Medical Pharmacology Commons^™

The Effect Of Snris On Pilot Reaction Time In Simulated Flight, Isabella Owen, Aidan Roach, Micah Henry, Casey Tressler

Discovery Day - Daytona Beach

Many aviators who are prescribed serotonin and norepinephrine reuptake inhibitors (SNRI) or selective serotonin reuptake inhibitors (SSRI) to treat mental health disorders such as major depressive disorder, general anxiety disorder, or post-traumatic stress disorder must halt their duties for a set amount of time. This is due to aviation authorities having data that suggests SNRIs and SSRIs lead to inhibitions in mental processes that can cause crashes or death. Most of the research that has been conducted examined the effects of SSRIs on individuals without mental health disorders in non-flight settings. This study will explore the effect SNRIs have on …

Quality Improvement Initiative To Improve Adherence To Ob Hemorrhage Policy And Standardize Pitocin Administration During Cesarean Sections To Reduce Postpartum Hemorrhage Risk, Lauren R. Litz, Monica Blauser

Doctor of Nurse Anesthesia Practice (DNAP) Manuscripts

Postpartum hemorrhage remains a leading cause of maternal morbidity and mortality, and Pitocin administration is an important component of hemorrhage prevention and management during cesarean delivery. Variation in Pitocin timing, dosing, method of administration, and adherence to evidence-based recommendations may compromise patient safety and create barriers to standardized obstetric anesthesia care. The purpose of this Doctorate of Nurse Anesthesia Practice quality improvement project was to evaluate current anesthesia provider practices for Pitocin administration during cesarean delivery, compare observed practices with the California Maternal Quality Care Collaborative hemorrhage toolkit and Society for Obstetric Anesthesia and Perinatology Enhanced Recovery After Cesarean recommendations, …

Kras-Independent Factors Drive Pi3k Signaling And Circumvent The Necessity Of Kras-Driven Pi3k Activation In Pdac, Lucas Christopher Bialousow

MUSC Theses and Dissertations

Pancreatic ductal adenocarcinoma (PDAC) has one of the lowest five-year survival rates among cancers and is characterized by near-ubiquitous occurrence of oncogenic KRAS mutations. Oncogenic KRAS activates several downstream pathways, including ERK 1/2 MAPK and PI3K, which are critical for PDAC. However, accumulating evidence suggests that PI3K activity can be maintained independent of oncogenic KRAS. The high prevalence of KRAS^G12R in PDAC challenges the prevailing model of KRAS-driven PI3K activation, as this mutant is defective in direct engagement with PI3Kα. These observations raise important questions regarding how PI3K signaling is sustained in PDAC. Here, we investigated KRAS-independent mechanisms that …

Fluoroquinolone Use And Risk Of Pneumothorax In Adults Hospitalized With Community Acquired Pneumonia: A Retrospective Cohort Study, Steven Yi B. S., Saurav Sumughan B.S., Jessica Cobb M. D., Erika J. Yoo

Department of Medicine Faculty Papers

Objectives: The objective of this study is to examine the relationship between fluoroquinolone exposure and pneumothorax risk in patients hospitalized with pneumonia.

Methods: This retrospective cohort study used the TriNetX US Collaborative Network. We defined two mutually exclusive cohorts of hospitalized adults based on exposure to antibiotic classes commonly used to treat community acquired pneumonia: fluoroquinolone (ciprofloxacin, moxifloxacin, levofloxacin, and ofloxacin) versus nonfluoroquinolone (amoxicillin, azithromycin, ceftriaxone, and doxycycline). Patients with connective tissue disorders were excluded. The primary outcome was the occurrence of pneumothorax within 60 days. We used Cox proportional hazards regression to estimate hazard ratios (HRs) adjusted for demographics, …

Evaluating The Market Withdrawal Of Andexanet Alfa, Jordyn Linfield, Addisyn Cooper, Alexander Defranco, Emma Gerding, Jessica Kelley, Tyler Henney, Connor Dains, Brenna Hissong, Brittany Bates

Pharmacy and Wellness Review

The coagulation cascade comprises intrinsic, extrinsic, and common pathways that converge when thrombin converts fibrinogen (factor I) into fibrin, leading to fibrin mesh formation, stabilization of the platelet plug, and ultimately thrombus formation. Inhibition of the coagulation cascade can be achieved with a variety of anticoagulant medications, including direct oral anticoagulants (DOACs). The mechanism of action of DOACs is to inhibit either factor Xa or thrombin. Reversal of anticoagulation remains an important clinical consideration when managing patients on DOACs who experience serious bleeding events. Andexanet alfa is a recombinant, modified human factor Xa protein previously indicated for patients receiving rivaroxaban …

Fda Approval Of Etripamil For The Treatment Of Paroxysmal Supraventricular Tachycardia, Kiley Devoll, Daniella Egbujor, Katy Grainger, Katherine Cook, Victoria Niese, Connor Dains, Brenna Hissong, Andrew Roecker

Pharmacy and Wellness Review

Paroxysmal supraventricular tachycardia (PSVT) is characterized by sudden, brief, intermittent episodes that result in a heart rate of 150 to 250 beats per minute (bpm). PSVT is difficult to diagnose, making proper treatment challenging. According to the 2015 American Heart Association (AHA)/American College of Cardiology (ACC)/Heart Rhythm Society (HRS) guidelines, current pharmacologic recommendations for PSVT include adenosine, verapamil, diltiazem, or nonpharmacologic vagal maneuvers.¹ These treatments each have a variety of adverse effects, contraindications, and dosing considerations, which highlight a need for novel therapies for the acute treatment and maintenance of PSVT.¹ The NODE-301 trial assessed the safety and …

Rocatinlimab As A Novel Treatment Strategy For Atopic Dermatitis, Haylee Whyde, Evan Blazek, Macy Davis, Parker George, Alex Lowery, Connor Dains, Brenna Hissong, David Koh

Pharmacy and Wellness Review

Atopic dermatitis is a common chronic inflammatory skin disease that affects millions of children and adults in the United States. Atopic dermatitis is characterized by recurrent pruritus, erythema, and relapsing symptoms that can significantly impair quality of life. The pathophysiology of atopic dermatitis involves epidermal barrier dysfunction, immune dysregulation, and genetic susceptibility. Atopic dermatitis guidelines follow a stepwise approach that begins with a severity assessment, trigger avoidance, and nonpharmacologic and pharmacologic treatments. First-line therapies include topical corticosteroids (TCSs), topical calcineurin inhibitors (TCIs), and emollients. Crisaborole and topical ruxolitinib are used for mild-to-moderate disease when prior therapy has been inadequate. Monoclonal …

Fda Approval Of Tradipitant: A Novel Approach To Motion Sickness Treatment, Haley Brown, Jennifer Cao, Allie Honigford, Leah Heitkamp, Sarah Hiett, Connor Dains, Brenna Hissong, Manoranjan D'Souza

Pharmacy and Wellness Review

Motion sickness is a prevalent neurophysiological condition affecting approximately one-third of the worldwide population, resulting from sensory mismatch and the brain’s internal model of motion. It is characterized by nausea, vomiting, dizziness, and autonomic symptoms during exposure to actual or virtual motion, which may significantly impair daily functioning and quality of life. Current guidelines recommend the prevention and treatment of motion sickness through pharmacologic, herbal, and non-pharmacologic strategies. Scopolamine and first-generation antihistamines are effective pharmacologic options, while ginger has demonstrated some benefit in reducing symptoms as an herbal option. Non-pharmacologic interventions such as habituation training, behavioral techniques, and sensory strategies …

Quality Improvement (Qi) Project Aimed At Reducing Unnecessary Antibiotic Usage Among Older Adult Patients By Addressing Inappropriate Antibiotic Prescribing In Primary And Long-Term Care Settings, Pamela M. Thomas

Seton Hall University Dissertations and Theses (ETDs)

Antibiotic overuse among older adults remains a significant patient safety and public health concern. Recent national data indicate that approximately 30%–50% of outpatient antibiotic prescriptions may be unnecessary, particularly for viral or self-limiting conditions (Chua et al., 2021). Antimicrobial resistance has been associated with more than 1.27 million deaths globally (Murray et al., 2022). This quality improvement project evaluated a multifaceted antimicrobial stewardship intervention in primary and long-term care settings. Baseline review of 167 antibiotic cases revealed 37.1% were inappropriate or questionable, and 28.7% lacked adequate diagnostic documentation. The intervention incorporated provider education, electronic health record decision-support tools, audit and …

Anticholinergic Toxicity Presenting As Acute Stroke Mimic: A Case Report, Dean Austin Esma, Kelsey Murray, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Anticholinergic toxicity classically presents with a constellation of peripheral and central symptoms including tachycardia, mydriasis, dry skin, urinary retention, and altered mental status. However, central anticholinergic effects can predominate, presenting as isolated delirium without peripheral manifestations. This report presents a case of a 57-year-old woman who developed acute altered mental status and aphasia following cumulative anticholinergic exposure from over-the-counter cold medications, initially triggering a stroke alert

Irritability And Related Behavioral Adverse Events Associated With Levetiracetam: A Meta‑Analysis And Meta‑Regression Of Randomized Trials, Ana Leticia Fornari Caprara Md, Daarsh Goradia, Nishant Patel, Jarvish Shah, Pranaya Gade, Jamir Pitton Rissardo Md

Rowan-Virtua Research Day

Background: Levetiracetam is commonly used in epilepsy management but has been associated with irritability‑predominant aggressive behavioral adverse events, including irritability and aggression. Reported risks vary across trials, and the influence of comparator type and outcome definition remains unclear. We aimed to estimate the risk of irritability‑related aggressive behavioral adverse events associated with levetiracetam and to assess whether outcome definition or comparator subgroup modifies this risk. Methods: We searched ClinicalTrials.gov for interventional trials with posted results involving levetiracetam. Studies reporting irritability, aggression, agitation, or related irritability‑driven behaviors in comparisons with placebo or another antiseizure medication were included. Random‑effects Mantel–Haenszel meta‑analyses were …

Efficacy And Safety Of Levetiracetam For Essential Tremor: A Systematic Review And Meta‑Analysis, Jamir Pitton Rissardo, Daarsh Goradia, Nishant Patel, Jarvish Shah, Pranaya Gade, Ana Leticia Fornari Caprara Md

Rowan-Virtua Research Day

Background: Essential tremor (ET) is a common movement disorder with limited therapeutic options. Levetiracetam has been proposed as a potential treatment, but published studies report inconsistent efficacy and safety findings. We performed a meta‑analysis to quantify the efficacy and safety of levetiracetam in patients with essential tremor using pooled effect estimates. Methods: A systematic review of PubMed was performed to identify clinical studies evaluating levetiracetam for ET. Continuous efficacy outcomes were pooled using standardized mean differences (SMD) with inverse‑variance random‑effects models. Binary adverse events were pooled using risk ratios (RR) with Mantel–Haenszel random‑effects models. Heterogeneity was assessed using I2 statistics. …

Efficacy And Safety Of Droxidopa For Neurogenic Orthostatic Hypotension: A Systematic Review And Meta‑Analysis, Jamir Pitton Rissardo, Jarvish Shah, Nishant Patel, Daarsh Goradia, Pranaya Gade, Ana Leticia Fornari Caprara Md

Rowan-Virtua Research Day

Neurogenic orthostatic hypotension (nOH) causes disabling symptoms such as dizziness, impaired daily activities, and increased fall risk. Droxidopa is approved for symptomatic treatment, but individual trials have reported heterogeneous results across outcomes and populations. We aim to evaluate the efficacy of droxidopa on symptoms, functional impact, blood pressure, and safety outcomes in patients with nOH. Methods: We conducted a systematic review and meta‑analysis of randomized controlled trials comparing droxidopa with placebo in nOH. Continuous outcomes were pooled using random‑effects models with standardized mean difference (SMD) for symptom scales and mean difference (MD) for standing systolic blood pressure (SBP). Binary outcomes …

The Complex World Of Emergency Department Medication Dosing: Weight Scalars, Dose And Area Under The Curve (Auc) In Medication Dosing--Areas For Future Research, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Weight-based dosing is foundational to emergency medicine practice. With modern ED beds capable of automatic patient weighing, inaccuracies in estimated weight have largely diminished. However, medication misalignment persists, particularly in patients at extremes of body weight and in high-stakes clinical contexts such as rapid sequence intubation (RSI), antimicrobial therapy, and anticoagulation. Emerging pharmacokinetic literature emphasizes total drug exposure—represented by the area under the concentration–time curve (AUC)—as a stronger correlate of efficacy and toxicity than single-point serum levels. This review explores where weight precision most likely matters in the ED, examines weight scalars, and reframes dosing decisions through an exposure-centered paradigm. …

Dexmedetomidine And The Prevention Of Emergence Agitation In Military Veterans With Post-Traumatic Stress Disorder, Taylor P. Ranegar

Doctor of Nursing Practice Scholarly Projects

Emergence agitation (EA) is a post-anesthetic complication that occurs when the patient is in a self-limited, nonfluctuating state of excitement while transitioning into a state of consciousness. EA can lead to negative adverse outcomes including, accidental invasive line removal, bleeding, respiratory depression, unintentional extubation, and injury to the staff and the patient. EA is often observed in military veterans who have a medical history of post-traumatic stress disorder (PTSD). For patients with a history of military exposure undergoing elective general anesthesia who also have PTSD, anxiety, and or depression, the incidence of EA was estimated to be around 27%. The …

From Confidence To Competence: Embedding Critical Genai Literacy In Physician Associate Education, Chanceeth Chandrakanthan, Amy H. Donaldson-Perrott Mrs, Jane Secker, Julie Voce, Tamara S. Ritsema

Journal Of Indian Physician Associates

Background: Generative artificial intelligence is now embedded in how many healthcare students learn. Tools provide rapid explanations, summaries and practice questions, but use does not equal AI literacy, particularly where accuracy, medicines safety and guideline alignment matter.

Objective: To describe current use of generative AI by Physician Associate students and outline a practical approach to teaching critical AI literacy.

Methods: Educational evaluation using three activities: (1) baseline survey of students about use and attitudes, (2) an embedded compare and critique session in applied pharmacology where small groups assessed AI answers against trusted UK sources, including BNF and NICE guidance, followed …

The Impact Of Glucose Exposure On Organic Cation Transporters (Oct) Function In A Corneal Epithelial Cell Line, David A. Garza

Theses & Dissertations

Organic cation transporters (OCT) facilitate the movement of neurochemicals and medications, contribute to the removal of cellular waste, and facilitate neuronal communication. Three subtypes of these high-capacity, low-affinity transporters (OCT1, OCT2, and OCT3) are differently expressed in peripheral tissues such as the liver, kidneys, as well as the central nervous system. OCTs are also expressed in ocular tissues. Chronic hyperglycemia is a complication commonly associated with diabetes that can lead to ocular diseases such as diabetic keratopathy, which affects the cornea. In this project, we expose immortalized human corneal epithelial cells (HCE-S) to various glucose concentrations to study their impact …

Comparative Analysis Of The Quality Of Life Of Schizophrenic Patients On Antipsychotic Treatment Between Aripiprazole Monotherapy And Combination Of Risperidone-Clozapine At Mental Hospital In West Java, Taufiqurahman Taufiqurahman, Sani Asmi Ramdani Lestari, Ardilla Kemala Dewi

Pharmacology and Clinical Pharmacy Research

Quality of life (QoL) is a critical outcome measure in schizophrenia management, yet antipsychotic side effects may negatively impact patients' well-being. Objective: This study aimed to compare the QoL of schizophrenia patients receiving aripiprazole monotherapy versus a risperidone-clozapine combination at West Java Mental Hospital. An analytical observational study with a cross-sectional design was conducted at the outpatient clinic of West Java Mental Hospital from March to May 2025. The Indonesian version of the WHOQOL-BREF questionnaire was used to assess QoL. A total of 58 outpatients with schizophrenia who met the inclusion criteria were enrolled, comprising 28 patients in the aripiprazole …

Balanced Scorecard In Healthcare Facilities: A Ten-Year Review Of Strategies To Improve Organizational Effectiveness, Larasati Tunggadewi, Sofa Dewi Alfian, Auliya A Suwantika

Pharmacology and Clinical Pharmacy Research

The Balanced Scorecard (BSC) has increasingly been adopted as a strategic performance management framework within healthcare organizations. Evidence from the past decade shows varied implementation outcomes, shaped by institutional readiness, leadership commitment, and the maturity of health information systems. This narrative review synthesizes findings from 47 scientific articles selected through a systematic screening process, covering studies conducted in hospitals, primary health centers, and pharmacy units in Indonesia, Morocco, Iran, China, and other countries. The studies employed case study and descriptive cross-sectional designs using both quantitative and qualitative approaches. Overall, BSC implementation contributed to improvements in service performance across the financial, …

Adherence To Malaria Treatment And Its Associated Factors: A Narrative Review, Lafie Urwatul Wutsqo, Eli Halimah, Sofa Dewi Alfian

Pharmacology and Clinical Pharmacy Research

Malaria is an infectious disease that remains a global health concern, particularly in Asia and Africa. The success of malaria medication largely depends on patients' adherence to the prescribed therapeutic regimen. This article aims to identify the level of adherence to malaria treatment and the factors that influence it, based on observational studies. A narrative review was conducted using the PRISMA approach, involving 12 articles published between 2019 - 2023 from various countries. The results indicate that adherence levels vary widely, ranging from 15.6% to 93.31%, depending on respondent characteristics and the intervention strategies implemented. Factors influencing adherence include patient-related …