhance transdermal drug delivery. In this review, different types of microneedles are described and their methods of fabrication highlighted. Microneedles can be fabricated in different forms: hollow, solid, and dissolving. There are also hydrogel-forming microneedles. A special attention is paid to hydrogel-forming microneedles. These are innovative microneedles which do not contain drugs but imbibe interstitial …

Descriptive Study Of Prescriptions For Opioids From A Suburban Academic Emergency Department Before New York's I-Stop Act., Lyncean Ung, Ronald Dvorkin, Steven Sattler, David P. Yens

The School of Health Sciences Publications and Research

Introduction: Controlled prescription opioid use is perceived as a national problem attributed to all specialties. Our objective was to provide a descriptive analysis of prescriptions written for controlled opioids from a database of emergency department (ED) visits prior to the enactment of the I-STOP law, which requires New York prescribers to consult the Prescription Monitoring Program (PMP) prior to prescribing Schedule II, III, and IV controlled substances for prescriptions of greater than five days duration.

Methods: We conducted a retrospective medical record review of patients 21 years of age and older, who presented to the ED between July …

A Randomized Prospective Study On Outcomes Of An Empathy Intervention Among Second-Year Student Pharmacists, Kajua B. Lor, Julie T. Truong, Eric J. Ip, Mitchell J. Barnett

Faculty Publications & Research of the TUC College of Pharmacy

Objective. To determine the impact of a single, 3-day intervention on empathy levels as measured by the validated Jefferson Scale of Empathy-Health Profession Students version (JSE-HPS).

Methods. Forty second-year student pharmacists were recruited to participate in a non-blinded prospective study. Subjects were randomized to an intervention group (n=20) or control group (n=20) and completed the JSE-HPS at baseline, 7 days postintervention, and 90 days postintervention. The intervention group consisted of a 3-day simulation, each day including a designated activity with loss of dominant hand usage, vision, and speech.

Results. The 3-day simulation increased empathy levels in the intervention group compared …

Development Of A Multivalent Subunit Vaccine Against Tularemia Using Tobacco Mosaic Virus (Tmv) Based Delivery System, Sukalyani Banik, Ahd Ahmed Mansour, Ragavan Varadharajan Suresh, Sherri Wykoff-Clary, Meenakshi Malik, Alison A. Mccormick, Chandra Shekhar Bakshi

Faculty Publications & Research of the TUC College of Pharmacy

Francisella tularensisis a facultative intracellular pathogen, and is the causative agent of a fatal human disease known as tularemia. F. tularensis is classified as a Category A Biothreat agent by the CDC based on its use in bioweapon programs by several countries in the past and its potential to be used as an agent of bioterrorism. No licensed vaccine is currently available for prevention of tularemia. In this study, we used a novel approach for development of a multivalent subunit vaccine against tularemia by using an efficient tobacco mosaic virus (TMV) based delivery platform. The multivalent subunit vaccine was formulated …

Off-Label Use Of Transmucosal Ketamine As A Rapidacting Antidepressant: A Retrospective Chart Review, Linda Nguyen, Patrick J. Marshalek, Cory B. Weaver, Kathy J. Cramer, Scott E. Pollard, Rae Reiko Matsumoto

Faculty Publications & Research of the TUC College of Pharmacy

Objective: This study evaluated the effectiveness and safety of subanesthetic doses of ketamine using an off-label, transmucosal administration route in patients with treatment-resistant depression.

Methods: A retrospective chart review was conducted to identify patients who met the inclusion criteria for treatment-resistant major depressive disorder. Seventeen such patients who received subanesthetic doses of ketamine were included. Patient demographics, efficacy (drug refill, clinician notes), side effects, and concurrent medications were assessed.

Results: Benefit from low-dose transmucosal ketamine was noted in 76% of subjects (average age 48 years, 88% female), with a dose duration lasting 7–14 days. No notable side …

In Planta Production Of Flock House Virus Transencapsidated Rna And Its Potential Use As A Vaccine, Yiyang Zhou, Payal D. Maharaj, Jyothi K. Mallajosyula, Alison A. Mccormick, Christopher M. Kearney

Faculty Publications & Research of the TUC College of Pharmacy

We have developed a transencapsidated vaccine delivery system based on the insect virus, Flock House virus (FHV). FHV is attractive due to its small genome size, simple organization, and non-pathogenic characteristics. With the insertion of a Tobacco mosaic virus (TMV) origin of assembly (Oa), the independently replicating FHV RNA1 can be transencapsidated by TMV coat protein. In this study we demonstrated that the Oa adapted FHV RNA1 transencapsidation process can take place in planta, by using a bipartite plant expression vector system, where TMV coat protein is expressed by another plant virus vector, Foxtail mosaic virus (FoMV). Dual infection in …

Inserting Pharmacists In Primary Care Roles In An Ambulatory Care Setting, Keith Yoshizuka, Katherine K. Knapp, Patricia A. Shane, Debbie H. Lu

Faculty Publications & Research of the TUC College of Pharmacy

In this report, we suggest how pharmacy personnel may be used to alleviate some of the pressures currently impacting health system administrators. We look back to the role(s) of the hospital pharmacy and the hospital pharmacist historically and outline changes that have occurred and how these changes may be helpful to address several problem areas in the ambulatory care venue.