• Clinical Utilization of Pharmacogenomic Testing in an integrated Behavioral Health Setting

      Leal, Sandra; Scovis, Nicole; Karnes, Jason; Garcia, Alexis; Pourshams, Tina; Moslem, Negeen; College of Pharmacy, The University of Arizona (The University of Arizona., 2018)
      Specific Aims: To explore whether pharmacogenomic (PGx) testing would lead to an overall reduction in number of medications and increased clinical efficacy of antidepressant therapy. Method: In this retrospective review, we reviewed the charts of 100 patients in a behavioral health clinic who have been diagnosed with depression and have received a neuro PGx panel to observe and assess the clinical effectiveness of implementing PGx tests. Based on the inclusion criteria 87 patients were qualified and 28 patients were eligible for analysis of pre-PGx and post-PGx Patient Health Questionnaire (PHQ-9) scores. Wilcoxon singed-rank test and paired t-test were used for comparing the PHQ-9 scores, number of medications and PGx recommendations. Main Results: There was a significant difference when comparing PHQ-9 scores pre- and post-PGx testing (W=289, CV=116, P-value 0.001, CI 95%; SD 13.7, Mean 6.2 for pre-PGX; SD 5.9, Mean 8.9 for post-PGx). However, there was no significant difference between the number of medication used pre- and post-PGx for patients that carried variants, considering both Wilcoxon singed-rank test and paired t-test (|W|=286 CV>300, P-value 0.212; T-test P-value 0.211, alpha 0.05). The number of patients advised to use their medications as directed did not change significantly Pre- and post-PGx (nprior=151, npost=163, P-value 0.393, alpha 0.05). The number of patients taking “Use with Caution” medications based on pharmacogenomic results decreased significantly after PGx testing (nprior=70, npost=49, P-value 0.012, alpha 0.05). Conclusion: This study shows that pharmacogenomics testing can significantly affect the PHQ-9 scores and therefore increase the clinical efficacy of antidepressant therapy.
    • Evaluation of CD4+ counts after switching to INSTI-based regimen in virologically suppressed, treatment-experienced HIV patients: a retrospective, descriptive study

      Chan, Connie; Ellis, Kristen; Sun, Xia; Phan, Thu; Nguyen, David; College of Pharmacy, The University of Arizona (The University of Arizona., 2018)
      Specific Aims: To determine if integrase strand transfer inhibitor (INSTI) based regimens initiated in antiretroviral treatment (ART) experienced, virologically suppressed HIV patients would result in favorable immunological function reflected by an increase in CD4 counts. Subjects: HIV-1 positive, age ≥ 18, on stable ART with non-INSTI based regimens and were switched to INSTI-based regimens. Methods: Patients were excluded for HIV RNA > 200 (copies/mL) within one year prior to switch or pregnancy. The primary outcome was the change in post-switch CD4 counts from baseline. A linear mixed effects model was used to define the change in CD4 counts over time. Secondary outcomes included comparison of median CD4 count at baseline and at furthest follow up, incidences of adverse effects, changes in safety profile (SCr, AST, ALT, lipids), and the number of HIV RNA > 200 during post-switch period. Main Results: A total of 53 patients were included: male (75%), white (57%), median age= 53, 74% had HIV ≥ 10 years, 58% were on non-nucleoside reverse transcriptase inhibitor (NNRTI), and 45% were on protease inhibitor (PI) based regimens. Median baseline CD4 = 588 cells/mm3 (CD4% = 30.0), and median CD8 = 818.5 (CD8% = 44). Median CD4 at furthest follow up was 622 (CD4% = 31.4), and median CD8 was 743.5 (CD8% = 44.2). The linear mixed effects model showed a statistically significant increase in CD4 count over time after switching to an INSTI-based regimen (P = 0.015). Higher baseline CD4 count was associated with higher CD4 counts later on (P = 0.001). Conclusions: Switching to an INSTI based regimen was associated with an increase in CD4 counts in ART experienced, stabilized individuals living with HIV.
    • Doctor of Pharmacy (PharmD) Students’ Opinions of the Pharmacy Curriculum Outcomes Assessment Exam (PCOA) at one College of Pharmacy

      Warholak, Terri; Zvavamwe, Simbarashe; College of Pharmacy, The University of Arizona (The University of Arizona., 2018)
      Specific Aims: Compare student’s opinions and get an overall understanding of which classes the student’s feel the College of Pharmacy can emphasize to better prepare them in their didactic course work. Subjects: Pharmacy students of the University of Arizona class of 2019 at the Tucson campus in Arizona. Methods: Students who had recently taken the Pharmacy Curriculum Outcomes Assessment Exam (PCOA) at one College of Pharmacy self-assessed their knowledge in each of the core subjects; pharmacology, management, statistics, medicinal chemistry, and clinical pharmacology, covered by the PCOA exam using a questionnaire. The questionnaires were administered during a regularly scheduled class and collected after completion. Data were analyzed using excel spreadsheets and nonparametric procedures for nominal and ordinal level data. Main Results: The response rate was 75%. The average age and Grade Point Average (GPA) of study respondents was 23 (SD= 8.354) and 3.28 (SD=0.9608) respectively. Out of the 5 core areas, medicinal chemistry was rated as the toughest section on the PCOA exam. Furthermore, more than 60% of the students indicated that they struggled with at least 2 classes from the core areas. Overall, many students agreed the level of difficulty on the exam was appropriate, helped identify the topics to review and the review session provided by the school was not adequate to help them excel on the exam. Conclusions The results suggest the PCOA exam helped identify the core classes in the curriculum that each student needs to review. Despite a great portion of the students struggling with at least 2 or more classes, the PCOA can be used as a tool to help both students and faculty members identify weaknesses.
    • A Qualitative Evaluation by Focus Group of Pharmacists on Patient Counselling on Inhaler Technique

      Lee, Jeannie; Tate, Jared; Avila, Sena; Day, Kendall; College of Pharmacy, The University of Arizona (The University of Arizona., 2018)
      Specific Aims The purpose of this study was to describe the barriers that exist at the pharmacy level in providing appropriate patient education on inhaler technique. Methods A focus group was used for this study, approved by the University of Arizona Institutional Review Board. De-identified demographic information was collected to describe the characteristics of the study participants and their experiences with inhaler education. During the focus group, conducted by student pharmacists, data were collected by note taking and audio recording. Descriptive data about the participants were reported using summary means, and standard deviations. Audio recording and researcher notes were analyzed by content analysis to extract common barriers that limit appropriate patient education on inhaled medication use. Results Ten pharmacists participated in the focus group discussion. The average age of participants was 46 years (SD=11.1, Range=29-61) and the majority were female (80%). The main themes identified centered on patient- and practice-specific factors for instituting patient education on inhaler technique. Conclusions Prioritizing common barriers identified by practicing pharmacists as a focus of pharmacist training and process implementation within pharmacies may help improve patient education, and in turn adherence to inhaled medications and outcomes.
    • Warnings for Drug-Drug Interactions in Consumer Medication Information Provided by Community Pharmacies

      Malone, Daniel; Panich, Jennifer; Gooden, Andrea; College of Pharmacy, The University of Arizona (The University of Arizona., 2018)
      Objective: In 2006, the Food and Drug Administration (FDA) outlined standards for consumer medication information (CMI) that pharmacies should provide to patients receiving new prescription medications. The objective of this study was to evaluate the CMI provided by six pharmacy chains for accuracy and completeness with respect to drug-drug interactions (DDIs). Methods: Medication leaflets were obtained from six different community pharmacy chains located in southern Arizona. Three medications chosen: azithromycin, ciprofloxacin, and simvastatin. The content of the information in the leaflets was examined and compared to information two drug information sources. The number of and information for DDIs mentioned in the CMI was evaluated. The reading level of each CMI was evaluated using the Flesch-Kincaid reading level scale. Results: The CMI provided by the six pharmacies appear to be produced by two information vendors, Wolter’s Kluwer or First Databank. This was evident based on the identical wording and reference to these sources. The CMI from First Databank mentioned 5 of the 11 known interactions with the target medications. The CMI that was developed by Wolter’s Kluwer mentioned only 2 of the 11 known DDIs. The average reading grade level for First Databank leaflets was 10.6 (SD=2.87), while the reading level for the CMI from Wolters Kluwer was 5.0. The font size varied from 8 to 12-point font. Conclusions: CMI has limited to no warnings about serious and well-known DDIs. Medication information vendors and community pharmacies should work together to improve CMI to help prevent dangerous DDIs.  
    • Effect of emergent magnetic resonance imaging on alteplase utilization for acute ischemic stroke

      Patanwala, Asad; Munoz, Jonis; Reyes, Dana; College of Pharmacy, The University of Arizona (The University of Arizona., 2018)
      Objectives: The purpose of this project was to assess appropriateness of alteplase (tPA) administration in patients undergoing magnetic resonance imaging (MRI) at Banner-University Medical Center Tucson (BUMC-T) and identify interruptions in therapy that could have been prevented. Methods: This descriptive quality improvement project evaluated retrospective data from the electronic health records at BUMC-T. Data was collected from patient charts using Epic. The data collection form included items based on demographics, tPA, symptoms and severity, utilization of computerized tomography, MRI, interventional radiology (IR), and complications. Wilcoxon Rank-sum test was used to compare the door-to-needle times if patients did or did not receive an MRI. Fisher’s exact test was used to compare the proportion of patients with interruption of infusion with or without emergent MRI (P<0.050). Main Results: Ninety-six patients received tPA for acute ischemic stroke with 13 having an interruption in infusion. Reasons documented were placed into 4 categories: MRI related, blood pressure related, adverse reactions related to tPA, or other. Four of 13 interruptions were related to an emergent MRI. This was not statistically significant (p>0.050). The remainder were not preventable as tPA was discontinued because of an adverse event. Patients that received an MRI received tPA faster than those patients who did not receive an MRI (48 minutes versus 63 minutes, respectively) (P=0.006). Conclusions: Alteplase interruptions did not occur more frequently in patients who received MRI. However, all preventable interruptions were due to MRI. Alteplase administration logistics should be optimized to minimize any preventable interruptions in therapy.
    • Capitalizing on Opportunities for Reaching Patients: Utilization of Providers in Delivering Medication Therapy Management (MTM) Services

      Forbes, Stephanie; Szabados, Kwyn; Harnisch, Alexa; Shoura, Aya; College of Pharmacy, The University of Arizona (The University of Arizona., 2018)
      Specific Aims: The specific aim of the project is the study the impact of connecting with primary care providers of eligible patients to complete MTM services though pharmacist-delivered CMRs. Our primary working hypothesis is that provider engagement though the Provider Outreach Program (POP) will allow more patients to receive MTM services than the standard MTM process. Methods: This study used a descriptive, retrospective design. Inclusion criteria for this study consisted of patients enrolled in the Provider Outreach Program. Beneficiaries of the program were the patients with two or more chronic conditions and taking multiple prescription medications eligible to receive MTM services as part of their Medicare Part D or individual prescription coverage. Since this study will be from 21 states and over a period of 4.75 months the estimated sample size was calculated to be roughly 53,000. The independent variable is the Provider Outreach Program (POP). The POP targets patients that the standard MTM process is unable to reach by directly contacting providers to increase the number of patients who benefit from MTM services. Demographics for all study participants consist of Medicare qualifying patients (65 years or older, disability, or end-stage renal disease). Descriptive variables will be participating state, total faxes sent, medication list received, POP CMRs completed, total outbound calls, standard CMRs completed, and reasons for denial of communication. The descriptive variables were analyzed by calculating percentages and totals for continuous variables (total faxes sent, medication lists received, POP CMRs completed, standard CMRs completed, and total outbound calls). Main Results: Of the total 52,170 faxes sent, 9,043 medication lists were received (17.9%) from PCPs. There was a 3.8-fold difference in successful CMR completion rates between the POP (16.4%) and the standard MTM program (4.3%). Conclusions: The POP can be utilized as a method to strengthen the outcomes of the standard process to increase the number of patients who benefit from MTM services.
    • Increased Awareness: The Role of Education in Influencing Attitudes and Understanding of Nonmedical Prescription Stimulants use in Greek-life Associated Undergraduate Populations

      Cooley, Janet; Djane, David; Venger, Nathan; Hagen, Christopher; College of Pharmacy, The University of Arizona (The University of Arizona., 2018)
      Specific Aims: To explore whether educational intervention of university students would improve their knowledge and perceptions of prescription stimulants. Subjects: Students between the ages of 18-22 years old who are current and enrolled members of a Greek Life organization that is recognized by a land-grant university in the Southwest. Methods: Questionnaires administered during a scheduled Greek Life chapter meeting that collected pre-presentation knowledge on general stimulant and prescription stimulant knowledge with a follow-up post-presentation questionnaire; additional data concerning age, ethnicity, and year of study was also collected. Main Results: Questionnaires were completed by 45 men (mean age = 19.96; SD = 1.31; 62% white). No advancement of knowledge regarding general stimulant and prescription stimulant knowledge was observed from the data analysis (p = 0.55). Conclusions: Verbal educational intervention as a sole monotherapy was not sufficient in changing the knowledge or attitudes regarding stimulants for a small portion of undergraduate students currently enrolled at a land-grant university in the Southwest who are actively involved in recognized Greek Life organizations. More studies with larger sample size need to be performed.
    • Title of project: Assessing Pharmacy Student’s and Alumni’s Perceived Benefit of 4th Year Professional Development Activities Through an Online Survey

      Cooley, Janet; Little, Amanda; College of Pharmacy, The University of Arizona (The University of Arizona., 2018)
      Specific Aims: Assess the perceived benefit of professional development activities provided to 4th year pharmacy students through a survey of alumni. Subjects: University of Arizona College of Pharmacy alumni from the class of 2013 through 2017. Methods: An email sent to all email addresses that were listed in the listserv invited alumni from the class of 2013 through 2017 to participate in the survey. The survey collected information on which events the alumni attended during their 4th year of pharmacy school and gauged how beneficial the respondents found the events that they participated in. Main Results: The survey was completed by a total of 100 alumni; 20 from the class of 2013 (60% female), 16 from the class of 2014 (75% female), 19 from the class of 2015 (68% female), 20 from the class of 2016 (60% female), and 25 from the class of 2017 (56% female). Respondents reported similar attendance for the 4 th year meetings (P4 meetings) (61.8%), the mock interview session (60%), and the residency/preceptor showcase (60%.) 55% of respondents reported attending career day. The following percentage of respondents strongly agree or agree that they found the events beneficial as described in the survey items: 77.5% for the P4 meetings, 78% for the mock interviews, 58.7% for the residency/preceptor showcase, and 65.1% for career day. Conclusions: The P4 meetings, mock interviews, residency/preceptor showcase and career day appear to have been beneficial for over 50% of the respondents that reported attendance of these events.
    • argeting Myosin Light Chain Kinase (MLCK) Catalytic Domain to Treat Endothelial Barrier Dysfunction

      Chapman, Eli; Machulis, Jason; College of Pharmacy, The University of Arizona (The University of Arizona., 2018)
      Specific Aims Aim 1: To develop an MLCK assay for a high-throughput screening (HTS) campaign. Working hypothesis: MLCK truncation, fusion, and correct bacterial expression host will produce functional MLCK for an HTS campaign. Aim 2: To screen for MLCK inhibitors using a natural product library for chemical diversity. Working hypothesis: Natural products have elaborate scaffolds that might reveal novel mechanisms of inhibition, giving better specificity. Aim 3: To convert hits to leads through biochemical, biophysical, and cellular analyses. Working hypothesis: Initial hits will be confirmed, expanded, and optimized to produce lead compounds. Methods Bacterial cell transformation, plasmid purification, PIPE cloning, small and large scale protein expression, and IMAC were used to purify recombinant MLCK. Purified samples were tested for size using gel electrophoresis. Main Results MLCK is insoluble in a pSpeed vector, and cannot be purified at large concentrations when expressed in a pGEX vector. No p-values or confidence intervals were used. Conclusions MLCK assay development for a HTS campaign cannot be completed due to low protein yield when expressed in bacteria.
    • Family-Oriented Community Clinic: Impact of Regular Education on Health Literacy and Self-Care

      Tong, Theodore; Slack, Marion; Lee, Betty; Huynh, Sarah; College of Pharmacy, The University of Arizona (The University of Arizona., 2018)
      Specific Aims: To compare the impacts of regularly scheduled education and health clinic sessions on individual’s health outcomes and self-care. Subjects: Tucson community members who are participants of Project Taking Charge and have attended more than three clinic sessions during the six-month study period. Methods: A retrospective review of a central database was used to collect baseline characteristics, blood glucose, A1c, blood cholesterol, blood pressure, BMI and weight. These clinical values were then used to assess participant clinical health outcomes. The questionnaire surveys distributed at the last clinic session were collected and used to analyze the improvement in participant understanding of self-care. Main Results: For weight, a 1.5% decrease from 186.1 (±50.7) to 183.3 (±50.4) pounds (p=0.012) was observed to be statistically significant. In response to the importance and the frequency of different self-care questions, participants had an improved perspective on the importance of exercise by 0.9 scale (p=0.008), a better understanding of having a balanced nutritious meals by 1.34 (p=0.0002), proper hand-washing technique by 0.54 (p=0.027), and eating at home more often by 0.31 (p=0.039) compared to baseline. Conclusions: Participant responses reflect positive changed perceptions of exercise and healthy lifestyle choices. Although post-clinical values for BMI, fasting blood glucose, A1c, systolic blood pressure, and blood cholesterol levels, did not meet p<0.05 statistical significance, the trend towards improved cholesterol levels, blood sugar levels and blood pressure levels indicate there may be some benefits attributed from participation in the clinic project.
    • Self-reported Management of Back Pain by Community Dwelling Adults: A Systematic Review

      Slack, Marion; Martin, Jennifer; Azadbakht, Mostafa; Rahim, Rasoul; College of Pharmacy, The University of Arizona (The University of Arizona., 2018)
      Purpose: The purpose of this systematic review is to identify strategies that community dwelling adults use to manage chronic back pain. Methods: Studies were eligible for inclusion if the study participants were at least 18 years of age, and currently suffering from back pain and living in the community. Excluded were reports on individuals who were institutionalized. The articles had to be written in English language. We searched Pubmed, Embase, and conducted citation searches on identified articles. Two researchers independently reviewed studies for inclusion, and extracted data from identified studies. Any differences were resolved by consensus. Data were extracted on strategies used to manage pain and outcomes. Data were analyzed by constructing tables to report types of strategies used and outcomes. Main Results: A total of 1929 study reports were identified; 9 were included in the systematic review. The primary strategy to manage back pain was using medications. 5 studies reported the use of opioids. All studies except one reported the use of anti-inflammatories. Studies also reported the use of psychological strategies (e.g. coping strategies), physical strategies (e.g. exercise), and remedies (e.g. rest). Most studies were cross sectional, participants were 29-49 percent male, average age (31-66). All studies were of community dwelling adults. Conclusions Medication was the primary strategy used to manage back pain. Opioids, and anti-inflammatories were the most common classes of medications. The most commonly reported non-medication strategy were physical strategies. Only limited information was provided on all the other strategies.
    • Retrospective Description of the Safety and Efficacy of Filgrastim-sndz as a Front-line Mobilization Agent in Combination with Plerixafor followed by Post autologous stem cell infusion use for Autologous peripheral blood stem transplantation in Multiple Myeloma

      McBride, Ali; Sandoval, Anthony; College of Pharmacy, The University of Arizona (The University of Arizona., 2018)
      Purpose Mobilization of hematopoietic stem cells, which has largely replaced bone marrow harvesting as a source of hematopoietic stem cells, utilizing filgrastim and/or plerixafor for peripheral blood stem cell collection for autologous stem cell transplantation. Current data has shown equicoval efficacy with G-CSF based mobilization, however, there has been little data with the combination of a biosimilar and plerixafor in upfront stem cell mobilization. Here we evaluate our institutional outcomes in this setting. Methods This study was a descriptive retrospective chart review. This study included all patients treated with filgrastin-sndz and filgrastim from January 1st 2016 to December 31st 2017, diagnosed with multiple myeloma. There was a total of 48 patients included in the study that met all of the criteria. The CD34+ cells/kg count and adverse events were all analyzed Results A total of 46 patients participated in this study. The goal of it was to collect an average of CD34+ stem cells > 7 x 106/kg. The average collected CD34+ stem cells was 14.7 x 106/kg. The average number of apheresis sessions was 3.59 and none of the patients has an adverse effect from the infusion of filgrastim-sdnz. The average days to 500 ANC and was 13.54 and the average days to platelet count of 50,000 was 22.82. Conclusions Patients treated with filgrastin-sndz had the expected outcomes and had similar adverse reactions to that of filgrastim when compared to other studies.
    • Utilization of Local Anesthetic Medications in Pediatric Patients prior to Venipuncture for Blood Draw or Intravenous Medication Administration

      Brandon, Megan; Crampton, Rachel; Joseph, Caroline; Tellez, Alexandria; College of Pharmacy, The University of Arizona (The University of Arizona., 2018)
      Specific Aims To increase nursing use of local anesthetics in pediatrics and to identify barriers for not using local anesthetics prior to any venipuncture. Subjects: Registered pediatric nurses working at Diamond Children’s BUMC-T hospital in General Medicine Units. Methods Pre-questionnaires and post questionnaires administered at the end of each shift daily for two weeks on knowledge, preference, practices of the day, years of work experience and any additional comment. A PowerPoint Intervention directed at the nursing staff educating about each of the local anesthetics used prior to venipuncture. Only used the nurses (N=8) that completed both pre and post questionnaires and excluded all other questionnaires. Main Results Out of the 50 possible registered pediatric nurses in the General Medicine Units, only 8 nurses (16%) completed both the pre and post questionnaires. There was an increase in the number of local anesthetic utilized prior to venipuncture from pre-questionnaires to post-questionnaires but it was not statistically significant. P value= 0.1817, CI=1.00 95% Confidence interval (-0.84-2.84). Conclusions Nursing staff did increase use of local anesthetics prior to venipuncture even with an educational intervention but it was not statistically significant. We did identify barriers for not administering local anesthetics prior to venipuncture which included: no time, no order for local anesthetic was available, and contraindicated.
    • Evaluating readmission rates due to gastrointestinal bleeds in post cardiac catheterization patients at an academic medical center

      Rubal-Peace, Georgina; Mann, Sedona; Tsang, Vincent; Vasquez, Julieta; College of Pharmacy, The University of Arizona (The University of Arizona., 2018)
      Specific Aims: To determine the proportion of patients placed on dual or triple antithrombotic therapy post-cardiac catheterization who were readmitted for gastrointestinal (GI) bleeds who were discharged on concomitant proton pump inhibitor (PPI)/histamine receptor 2 antagonist (H2RA) therapy. Methods: Retrospective chart review of patients who presented to Banner University Medical Center South Campus (BUMCS) for cardiac catheterization who underwent percutaneous coronary intervention (PCI) from January 1st, 2016 to December 31st, 2016. Discharge medications of those patients were reviewed, with a focus on dual/triple therapy and contaminant gastroprotective therapy. The concomitant use of gastro-protective therapy (PPI/ H2RA) among those patients were identified. Demographics, past medical history, pertinent laboratory values and HAS-BLED score were obtained from the patient’s electronic health record. Main Results: A total of 147 patient charts were reviewed. A total of 133 patients received dual antiplatelet therapy, nine received triple antithrombotic therapy, and five received neither treatment. The patients were separated into two groups: PPI/H2RA or no PPI/H2RA. There was no significant difference between those on gastroprotective therapy (n= 53, 36%) and those not on gastroprotective therapy (n =94, 64%) with concomitant dual/triple antithrombotic therapy (p= 0.94). A total of 31 readmissions, 30-days within stent placement, were found. Among readmissions, one was attributed to gastrointestinal bleeding and was readmitted 11-days after discharge and was on gastroprotective therapy. Conclusions: There was no significant difference of readmissions due to GI bleeding between those on gastroprotective therapy and those not on gastro-protective therapy with concomitant dual/triple antithrombotic therapy as only one GI bleed was found.
    • Title of project: Describing and measuring the pharmacists’ involvement in dosing and monitoring vancomycin at Tucson Medical Center, a community teaching hospital

      Bergstrom, Eric; Neopaney, Tek; Kafley, Puspa; Tran, Kelvin; College of Pharmacy, The University of Arizona (The University of Arizona., 2018)
      Specific Aims: To measure the amount of time spent by pharmacists on vancomycin dosing and monitoring at Tucson Medical Center (TMC). Methods: This is a descriptive study that used data obtained through a questionnaire and data collection sheets from pharmacists at TMC from September 18 through October 13, 2017. Pharmacists were eligible to participate in the study if they were working in an inpatient pharmacy setting at this community hospital for at least 24 hours a week and more than 6 months. Data were analyzed by using student t-test to compare between groups. Main Results: Through a questionnaire, pharmacists reported spending an average of 13.5 minutes (SD 6.9) and 9.5 minutes (SD 4.3) for new and continuous vancomycin therapeutic drug monitoring per encounter, respectively. Data collection over a period of 29 days revealed that pharmacists spent a total of 112.33 hours and an average of 3.85 hours per day on vancomycin TDM. In general, pharmacists spent an average of 10.27 minutes (SD 6.76) per encounter and 30.42 minutes (SD 27.53) per patient. The mean time for new (n=163) versus continuous (n=493) vancomycin TDM was 11.7 minutes (SD 5.6) and 9.8 minutes (SD 7.0), respectively, with statistically significant P values of 0.001. The mean time spent per encounter was statistically significant between groups that used a vancomycin calculator (n=323) [13 minutes (SD 7.9)] versus those that did not use a calculator (n=333) [7.6 minutes (SD 3.9); P = 0.001]. Conclusions: The average time spent per patient by the pharmacist for vancomycin therapeutic drug monitoring (TDM) was about half an hour, which supported the prediction for the time spent on vancomycin by pharmacists prior to our study. More time was spent on new-start vancomycin TDM than existing vancomycin drug monitoring. In addition, more time was spent on vancomycin TDM with the use of a calculator.
    • An Evaluation of Outcomes Related to the Use of a VTE Prophylaxis Assessment Tool in Obstetrical Patients at Northwest Medical Center

      Sullivan, Christopher; Salek, Ferena; Calkins, Linda; Smith, Katherine; Smith, Karen; Blanco, Hayde; Kelly, Melissa; Romero, John; Wilkerson, Aaron; College of Pharmacy, The University of Arizona (The University of Arizona., 2018)
      Specific Aims: To evaluate the relationship between standardized venous thromboembolism (VTE) risk assessment, subsequent use of pharmacologic prophylaxis and outcomes related to VTE and bleeding. Subjects: Pregnant women who were admitted to NMC Women’s Center from January 1, 2017 to October 1, 2017 to give birth and who consented to a post-discharge phone call. Methods: An in-house risk assessment instrument was used to measure an individual’s risk of VTE on admission and post-delivery. Six weeks post-discharge, consented eligible patients were contacted via phone to determine VTE occurrence outpatient or inpatient, VTE prophylaxis occurrence, and experienced outpatient adverse drug events (ADE). All data were recorded in a data collection spreadsheet and analyzed. Main Results: A total of 707 women were included in the study. Most patients had a total risk score of zero (antepartum [AP]: 74.4%, postpartum [PP]: 51.9%). Seventeen (2.4%) AP patients and 72 (12.8%) PP patients scored high risk (defined as total score ≥ 4). Of the 17 high risk AP patients, 8 received postpartum prophylaxis. Of the 72 high risk PP patients, 13 received postpartum prophylaxis. There were no reported ADEs associated with any prophylactic drug therapy. One patient experienced a deep vein thrombosis incident in the six weeks postpartum period and zero in the antepartum period. Conclusions: Among the participants who received a VTE risk assessment pre- and postpartum, one participant experienced a VTE during the six week postpartum window. Additionally, there was no notable difference in ADEs in patients receiving pharmacological prophylaxis despite increased use.
    • A Systematic Review of Alzheimer’s Disease Prevention with Diet

      Lee, Jeannie; Bhattacharjee, Sandipan; Martin, Jennifer; Robinson, Chris; Johnson, Mary; College of Pharmacy, The University of Arizona (The University of Arizona., 2018)
      Specific Aims: Examine the effects of the Mediterranean Diet as prevention of cognitive decline in older adults. Methods: We developed a systematic review searching ten different databases from inception of the database to March 2018. The database search provided 1,379 studies, of which five studies met the inclusion and exclusion criteria. Studies were included if there were no other modalities such as: physical activity, vitamins, minerals, and supplements. Main Results: The final five studies were either sub-analyses of randomized controlled trials or prospective cohort studies that included both males and females with an average age of 70.8 years old (range: 61.9 to 77.2 years-old) and an average follow-up of 4.6 years (range 2 to 6.6 years). The five studies reported profound differences in the risk of dementia among study participants. The consensus of the studies is that greater adherence to a Mediterranean Diet appears to influence prevention of cognitive decline. Even though the consensus is that a Mediterranean diet can prevent dementia, more research is needed to prove a stronger correlation. Conclusions: As a result of heterogeneous data, a meta-analysis of the five studies proved inconclusive. The five articles differed in outcomes related to Mediterranean Diet adherence, such as different Mediterranean diet groups with modified versions of the Mediterranean Diet or adherence to the Mediterranean diet using the validated Mediterranean Diet Score (MDS) point system classifying adherence based on low, medium, and high. Lastly, the studies differed in how they measured cognitive decline.
    • A Single Center, Retrospective Chart Review Studying Survival Rates in Patients Treated with IMiDs for Multiple Myeloma

      McBride, Ali; Chung, Jisu; Patel, Toral; Trinh, Christina; College of Pharmacy, The University of Arizona (The University of Arizona., 2018)
      Specific Aims: To evaluate the survival rate between dose adjustment group and non-dose adjustment group in patients diagnosed with multiple myeloma taking IMids. Methods: In this retrospective study design, a total of 100 patients diagnosed with multiple myeloma who received at least one dose of studied IMids were included. The primary finding was survival rate between the dose adjustment group and the non-adjustment group. The secondary findings include the prevalence of side effects and the length of survival. Chi square test was used to analyze the data collected. Main Results: Of the 100 patient charts reviewed, 37 subjects (37%) were dose adjusted (dose adjustment group) whereas 63 subjects (63%) didn’t require dose adjustment (non-dose adjustment group). The incidence of death in both groups were not statistically different with 4 death in dose adjustment group and 7 deaths in non-adjustment group (p=0.96). The most commonly reported side effects in both groups were bone marrow suppression (24.8%), anemia (15.3%), fatigue (14.6%), and diarrhea (12.4%). Conclusions: The incidence of death in both dose adjusted group and non-dose adjusted group were not statistically different (p=0.96).
    • Comparison of Vancomycin AUC Calculation Methods in Patients with Cystic Fibrosis

      Phan, Hanna; Matthias, Kathryn; Coulter, Josh; Hilde, Casey; College of Pharmacy, The University of Arizona (The University of Arizona., 2018)
      Specific Aims: Determine if there is clinical and statistical significance between using a predictor equation versus a 2S method of vancomycin monitoring in cystic fibrosis (CF) patients. Evaluate if there is a correlation between vancomycin trough values and AUC0-24/MIC in patients with CF. Methods: This study was a retrospective cohort study using patient charts using EPIC software provided from Banner-UMC. Demographic and vancomycin pharmacokinetic data was documented from patients with CF being treated for MRSA respiratory infections. Pharmacokinetic data was then used to calculate the AUC0-24/MIC using regular two level kinetics as well as three population-based pharmacokinetic equations to test their validity against regular kinetics. Main Results Conclusions