Pharmacy and Pharmaceutical Sciences Commons^™

Successful Desensitization To Docetaxel After Severe Hypersensitivity Reactions In Two Patients, David J. Reeves, Michael J. Callahan, Gregory P. Sutton

Scholarship and Professional Work – COPHS

Purpose Two cases of successful desensitization to docetaxel after severe hypersensitivity reactions are reported.

Summary Two patients with gynecological malignancies (uterine leiomyosarcoma and ovarian adenocarcinoma) experienced severe hypersensitivity reactions with docetaxel, including flushing, numbness, sharp radiating pain, severe nausea and vomiting, apnea, and unresponsiveness. Both patients received ondansetron before docetaxel. One patient received dexamethasone, diphenhydramine, and famotidine premedication before docetaxel, as she had previously reacted to paclitaxel. Docetaxel infusions were stopped, and the reactions were treated with diphenhydramine and dexamethasone (one patient also received famotidine). After resolution of symptoms, the docetaxel was not reinitiated due to the nature of the …

Leukopenia Associated With Long-Term Colchicine Adminsitration, Ashton E. Beggs, David J. Reeves, Nancy S. Noel

Scholarship and Professional Work – COPHS

Purpose A case of leukopenia in a patient receiving colchicine for calcium pyrophosphate dihydrate deposition disease, or pseudogout, is reported.

Summary An 85-year-old man experienced leukopenia likely due to colchicine. His medical history included chronic lymphocytic leukemia (CLL), pseudogout, osteoarthritis, and hypertension. In February 2011, his white blood cell (WBC) count was 2700 cells/μL, and his absolute neutrophil count (ANC) was 2200 cells/μL. Colchicine 0.6 mg orally daily was initiated in March for the prophylaxis of pseudogout. His WBC count decreased, and his colchicine dosage was reduced to 0.6 mg every other day. Despite this decreased dosage, his WBC count …

Dietary Supplement Education In A Senior Population, Kimberly G. Elder, Sarah A. Nisly

Scholarship and Professional Work – COPHS

Background. Dietary supplements are widely used among United States senior citizens for various indications. Potential dangers with supplement use include the lack of regulation by the Food and Drug Administration (FDA) and the possibility for drug-supplement interactions. Senior focused education may in- crease the safe use of dietary supplements by older adults.

Objective. The primary objective of this study was to determine the effectiveness of a pharmacist driven educational seminar in a local senior population.

Methods. Participants aged 55 years and older in one of three senior programs were eligible for inclusion. Initially, a needs-assessment interview was con- ducted …

Nutrition Support In Acute Kidney Injury, Jane M. Gervasio, Wesley P. Garmon, Michael Holowatyj

Scholarship and Professional Work – COPHS

Acute kidney injury is a frequent complication affecting many hospitalized patients and is associated with increased morbidity and mortality. Acute kidney injury often occurs in conjunction with critical illness, which is a hypermetabolic state presenting with hyperglycemia, insulin resistance, hypertriglyceridemia, and increased protein catabolism. In addition to addressing these changes, the clinician should evaluate the important nutrition implications of decreased kidney function. These include vitamins, electrolytes, minerals, trace elements, and the presence and type of renal replacement therapy. Optimal nutrition management in acute kidney injury includes providing adequate macronutrient support to correct underlying conditions and prevent ongoing loss, supplementing micronutrients …

Efficacy Of Limited Cefuroxime Prophylaxis In Pediatric Patients After Cardiovascular Surgery, Chad A. Knoderer, Elaine G. Cox, Michelle D. Berg, Andrea H. Webster, Mark W. Turrentine

Scholarship and Professional Work – COPHS

Purpose The efficacy of limited cefuroxime prophylaxis in pediatric patients after cardiovascular surgery was evaluated.

Methods All patients age 18 years or younger who underwent cardiovascular surgery and received postoperative care from the cardiovascular surgery team between February and July 2006 (preintervention group) and between August 2006 and January 2007 (postintervention group) were eligible for study inclusion. Patients were excluded if they did not receive cefuroxime as postoperative prophylaxis, had a preexisting infection, underwent cardiac transplantation or extracorporeal membrane oxygenation, or underwent delayed sternal closure. The preintervention group received prolonged cefuroxime prophylaxis, and the postintervention group received 24 hours of …

Back Talk: The Medicine Cabinet, Dane L. Shiltz

Scholarship and Professional Work – COPHS

Presenation to pharmacists at Butler CE Symposium, June 2012, Indianapolis, Indiana.

Cefuroxime Pharmacokinetics In Pediatric Cardiovascular Surgery Patients Undergoing Cardiopulmonary Bypass, Chad A. Knoderer, Sarah A. Saft, Scott G. Walker, Markl D. Rodefeld, Mark W. Turrentine, John W. Brown, Daniel P. Healy, Kevin M. Sowinski

Scholarship and Professional Work – COPHS

Objectives

The objective of this study was to determine the pharmacokinetics of cefuroxime in children undergoing cardiopulmonary bypass (CPB) for cardiovascular surgery.

Design

A prospective study.

Setting

A tertiary pediatric teaching hospital.

Participants

Infants and children undergoing CPB were enrolled in the study.

Intervention

An initial dose (mean, 24.2 ± 1.6 mg/kg) of cefuroxime was administered before surgical incision, and a second dose (mean, 14.4 ± 7.9 mg/kg) was administered in the CPB prime solution. Serial blood samples were obtained before, during, and after the CPB process. Samples were shipped on dry ice to the analytic laboratory and concentrations determined …

Assessment Of The Validity Of Reported Antibiotic Allergic Reactions In Pediatric Patients, Lauren E. Miller, Chad A. Knoderer, Elaine G. Cox, Martin B. Kleinman

Scholarship and Professional Work – COPHS

Study Objective. To determine whether a reported antibiotic allergy was likely to have been immunologically mediated.

Design. Questionnaire-based study.

Setting. Tertiary care, freestanding children's hospital.

Patients. One hundred patients aged 1 month-18 years for whom guardians reported an allergy to an antibiotic at the time of hospital admission between October 2009 and March 2010.

Intervention. Guardians of the patients were interviewed by using a standardized allergy assessment questionnaire.

Measurements and Main Results. Based on answers to the questionnaire, the reported allergic reactions were categorized to determine if they were true allergies or adverse reactions. Among the 100 patients, reported allergies …

Cefepime Neurotoxicity In An Adolescent Cystic Fibrosis Patient With Aminoglycoside-Induced Acute Kidney Injury, Kristen R. Nichols, Danielle M. Brown, Chad A. Knoderer, Sharon P. Andreoli

Scholarship and Professional Work – COPHS

Objective: To describe a case of cefepime neurotoxicity in an adolescent with cystic fibrosis and aminoglycoside-associated acute kidney injury (AKI).

Case Summary: A 15-year-old, 46-kg male with cystic fibrosis (CF) and chronic sinusitis was admitted to the hospital for CF exacerbation. The patient was subsequently discharged to complete home antibiotic therapy with intravenous gentamicin and cefepime. Thirteen days after discharge, while still receiving intravenous antibiotics, the patient presented to an outside hospital complaining of vomiting, fatigue, decreased appetite, and decreased urine output. The patient was diagnosed with AKI and was transferred to our institution, where he displayed signs and symptoms …

Assessment Of Web-Based Training (Wbt) Modules On Learning Facilitation For Advanced Pharmacy Practice Experiences (Appe) In Pediatrics, Jennifer L. Morris, Chad A. Knoderer

Scholarship and Professional Work – COPHS

OBJECTIVES: To assess the effectiveness of web-based training (WBT) modules to enhance and facilitate student pharmacists’ learning and their ability to provide pharmaceutical care to children during a pediatric advanced pharmacy practice experience (APPE).

METHODS: Pediatric-specific WBT modules were developed for completion by APPE students during a 4- week rotation. Pediatric modules covered developmental pharmacology; antimicrobial use and monitoring; fluids, electrolytes, and dehydration; and drug information. Students were responsible for completing all modules within the first week of the APPE. Preassessments and postassessments consisted of 8 to 10 multiple-choice questions, with scores ranging from 0 to 100 points. Data were …

Hyperphosphatemia In Pediatric Oncology Patients Receiving Liposomal Amphotericin B, Chad A. Knoderer, Holly M. Knoderer

Scholarship and Professional Work – COPHS

OBJECTIVE: After transitioning our front-line amphotericin product to the liposomal formulation, we observed an increased incidence of hyperphosphatemia. We aimed to determine the incidence of hyperphosphatemia in children with oncologic disorders receiving an amphotericin B product and to establish whether the incidence varies depending on amphotericin formulation.

METHODS: This retrospective review of the medical record was conducted at a tertiary, free standing children’s hospital. Pharmacy data revealed 159 patients receiving an amphotericin product between November 2006 and December 2008. Doses of amphotericin, serum phosphorous, calcium and creatinine concentrations were recorded at daily time points during the 10 days following both …

Pharmacotherapy And Pregnancy: Highlights From The Third International Conference For Individualized Pharmacotherapy In Pregnancy, David M. Haas, Beverly Gallauresi, Kristine Shields, Deborah S. Zeitlin, Shannon M. Clark, Mary F. Herbert, Zhaoxia Ren, Srikanth C. Nallani, Eric M. Meslin, Karen B. Feibus, Gideon Koren, W. Scott Goebel, Thomas Easterling, Scott C. Denne, David A. Flockhart, Jamie L. Renbarger

Scholarship and Professional Work – COPHS

To address provider struggles to provide evidence-based, rational drug therapy to pregnant women, this third Conference was convened to highlight the current progress and research in the field. Speakers from academic centers, industry, and governmental institutions spoke about: the Food and Drug Administration’s role in pregnancy pharmacology and the new labeling initiative; drug registries in pregnancy; the pharmacist’s role in medication use in pregnancy; therapeutic areas such as preterm labor, gestational diabetes, nausea and vomiting in pregnancy, and hypertension; breast-feeding and medications; ethical challenges for consent in pregnancy drug studies; the potential for cord blood banks; and concerns about the …

Self-Assessed Proficiency And Application Of Various Skills Learned During Postgraduate Pharmacy Teaching Skills Development Programs, Anna Ratka, Paul O. Gubbins, Carol A. Motycka, Jane M. Gervasio, Mark S. Johnson, Ron W. Maddox

Scholarship and Professional Work – COPHS

The purpose of this study was to identify teaching skills commonly taught during the postgraduate pharmacy teaching skills development programs, to describe trainees' perceived teaching proficiency, and the extent to which the learned teaching skills are applied in trainees' current positions. An online survey was developed for pharmacists who completed postgraduate teaching skills development programs. The survey included demographic and program queries as well as questions on 23 teaching skills. Participants self-assessed their proficiency in and application of their learned teaching skills. The online survey resulted in 122 qualified responses. After training, the perceived proficiency in nearly all 23 teaching …

Evaluation Of Enteral Feeding Success In Head Injured Patients Placed In Pentobarbital Induced Comas, Jane M. Gervasio, Jonathan Egel, Joshua Mcgehee, Gabriel Drew Stillabower, Nicole Ponton, Lawrence Bortenschlager, Timothy Pohlman

Scholarship and Professional Work – COPHS

Abstract of Distinction from Clinical Nutrition Week, Las Vegas, NV, February 8-10, 2010.

A Comparison Of Efficacy Of Heparin 0.5 Unit/Ml Versus Heparin 1 Unit/Ml In Parenteral Nutrition Administrated In The Neonatal Population, Jane M. Gervasio, Meredith Mckinney, Iftekar Kalsekar, Elaina Szeszycki

Scholarship and Professional Work – COPHS

Abstract from Clinical Nutrition Week, Las Vegas, NV, February 8-10, 2010.

Evaluating The Duration Of Post-Operative Cefuroxime Prophylaxis On Infectious Outcomes In Pediatric Cardiovascular Surgery Patients., Chad A. Knoderer, Michelle D. Berg, Andrea H. Webster, Elaine G. Cox

Scholarship and Professional Work – COPHS

Abstract of poster presented at: Pediatric Academic Societies Annual Meeting; May 2010; Vancouver, British Columbia.

Aspirin Dosing For The Prevention And Treatment Of Ischemic Stroke: An Indication-Specific Review Of The Literature, Alexander J. Ansara, Sarah A. Nisly, Sally A, Arif, Julia M. Koehler, Sarah T, Nordmeyer

Scholarship and Professional Work – COPHS

OBJECTIVE: To evaluate the efficacy of aspirin for the treatment and prevention of ischemic stroke and identify the minimum dose proven to be effective for each indication.

DATA SOURCES: PubMed and MEDLINE searches (January 2009–January 2010) were performed to identify primary literature, using search terms including aspirin, stroke prevention, acute ischemic stroke, acetylsalicylic acid, atrial fibrillation, myocardial infarction, and carotid endarterectomy. Additionally, reference citations from publications identified were reviewed.

STUDY SELECTION AND DATA EXTRACTION: Articles published in English were evaluated and relevant primary literature evaluating the efficacy of aspirin in the prevention of stroke was included in …

Pharmacokinetics Of Cefuroxime Are Not Significantly Altered By Cardiopulmonary Bypass In Children, Chad A. Knoderer, Sarah A. Saft, Scott G. Walker, Daniel P. Healy, Kevin M. Sowinski

Scholarship and Professional Work – COPHS

Poster presented at: SPA/AAP PEDIATRIC ANESTHESIOLOGY 2010 - Winter Meeting; April 2010; San Antonio, TX.

Continuous Infusion Of Nafcillin For Sternal Osteomyelitis In An Infant After Cardiac Surgery, Chad A. Knoderer, Jennifer L. Morris, Elaine G. Cox

Scholarship and Professional Work – COPHS

We report the use of the continuous infusion of nafcillin for the treatment of an infant who had methicillinsusceptible Staphylococcus aureus sternal osteomyelitis not responsive to traditional nafcillin dosing. The patient was successfully treated with surgical debridement and the continuous infusion of nafcillin. To our knowledge, this is the first report describing the successful use of the continuous infusion of nafcillin to treat an infant who had sternal osteomyelitis after cardiac surgery.

The Impact Of An Immunization Training Certificate Program On The Perceived Knowledge, Skills And Attitudes Of Pharmacy Students Toward Pharmacy-Based Immunizations, Zachary A. Marcum, Carrie M. Maffeo, Iftekhar Kalsekar

Scholarship and Professional Work – COPHS

Objective: To assess the impact of a national immunization training certificate program on the perceived knowledge, skills and attitudes of pharmacy students toward pharmacy-based immunizations.

Methods: The study design utilized a pre- and post- survey administered to pharmacy students before and after the American Pharmacists Association’s (APhA) Pharmacy-Based Immunization Delivery program. The primary outcome explored was a change in the perceived knowledge, skills, and attitudes of the pharmacy students. A five-point Likert scale (i.e. strongly agree = 5, strongly disagree = 1) was used for measuring the main outcomes, which was summated by adding the individual item scores in each …

Functional Interplay Between Chromatin Remodeling Complexes Rsc, Swi/Snf And Iswi In Regulation Of Yeast Heat Shock Genes, Tamara Y. Erkina, Y. Zou, S. Freeling, V. I. Vorobyev, Alexander M. Erkine

Scholarship and Professional Work – COPHS

Chromatin remodeling is an essential part of transcription initiation. We show that at heat shock gene promoters functional interactions between individual ATP-dependent chromatin remodeling complexes play critical role in both nucleosome displacement and Pol II recruitment. Using HSP12, HSP82 and SSA4 gene promoters as reporters, we demonstrated that while inactivation of SNF2, a critical ATPase of the SWI/SNF complex, primarily affects the HSP12 promoter, depletion of STH1- a SNF2 homolog from the RSC complex reduces histone displacement and abolishes the Pol II recruitment at all three promoters. From these results, we conclude that redundancy between SWI/SNF and RSC complexes …

Medication Use In Pregnant Women With Chronic Medical Conditions, Deborah S. Zeitlin

Scholarship and Professional Work – COPHS

Dr. Deborah Zeitlin addresses medication options for pregnant women with chronic conditions such as: hypertension, asthma, diabetes, and depression. Risks of medication use to the fetus are addressed.

Mandatory Pharmacy Residencies: One Way To Reduce Medication Errors, Rami B. Ibrahim, Lilian Baghat-Ibrahim, David J. Reeves

Scholarship and Professional Work – COPHS

We read with disbelief about a newly graduated pharmacist dispensing 30 times the amount of injectable sodium bicarbonate intended, an error that led to a patient’s death.1 As clinicians, we wondered what clinical scenario might mandate the large amount of sodium bicarbonate dispensed—the answer was none. So why did the pharmacist dispense it? The answer is all too clear: With rare exceptions, institutional pharmacists nationwide are largely focused on dispensing. Postgraduate clinical training in the basic aspects of pharmacotherapy is scarce and not viewed as essential. Inadequate pharmacist training and a staffing shortage were suggested as contributing to the …

Role Of Intrathecal Rituximab And Trastuzumab In The Management Of Leptomeningeal Carcinomatosis, Anthony J. Perissinotti, David J. Reeves

Scholarship and Professional Work – COPHS

OBJECTIVE: To review evidence for the use of intrathecal rituximab and trastuzumab in the management of leptomeningeal carcinomatosis.

DATA SOURCES: A search of MEDLINE (1966-July 2010) and International Pharmaceutical Abstracts (1970-July 2010) was performed using search terms intrathecal, trastuzumab, rituximab, and monoclonal antibody. Additionally, American Society of Clinical Oncology, San Antonio Breast Conference, American Association for Cancer Research, and American Society of Hematology meeting abstracts were searched.

STUDY SELECTION AND DATA EXTRACTION: Publications were reviewed for inclusion. Those reporting use of rituximab and trastuzumab intrathecally are reviewed and include 1 Phase 1 trial, 2 small prospective studies, 1 case series, …

Evaluation Of Pharmacy-Implemented Medication Reconciliation Directed At Antiretroviral Therapy In Hospitalized Hiv/Aids Patients [Letter], Megan A. Corrigan, Kendra Atkinson, Beverly E. Sha, Christopher W. Crank

Scholarship and Professional Work – COPHS

Short communications published in Annals of Pharmacotherapy, 44(1).

Nutrition Support Therapy In Acute Kidney Injury: Distinguishing Dogma From Good Practice, Jane M. Gervasio, Ann B. Cotton

Scholarship and Professional Work – COPHS

Acute kidney injury (AKI) is a frequently observed complication in critically ill patients. Its presentation may range from the early risk of renal dysfunction to complete renal failure. Morbidity and mortality in the AKI patient increase with the decline of renal function. Appropriate nutrition therapy is essential in the medical management of the AKI patient. Assessment of nutritional requirements should take into account the patient’s underlying complication, comorbid medical conditions, and severity of the renal dysfunction. Various stages of AKI determine the direction of nutrition therapy. Additionally, understanding the macro- and micronutrient modifications and electrolyte and vitamin alterations that should …

Enhanced Student Learning And Public Health Awareness Through Capstone Projects, Jane M. Gervasio, Carriann E. Richey, Bruce G. Hancock, Iftekhar Kalsekar, Julie M. Koehler, Mary H. Andritz

Scholarship and Professional Work – COPHS

Abstract from the 110th Annual Meeting of the American Association of Colleges of Pharmacy, Boston, MA, July 18-22, 2009.

Sildenafil For The Treatment Of Pulmonary Hypertension In Pediatric Patients, Alice J. Huddleston, Chad A. Knoderer, Jennifer L. Morris, Eric S. Ebenroth

Scholarship and Professional Work – COPHS

Sildenafil is a phosphodiesterase 5 inhibitor widely used for the treatment of pulmonary hypertension in children. Despite limited available safety and efficacy evidence, use of sildenafil continues to increase. To date, sildenafil use for pediatric pulmonary hypertension has been characterized for 193 children through 16 studies and 28 case series and reports. The primary efficacy data suggest that sildenafil is beneficial for facilitating the weaning of inhaled nitric oxide in children after cardiac surgery. Compiled safety data suggest that sildenafil is well tolerated among children with idiopathic pulmonary arterial hypertension and pulmonary arterial hypertension associated with congenital heart disease. This …

Administrators’ Perceptions Of Medication Management In Assisted Living Facilities: Results From Focus Groups, Priscilla T. Ryder, Melanie Joseph, Marnie Zuckermann, Ilene H. Zuckermann

Scholarship and Professional Work – COPHS

Objective: Assisted living (AL) residents are vulnerable to adverse events as a result of using numerous medications and frequently need assistance in administering medications. Very little is known, however, about the ways in which medications are managed within this level of care. Design: AL administrators from the metropolitan Baltimore, Maryland area were invited to participate in focus groups to explore issues involved in medication management.

Setting and Participants: Four administrators from smaller (15 beds or fewer) and six larger (more than 15 beds) certified AL facilities serving primarily older residents participated. Administrators must have served in their position at least …

Association Of Antipsychotic Use With Hospital Events And Mortality Among Medicare Beneficiaries Residing In Long-Term Care Facilities, Linda Simoni-Wastila, Priscilla T. Ryder, Jingjing Qian, Ilene H. Zuckermann, Thomas Shaffer, Lirong Zhao

Scholarship and Professional Work – COPHS

Objective—Antipsychotic (AP) utilization has grown significantly in long-term care (LTC) settings. Although a growing literature associates AP use with higher mortality in elderly with dementia, the association of APs with hospital events is unclear. The authors examine prevalence and trends in AP use by Medicare beneficiaries residing in LTC and the association of APs and other drug use variables with hospital events and mortality.

Design—Retrospective analysis using sequential multivariate Cox proportional hazards models.

Setting—Medicare Current Beneficiary Survey linked to Institutional Drug Administration and Minimum Data Set files.

Participants—A total of 2,363 LTC Medicare beneficiaries, 1999–2002. Measurements—Trends in LTC AP use …