Pharmacy and Pharmaceutical Sciences Commons^™

Empirical Assessment Of The Impact Of Low-Cost Generic Programs On Adherence-Based Quality Measures, Nathan J. Pauly, Jeffery C. Talbert, Joshua D. Brown

Pharmacy Practice and Science Faculty Publications

In the United States, federally-funded health plans are mandated to measure the quality of care. Adherence-based medication quality metrics depend on completeness of administrative claims data for accurate measurement. Low-cost generic programs (LCGPs) cause medications fills to be missing from claims data as medications are not adjudicated through a patient’s insurance. This study sought to assess the magnitude of the impact of LCGPs on these quality measures. Data from the 2012–2013 Medical Expenditure Panel Survey (MEPS) were used. Medication fills for select medication classes were classified as LCGP fills and individuals were classified as never, sometimes, and always users of …

Adverse Events And Treatment Discontinuations Of Antimuscarinics For The Treatment Of Overactive Bladder In Older Adults: A Systematic Review And Meta-Analysis, Scott Martin Vouri, Clark D. Kebodeaux, Paul M. Stranges, Besu F. Teshome

Pharmacy Practice and Science Faculty Publications

Introduction

Antimuscarinics should be used with caution in older adults with overactive bladder (OAB) due to anticholinergic adverse events (AEs). Systematic reviews and meta-analyses (SRMAs) have analyzed safety-related outcomes but have not specified risk in the elderly, the population at highest risk for AEs. The aim of this review is to explore and evaluate AEs and treatment discontinuations in adults 65 or older taking antimuscarinics for OAB.

Methods

Keywords were searched in MEDLINE, EMBASE, SCOPUS, and Cochrane Central Register for Controlled Trials. Randomized controlled trials (RCTs) along with sub-analyses and pooled analyses that compared antimuscarinics to placebo or another antimuscarinic …

Nephrotoxicity During Vancomycin Therapy In Combination With Piperacillin-Tazobactam Or Cefepime, Wilbur Cliff Rutter, Jessica N. Cox, Craig A. Martin, Donna R. Burgess, David S. Burgess

Pharmacy Practice and Science Faculty Publications

Recent reports have demonstrated that vancomycin (VAN) may lead to an increase in the incidence of acute kidney injury (AKI) when it is combined with antipseudomonal beta-lactams. This study compared the incidence of AKI associated with VAN plus piperacillin-tazobactam (TZP) or cefepime (FEP). This was a retrospective, matched cohort study that was conducted at an academic medical center between September 2010 and September 2014 and that included adult patients without severe chronic or structural kidney disease, dialysis, pregnancy, cystic fibrosis, or a hospital transfer receiving TZP-VAN or FEP-VAN for at least 48 h. The primary outcome was the difference in …

Bladder Antimuscarinics And Cognitive Decline In Elderly Patients, Daniela Claudia Moga, Erin L. Abner, Qishan Wu, Gregory A. Jicha

Pharmacy Practice and Science Faculty Publications

Introduction: The evidence on the impact of bladder antimuscarinics initiation on cognitive function in older adults is inconsistent.

Methods: A retrospective analysis of data from the National Alzheimer's Coordinating Center (NACC) on enrollees 65 years and older evaluated the association between antimuscarinic initiation and cognitive decline. We defined decline from baseline (yes/no) for cognitive assessments included in the NACC Uniform Data Set 2.0 battery. New users were matched on year of enrollment and time in the cohort to randomly selected nonusers. Analyses were conducted using inverse probability of treatment weights based on baseline propensity scores.

Results: Our analyses included 698 …

A Comparison Of Sex Differences In Psychotropic Medication Use In Older People With Alzheimer's Disease In The Us And Finland, Daniela C. Moga, Heidi Taipale, Anna-Maija Tolppanen, Antti Tanskanen, Jari Tiihonen, Sirpa Hartikainen, Qishan Wu, Gregory A. Jicha, Danijela Gnjidic

Pharmacy Practice and Science Faculty Publications

Aims—Given the high prevalence of psychotropic medication use in people with dementia and the potential for different prescribing practices in men and women, our study aimed to investigate sex differences in psychotropic medication use in older adults with Alzheimer’s disease (AD) living in the US and Finland.

Methods—We used data collected between 2005 and 2011 as part of the National Alzheimer’s Coordinating Center (NACC) in the US, and Medication use and Alzheimer’s disease (MEDALZ) cohorts in Finland. We evaluated psychotropic medication use (antidepressant, antipsychotic, anxiolytic, sedative, or hypnotic) in participants aged 65 years or older. We employed multivariable …

Impact Of Time-Varying Treatment Exposures On The Risk Of Venous Thromboembolism In Multiple Myeloma, Joshua D. Brown, Val R. Adams, Daniela C. Moga

Pharmacy Practice and Science Faculty Publications

Multiple myeloma (MM) has one of the highest risks of venous thromboembolism (VTE) of all cancers due to pathologic changes and treatment-related exposures. This study assessed the one-year incidence of VTE in newly diagnosed MM and to determine the baseline and time-varying treatment-related factors associated with VTE risk in a U.S.-based cohort. MM patients were identified and age, gender, and baseline comorbidities were determined. Treatment-related exposures included thalidomide derivatives (IMIDs), proteasome inhibitors, cytotoxic chemotherapy, steroids, erythropoietin-stimulating agents (ESAs), stem cell transplants (SCT), hospitalizations, infection, and central venous catheters (CVC). Multiple statistical models were used including a baseline competing risks model, …

National Trends In Off-Label Use Of Atypical Antipsychotics In Children And Adolescents In The United States, Minji Sohn, Daniela C. Moga, Karen Blumenschein, Jeffery C. Talbert

Pharmacy Practice and Science Faculty Publications

The objectives of the study were as follows: to examine the national trend of pediatric atypical antipsychotic (AAP) use in the United States; to identify primary mental disorders associated with AAPs; to estimate the strength of independent associations between patient/provider characteristics and AAP use. Data are from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey. First, average AAP prescription rates among 4 and 18-year-old patients between 1993 and 2010 were estimated. Second, data from 2007 to 2010 were combined and analyzed to identify primary mental disorders related to AAP prescription. Third, a multivariate logistic …

Inadequate Sedation During Therapeutic Paralysis: Use Of Bispectral Index In Critically Ill Patients, Chelsea L. Tasaka, Jeremiah J. Duby, Komal Pandya, Machelle D. Wilson, Kimberly A. Hardin

Pharmacy Practice and Science Faculty Publications

Background Patients receiving therapeutic paralysis may experience inadequate sedation due to intrinsic limitations of behavioral sedation assessment. Bispectral index (BIS™) provides an objective measure of sedation; however, the role of BIS™ is not well defined in intensive care unit (ICU) patients on neuromuscular blocking agents (NMBA).

Objective The aim of this study was to delineate the relationship between BIS™ and level of sedation for critically ill patients during therapeutic paralysis.

Methods This was a retrospective observational study conducted in ICU patients receiving continuous infusion NMBA and BIS™ monitoring. The primary endpoint was the correlation of BIS™ < 60 during therapeutic paralysis with a Richmond Agitation Sedation Score (RASS) of −4 to −5 (i.e., deep or unarousable sedation) at the time of emergence from therapeutic paralysis.

Results Thirty-one patients were …

The Prevalence And Predictors Of Low-Cost Generic Program Use In A Nationally Representative Uninsured Population, Joshua D. Brown, Nathan J. Pauly, Jeffery C. Talbert

Pharmacy Practice and Science Faculty Publications

The uninsured population has much to gain from affordable sources of prescription medications. No prior studies have assessed the prevalence and predictors of low-cost generic drug programs (LCGP) use in the uninsured population in the United States. A cross-sectional study was conducted using data from the Medical Expenditure Panel Survey (MEPS) during 2007–2012 including individuals aged 18 and older who were uninsured for the entire 2-year period they were in MEPS. The proportions of LCGP fills and users was tracked each year and logistic regression was used to assess significant factors associated with LCGP use. A total of 8.3 million …

Incidence And Risk Factors Of Thromboembolism With Multiple Myeloma In The Presence Of Death As A Competing Risk: An Empirical Comparison Of Statistical Methodologies, Joshua D. Brown, Val R. Adams

Pharmacy Practice and Science Faculty Publications

Multiple myeloma (MM) has an inherent high risk of thromboembolic events associated with patient as well as disease- and treatment-related factors. Previous studies have assessed the association of MM-related thromboembolism using “traditional” Kaplan–Meier (KM) and/or Cox proportional hazard (PH) regression. In the presence of high incidence of death, as would be the case in cancer patients with advanced age, these statistical models will produce bias estimates. Instead, a competing risk framework should be used. This study assessed the baseline patient demographic and clinical characteristics associated with MM-related thromboembolism and compared the cumulative incidence and the measures of association obtained using …

Use Of Continuous Renal Replacement Therapy For Removal Of Dabigatran In A Patient In Need Of Emergent Surgery, Sara E. Parli, Melissa L. Thompson Bastin, Daniel A. Lewis

Pharmacy Practice and Science Faculty Publications

Purpose. To report the ability to remove serum dabigatran using continuous renal replacement therapy (CRRT) in a patient with life-threatening bleeding. Summary. A 77-year-old female with history of atrial fibrillation who takes dabigatran for stroke prevention presented with abdominal pain. Patient was found to have bleeding and possible mesenteric ischemia and was taken to the operating room and had continued bleeding postoperatively. CRRT was initiated for the removal of any remaining dabigatran, with serum dabigatran levels collected to evaluate removal of dabigatran with CRRT. This patient had an increased dabigatran level prior to intervention, which decreased to an …

Utilizing Monte Carlo Simulations To Optimize Institutional Empiric Antipseudomonal Therapy, Sarah J. Tennant, Donna R. Burgess, Jeffrey M. Rybak, Craig A. Martin, David S. Burgess

Pharmacy Practice and Science Faculty Publications

Pseudomonas aeruginosa is a common pathogen implicated in nosocomial infections with increasing resistance to a limited arsenal of antibiotics. Monte Carlo simulation provides antimicrobial stewardship teams with an additional tool to guide empiric therapy. We modeled empiric therapies with antipseudomonal β-lactam antibiotic regimens to determine which were most likely to achieve probability of target attainment (PTA) of ≥90%. Microbiological data for P. aeruginosa was reviewed for 2012. Antibiotics modeled for intermittent and prolonged infusion were aztreonam, cefepime, meropenem, and piperacillin/tazobactam. Using minimum inhibitory concentrations (MICs) from institution-specific isolates, and pharmacokinetic and pharmacodynamic parameters from previously published studies, a 10,000-subject Monte …

Flucytosine Pharmacokinetics In A Critically Ill Patient Receiving Continuous Renal Replacement Therapy, Megan E. Kunka, Elizabeth A. Cady, Heejung C. Woo, Melissa L. Thompson Bastin

Pharmacy Practice and Science Faculty Publications

Purpose. A case report evaluating flucytosine dosing in a critically ill patient receiving continuous renal replacement therapy. Summary. This case report outlines an 81-year-old male who was receiving continuous venovenous hemofiltration (CVVH) for acute renal failure and was being treated with flucytosine for the treatment of disseminated Cryptococcus neoformans infection. Due to patient specific factors, flucytosine was empirically dose adjusted approximately 50% lower than intermittent hemodialysis (iHD) recommendations and approximately 33% lower than CRRT recommendations. Peak and trough levels were obtained, which were supratherapeutic, and pharmacokinetic parameters were calculated. The patient experienced thrombocytopenia, likely due to elevated flucytosine …

Prescription Drug Monitoring Program Utilization In Kentucky Community Pharmacies, Sarah E. Wixson, Karen Blumenschein, Amie J. Goodin, Jeffery Talbert, Patricia R. Freeman

Pharmacy Practice and Science Faculty Publications

OBJECTIVE: Identify characteristics of Kentucky community pharmacists and community pharmacists' practice environment associated with utilization of the Kentucky All Schedule Prescription Electronic Reporting Program (KASPER).

METHODS: Surveys were mailed to all 1,018 Kentucky pharmacists with a KASPER account and an additional 1,000 licensed pharmacists without an account. Bivariate analyses examined the association between KASPER utilization and practice type (independent or chain) and practice location (rural or urban). A multivariate Poisson regression model with robust error variance estimated risk ratios (RR) of KASPER utilization by characteristics of pharmacists' practice environment.

RESULTS: Responses were received from 563 pharmacists (response …

A Coming Disruption In Pharmacy?, Frank Romanelli, Timothy S. Tracy

Pharmacy Practice and Science Faculty Publications

No abstract provided.

Pharmacy Law Brief: Alternative Dispute Resolution, Joseph L. Fink Iii

Pharmacy Practice and Science Faculty Publications

No abstract provided.

Pharmacy Law Brief: The Federal False Claims Act, Joseph L. Fink Iii

Pharmacy Practice and Science Faculty Publications

No abstract provided.

Pharmacy Law Brief: Medications And Lawful Executions, Joseph L. Fink Iii

Pharmacy Practice and Science Faculty Publications

No abstract provided.

Pharmacy Law Brief: Implications Of Being A Specialist, Joseph L. Fink Iii

Pharmacy Practice and Science Faculty Publications

No abstract provided.

Pharmacy Law Brief: Pharmacy Law Exam For Licensure, Joseph L. Fink Iii

Pharmacy Practice and Science Faculty Publications

No abstract provided.

Clinical Inertia In Type 2 Diabetes: A Retrospective Analysis Of Pharmacist-Managed Diabetes Care Vs. Usual Medical Care, Felix K. Yam, Aimee G. Adams, Holly Divine, Douglas Steinke, Mikael D. Jones

Pharmacy Practice and Science Faculty Publications

Background: Evidence suggests that patients with type 2 diabetes (T2DM) suffer from a high rate of “clinical inertia” or “recognition of the problem but failure to act.”

Objective: The aim of this study is to quantify the rate of clinical inertia between two models of care: Pharmacist-Managed Diabetes Clinic (PMDC) vs. Usual Medical Care (UMC).

Methods: Patients in a university based medical clinic with type 2 diabetes (T2DM) were analyzed in this retrospective cohort study. Patients were exposed to either PMDC or UMC. The difference in days to intervention in response to suboptimal laboratory values and time …

Pharmacy Law Brief: National Practitioner Data Bank - What Is It?, Joseph L. Fink Iii

Pharmacy Practice and Science Faculty Publications

No abstract provided.

Pharmacy Law Brief: Exclusion Of Practitioners From Federally Funded Health Programs, Joseph L. Fink Iii

Pharmacy Practice and Science Faculty Publications

No abstract provided.

Pharmacy Law Brief: Contemporary Legal Issues For Leadership In Non-Profits - Iv, Joseph L. Fink Iii

Pharmacy Practice and Science Faculty Publications

No abstract provided.

Pharmacy Law Brief: Contemporary Legal Issues For Leadership In Non-Profits - Iii, Joseph L. Fink Iii

Pharmacy Practice and Science Faculty Publications

No abstract provided.

Treatment Of Klebsiella Pneumoniae Carbapenemase (Kpc) Infections: A Review Of Published Case Series And Case Reports, Grace C. Lee, David S. Burgess

Pharmacy Practice and Science Faculty Publications

The emergence of Klebsiella pneumoniae carbapenemases (KPCs) producing bacteria has become a significant global public health challenge while the optimal treatment remains undefined. We performed a systematic review of published studies and reports of treatment outcomes of KPC infections using MEDLINE (2001-2011). Articles or cases were excluded if one of the following was fulfilled: no individual patient data provided, no treatment regimen specified, no treatment outcome specified, report of colonization, or greater than three antibiotics were used to treat the KPC infection. Data extracted included patient demographics, site of infection, organism, KPC subtype, antimicrobial therapy directed at KPC-infection, and treatment …

Pharmacy Law Brief: Contemporary Legal Issues For Leadership In Non-Profits - Ii, Joseph L. Fink Iii

Pharmacy Practice and Science Faculty Publications

No abstract provided.

Leadership Development Of Students Through An Integrated Student Organization Structure In A College Of Pharmacy, T. Joseph Mattingly, David Marr, Joseph L. Fink Iii

Pharmacy Practice and Science Faculty Publications

Pharmacy is a profession that requires those who practice to be very well educated within their specialty. However, it is equally important for pharmacists to conduct themselves as professionals in all that they do so they can retain the trust of the public and the professionals with whom they deal on a daily basis. In addition, pharmacists are frequently called on to serve in leadership roles in several forums – professional associations, civic clubs, health-related voluntary organizations and a wide variety of other community or religious organizations.

Pharmacy Law Brief: Contemporary Legal Issues For Leadership In Non-Profits - I, Joseph L. Fink Iii

Pharmacy Practice and Science Faculty Publications

No abstract provided.

Chain Community Pharmacists' Willingness, Attitudes, And Barriers In Providing Self-Care Medication And Supplement Recommendations, Clark Kebodeaux, William M. Grise, Brooke Hudspeth, Holly Divine

Pharmacy Practice and Science Faculty Publications

BACKGROUND: Pharmacists are commonly called on as the first resource for patients when selecting an appropriate self-care medication or supplement. This study examines pharmacists’ over-the-counter (OTC) recommendations in the chain community pharmacy setting in the United States.

OBJECTIVES: The objective of the study was to assess chain community pharmacists’ willingness and attitudes to provide self-care recommendations to patients and to identify chain community pharmacists’ barriers to making OTC medication and supplement recommendations.

METHODS: An anonymous survey was created to identify pharmacists’ attitudes and their willingness to perform these recommendations. The questionnaire included specific questions to identify barriers that exist to …