Pharmacy and Pharmaceutical Sciences Commons^™

Increasing Bedside Medication Safety In An Intensive Care Setting, Natasha Stankiewicz, Jonathan Archibald, Scu 2, Mark Parker, Stephen Tyzik, Suneela Nayak, Ruth Hanselman, Amy Sparks

Operations Transformation

A PERFORMANCE IMPROVEMENT PROJECT FOR INCREASED BEDSIDE MEDICATION SAFETY

The convenience of having certain medications directly available at bedside has long been a priority for a medical intensive care nursing team in an academic tertiary medical center.

However, it was apparent to new staff and leadership that there was a lack of awareness and interest in securing medications within the department. This posed a risk to patients, families, visitors and colleagues.

Baseline metrics on patient safety were collected and a root cause analysis was conducted. Countermeasures included increased education of medication safety as well as a instituting a KPI which …

Evaluation Of Processes And Procedures For Care Of The Opioid Recipient Patient In The Primary Care Setting, Anne Sproat

Doctoral Projects

Introduction: Chronic non-cancer pain is far reaching, affecting over 100 million Americans (Zgierska et al., 2018). Opioids are commonly prescribed for chronic pain, with approximately 20% of patients presenting to primary care offices with symptoms of pain or pain-related diagnoses (Dowell, Haegerich, & Chou, 2016). As a result, opioid prescribing rates are increasing at a faster rate for primary care practice compared with other specialties (Dowell et al., 2016). Within the United States population, it is estimated that three percent to four percent of the adult population are prescribed long-term opioids for the treatment of chronic non-cancer pain (Dowell et …

The Role Of Cdk8 In Metastatic Growth Of Colon Cancer, Jiaxin Liang

Theses and Dissertations

Unresectable hepatic metastases of colon cancer poorly respond to existing therapies and are a major cause of colon cancer lethality. Transcription- regulating Mediator kinase CDK8, an early clinical stage drug target, is amplified or overexpressed in many colon cancers and CDK8 expression correlates with shorter patient survival. Here we show that CDK8 inhibition does not generally suppress proliferation of CDK8-overexpressing colon cancer cells but nevertheless CDK8 knockdown by shRNA or CDK8 kinase inhibition by a selective small-molecule drug candidate suppresses metastatic growth of mouse and human colon cancer cells in the liver. This effect is due at least in part …

Structure-Activity Profiling Of Alkaloid Natural Product Pharmacophores Against A Schistosoma Serotonin Receptor, Jonathan S. Marchant, Wayne W. Harding, John D. Chan

Publications and Research

Serotonin (5-HT) is an important regulator of numerous aspects of flatworm biology, ranging from neuromuscularfunctionto sexualmaturationandegglaying. Intheparasiticblood flukeSchistosomamansoni,5-HTtargets several G-protein coupled receptors (GPCRs), one of which has been demonstrated to couple to cAMP and regulate parasite movement. This receptor, Sm.5HTRL, has been successfully co-expressed in mammalian cells alongside a luminescent cAMP-biosensor, enabling pharmacological profiling for candidate anti-schistosomal drugs. Here, we have utilized this assay to perform structure-activity investigations of 143 compounds containing previously identified alkaloid natural product pharmacophores (tryptamines, aporphines and protoberberines) shown to regulate Sm.5HTRL. These experiments mapped regions of the tryptamine pharmacophore amenable and intolerant to substitution, highlighting …

Epidemiology Of Diabetic Foot Infection In The Metro-Detroit Area With A Focus On Independent Predictors For Pathogens Resistant To Recommended Empiric Antimicrobial Therapy, Oryan Henig, Jason M. Pogue, Raymond Cha, Paul E. Kilgore, Umar Hayat, Mahmoud Ja'ara, Raza Muhamad Ali, Salman Mahboob, Rahul Pansare, Kathryn Deeds, Bushra Joarder, Hyndavi Kandala, Sorabh Dhar, Keith S. Kaye

Department of Pharmacy Practice

Background. The polymicrobial nature of diabetic foot infection (DFI) and the emergence of antimicrobial resistance have complicated DFI treatment. Current treatment guidelines for deep DFI recommend coverage of methicillin-resistant Staphylococcus aureus (MRSA) and susceptible Enterobacteriaceae. This study aimed to describe the epidemiology of DFI and to identify predictors for DFI associated with multidrug-resistant organisms (MDROs) and pathogens resistant to recommended treatment (PRRT).

Methods. Adult patients admitted to Detroit Medical Center from January 2012 to December 2015 with DFI and positive cultures were included. Demographics, comorbidities, microbiological history, sepsis severity, and antimicrobial use within 3 months before DFI were obtained …

Pediatric Obesity: Influence On Drug Dosing And Therapeutics, Barbara Ameer Pharmd, Mba, Bcps, Fcp, Michael Weintraub Md

Department of Medicine Faculty Papers

Obesity is an ongoing global health concern and has only recently been recognized as a chronic disease of energy homeostasis and fuel partitioning. Obesity afflicts 17% of US children and adolescents. Severe obesity (³120% of the 95^th percentile of BMI-for-age, or a BMI of ³35 kg/m²) is the fastest growing subgroup and now approaches 6% of all US youth. Health consequences (e.g., type 2 diabetes, coronary heart disease) are related in a dose-dependent manner to severity of obesity. Since therapeutic interventions are less effective in severe obesity, prevention is a high priority.

Treatment plans involving combinations of …

Stability And Compatibility Of Diphenhydramine Hydrochloride In Intravenous Admixtures: A New Look At An Old Drug, Daniel Sabins, Tuong Diep, Pamela Mccartan, Shashi Patel, Fang Zhao

Doctoral External Publications

Purpose: Intravenous (IV) admixtures of diphenhydramine are widely used in hospitalized patients to prevent or treat hypersensitivity reactions. However, there is limited data to support the admixture preparation in this manner. This study was designed to investigate the stability and compatibility of diphenhydramine in IV admixtures with a goal to establish a 14-day beyond-use dating with storage under refrigeration. Methods: The commercially available 50 mg/mL diphenhydramine hydrochloride injection vials were used to prepare the 0.2 and 1.0 mg/mL IV admixtures in 0.9% sodium chloride injection and 5% dextrose injection in 50 mL polyvinyl chloride (PVC) bags. The IV bags were …

Formulation, Characterization And Evaluation Of Morusin Loaded Niosomes For Potentiation Of Anticancer Therapy, Srishti Agarwal, M. Sheikh Mohamed, Sreejith Raveendran, Ankit K. Rochani, Toru Maekawa, D. Sakthi Kumar

College of Pharmacy Faculty Papers

Morusin, a water-insoluble prenylated flavonoid is known for its numerous medicinal properties. It manifests its anticancer potential by suppression of genes involved in tumor progression. However, poor solubility of the drug results in low bioavailability and rapid degradation thus hindering its clinical utilization. In order to overcome this, we have synthesized a niosome system composed of non-ionic surfactant span 60 and cholesterol using a thin-layer evaporation technique to improve the aqueous-phase solubility of the drug. Highly cytocompatible niosomes of 479 nm average size with smooth and uniform spherical morphology were synthesized in a facile manner. Unlike free morusin, nanomorusin was …

Gaw20: Methods And Strategies For The New Frontiers Of Epigenetics And Pharmacogenomics, Nathan L. Tintle, David W. Fardo, Marzia De Andrade, Stella Aslibekyan, Julia N. Bailey, Justo Lorenzo Bermejo, Rita M. Cantor, Saurabh Ghosh, Philip Melton, Xuexua Wang, Jean W. Maccluer, Laura Almasy

Biostatistics Faculty Publications

GAW20 provided a platform for developing and evaluating statistical methods to analyze human lipid-related phenotypes, DNA methylation, and single-nucleotide markers in a study involving a pharmaceutical intervention. In this article, we present an overview of the data sets and the contributions analyzing these data. The data, donated by the Genetics of Lipid Lowering Drugs and Diet Network (GOLDN) investigators, included data from 188 families (N = 1105) which included genome-wide DNA methylation data before and after a 3-week treatment with fenofibrate, single-nucleotide polymorphisms, metabolic syndrome components before and after treatment, and a variety of covariates. The contributions from individual …

Methods For Treating Neuropathic Pain, Joseph R. Holtman, Peter Anthony Crooks, Linda Phyliss Dwoskin, Michael J. Mcintosh, Elzbieta Pogonowska Wala

Pharmaceutical Sciences Faculty Patents

Provided are methods for using bis-quaternary ammonium compounds to treat inflammatory pain, neuropathic pain and nociceptive pain.

Ubiquitin Receptor Rpn13 Mediates The Inhibitory Interaction Of Diphenyldihaloketones Clefma And Ef24 With The 26s Proteasome, Geeta Rao, Gregory Nkepang, Jian Xu, Hooman Yari, Hailey Houson, Chengwen Teng Pharm.D., Ph.D., Vibhudutta Awasthi

Faculty Publications

The proteasome is a validated target in drug discovery for diseases associated with unusual proteasomal activity. Here we report that two diphenyldihaloketones, CLEFMA and EF24, inhibit the peptidase activity of the 26S proteasome. The objective of this study was to investigate interaction of these compounds with the proteasome and identify a putative target within the protein components of the 26S proteasome. We employed standard fluorogenic peptide-based proteasome activity assay for trypsin-like, chymotrypsin-like, and caspase-like activities of human purified 26S proteasome in cell-free conditions. GFPu-1 and HUVEC cells were used as proteasome reporter cells. Direct binding studies used purified 19S, 20S, …

Brain Endothelial Erythrophagocytosis And Hemoglobin Transmigration Across Brain Endothelium: Implications For Pathogenesis Of Cerebral Microbleeds, Rudy Chang, Juan Castillo, Alexander C. Zambon, Tatiana B. Krasieva, Mark J. Fisher, Rachita K. Sumbria

Pharmacy Faculty Articles and Research

Peripheral endothelial cells are capable of erythrophagocytosis, but data on brain endothelial erythrophagocytosis are limited. We studied the relationship between brain endothelial erythrophagocytosis and cerebral microhemorrhage, the pathological substrate of MRI-demonstrable cerebral microbleeds. To demonstrate the erythrophagocytic capability of the brain endothelium, we studied the interactions between brain endothelial cells and red blood cells exposed to oxidative stress in vitro, and developed a new in vitro cerebral microbleeds model to study the subsequent passage of hemoglobin across the brain endothelial monolayer. Using multiple approaches, our results show marked brain endothelial erythrophagocytosis of red blood cells exposed to oxidative stress compared …

Interfering With Dna Decondensation As A Strategy Against Mycobacteria, Enzo M. Scutigliani, Edwin R. Scholl, Anita E. Grootemaat, Sadhana Khanal, Jakub A. Kochan, Przemek M. Krawczyk, Eric A. Reits, Atefeh Garzan, Huy X. Ngo, Keith D. Green, Sylvie Garneau-Tsodikova, Jan M. Ruijter, Henk A. Van Veen, Nicole N. Van Der Wel

Pharmaceutical Sciences Faculty Publications

Tuberculosis is once again a major global threat, leading to more than 1 million deaths each year. Treatment options for tuberculosis patients are limited, expensive and characterized by severe side effects, especially in the case of multidrug-resistant forms. Uncovering novel vulnerabilities of the pathogen is crucial to generate new therapeutic strategies. Using high resolution microscopy techniques, we discovered one such vulnerability of Mycobacterium tuberculosis. We demonstrate that the DNA of M. tuberculosis can condense under stressful conditions such as starvation and antibiotic treatment. The DNA condensation is reversible and specific for viable bacteria. Based on these observations, we hypothesized …

Epigenetic Biomarkers For Alzheimer’S Disease Using A Transgenic Porcine Model, Yoon Hee Cho

University Grant Program Reports

Alzheimer’s disease (AD) is the most common cause of dementia, accounting for approximately 60~70% of dementia cases. AD afflicts more than 35.6 million individuals worldwide and is expected to increase to 65.7 million by 2030 and 115.4 million by 2050 ¹; AD is a serious public health problem that is causing increased health care costs worldwide. Typically, AD is a relentlessly progressive disorder that initially manifests as severe loss of memory, particularly episodic memory.² The disorder is not curable at present, and the mechanisms driving development of AD are not fully understood. Therefore, there is an urgent need …

Pharmacy Newsletter : September 2018, Pharmacy Department

Department of Pharmacy Archives

Content:

• Stress Ulcer Prophylaxis
• New Update: Direct Oral Anti-Coagulants (DOACs)
• Case Study: Use of Cholestyramine for Management Of Digoxin Toxicity
• Updates : Use of Doxycycline in Children
• Serotonin Syndrome – Myths & Misconceptions

Formulation And Stability Study Of Eslicarbazepine Acetate Oral Suspensions For Extemporaneous Compounding, Fang Zhao, Vivek S. Dave, Mazin Z. Mar, Jonathan R. Perri

Pharmacy Faculty/Staff Publications

Eslicarbazepine acetate is an anticonvulsant drug with a recent U.S. Food and Drug Administration approval for expanded use in children and adolescents. Currently, eslicarbazepine acetate is only available in the U.S. as 200-mg to 800-mg strength tablets (Aptiom), which are not easy to administer for pediatric patients. This study was initiated to develop an oral suspension formulation for extemporaneous compounding by pharmacists and to generate stability data for storage recommendations. Nine suspension formulations of eslicarbazepine acetate were prepared from Aptiom tablets and commercially available liquid vehicles using the standard mortar/pestle method. The vehicles varied mainly in their solvents, viscosities, and …

Burden Of Lipohypertrophy Among Insulin Dependent Diabetes Mellitus Patients In China: An Analysis Of Outcomes And Impact Of Pen Needle Reimbursement Policy, Arthi Chandran

Dissertations and Theses

Background

Diabetes is a global epidemic and with an aging population accompanied by rapid urbanization China ranks highest in disease prevalence and associated burden. Independent of diabetes type, insulin is an eventual and costly requirement for disease management. The consequences of insulin administration however are poorly understood. Lipohypertrophy (LH) is one such consequence. It is hypothesized that method of insulin delivery and poor delivery technique are significant risk factors for this condition which is believed to alter insulin pharmacodynamics. Subsequently, insulin pen needles are a critical component of care however access to pen needles varies across China.

Objective

The objective …

Bivalirudin Anticoagulation Dosing Protocol For Extracorporeal Membrane Oxygenation: A Retrospective Review., Jared W. Netley Pharmd, Mpa , Bcps, James Roy Pharmd, Joseph Greenlee Iii Md, Shaun Hart Np, Michael Todt Pharmd, Bryan Statz Pharmd

Parkview Pharmacy Department

Anticoagulation with unfractionated heparin during extracorporeal membrane oxygenation (ECMO) is common, but alternative agents are being evaluated for safety and efficacy. The objective of this analysis was to assess if a comprehensive bivalirudin dosing and monitoring protocol effectively guides dose adjustments and monitoring of bivalirudin in patients during ECMO. Our analysis included 11 patients who received bivalirudin during ECMO therapy and had dosing managed using our hospital derived protocol. Patients treated over a 1-year period were included in this retrospective analysis. Clinical characteristics and changes in activated partial thromboplastin time (aPTT) were evaluated from medical records to determine the efficacy …

L-Citrulline As Alternative Pharmacological Substance In Protecting Against Cardiovascular Disease, Andrea Laurentius, Gregorius Bhaskara Wikanendra, Tzeto Han Cong, Wawaimuli Arozal

Pharmaceutical Sciences and Research

Cardiovascular disease (CVD) has taken up to average 30% of death diagnoses in the world. Prevalent attempts of physicians to treat this disease came down to focus on using drugs with their specific mechanism of action. Since the method only cures the symptoms and need to be pharmacologically monitored, physicians and scientists have been struggling to find other treatment strategies. This problem led us to search for another substance dealing with CVD via preventive therapy, which does not require such close monitoring by physicians in its use. The answer relies on using L-citrulline as potential therapeutics in treating and preventing …

Evaluasi Kesesuaian Dosis Pada Pasien Pediatri Bronkitis Akut Di Rumah Sakit Tentara Kartika Husada Kubu Raya, Variandini Aldhila Kharis, Rise Desnita, Hariyanto Ih

Pharmaceutical Sciences and Research

Selection and usage of rational drugs determine the success of expected therapeutic effect, especially for pediatrics. Acute bronchitis in pediatrics is one of the highest incidents of Acute Respiratory Infection (ARI) in Army Hospital Kartika Husada Kubu Raya. This study aimed to evaluate rationality of drug doses conformity in outpatient pediatric acute bronchitis in Army Hospital Kartika Husada Kubu Raya on 2015. This research was a descriptive observational research with cross-sectional design. The sample was taken with purposive sampling amounted to 36 prescriptions. Then the evaluation of drug doses conformity was counted according to the literature. The results showed that …