Pharmacy and Pharmaceutical Sciences Commons^™

Retrospective Analysis Of Methotrexate Elimination When Coadministered With Levetiracetam, David Reeves, Sarah Didominick, Suzanne Finn, Hyeon Jin Kim, Amanda Shake

Scholarship and Professional Work – COPHS

Background: Delayed elimination of methotrexate was previously reported in 2 patients receiving concomitant levetiracetam. Objective: To explore the potential interaction between methotrexate and levetiracetam in patients receiving high-dose methotrexate. Methods: This retrospective study reviewed the records of 81 adults receiving 280 cycles of methotrexate to determine the effects of levetiracetam on methotrexate elimination. Institutional review board approval was obtained. Results: Levetiracetam was administered in 33 (12%) cycles of methotrexate. Patients receiving levetiracetam had significantly lower 24-hour methotrexate concentrations compared with those not receiving levetiracetam (2.91 vs 7.37 µmol/L, P = 0.005). Despite this difference, concentrations at 48 and 72 hours …

Population Pharmacokinetics And Pharmacodynamics Of Extended-Infusion Piperacillin And Tazobactam In Critically Ill Children, Chad A. Knoderer, Kristen R. Nichols, Eun Kyoung Chung, Lauren E. Buenger, Daniel P. Healy, Jennifer Dees, Ashley S. Crumby, Michael B. Kays

Scholarship and Professional Work – COPHS

The study objective was to evaluate the population pharmacokinetics and pharmacodynamics of extended-infusion piperacillintazobactam in children hospitalized in an intensive care unit. Seventy-two serum samples were collected at steady state from 12 patients who received piperacillin-tazobactam at 100/12.5 mg/kg of body weight every 8 h infused over 4 h. Population pharmacokinetic analyses were performed using NONMEM, and Monte Carlo simulations were performed to estimate the piperacillin pharmacokinetic profiles for dosing regimens of 80 to 100 mg/kg of the piperacillin component given every 6 to 8 h and infused over 0.5, 3, or 4 h. The probability of target attainment (PTA) …

Compatibility Of Vancomycin And Oxacillin During Simulated Y-Site Delivery, Chad A. Knoderer, Hilary M. Teibel, Kristen R. Nichols

Scholarship and Professional Work – COPHS

Background: Vancomycin and oxacillin may be used together as empiric coverage in patients with proven or suspected Staphylococcus aureus infections. Though vancomycin hydrochloride 20 mg/mL and oxacillin sodium 160 mg/mL are reported to be compatible via Y-site delivery, Y-site compatibility of commonly used concentrations, vancomycin 10 mg/mL and oxacillin 20 mg/mL, has not yet been reported. Objective: To determine the Y-site compatibility of vancomycin 10 mg/mL and oxacillin 20 mg/mL. Methods: One vancomycin hydrochloride 1 g vial was reconstituted with 10 mL sterile water for injection (SWFI) and diluted with 90 mL 5% dextrose in water (D5W) …

Interactive Web-Based Learning Modules Prior To General Medicine Advanced Pharmacy Practice Experiences, Alex N. Isaacs, Alison M. Walton, Sarah A. Nisly

Scholarship and Professional Work – COPHS

Objective. To implement and evaluate interactive web-based learning modules prior to advanced pharmacy practice experiences (APPEs) on inpatient general medicine.

Design. Three clinical web-based learning modules were developed for use prior to APPEs in 4 health care systems. The aim of the interactive modules was to strengthen baseline clinical knowledge before the APPE to enable the application of learned material through the delivery of patient care.

Assessment. For the primary endpoint, postassessment scores increased overall and for each individual module compared to preassessment scores. Postassessment scores were similar among the health care systems. The survey demonstrated positive student perceptions of …

Acid-Suppressing Agents And Risk For Clostridium Difficile Infection In Pediatric Patients, Katelyn E. Brown, Chad A. Knoderer, Kristen R. Nichols, Ashley S. Crumby

Scholarship and Professional Work – COPHS

Background. Acid-suppressing agents have been associated with increased Clostridium difficile infection (CDI) in adults. The objective of this study was to evaluate the association of acid-suppressing therapy with the development of CDI in the pediatric population.

Methods. This was a retrospective case-control study. Children aged 1 through 17 years with a positive C difficile polymerase chain reaction (PCR) result obtained between June 1, 2008, and June 1, 2012, were randomly matched to a control population selected from patients with negative PCR.

Results. A total of 458 children were included. No difference was observed in acid-suppressive therapy prior …

Implementing Extended-Infusion Cefepime As Standard Of Care In A Children’S Hospital: A Prospective Descriptive Study, Kristen R. Nichols, Lauren C. Karmire, Elaine G. Cox, Michael B. Kays, Chad A. Knoderer

Scholarship and Professional Work – COPHS

Background: Extended-infusion cefepime (EIC) has been associated with decreased mortality in adults, but to our knowledge, there are no studies in children.

Objective: The objective of this study was to determine the feasibility of implementing EIC as the standard dosing strategy in a pediatric population.

Methods: This was a descriptive study of children aged 1 month to 17 years, including patients in the intensive care unit, who received cefepime after admission to a freestanding, tertiary care children’s hospital. Patients were excluded if they were admitted to the neonatal intensive care unit or received cefepime in the outpatient, …

Prescriptions For Bedtime Sedatives After The Introduction Of A General Admission Order Set At An Academic Health Center: The Potential And Pitfalls Of Order Sets, Areeba Kara, Alex N. Isaacs, Sarah A. Nisly

Scholarship and Professional Work – COPHS

Objective: This study describes the impact of modifications to a general admission order set on physician prescribing of 2 as-needed or pro re nata (PRN) bedtime sedatives.

Methods: The hospitalists at our institution have used a general medical admission order set since 2005. Zolpidem was the only as-needed (PRN) bedtime sedative option on the order set until trazodone was added in December 2008. Trazodone is preferred over zolpidem in the geriatric population. We identified patients admitted by the hospitalists between January 2007 and August 2013 who were prescribed with either zolpidem or trazodone as a PRN sedative. Patient demographics, date …

Prescriptions For Bedtime Sedatives After The Introduction Of A General Admission Order Set At An Academic Health Center: The Potential And Pitfalls Of Order Sets., Areeba Kara, Alex N. Isaacs, Sarah A. Nisly

Scholarship and Professional Work – COPHS

OBJECTIVE:

This study describes the impact of modifications to a general admission order set on physician prescribing of 2 as-needed or pro re nata (PRN) bedtime sedatives.

METHODS:

The hospitalists at our institution have used a general medical admission order set since 2005. Zolpidem was the only as-needed (PRN) bedtime sedative option on the order set until trazodone was added in December 2008. Trazodone is preferred over zolpidem in the geriatric population. We identified patients admitted by the hospitalists between January 2007 and August 2013 who were prescribed with either zolpidem or trazodone as a PRN sedative. Patient demographics, date …

Success With Extended-Infusion Meropenem After Recurrence Of Baclofen Pump-Related Achromobacter Xylosoxidans Meningitis In An Adolescent, Kristen R. Nichols, Chad A. Knoderer, Nicholas G. Jackson, John J. Manaloor, John C. Christenson

Scholarship and Professional Work – COPHS

A 13-year-old female experienced a recurrence of baclofen pump-related central nervous system (CNS) infection caused by Achromobacter, despite absence of retained foreign material. Due to the failure of meropenem (120 mg/kg/d in divided doses every 8 hours and infused over 30 minutes) in the initial infection, the dose was infused over 4 hours during the recurrence. Meropenem is an antibiotic for which efficacy is time dependent, and 4-hour versus 30-minute infusions have been shown to prolong the time the concentration of the antibiotic exceeds the minimum inhibitory concentration (MIC) of the organism at the site of infection (T>MIC). …

Late-Occurring Vancomycin-Associated Acute Kidney Injury In Children Receiving Prolonged Therapy, Chad A. Knoderer, Allison L. Gritzman, Kristen R. Nichols, Amy C. Wilson

Scholarship and Professional Work – COPHS

Background: Acute kidney injury (AKI) in patients receiving vancomycin has been associated with trough concentrations ≥15 mg/L and longer therapy duration. The objective of this study was to determine the incidence and factors associated with late AKI in children receiving ≥8 days of vancomycin therapy. Methods: Children aged 30 days to 17 years who were admitted to our institution and received intravenous vancomycin for at least 8 days during January to December of 2007 and 2010 and had a suspected or proven gram-positive infection were included. Late AKI was categorized as AKI occurring after the first 7 days of therapy …

Analysis Of A Standardized Perioperative Pain Management Order Set In Highly Opioid-Tolerant Patients, Alex. N. Isaacs, Kellie L. Knight, Sarah A. Nisly

Scholarship and Professional Work – COPHS

Objective: The aim was to assess a standardized order set for perioperative pain management in highly opioid-tolerant patients undergoing elective orthopedic surgery.

Methods: This retrospective chart review evaluated a pain order set in highly opioid-tolerant patients undergoing elective total knee or total hip arthroplasty from January 2010 through August 2012. Based on the date of the surgery, patients were allocated into preimplementation or postimplementation order set groups. The primary outcome assessed whether an adjustment in daily opioid dosage was required within the first 48 hours postoperatively. Secondary outcomes included pain scores, length of hospitalization, and safety outcomes.

Results: Sixty patients …

Hypertension Management: Making Sense Of Guidelines And Therapy Options For The Elderly, Miranda Arthur, Lindsay Saum, Jessica E. Wilhoite

Scholarship and Professional Work – COPHS

Goal: The goal of this activity is to increase the awareness of the pharmacist on the complications surrounding hypertension management in the elderly individual, clarify the differences in current guideline recommendations, and aid in making the most appropriate drug therapy decisions regarding the management of hypertension.

Total Nutrient Admixtures (3-In-1): Pros Vs Cons For Adults, Jane Gervasio

Scholarship and Professional Work – COPHS

Total nutrient admixture (TNA) is a complete parenteral nutrition (PN) formulation composed of all macronutrients, including dextrose, amino acids, and intravenous fat emulsions (IVFE), in one bag. The TNA may be safely administered to the patient, with all components aseptically compounded and minimal administration manipulation required, lending itself to decreases in risks of catheter contamination and patient infections. The TNA is compatible and stable at recommended concentrations, and since the IVFE is in the TNA, it is infused at slower rates, allowing for better fat clearance. The TNA offers convenience of administration and a potential cost savings to the healthcare …

Standardized Competencies For Parenteral Nutrition Prescribing: The American Society For Parenteral And Enteral Nutrition Model, Peggi Guenter, Joseph I. Boullata, Phil Ayers, Jane Gervasio, Ainsley Malone, Erica Raymond, Beverly Holcombe, Michael Kraft, Gordon Sacks, David Seres, Parenteral Nutrition Safety Task Force, American Society For Parenteral And Enteral Nutrition (A.S.P.E.N.)

Scholarship and Professional Work – COPHS

Parenteral nutrition (PN) provision is complex, as it is a high-alert medication and prone to a variety of potential errors. With changes in clinical practice models and recent federal rulings, the number of PN prescribers may be increasing. Safe prescribing of this therapy requires that competency for prescribers from all disciplines be demonstrated using a standardized process. A standardized model for PN prescribing competency is proposed based on a competency framework, the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.)–published interdisciplinary core competencies, safe practice recommendations, and clinical guidelines. This framework will guide institutions and agencies in developing and maintaining …

The Cost Of Treating Cancer Patients With Antineoplastic Medications During Inpatient Hospital Admission, Alexandra Foster, David J. Reeves

Scholarship and Professional Work – COPHS

Abstract from 2015 American College of Clinical Pharmacy Global Conference, San Francisco, CA

Tolerability Of Induction Chemotherapy Dosing Practices In Acute Myeloid Leukemia Patients, Kaylene M. Peric, David J. Reeves

Scholarship and Professional Work – COPHS

For patients with high body surface areas (BSA), differing chemotherapy dosing strategies have been utilized in attempts to reduce toxicity. In a retrospective evaluation, we compared the effects of chemotherapy dosing in acute myeloid leukemia patients with high BSA (>2 m²) who received capped doses (n = 12) to those who received uncapped doses (n = 24), and to patients with BSA ≤ 2 m² (n = 42). There were no statistically significant differences among groups (BSA ≤ 2 m², BSA > 2 m² capped, and BSA > 2 m² uncapped) …

Self-Assembling Modified Β -Cyclodextrin Conjugated Sirna Nanoparticles And Liposomal Sirna Efficiently Knock Down The Mutant Huntingtin Gene In A Modified Pc-12 Cell Line, Rukmini Ladi, Sudip Das, Nandita Das

Scholarship and Professional Work – COPHS

Purpose: To formulate and characterize liposomal siRNA (LP-siRNA) and cationic β-cyclodextrin siRNA (CD-siRNA) nanoparticle complexes and evaluate their efficacy in knockdown of mutant Huntingtin protein (mHtt) in a modified PC-12 cell line.

Curcuminoid In Nanoemulsion Formulations Cause Enhanced Cell Death In The Hela Cancer Cell Culture Model, Nikita Kheradia, Nandita Das, Sudip Das

Scholarship and Professional Work – COPHS

Purpose: To formulate and characterize curcuminoid (insoluble chemoprevention agent) loaded nanoemulsions and evaluate their cytotoxicity in HeLa cells.

Evaluation Of A Vancomycin Dosing Protocol And Pharmacokinetic Parameters In Burn Patients, T. A. Walroth, K. A. Lavery, S. Erdman, N. R. Buening, D. R. Foster, Kendra M. Damer, R. Sood

Scholarship and Professional Work – COPHS

Published abstract from the 47th American Burn Association Annual Meeting. Chicago, IL April 2015.

Evaluation And Revision Of An Introduction To Experiential Rotations Course, Eliza A. Dy, Sarah Nisly

Scholarship and Professional Work – COPHS

The objectives of this study were to evaluate the perceived student value of topics taught in Butler University’s Introduction to Experiential Rotations (RX500) course, implement course revisions to address any perceived weaknesses, and to reassess the course following implementation of those course revisions. Advanced Pharmacy Practice Experience (APPE) students from Butler University’s 2012 doctorate of pharmacy class were initially surveyed to assess the perceived usefulness and design of RX500. Based on the findings of the initial data, course revisions were developed and implemented for the following semester’s RX500 course. In order to assess for potential changes in the perceived value …

A.S.P.E.N. Parenteral Nutrition Safety Consensus Recommendations, Phil Ayers, Stephen Adams, Joseph Boullata, Jane M. Gervasio, Beverly Holcombe, Michael D. Kraft, Neil Marshall, Antoinette Neal, Gordon Sacks, David S. Seres, Patricia Worthington, American Society For Parenteral And Enteral Nutrition

Scholarship and Professional Work – COPHS

Parenteral nutrition (PN) serves as an important therapeutic modality that is used in adults, children, and infants for a variety of indications. The appropriate use of this complex therapy aims to maximize clinical benefit while minimizing the potential risks for adverse events. Complications can occur as a result of the therapy and as the result of the PN process. These consensus recommendations are based on practices that are generally accepted to minimize errors with PN therapy, categorized in the areas of PN prescribing, order review and verification, compounding, and administration. These recommendations should be used in conjunction with other A.S.P.E.N. …

Use Of Web-Based Learning Modules For A General Medicine Advanced Pharmacy Practice Experience., Sarah A. Nisly, Alex N. Issacs, Kathryn Givens Merkel

Scholarship and Professional Work – COPHS

Objective. To implement and assess web-based learning modules on baseline pharmacy student knowledge prior to a general medicine advanced pharmacy practice experience (APPE).

Methods. Three web-based learning modules were developed for use prior to a general medicine APPE. Students completed pre- and post-assessments specific to each learning module. Additionally, students completed perception surveys at the conclusion of the APPE to determine the utility of these modules and the impact on student learning experiences.

Results. Use of the web-based training (WBT) modules resulted in a statistically significant improvement in post-assessment scores for two of the three modules (p < 0.001). Student participants found the modules easy to use and helpful in APPE preparation.

Conclusions. Utilization …

Are Elevated Vancomycin Serum Trough Concentrations Achieved Within The First 7 Days Of Therapy Associated With Acute Kidney Injury In Children?, Chad A. Knoderer, Kristen R. Nichols, Kelsey C. Lyon, Megan M. Veverka, Amy C. Wilson

Scholarship and Professional Work – COPHS

Background In 2008, the empiric vancomycin dosing recommendation in children at our institution was changed from 40 to 60 mg/kg per day. Subsequently, an increased incidence of acute kidney injury (AKI) in patients receiving vancomycin was suspected. The objective of this study was to evaluate AKI in children receiving vancomycin and to determine risk factors for AKI development.

Methods Medical records of patients aged 30 days through 17 years who received vancomycin for at least 72 hours between January and December 2007 (40 mg/kg per day) and January and December 2010 (60 mg/kg per day) were reviewed. Patients with cystic …

Correlation Of Treatment Dose Enoxaparin With Anti-Xa Concentrations In Adult Hemodialysis Inpatients, Paul E. Brumley, Miroslav A. Anguelov, Jason P. Hecht, Dane L. Shiltz

Scholarship and Professional Work – COPHS

Enoxaparin, a low-molecular-weight-heparin, is being used in hemodialysis patients despite a lack of guideline or manufacturer dose recommendations. Due to enoxaparin’s renal excretion, the possibility of accumulating anti-Xa concentrations in hemodialysis patients using enoxaparin creates a hemorrhagic risk, calling for more research. The objectives of this study are to determine the correlation between treatment dose enoxaparin use and anti-Xa concentrations within the defined therapeutic range in patients receiving chronic, scheduled hemodialysis to determine the degree of change in anti-Xa concentrations in those cases where a concentration was obtained before and after a specific hemodialysis session, and to determine if there …

A Retrospective Comparison Of Daptomycin Thrice-Weekly Versus Q48h Dosing In Hemodialysis Patients With Vancomycin-Resistant Enterococcus (Vre) Or Methicillin-Resistant Staphylococcus Aureus (Mrsa) Bacteremia, Katie L. Axford, Dane L. Shiltz

Scholarship and Professional Work – COPHS

Background. Multi-drug resistant bacteria are a growing concern in healthcare. Daptomycin is being used with increasing frequency in the treatment of vancomycin-resistant enterococci (VRE) and methicillin-resistant Staphylococcus aureus (MRSA) bacteremias in hemodialysis (HD) patients. Thrice-weekly dosing of daptomycin in this population would allow for coordination of dosing with common outpatient HD schedules. The aim of this study is to determine if thrice-weekly dosing of daptomycin is equivalent to dosing every 48 hours in patients receiving chronic intermittent hemodialysis. Equivalence will be assessed with regard to microbiological cure, clinical cure, hospital length of stay, and mortality. Methods. All patients with positive …

Cinacalcet Administration By Gastrostomy Tube In A Child Receiving Peritoneal Dialysis, Kristen R. Nichols, Chad A. Knoderer, Bethanne Johnston, Amy C. Wilson

Scholarship and Professional Work – COPHS

A 2-year-old male with chronic kidney disease with secondary hyperparathyroidism developed hypercalcemia while receiving calcitriol, without achieving a serum parathyroid hormone concentration within the goal range. Cinacalcet 15 mg (1.2 mg/kg), crushed and administered via gastrostomy tube, was added to the patient’s therapy. This therapy was effective in achieving targeted laboratory parameters in our patient despite instructions in the prescribing information that cinacalcet should always be taken whole.

Association Between Applications Scores And Positive Onsite Interviews Of Pharmacy Residency Applicants, Sarah Nisly, Meredith L. Howard, Alex N. Issacs, Tate Trujillo

Scholarship and Professional Work – COPHS

Application to pharmacy residency programs has become increasingly competitive over the past several years. Although successful candidates must excel in the various stages of the application process, preparing written applications and securing onsite interviews are early and arguably the most difficult steps. Residency programs vary in the criteria used for offering onsite interviews. The majority of insight into this topic comes from surveys of residency program directors, but corresponding analyses of interview offers have been minimal...

Optimized Antimicrobial Dosing Strategies: A Survey Of Pediatric Hospitals, Chad A. Knoderer, Kristen R. Nichols, Elaine G. Cox

Scholarship and Professional Work – COPHS

Background

Extended-interval aminoglycoside (EIAG) and extended- and continuous-infusion β-lactam (EIBL and CIBL) dosing strategies are increasingly used in adults, but pediatric literature is limited.

Objective

The objective of this study was to describe the use of EIAG, EIBL, and CIBL dosing in pediatric hospitals in the USA.

Study Design, Setting, and Participants

A national survey of children’s hospitals was conducted. A single practitioner from each target hospital was identified through the Children’s Hospital Association. Practice-based survey questions identified whether hospitals utilize EIAG, EIBL, and CIBL dosing.

Main Outcome Measure

The main outcome measure was the percentage utilization of the dosing …

Ceftriaxone Potentiates Warfarin Activity Greater Than Other Antibiotics In The Treatment Of Urinary Tract Infections, Lindsay M. Saum, Ryan P. Balmat

Scholarship and Professional Work – COPHS

Background: The cephalosporin class has been associated with an increased risk of bleeding among elderly patients receiving warfarin. Urinary tract infections (UTI) are the most prevalent infection in elderly patients.

Objective: To determine the extent of interaction between antibiotics used in the treatment of UTI, particularly specific cephalosporins and warfarin.

Methods: A retrospective chart review was conducted on chronic warfarin patients with a diagnosis of UTI treated with ceftriaxone, a first-generation cephalosporin, penicillin, or ciprofloxacin. The primary outcome was the comparison of the extent of international normalized ratio (INR) change from baseline between each antibiotic group.

Results: The ceftriaxone group …

Promoting Interprofessional Education Through A Student Led Community Health Screening Event, Carrie Maffeo, Eileen Carroll, Alexandra Foster, Kelly Daneri, Isabel Hagedorn, Mary Graham, Jane Gervasio

Scholarship and Professional Work – COPHS

Published abstract from the 115th Annual Meeting of the American Association of Colleges of Pharmacy, Grapevine, TX, July 26-30.