PGY2 Ambulatory Care Pharmacy Resident

Objectives: 1. Explain the screening, diagnosis, and pathophysiology of diabetic nephropathy 2. Describe the renin-angiotensin-aldosterone system (RAAS) and the mechanism of action and effects of angiotensin-converting enzyme inhibitors (ACE-I) and angiotensin II receptor blockers (ARB) 3. Review the current guidelines and treatment recommendations for diabetic nephropathy 4. Evaluate the available literature regarding the effects of RAAS on diabetic nephropathy in normoalbuminuric patient

Impact of Antibiotic Shortage on H. Pylori Treatment: A Step-Wise Approach for Pharmacist Management

The current drug shortage crisis involving multiple oral antibiotics has significantly impacted preferred therapeutic options for treatment of H.pylori infection. Pharmacists may help alleviate the impact of this shortage through a proposed step-wise approach which includes proper inventory management, verification of indication, evaluation of regimen, therapeutic monitoring, and communication with patients and providers regarding alternative therapy or symptomatic relief

Imipenem/cilastatin versus Meropenem on Fever Defervescence in Septic Febrile Patient: A Comparative Prospective Study

Objective: Meropenem efficacy and tolerability was reported to measure up toimipenem/cilastatin, though some data reported that it may be more efficient incertain clinical and bacteriological settings. Our aim here is to demonstrate anypossible difference between the two carbapenems in major septic clinical scenarios.Fever defervescence was selected as a clinical primary “broad†parameter to comparethe effectiveness of imipenem/cilastatin and meropenem on fever defervescencein febrile septic patients.Methods: A prospective multicenter, observational, comparative open label study.The study was conducted in three hospitals between February – September 2009 inAmman-Jordan. Data were collected for patients whom were started on imipenem/cilastatin or meropenem; the study team did not contribute to the antibacterialselection for patients.Results: Seventy patients were evaluated, thirty-two imipenem/cilastatin and thirty-eight meropenem treated patients. Age mean was 60 and 57.6 years for Imipenem/cilastatin and meropenem respectively. The APACHE II score was similar, mean14.4 for both study arms. There was no significant difference in rates of clinicaldiagnoses for both study arms; ventilator-associated pneumonia (VAP), urinary tractinfection (UTI), intra-abdominal infections (IAI), blood stream infection (BSI) or forothers sources. Additional anti-gram negative agents were administered in 10 and9 patients, added anti-MRSA agents in 11 and 12 patients, and antifungal agentsin 3 and 1 patient in imipenem/cilastatin and meropenem treated patients respectively.There was no significant difference between the mean temperatures (38,60C for both), antimicrobial utilization days (8.33 versus 6.67), mean days for feverdefervescence (3.31 versus 2.37, p = 0.36, 95% C.I. (-1.09 - 2.98) for imipenem/cilastatin and meropenem treated patients respectively, mortality was the same.Conclusion: There is no evidence to support the notion that there is clinical differencein fever defervescence between Imipenem/cilastatin and meropenem inthis evaluated group

Ambulatory Care Pharmacy Resident

Objectives: 1. Review the background, epidemiology, and diagnostic criteria for the antiphospholipid syndrome 2. List clinical manifestations associated with antiphospholipid syndrome 3. Describe the pathophysiology of thrombosis in the antiphospholipid syndrome 4. Evaluate the evidence for the different intensities of oral anticoagulation in the 1. Background 1-3 i. Antiphospholipid syndrome (APS) is an autoimmune disease characterized by the presence of antiphospholipid antibodies (aPL)

Preparation of Diltiazem Topical Gel for the Treatment of Anal Fissure and In-vitro, Ex-vivo Drug Release Evaluations

Abstract: Introduction: Anal fissures are small tears in the lining skin of the anus presenting with typical symptoms of pain and bleeding during defecation. Several new forms of medicines such as glyceryle trinitrate (GTN) ointments and diltiazem, a calcium channel-blocking agent, have been recently used for the treatment of these fissures. Diltiazem relaxes the muscle of anal sphincter and consequently increases blood flow to promote healing. It does not have GTN side effects like headache, anal burning and hypotension. The objective of this study was to formulate a suitable topical gel from diltiazem and then to investigate its physicochemical stability and also the drug release profiles from the bases. Methods: Various formulations of gel base including Guar 1.25%, Tragacanth 1.5%, HPMC 1%, and HPMC 1.5% were prepared and in vitro release and penetration characteristics of diltiazem from each preparation were studied through a hydrophilic dora pore diffusion barrier and membrane excised rat skin using Franz cell over a period of 5 hours. The amount of drug released from topical preparations was determined spectrophotometrically at ? max=236 nm. Stability studies and shelf life assessments were performed too. Results: Gel formulations containing HPMC, Guar and Tragacanth presented both good chemical and physical stabilities. The rates of cumulative drug release from HPMC 1%, HPMC 1.5%, Guar 1.25% and Tragacanth 1.5% bases using synthetic membrane were 89.7%, 76.7%, 94.9% and 66.1% respectively. For excised rat skin test, the cumulative percent of penetrated drug at the end of each experiment were 52.7 %, 50.9%, 64.6% and 42.6% for HPMC 1%, HPMC 1.5%, Guar 1.25% and Tragacanth 1.5% bases respectively. Conclusion: The comparative study showed that the percent of drug release from synthetic membrane was more than the percent of penetrated drug through excised rat skin for all bases (P<0.05). It was concluded that the kinetics of diltiazem release in vitro was not affected by the kind of gel forming agent and for all of the formulations, Higuchi’s kinetic model was suitable to explain their kinetics. Keywords: Diltiazem, Topical gel, Anal fissur

The Need for Prenatal Programs in Areas of Low Socioeconomic Status

Adverse birth outcomes are a continual issue throughout the United States despite current research and major medical advances over the past few decades. One of the target goals set forth by Healthy People 2010 is for 90% of pregnant women to begin receiving prenatal care in the first trimester. According to Healthy People 2010, prenatal care includes three major areas which are: assessment of risk, treatment for current medical condition and education. Approximately three-quarters of all pregnant women receive some type of prenatal care at some point during their pregnancy. This number varies greatly over different levels of socioeconomic status (SES). Research suggests that pregnant women in areas of low SES are more likely to receive prenatal care late in pregnancy or not at all (Sunil T et al., 2008). Receiving little or no prenatal care throughout pregnancy can result in poor birth outcomes, pregnancy associated complications and infant mortality. According to the CDC, it is projected that approximately one-half of all pregnancy associated dealths could have been prevented with early prenatal care. These adverse events include birth defects, stillbirths, pre-term birth, neonatal and post-neonatal deal, SGA (small-gestational age), among many others. Recent studies have shown that the introduction of a prenatal program can greatly reduce these adverse birth events in areas of low SES.Master of Public Healt

Psychometric Assessment of the PPDG: Utilizing Cronbach’s Alpha as a Means of Reliability

Introduction: Since the development of the 10 item Purdue Pharmacist Directive Guidance (PPDG) Scale several studies of the psychometric properties of the PPDG have been conducted. Although Cronbach’s alpha was calculated as a means of internal consistency reliability, a demonstration of the mean centering of the individual items from the instrument were not explored.Objectives: This study focused on investigating the mean stabilization of items within the PPDG as they pertain to Cronbach’s reliability coefficient calculation.Methods:Using item analysis procedures in SPSS, the mean stability of items within the general factor of directive guidance and subscales of instruction and feedback and goal setting were examined for the PPDG.Results:Mean stability scores for entire PPDG scale and the subscales of instruction and feedback and goal setting were strong. Also, corrected item-total correlations and Cronbach’s alphas following item deletion were good for the overall PPDG scale and the subscales.Conclusions: The results provide evidence to enhance understanding of the psychometric stability of the PPDG scale and its subscales

Urogenital chlamydia trachomatis treatment failure with azithromycin: A meta-analysis

Background: Chlamydia Trachomatis is one of the most common pathogens transmitted through the genital tract in humans that leads to urogenital infection. Objective: Given the high prevalence of chlamydia infection and its adverse effects on the health of women and men, the present meta-analysis was conducted to determine the rate of treatment failure with azithromycin. Materials and Methods: Databases including MEDLINE, ISI - Web of Science, PubMed, EMBASE, Scopus, ProQuest, and Science Direct were searched for articles published between 1991 and 2018. The quality of the selected articles was assessed using the Cochrane risk of bias assessment tool. Heterogeneity was determined using the I2 and Cochrane Q-Test. Subgroup analysis and meta-regression were used to compare the prevalence rates on different levels of the variables. Results: A total of 21 articles that met the inclusion criteria were ultimately assessed. The pooled estimate of azithromycin failure rate was 11.23% (CI 95%: 8.23%-14.24%). Also, the azithromycin failure rate was 15.87% (CI 95%: 10.20%-21.54%) for the treatment of urethritis, 7.41% (CI 95%: 0.60%-14.22%) for cervicitis, and 7.14% (CI 95%: 10.90%-3.39%) for genital chlamydia. The pooled estimate of failure rate difference was 2.37% (CI 95%: 0.68%-4.06%), which shows that azithromycin has a higher failure rate in the treatment of chlamydia compared to doxycycline and other examined medications. The meta-regression results showed that the patient’s age contributes significantly to the heterogeneity for azithromycin treatment failure rate (β = 0.826; p = 0.017). Conclusion: Azithromycin has a higher failure rate than doxycycline and other studied medications in treating urogenital chlamydia infections. Key words: Azithromycin, Chlamydia trachomatis, Urogenital, Treatment failure, Meta-analysis

A Survey of Kansas Physicians' Perceptions of Physician Assistant Education and Qualifications

BACKGROUND: Effective physician-physician assistant (PA) teams improve patient access and satisfaction, and increase productivity and revenue while reducing physician workload. This survey assessed perceptions of Kansas primary care physicians regarding educational requirements and qualifications of PAs, professional and legal regulations, and the most important skills and competencies for PAs to possess. Understanding these perceptions may lead to improved communication and refined expectations of physician-physician assistant teams, thereby increasing their utilization and effectiveness. METHODS: A 20-question survey was emailed to all 1,551 primary care physicians registered with the Kansas Board of Healing Arts in 2012. Descriptive data were reported as frequencies; comparisons between groups were analyzed using Chi-square. RESULTS: The response rate was 9.2% (n = 143). Physicians were highly accurate regarding the program’s generalist/primary care educational model and moderately accurate regarding the degree awarded, average pre-program grade point average, lock-step full-time curriculum, weeks of clinical rotations, recertification and continuing medical education hours, and Medicare PA fee schedule. Physicians had low accuracy regarding program and pharmacology credit hours, strict dismissal policy, pre-program healthcare experience, and co-signatory regulations. Physicians with PA supervisory experience had higher knowledge than those without (p = 0.001). Physicians most commonly selected history taking and performing physical exam as the most important skill (49%) and providing patient care that is patient-centered, efficient, and equitable as the most important competency (42%). CONCLUSIONS: Physicians often underestimated the average PA applicant qualifications, program rigor and intensity, professional regulatory standards, and co-signatory requirements. Correcting misperceptions and improving understanding of which PA skills and competencies are most valued by physicians may optimize PAs as part of the healthcare team