• The impact of 90-day blister pack refill and patient education on compliance and blood pressure control in a Federally Qualified Health Center

      Hall-Lipsy, Elizabeth; Lopez, Dania; Flores, Randall; College of Pharmacy, The University of Arizona (The University of Arizona., 2019)
      Purpose: The purpose of this study is to examine and evaluate the impact of: 1) a pharmacy managed 90-day blister package refill on adherence and 2) educational intervention on medication adherence plus blood pressure outcomes. Introduction: Hypertension is one of the most common health condition amongst adults in the US. It is most often managed with the use of antihypertensive medications. Non-compliance to medication is often one of the biggest barriers in the management of hypertension and impacts health and increased health care costs. Community health centers like Mariposa Community Health Center in rural locations often have difficulty improving their patients’ medication adherence. Different strategies have been developed in order address medication adherence and improve health outcomes. Methods: A prospective, randomized controlled trial study that measured and compared adherence and blood pressure (BP) values of patients enrolled in a 90-day blister pack refill who participated in an educational workshop about hypertension. Participants completed a knowledge test survey before and after the educational workshop as well as an ASK-12 survey in order to identify potential barriers that affect medication adherence. Randomization was done utilizing a block randomization method. Adherence was calculated utilizing portion of days covered (PDC) formula. BP was analyzed utilizing a paired T-test. Knowledge and ASK-12 surveys were analyzed utilizing Wilcoxon signed-rank test. Results: In the first 90-day period, systolic blood pressure (SBP) was significantly decreased by mean of 6.84mmHg (p=0.05, 95% CI -.078-13.77). Diastolic had a similar decreasing trend but was not statistically significant (p=23 95% CI -2.42-9.04). 93.3% of the participants were adherent to their antihypertensive medications (PDC>80%). Pre and post knowledge surveys did not show any significant difference in the first 90 days. Questions 3 and 7 of the ASK-12 survey had a significant difference (p=0.021, p=0.15, 95% CI) in the first 90-day period. CONCLUSION: The number of patients vs those who consented yielded a less than desirable turnout limiting the intervention and making all those who consented assigned to the 90-day refill group limiting our data and having a comparison group. A significant decrease in SBP from their baseline BP was observed.
    • Influenza Acquisition occurring Post-Vaccination Among University of Arizona College of Pharmacy Students

      Tran, Kim; Slack, Marion; Flynn, Shannon; Malott, Megan; College of Pharmacy, The University of Arizona (The University of Arizona., 2019)
      Specific Aims: Assess the incidence of influenza despite being vaccinated among pharmacy students in the 2017/2018 influenza season at the University of Arizona. Our working hypothesis is that pharmacy students who received the influenza vaccine in the 2017 year will have a lower rate of acquisition than among people who did not receive the influenza vaccine. Methods: Questionnaires were administered to first, second, and third year pharmacy students during scheduled class times to gather information on influenza acquisition, influenza symptoms, vaccine attainment, and demographic characteristics through self-reported answers. Main Results: The characteristics of pharmacy students were similar between those who acquired the flu or not. However, whether or not the pharmacy students had kids was significantly different between those who had influenza versus not ( p= 0.0146) Pharmacy students who received the vaccine had lower rates of acquiring the flu compared to the national average (p=0.0005). When comparing pharmacy students who received the vaccine and those who did not there was no difference in acquiring influenza (p= 0.854) Conclusions: The findings for this study show that pharmacy students who received the influenza vaccine had lower rates of acquiring the flu when compared to the national average of people who were not vaccinated and acquired the flu. It can be assumed that even with an efficacy as low as 40%, the vaccine still plays a great role in influenza prevention. However, pharmacy students who received the influenza vaccine in the 2017 year did not have significantly different acquisition rates of the flu when compared to the students who did not receive the influenza vaccine that year.
    • Availability of information for dosing commonly used medications in special ICU populations

      Erstad, Brian; Eastman, Candice; College of Pharmacy, The University of Arizona (The University of Arizona., 2019)
      Specific Aims: Product labeling was reviewed to determine if sufficient information is available to appropriately calculate dosing regimens for special intensive care unit (ICU) populations including extremes of body habitus, patients on hemodialysis, continuous renal replacement therapy (CRRT), and extracorporeal membrane oxygenation (ECMO). Methods: The 100 most commonly used injectable medications in the adult ICUs of an academic medical center in Southern Arizona were evaluated. Any information related to adult weight-based dosing, weight descriptors, dosing of patients with extremes of weight (body mass index of <18.5 or >40 kg/m2), and dosing of patients on hemodialysis, CRRT, or ECMO was extracted from Food and Drug Administration product labeling. Information was evaluated with a dosing usefulness score of 0-3; a score of 2 or greater was considered minimally adequate for dosing special ICU populations. Main Results: Of the 100 medications evaluated, 47 had weight-based dosing of which 30% had reference to a specific weight descriptor. Fifteen medications had dosing information for patients with extremes of body habitus (3 underweight, 12 obese, and 2 extreme obesity), of which 8 scored >2 (2, 6, and 1 in the respective categories). Of the 42 medications with hemodialysis dosing information, 53% had a usefulness score >2. Of the 3 medications with CRRT dosing information, 1 had a score >2. ECMO dosing information was available for 2 medications with one score >2. Conclusion: Information from product labeling involving commonly used ICU injectable medications is limited and generally inadequate for calculating an appropriate dose for special ICU populations.
    • Retrospective Analysis on Patient Starter Kits Value for Improving Outcomes for Patients Taking Oral Oncolytics

      Mathews, Kelly; Harmon, Mark; Rounsaville, Haley; Uribe, Nichole; College of Pharmacy, The University of Arizona (The University of Arizona., 2019)
      Specific Aims: To determine if administration of a starter kit at the beginning of chronic oral oncolytic therapy improves medication persistence, adherence, and adverse event (ADE) incidence and grading by patients. Also, to determine missed revenue from undispensed starter kits. Methods: Data on persistence (duration of therapy), adherence (portion of days covered), ADE incidence and grading was collected electronically from patient charts and manually through chart review on 10 different oral oncolytic therapies. Data on age, sex, insurance type, and ICD-10 codes was also collected. Main Results: A total of 1,945 patients were included in this study with 1,478 in the starter kit group (mean age=69, 58.9% male, 58.9% Medicare, 88.8% FDA indicated therapy) and 467 in the non-starter kit group (mean age=69, 58.0% male, 54.6% Medicare, 88.9% FDA indicated therapy). Persistence was higher (p<0.0001) and ADE incidence was lower (p<0.0001) in the starter kit group. Adherence and ADE grading did not differ between groups (p=0.95 and p=0.09, respectively). Missed revenue from undispensed starter kits was $20,695. Conclusions: Receiving a starter kit at the beginning of a new oral oncolytic therapy potentially results in higher persistence along with lower ADE incidence among patients. Medication adherence and ADE grading does not seem to be affected by the administration of one. Nonetheless, the dispensing of a starter kit presents an opportunity to improve patient outcomes on oncolytic therapy, while also increasing revenue for the specialty pharmacy.
    • Are Amphetamine/dextroamphetamine Doses Related to Prior History of Drug Abuse?

      Slack, Marion; Pourshams-Manzouri, Tania; Rahim, Hatef; College of Pharmacy, The University of Arizona (The University of Arizona., 2019)
      Specific Aims: The aim of this study was to see if there was a difference between the doses of amphetamine/dextroamphetamine being prescribed to patients that are using illicit substances. Methods: A retrospective cohort study was conducted to compare the dose of amphetamine/ dextroamphetamine of patients with an active prescription of amphetamine/dextroamphetamine with a history of substance abuse to the dose for patients with no history of substance abuse. The sample selection was collected from CODAC patients with an active prescription of amphetamine/ dextroamphetamine. A pool of 238 patients at CODAC were screened who had a history of substance abuse and prescribed amphetamine/ dextroamphetamine. A Chi Square test was used to determine if there was a difference between high and low doses of amphetamine/ dextroamphetamine and a history of substance abuse. High doses were between 20-30 mg per day and low doses were between 10-15 mg per day. The sample selection were currently admitted patients with an active prescription for amphetamine/dextroamphetamine. Main Results: Charts of 238 patients (mean age of 38.6; SD = 12.7) that were prescribed high doses of amphetamine/dextroamphetamine (20-30mg) at CODAC were reviewed. Of the total patient pool, 50.4% were female and 49.6% were male. Of the female patients, 56.6% of them had a history of substance abuse. Of the male patients, 71.2% of them had a history of substance abuse. Conclusions: Results indicate that patients with history of substance abuse may need high doses of amphetamine/dextroamphetamine.
    • Identifying Barriers to Adherence Amongst Patients Speaking Different Languages

      Forbes, Stephanie; Orsini, Roxanna; Trinh, Henry; College of Pharmacy, The University of Arizona (The University of Arizona., 2019)
      Specific Aims: To compare the factors associated with patient non-adherence to medications in relationship to preferred language. Subjects: United States residents enrolled in Medicare Part D and MTM eligible January 2018 through December 2018. Methods: The sample population was divided into preferred language of either English or non-English. Targeted medication review (TMR) from January 2018 to December 2018 was provided by SinfoníaRx. Reasons given for non-adherence between English and non-English were grouped into one of the five following categories: adverse drug reaction, cost, forgetfulness, misunderstood instructions/self-adjusted, and refill issues. English and non-English groups were compared by counting the number of patients citing each reason and calculating percentages. The composite of the five reported patient barriers (adverse drug reaction, cost, forgetfulness, misunderstood instructions/self-adjusted, and refill issues) was compared between the two language groups using a Chi square test with an alpha priori level of 0.05. Main Results: A total of 201 patients were included in this study (100 English and 101 non-English). The majority of patients resided between 60-69 years of age for English patients and was evenly distributed for age ranges between 60-69 and 70-79 for non-English patients. The composite of all five reported patient barriers compared between English and non-English is statistically significant (p=0.0043). Conclusions: Factors associated with patient non-adherence to medications appear to be dependent on preferred language.
    • Analysis of Medical Tourism at the Andrade Port of Entry

      Warholak, Terri; Miller, Andrea; Woods, Nicole; Smith, Rebecca; College of Pharmacy, The University of Arizona (The University of Arizona., 2019)
      Specific Aims: To identify which medications and/or medical services are being sought most frequently, the reason for these specific instances of medical tourism, perceived efficacy or satisfaction of these medications and services, and the likelihood of people continuing to receive their healthcare in Mexico. Methods: Utilizing a cross-sectional survey design, 427 participants were recruited to participate in an anonymous electronic 12 question survey at or near the US-Mexico border at the Andrade port of entry. Main Results: Most participants had a high-school diploma or four-year university degree, and the most common income bracket reported was between $25,000-$50,000 annually. Respondents reported traveling from four different countries, and of those from the US, 29 different home states were reported. The average age of participants was 64.5, with a range between 19 and 93. Dental was the most common medical service, and antibiotics were the most common class of medications reported on the survey. The majority of participants stated comparable or better efficacy of Mexican products, and expressed intent to continue to participate in medical tourism. Conclusions: Based on the survey, patients feel as though these medications are just as good as what they would get in the states and will continue to buy them until research proves otherwise. Further research should be done to determine if these medications purchased in Mexico are indeed what they claim to be.
    • Impact of Depression on Health-Related Quality of Life Among Older Adults with Myocardial Infarction in the United States

      Bhattacharjee, Sandipan; Vadiei, Nina; Howard, Brooke; Lundgren, Terra; Morse, Shawn; College of Pharmacy, The University of Arizona (The University of Arizona., 2019)
      Specific Aims: We assessed the effect of depression on health-related quality of life (HRQoL) among myocardial infarction (MI) survivors in the United States (US). Methods: Using the 2015 Behavioral Risk Factor Surveillance System (BRFSS) data, our study sample consisted of survey participants who were MI survivors aged 50 years and older who also reported having depression post-MI. Our dependent variable (HRQoL) comprised of number of days physical and mental health was poor during the past 30 days; activity limitations; received recommended sleep; how often emotional support received; life satisfaction and perceived general health. We conducted multivariable binomial and multinomial logistic regression analyses examining the association of presence/absence of depression on HRQoL after adjusting for demographic, socioeconomic and other health variables (a-priori α=0.05). Main Results: Our study sample consisted of 20,483 adults with MI; 5,343 (26.19%) reported having depression. Survivors with depression were more likely to report fair/poor general health, limitations in activity, dissatisfaction with life, and a greater number of poor mental and physical health days compared to those without depression. For example: MI survivors with depression reported 2.7 times more (Adjusted Odds Ratio: 2.65: 95% Confidence Interval 2.06-3.45; p<0.0001) fair/poor perceived general health than MI survivors without depression. There was no difference in level of emotional support or sleep quality. Conclusions: In this nationally representative sample of adults in the US, MI survivors with depression had poorer HRQoL compared to MI survivors without depression. These findings underline the need for developing appropriate supportive care for MI survivors with depression.
    • Assessment of Pharmacists’ and Pharmacy Students’ Confidence and Knowledge of Common Asthma Inhaler Devices

      Phan, Hanna; Spencer, Jenene; Hall-Lipsy, Elizabeth; Luu, Michael; Nguyen, Vy Thuy; Lee, Yvonne; Chandler, Krystal; College of Pharmacy, The University of Arizona (The University of Arizona., 2019)
      Specific Aims: To compare pharmacists’ and pharmacy students’ confidence and knowledge level with educating/counseling adolescents/adults, caregivers, and children on appropriate technique and use of common inhaler devices. To identify possible factors that may influence pharmacists’ and pharmacy students’ knowledge and confidence level with educating/counseling patients/caregivers on appropriate technique and use of common inhaler devices. Methods: A survey study using a questionnaire tool consisting of confidence level and knowledge-based questions was distributed to first through fourth year pharmacy students as well as pharmacists registered through the Arizona Pharmacy Association. Main Results: Pharmacists were more confident and knowledgeable with their ability to educate on appropriate inhaler device technique compared to pharmacy students. Both the pharmacist group and pharmacy student group reported health fairs and coursework highest as contributing factors to their knowledge. In general, pharmacists and students were more comfortable with their knowledge of inhaler devices that are more commonly prescribed. Conclusion: Confidence and knowledge level with their ability to educate on appropriate inhaler device technique in all devices and demographics of patients were higher in the pharmacist group than the pharmacy student group.
    • Meta-Analysis of Safety Effectiveness Profile and Overall Response Rate of Metastatic Renal Cell Carcinoma Treatments

      Abraham, Ivo; Kojs, Pawel; College of Pharmacy, The University of Arizona (The University of Arizona., 2019)
      Specific Aims: The aim of this project was to determine the overall efficacy of metastatic renal cell carcinoma pharmacotherapeutic agents as well as determine which chemotherapeutic treatment had the lowest side effect profile. Methods: Overall, a MESH database search was done in PubMed that pulled relative clinical trials that examined chemotherapeutic medications for metastatic renal cell carcinoma. From there the papers were analyzed based on particular demographics such as: Drug Treatment, Drug Comparator, Overall Survival, Progression Free Survival, and Overall Response Rate. This was done through a fixed effects analysis comparing the odds ratios for the different mediations. A network diagram was also developed to show the relationship of the studies. Data was then further analyzed for overall side effect profiles which looked at the total number of adverse events in a study. Main Results: The main result is that Nivolumab + Ipilimumab has the lowest Odds Ratio OR = 0.08 ( 0.03 – 0.21, 95% CI) when compared to Lenvatinib. This is in terms of overall response. With regards to the side effect profiles of the medications, Nivolumab vs Everolimus produced the lowest side effect profile with roughly 27%. Conclusions Nivolumab appears to be the medication that has the greatest overall response rate and least adverse side effect profile. This also depends if the medication is combined with Ipilimumab for greater overall treatment response.
    • Assessing Arizona Pharmacists’ Knowledge of and Confidence with Photosensitizing Drugs

      Spencer, Jenene; Kilgore, Megan; Throckmorton, Hannah; College of Pharmacy, The University of Arizona (The University of Arizona., 2019)
      Specific Aims: To assess Arizona pharmacists’ knowledge of and confidence with identifying and counseling about photosensitizing drugs to determine the need for further education in this subject area. Methods: A voluntary anonymous questionnaire was administered in person at the 2018 Arizona Pharmacy Association Annual Convention. Sixty of the 136 Arizona licensed pharmacists in attendance completed the questionnaire consisting of opinion, knowledge, and demographic sections. A passing grade for the knowledge section was defined as eighty percent accuracy. A score of eighty percent was chosen as the minimum passing rate based on conventionally used rules of competence. T-tests and chi-square tests were used to analyze any differences between the pass and fail groups. Main Results: There was no difference between pass and fail groups with regard to age, gender, years practicing, years spent in Arizona, and practice setting (p greater than 0.05) or with regard to their confidence with counseling about photosensitizing drugs (p greater than 0.05). Pharmacists reported feeling “mostly confident” about identifying photosensitizing drugs (n equals 33), with a range of “not at all” (n equals 2) to “very” (n equals 11) confident. Only 19 (32 percent) of the 60 pharmacists who completed the survey passed the knowledge section with a score of eighty percent or greater. Conclusions: Twice as many pharmacists did not achieve a passing score for the knowledge assessment despite most pharmacists reporting they feel “mostly confident” counseling about photosensitizing drugs. These results demonstrate a need for more education either in college curriculums or continuing education regarding photosensitizing drugs and reactions.
    • Comparing Evidence-Based Learning Methods in a Self-Care Therapeutics Classroom

      Cooley, Janet; Giblin, Lauren; Gonzales, Caitlin; Lychwick, Megan; College of Pharmacy, The University of Arizona (The University of Arizona., 2019)
      Objectives: The objectives of this study were to examine how teaching using case study or role play affects the retention rate of the material being taught in the form of test scores, as well as to assess which teaching styles students prefer. Methods: This study was a dependent groups design. One group was the case study activity and the other group was the role play activity. All students received both interventions. 106 subjects participated in the study and were second year pharmacy students at the University of Arizona College of Pharmacy who were enrolled in the Self Care Therapeutics course on either the Tucson or Phoenix campus. Data was collected from the final exam on the number of correct answers for topics taught using the two teaching methods. A survey was also administered during class time to record student satisfaction with the activity. The data was analyzed using a paired t-test and an alpha level of 0.05. Results: Case study questions were answered correctly on the final exam 83.7% of the time while role play questions were answered correctly 89% of the time. This produced a p-value of 0.057 with no statistically significant difference between the two groups. Case study activities scored higher in survey responses regarding student satisfaction with a statistically significant p-value of 0.027. Conclusions: In conclusion, case study and role play learning strategies did not produce statistically significant difference in test scores. Students responded significantly more positively to case study activities than role play activities.
    • Up to Date or Out of Date: Pharmacist Knowledge of Plan B Contraceptive Regulations in the United States of America

      Leal, Sandra; Daconta, Jesse; Padilla, Craig; Rosa, Lauren; College of Pharmacy, The University of Arizona (The University of Arizona., 2019)
      Specific Aims:​ To assess pharmacists’ knowledge of emergency contraceptive (EC) regulations in a community pharmacy setting around the United States (U.S.) according to the FDA and their state. Methods: ​Authors collected every community pharmacy phone number from 15 different states by contacting each state board of pharmacy. Over 1% of pharmacies were called and the data collected included whether or not the pharmacist knew the EC laws, the gender of the pharmacist, and the ages each pharmacist responded with. Main Results: ​Out of the 308 pharmacists who completed the interview, 158 were males and 150 were females. 62.0% (98/158) of men and 59.3% (89/150) of women did not know the EC regulations. The average ages each incorrect pharmacist gave were: 18 (96/187; 51.3%), 17 (51/187; 27.3%), 16 (20/187; 10.7%), 15 (14/187; 7.5%), 14 (3/187; 1.6%), 13 (1/187; 0.53%), and 11 (1/187; 0.53%). There was no significant difference between men and women in regards to the correct answer (38.0% males vs. 40.7% women; ​X ​ 2 ​ (2, N = 308) = 0.2338, p > 0.05). Overall, 39.3% (121/308) of pharmacists knew EC regulations and 60.7% (187/308) did not. Conclusions: ​The majority of pharmacists around the U.S. are out of date when dealing with EC regulations.
    • Research-related Curriculum and its Applications in US College of Pharmacy Programs

      Slack, Marion; Cushing, Justin; Merchant, Stephen; Schapker, Allie; May, Rebecca; College of Pharmacy, The University of Arizona (The University of Arizona., 2019)
      Specific Aims: To quantify the number of PharmD programs that require completion of a research project. To describe the types of research being undertaken within PharmD programs. To compare current responses with those obtained in the last survey (2007). Methods: Collaborative effort including students and faculty at three pharmacy programs (AZ, FL and MI). Cross-sectional analysis utilizing the survey (with modifications) developed in 2007. Peer review of questions (face-validity); format included dichotomous response, multiple-choice, and open response. Qualtrics® survey distributed via email to Academic Affairs (or comparative) Dean at AACP affiliate institutions. Descriptive analyses; duplicate responses combined when possible. Project was deemed exempt by IRB. Main Results: Seventy-four programs responded (54% response rate). A total of 22 (30%) programs have a required student research project compared to 25% in 2007. Project requirements were similar among the programs requiring a project: proposal (95%), IRB application (90%), collect and analyze data (77%), prepare a written report (86%), and present findings (82%). The most common methods of collecting data were surveys (91%) and chart reviews (86%). Research related coursework was similar between programs except for research methods courses, which were 36% among programs requiring a research project, and 14% among those not requiring a project. Conclusions: The number of programs requiring student research appears to have increased since 2007. Based on the survey data, students could expect to have similar research experiences in any of the colleges requiring a research project. Most colleges provide coursework related to research.
    • Preformulation studies on trametinib and panobinostat for a prospective topical combination product for the treatment of melanoma

      Myrdal, Paul; Younis, Usir; Slack, Marion; Horn, Jonah; Patel, Sid; College of Pharmacy, The University of Arizona (The University of Arizona., 2019)
      Specific Aims: Specific Aim #1: Evaluate the stability of both pharmacologic agents in the varying conditions (pH and temperature). Our working hypothesis #1 is that both agents will degrade readily at an elevated temperature (65°C) and pH (>7). Specific Aim #2: Determine the solubility profiles of both pharmacologic agents in varying conditions (pH and solvent). Our working hypothesis #2 is that solubility of panobinostat and trametinib will be greatest at a pH <7, as well as in a polyethylene glycol (PEG) solvent. Methods: Data for quantity, solubility, and stability will be recorded for trametinib and panobinostat. 1. Standards: Stock solutions of both compounds will be repeatedly diluted into 5 concentrations in varying solvents until a quantifiable, distinct peak is present on the HPLC around 6-8 minutes. 2. Solubility: In order to test the solubility of both compounds, 1-2 mg of each drug will be put into varying solvents and buffers. If the drug is visibly in solution, 1-2 mg more of drug will be added at a time until a limit of solubility is determined. a. Trametinib: The solubility as a function of pH will be conducted at four pH values between 3.0 and 9.0, as well as with various solvents (ACN, EtOH, PEG400, and PG). Each sample will be saturated with raw drug and allowed to agitate for at least 30 min. Samples will then be visually inspected to ensure that solid drug is still in excess, then will be filtered through an RC filter. The filtrate will be diluted appropriately with distilled water and analyzed using the HPLC assay. b. Panobinostat: The solubility as a function of pH will be conducted at ten pH values between 4.0 and 10.0, as well as with various solvents (10% ACN, 10% DMSO, 10% PEG, and 100% PEG). Each sample will be saturated with raw drug and allowed to agitate for at least 30 min. Samples will then be visually inspected to ensure that solid drug is still in excess, then will be filtered through an RC filter. The filtrate will be diluted appropriately with distilled water and analyzed using the HPLC assay. 3. Stability: The stability of both agents will be tested in various conditions including temperature, pH, and solvents. Stability results will be obtained until peaks varied from that of the original determined during respective standards. a. Trametinib: The influence of pH will be studied with a citrate buffer (pH 2.0), and a borate buffer (pH 9.0). The pH will be adjusted with distilled water. b. Panobinostat: The influence of pH on the stability will be studied with a citrate buffer (pH 4.0 and 5.1), a phosphate buffer (pH 6.0, 7.0, 7.4, and 8.0), and a borate buffer (pH 9 and 10). The pH will be adjusted with NaOH or concentrated HCl. The influence of solvents will be studied with 10% ACN, 10% DMSO, 10% PEG, and 100% PEG. Main Results: 1. Panobinostat: a. Solubility – Increased solubility around pH < 6.5, and > 8.5. Intrinsic solubility seems to be around 7.4 to 7.8. Solubility in 100% PEG appears to be roughly 2750 ug/mL, while in 10% showed moderate solubility (~140 ug/mL). b. Stability – 1st order degradation is noted, with higher rates with an increase in pH for the most part. The most distinguished degradation is seen at pH 7 for this experiment. Higher temperatures (65 C) yielded faster degradation. With respect to both experimented temperatures (48 C and 65 C), pH 4 and 5.1 appeared to be most stable (see attached graphs). Stability in PEG complex was poor. c. Dermabase: Drug crystals present in both phases: Not in solution. 2. Trametinib: a. Solubility – @63 C: Not soluble in MeOH, low solubility in EtOH and PG, pH 3 solubility > 2 mg/mL, ~1.93 mg/mL in PEG, 0.73 mg/mL in ACN. Limit of quantification > 40 nanograms. b. Stability – Relatively stable in light, degrades fast a pH 9, slow at pH 2. New peak present at pH 2, degradation around 11%. c. Dermabase: Drug crystals present in both phases: Not in solution. Conclusion: 1. The two medications in combination were incompatible in solution in Dermabase. 2. Additional research will need to be completed in efforts to get these two medications to go into a solution. 3. However, time, money, and the unfortunate death of the preceptor terminated further research for this project.
    • Comparing Cytochrome P450 Variant Alleles Tested and Reported in Clinical Pharmacogenomic Testing Panels

      Leal, Sandra; Hoogervorst, Meghan; Patel, Sidhi; Pina, Joel; College of Pharmacy, The University of Arizona (The University of Arizona., 2019)
      Specific Aims: To evaluate and describe the variability in cytochrome P450 genetic polymorphisms tested by laboratories offering pharmacogenomic (PGx) genotyping panels using website information and sample reports for various genetic panels. Methods: This was a descriptive study evaluating pharmacogenomic testing company websites for cytochrome P450 genetic polymorphisms. An information extraction form was developed to assess which genetic polymorphisms for CYPs 2C9, 2C19, 2D6, 3A4, and 3A5 were tested and reported for each PGx company website offering genotyping panels. Each student investigator completed an electronic copy of the extraction form for each PGx website to confirm consistency of findings. Main Results: Of the ten PGx allele panels that were reviewed, consistency varied greatly as CYP2C19 had the highest consistency frequency amongst the panels reviewed with 4 out of 11 alleles having concordance (36.4%), followed by CYP2D6 (23.7%), CYP3A5 (16.7%), CYP2C9 (12.5%) and CYP3A4 (0%). Conclusions: As the laboratories that offer PGx testing rapidly increases with the field of PGx, the consistency of reporting amongst companies is different. From the ten panels that were reviewed it can be concluded that each company is dissimilar in the alleles tested and reported. PGx testing is becoming widely used to safely personalize medication therapy for various medical disease states. Currently, the variation in testing panels make it difficult for clinicians to incorporate the results into clinical practice with confidence.
    • Economic Evaluation of FOLFIRINOX vs nab-paclitaxel plus gemcitabine in advanced pancreatic cancer

      McBride, Ali; Abraham, Ivo; Hanson, Thomas; Komerdelj, Ivan; Fletcher, Stephanie; College of Pharmacy, The University of Arizona (The University of Arizona., 2019)
      Specific Aims: Determine if FOLFIRINOX or nab-paclitaxel plus gemcitabine (NAB+G) has no difference in the cost per life year gained as a first line treatment for metastatic pancreatic cancer. Methods: This study used a retrospective chart review. Charts were accessed via the UACC electronic health records EPIQ and Cerner. Data collected consist of demographic information, number of co-morbidities, biological markers, treatment type, treatment duration, treatment dosing, supportive care measures, hospitalizations, and patient survival. Primary outcomes were assessed based on cost per life year gained. Average monthly cost of treatment is based off of known literature values. Main Results: Patients in the FOLFIRINOX group showed higher rates of provider visits. The average number of visits was 14.3 vs 7.6 in FOLFIRINOX and NAB+G respectively (p=0.014). The cost per life year gained was $86,493 for the FOLFIRINOX group and $146,652 for the NAB+G group. Conclusions: This study determined that patients treated with FOLFIRINOX experience significantly more provider visits during the course of their treatment when compared to nab-paclitaxel plus gemcitabine. While the average total cost of treatment was similar, the cost per life year gained was greater in the nab-paclitaxel plus gemcitabine group.
    • Patterns and Predictors of Depression Treatment among Older Adults with Dementia and Depression in Ambulatory Care Settings in the United States

      Bhattacharjee, Sandipan; Sun, Chongwoo; Gobin, Philippe; College of Pharmacy, The University of Arizona (The University of Arizona., 2019)
      Specific Aims: Dementia, or neurocognitive disorder (NCD), is the deterioration of performance in mental function, and is a disease state only expected to become more prevalent in the coming decades. Depression is twice as likely to develop in this population and is also shown to increase the rate of decline in those with NCD. This study was designed to determine patterns and predictors of depression treatment in elderly dementia patients in the ambulatory care setting in the United States using the Anderson Behavioral Model (ABM) Methods: We conducted retrospective cross-sectional study design by using multiple years (2005–2015) of data from the National Ambulatory Medical Care Survey (NAMCS), an ongoing yearly survey administered by the National Center for Health Statistics (NCHS) of the Centers for Disease Control and Prevention (CDC). The NAMCS uses a multistage probability design to obtain systematic random weekly samples of patients from physicians across the nation using a Patient Record Form capable of recording up to three diagnoses codes and eight prescription medications for each visit. A weighted frequency for national prevalence values was generated from our data analysis. A multivariate regression analysis was completed to determine which predisposing, enabling, and need factors were significant determinants to the nature of antidepressant treatment. Main Results: A total of 655 (un-weighted) ambulatory visits by older adults with dementia and depression were recorded by National Ambulatory Medical Care Survey, or a national estimate of 14.46 million elderly patients visits with both NCD and depression. Predisposing factors such as race, age, sex, geographic region, and metro/non-metro; enabling factors such as insurance and physician specialty; and need factors such as new prescription drug, new patient, or reason for visit, or chronic disease states, were recorded. Multivariate analysis revealed gender, physician specialty, metro/non-metro, geographical region, and number of medications were significant determinants in how an elder NCD patient in the ambulatory setting receives treatment for depression. Conclusions: 62.89% of patients were treated for depression, with 61.45% of all patients receiving an antidepressant and 4.94% of patients receiving psychotherapy. Psychotherapy was utilized infrequently in this population, and SSRIs were the most common form of pharmacotherapy. This suggests this patient population is vulnerable to untreated depression and reveals a need for long-term studies investigating health outcomes in these patients.
    • Pharmacists’ Attitudes Toward Including Diagnosis or Clinical Indication on Prescriptions

      Warholak, Terri; Murata, Joseph; College of Pharmacy, The University of Arizona (The University of Arizona., 2019)
      Specific Aims: To assess Arizona pharmacists’: support for the inclusion of diagnosis or clinical indication on prescription orders; current access to diagnosis or clinical indication on prescriptions orders; perceived barriers to and/or concerns about requiring diagnosis or clinical indication on prescription orders in Arizona. Methods: This was a descriptive study with data obtained from questionnaires. The questionnaire consisted of 3 recall questions from the participant’s experiences, 11 questions regarding the participant’s opinion about the topic, and 5 descriptive and demographic questions about the participant. Main Results: Participants were licensed pharmacists in the state of Arizona who attended a presentation on enhanced pharmacist clinical decision-making information at the Arizona Pharmacy Association Southwest Clinical Pharmacy Seminar. 96.3% of participants supported requiring diagnosis or clinical indication on prescription orders. They reported a mean of 25.2% of current prescription orders including a diagnosis or clinical indication. Major challenges identified in requiring diagnosis or clinical indication included potential software transmission problems, prescriber having no definitive diagnosis or clinical indication for a medication, additional prescriber time, and concerns that inclusion may result in insurers rejecting claims for off-label use. Conclusions: Most respondents supported requiring diagnosis or clinical indication on prescription orders and reported about one-fourth of prescription orders they currently receive including a diagnosis or clinical indication. Multiple perceived barriers and concerns were identified by the participants.
    • Systematic review meta analysis of adherence measures for common chronic medications used in the treatment of cystic fibrosis

      Phan, Hanna; Slack, Marion; Martin, Jennifer; Park, Haeun; Park, Sohyun; Tam, Katie; College of Pharmacy, The University of Arizona (The University of Arizona., 2019)
      Specific Aims: The aim of this systematic review and meta analysis is to determine the best method to measure medication adherence in cystic fibrosis patients by assessing the rates of adherence to cystic fibrosis medications using different measuring methods. Methods: Using multiple bibliographic databases (including Embase, Pubmed, Cochrane, PsychINFO, WHO, Web of Science, Scopus, and IPS) and reviewing grey literature and association websites, a systematic literature search of articles related to medication adherence in cystic fibrosis patients was conducted in February 2018. The limits applied to all articles were the English language and publication dates between 1989 to the present day. The literature screening was conducted by 3 pharmacy students, professors at the University of Arizona College of Pharmacy, and members of the Cystic Fibrosis Foundation (CFF). The studies were assessed for quality using a abstract and data extraction screening tool. Main Results: The bibliographic database searches generated 1,955 articles, and the grey literature and association websites generated 15 articles. 1,549 of the 1,955 articles and 0 of the 15 articles met the inclusion criteria and underwent data extraction screening. Then, after the abstract screening, 42 articles were identified for eligible to proceed to data extraction. Medication adherence was measured using paper/hard copy reminder tool, pager application, mobile application, electronic device, medication container with tracking, education sessions, and medication organizer. Conclusions: In the preliminary results, seven studies were included in the meta-analysis measuring five different methods of adherence: written diary, electronic monitoring, self-report, Medication Possession Ratio (MPR) and Proportion of Days Covered (PDC). Overall, adherence measured by written diary was significantly different than all other adherence measures except MPR. Further data analysis will be conducted when the data extraction and review is completed by Cystic Fibrosis clinicians and experts.