ABSTRACTS

American College of Clinical Pharmacy

2007 Spring Practice and Research Forum
April 21–25 • 2007
Memphis • TN
e10 PHARMACOTHERAPY Volume 27, Number 4, 2007

American College of superior vena cava. UDVT occurred in 25 patients (3.2%), and PE occurred in
27 patients (3.5%) with a single line. Overall, VTE occurrd in 6.27% of
patients with a single line (3 patients experienced UDVT with PE). The VTE
Clinical Pharmacy rate was 6.9 per 1,000 PICC-days. The average length of hospital stay was 15
days in those without VTE and 22 days in those with VTE. The patients with
multiple PICC lines had a VTE rate of 9.7 per 1,000 PICC-days. The length of
2007 Spring Practice and stay was 42 days in patients with multiple PICC lines with VTE versus 30
days without VTE.
Research Forum CONCLUSIONS: UDVT and PE occur frequently in hospitalized patients
with PICC lines, especially when multiple PICC lines are placed.

April 21–25, 2007 3. Evaluation of the relationship between level of education and preferred
learning method in inpatients receiving warfarin. Erin P. Simone, Pharm.D.,
Memphis,TN David A. Kuhl, Pharm.D., Marilyn D. Lee, Pharm.D., N. Elizabeth Piana,
Pharm.D.; The Regional Medical Center at Memphis, Memphis, TN.

PURPOSE: A prior study in warfarin patients identified level of education as

ORIGINAL RESEARCH a factor associated with poor anticoagulation control and increased bleeding.
However, the preferred method of learning in relation to education level has
not been described in this population. This study evaluated self-described
ADR/Drug Interactions education level and preferred method of learning in hospitalized patients
receiving warfarin.
1. Ramipril-induced acute liver toxicity. Holli A. Winters, Pharm.D., Shiv METHODS: Electronic records of warfarin patients admitted to the study
Seth, [Link]., Ph.D., Lee Hebert, M.D.; The Ohio State University Medical institution between January 1 and June 30, 2006, were included.
Center, Columbus, OH. Readmissions and patients with incomplete data were excluded. Data
collected included age, gender, race, and self-described education level (grade
PURPOSE: Hepatotoxicity is a rare adverse effect associated with school, high school, high school degree, college) and preferred method of
angiotensin-converting enzyme inhibitors (ACEI). The incidence of liver learning (audio, demonstration, written, visual, no preference). Patients were
toxicity is estimated to be less than 0.1%. Our case report describes ramipril- subsequently combined into two groups (degree, no degree). Univariate and
induced hepatotoxicity with a rechallenge. multivariate analyses assessed the association of education level to
METHODS: T.T. is a 70-year-old white woman with a medical history demographic variables and preferred learning method.
significant for hypothyroidism, migratory arthiritis, leukocytoclastic vasculitis RESULTS: 204 patients were included with no significant difference being
of the lower extremities, and Type II cryoglobulinemia. Her medications identified between grade school versus high school and high school degree
included prednisone, cyclophosphamide, levothyroxine, and versus college for any study variable. There was no significant difference in
hydrochlorothiazide. Ramipril 5 mg once/day was initiated for hypertension. female gender between degree (61/150) and no degree (25/54). Patients
One month after starting ramipril the patient was admitted to the hospital without a degree were more likely African American (76% vs. 61%, p<0.005),
with severe painless jaundice, elevated liver function tests (LFTs), and older (53 ± 19 vs. 44 ± 14, p<0.005), and preferred audio (24% vs. 9%,
complaining of malaise, fatigue, and decreased appetite. Her LFTs on p<0.005), while the degree group chose no preference (47% vs. 28%, p<0.05)
admission were alanine aminotransferase (ALT) 3796 U/L, aspartate more frequently. Multivariate analysis revealed that the no degree group
aminotransferase (AST) 1909 U/L, and total bilirubin 5.5 mg/dL (baseline preferred audio (OR 3.9 (1.5–10.7), p=0.007), and no degree was more
2 months prior; ALT 13 U/L, AST 19 U/L, total bilirubin 0.7 mg/dL). The common with increasing age (OR 1.04 (1.01–1.06), p<0.005).
patient's cyclophosphamide was held prior to admission for suspected CONCLUSIONS: Patients without a degree, who were more likely to be
hepatotoxicity. Her antihypertensives were also held upon admission, and her older, highly preferred audio learning methods. Institutions should assess
LFTs began to decline (ALT 2174 U/L, AST 824 U/L, total bilirubin current patient education tools and incorporate appropriate audio methods
6.5 mg/dL). On preparation for discharge the patient's ramipril was into educational programs. Further studies are needed to assess the impact of
reinitiated. Approximately 1 week after discharge, all LFT parameters were learning method on patient outcomes in warfarin patients.
significantly elevated (ALT 2313 U/L, AST 1011 U/L, total bilirubin
9.7 mg/dL). The patient was instructed to discontinue the ramipril, and all
4. Adherence with advanced cardiac life support guidelines during in-
LFTs returned to normal within 6 weeks.
hospital cardiac arrest: a role for clinical pharmacy. Heather M. Draper,
CONCLUSIONS: Hepatoxocity is a potential adverse effect associated with
Pharm.D.1, Rima A. Mohammad, Pharm.D.1, G. Robert DeYoung, Pharm.D.,
ramipril therapy. The onset of liver toxicity was within 6 weeks in our case.
BCPS 2; (1)University of Tennessee College of Pharmacy, Knoxville, TN;
We recommend monitoring liver function at baseline and for the first few
(2)Saint Mary's Health Care and Advantage Health Physicians, Grand Rapids,
months after initiating ACEI therapy.
MI.

PURPOSE: Limited published research has evaluated adherence to advanced

Adult Medicine cardiac life support (ACLS) guidelines during in-hospital cardiac arrest.
Recent reviews of ACLS practices indicate that an audit of in-hospital
2. Incidence and risk factors for upper extremity thrombosis in resuscitation practices be performed to guide future resuscitation training
hospitalized patients with peripherally inserted central catheters. Bob Lobo, programs for hospital personnel. The primary objective of this study was to
Pharm.D., BCPS1, Georgeta Vaidean, M.D., MPH, Ph.D.2, Ron Shorr, M.D., assess adherence to ACLS guidelines at a community teaching hospital and
M.S.2, Terry Hodge, B.S.3, Anne Reaves, Pharm.D.1, Joyce Broyles, Pharm.D., determine the potential role for pharmacist presence during resuscitation
M.S., BCNSP1; (1)Methodist University Hospital, Memphis, TN; (2)University practices.
of Tennessee Department of Preventive Medicine, Memphis, TN; METHODS: A retrospective chart review of 74 consecutive in-hospital
(3)University of Tennessee, Memphis, TN. cardiac arrests occurring from January 1, 2003, to June 30, 2004, were
evaluated for 1) administered treatment interventions, 2) adherence with the
PURPOSE: The objective of this study was to estimate the frequency and 2000 American Heart Association (AHA) ACLS treatment guidelines, and 3)
clinical correlates of upper limb deep vein thrombosis (UDVT) and pharmacist presence at the resuscitation. Non-adherent interventions were
pulmonary embolism (PE) in patients with peripherally inserted central classified into the following categories: deviation in the sequence of
catheters (PICC). interventions, omission of indicated treatment, incorrect dosage of
METHODS: We collected data by retrospective review of the electronic medication or defibrillation, or time delay in provided intervention.
medical record on all hospitalized patients who had a PICC inserted between RESULTS: Of the 650 treatment interventions identified, 10.6% were non-
August 1, 2005, and November 1, 2005, at Methodist University Hospital, adherent with ACLS guidelines. The most common reasons recorded for non-
Memphis, TN. All patients who had a PICC inserted sucessfully during the adherence were an incorrect dosage of medication (35%), prolonged period of
study period were included. Patients were excluded if they already had an time between sequential interventions (25%), and omission of an indicated
upper extremity DVT or sepsis at the time of PICC insertion. Clinically treatment (19%). A pharmacist was present at 36.5% of documented arrests.
suspected UDVT was confirmed by ultrasound, and PE was confirmed by CONCLUSIONS: Based on the modes of non-adherence noted, a pharmacist
either high-resolution CT or VQ scan. trained in ACLS could have the potential to influence drug therapy, resulting
RESULTS: There were 954 PICC lines inserted in 781 patients. The mean in improvement of non-adherence rates during in-hospital resuscitation
duration of catheterization was 9.7 days (7119 PICC days). Among the practices. ACLS education of pharmacists and participation on the
781 patients with single lines, 61% were women, 70% were African American, resuscitation team is warranted to affect the rates and modes of non-
and the mean age was 60 years. Most catheter tips (78%) were placed in the adherence.
 ACCP 2007 SPRING PRACTICE AND RESEARCH FORUM e11
Ambulatory Care and/or valvular surgery from the randomized, controlled Atrial Fibrillation
Suppression Trials II and III (AFIST II and III) were evaluated in this nested
cohort evaluation. Patient demographics, surgical characteristics, medication
5. Evaluation of patient perceptions and outcomes related to use, and the incidence of POAF (defined as AF lasting at least 5 minutes in
anticoagulation point-of-care testing in ambulatory care clinics. Amy N. duration documented by telemetry) were all uniformly and prospectively
Thompson, Pharm.D., Kelly R. Ragucci, Pharm.D., FCCP, BCPS, CDE; Medical collected as part of AFIST II and III. The low-dosing intensity statin group
University of South Carolina, Charleston, SC. consisted of patients who received no statin or less than 40 mg/day (in
atorvastatin dosing equivalents). The high-dosing intensity group consisted of
PURPOSE: The study aim is to analyze humanistic and clinical outcomes in those receiving greater than or equal to 40 mg/day. Multivariate logistic
patients currently on warfarin and being monitored through an anticoagu- regression was used to calculate adjusted odds ratios (AORs) with 95%
lation point-of-care testing (POCT) device within ambulatory care clinics at confidence intervals (CIs).
our institution. RESULTS: A total of 338 patients were evaluated of which 287 (84.9%)
METHODS: All patients currently on warfarin therapy, who are being received low-dosing intensity statin therapy and 51 (15.1%) received high-
followed by clinical pharmacists for anticoagulation monitoring at the dosing intensity statin therapy. The study population was 65.7 ± 9.1 years of
Medical University of South Carolina Family Medicine Center and University age; 77.8% were male; 11.2% underwent valve surgery; 3.6% had prior AF;
Diagnostics Center were enrolled. All patients were asked to complete a 10.1% had heart failure; and 84.0% and 37.9% received postoperative
satisfaction survey with regard to their anticoagulation monitoring. In b-blockade and prophylactic amiodarone, respectively. In total, 110 (32.5%)
addition, we collected data on these patients with regard to emergency room patients developed POAF. Upon multivariate logistic regression, the
visits, hospitalizations, and percent of time in INR therapeutic range for preoperative use of high-dosing intensity statin therapy was associated with a
6 months pre- and post-implementation of the POCT device. This infor- statistically significant 57% reduction in patients' odds of developing POAF
mation was obtained through our electronic patient information database, Oacis. compared to those receiving low-dosing intensity statin therapy [AOR; 0.43
RESULTS: A total of 180 patients were evaluated from the two clinics. The (95% CI=0.19–0.96), p=0.04].
majority (41%) of these patients were taking warfarin for atrial fibrillation. CONCLUSIONS: The use of high-dosing intensity statin therapy is associated
Satisfaction surveys were completed by 86 patients. These surveys revealed with the greatest reductions in the development of POAF.
that the POCT device was preferred over venous puncture in 95% of patients.
Reasons for the preference included more face-to-face interaction, less wait 10. Preoperative statins for the prevention of infectious complications
time, less pain/blood, and quicker results. Of the 145 patients who were following cardiac surgery. Diana M. Lucek, Pharm.D.1, C. Michael White,
included in the objective data analysis, no significant differences were found Pharm.D., FCCP, FCP2, Craig I. Coleman, Pharm.D.2; (1)Hartford Hospital,
in the number of hospitalizations, emergency room visits, or percent of time Hartford, CT; (2)University of Connecticut, Hartford, CT.
in INR therapeutic range pre- and post- implementation of the POCT device.
CONCLUSIONS: Limited information is published on both the humanistic
PURPOSE: Recent observational studies have suggested that statins can
and clinical outcomes of such a device in pharmacy-run ambulatory care
decrease the incidence and severity of various infections including
clinics. Although the results of this project show no significant differences in
pneumonia and bacteremia. However, the effect of statins on post-cardiac
clinical outcomes between the POCT device and conventional venous
surgery infection has not been adequately evaluated. Therefore, we sought to
puncture for INR monitoring, patient satisfaction was greatly improved.
determine whether preoperative statin use results in a reduction in infection
following cardiac surgery.
6E. Double blind, randomized clinical trial to evaluate the effectiveness of METHODS: This was a cohort evaluation of all consecutive patients who
ezetimibe 5 mg versus ezetimibe 10 mg when added to statin therapy. underwent coronary artery bypass graft (CABG) and/or valve surgery at our
Alison Sandherr, Pharm.D.1, Brian Peek, Pharm.D.1, Angela Porter, Pharm.D.1, institution between January 1, 2004, and August 31, 2006. Our primary
Angela Pentecost, Pharm.D.1, Antoine Al-Achi, Ph.D2; (1)Asheville Veterans outcome measure was the combined incidence of postoperative infectious
Affairs Medical Center, Asheville, NC; (2)Campbell University School of complications [pneumonia, bacteremia, sternal wound, leg vein harvest site
Pharmacy, Buies Creek, NC. infection, urinary tract infection, or tracheotomy site infection]. We used
multivariate logistic regression to control for potential confounding and to
Presented at the 37th Annual Southeastern Residency Conference, Athens, calculate adjusted odds ratios (AORs) and 95% confidence intervals (CIs).
GA, April 27-28, 2006. RESULTS: A total of 1,934 patients were included in this evaluation of which
1,248 patients received a statin preoperatively and 686 did not. The study
population was 66.3 ± 11.6 years of age, 71.3% male, 34.0% valve surgery,
Cardiovascular 71.5% hypercholesterolemic, and 32.0% diabetic. In total, 151 (7.8%) patients
developed an infectious complication. Upon multivariate logistic regression,
preoperative statin use was associated with a significant reduction in the
7E. Pharmacist-provided metabolic syndrome screening and educational development of infection [AOR; 0.67 (95% CI=0.46–0.99), p=0.04].
program reduces prevalence of cardiometabolic risk factors. Amy M. Franks, CONCLUSIONS: Preoperative statin use is associated with a 33% reduction
Pharm.D., T. Scott Warmack, Pharm.D., Donna S. West, Ph.D.; University of in patients' odds of developing a postoperative infection following cardiac
Arkansas for Medical Sciences, Little Rock, AR. surgery.

Presented at the 47th Annual Conference on Cardiovascular Disease

11E. Lipoprotein particle size, concentration and lipid ratio effects of
Epidemiology and Prevention of the American Heart Association, in
colesevelam HCl in combination with ezetimibe and simvastatin. Harold
association with the Council on Nutrition, Physical Activity, and Metabolism,
Bays, M.D., FACP1, James Rhyne, M.D.2, Stacey Abby, Pharm.D.3, Chhaya
Orlando, FL, February 28–March 3, 2007.
Shah, Pharm.D. 3 , Yu-Ling Lai, RNC, MSN 3 , Michael Jones, Ph.D. 3 ;
(1)Louisville Metabolic and Atherosclerosis Research Center, Louisville, KY;
8E. Arterial stiffness and renal function in patients with coronary artery (2)The Lipid Center, Statesville, NC; (3)Daiichi Sankyo, Inc., Parsippany, NJ.
disease. Bushra S. Ilyas, [Link].(Hons), [Link]., Donna Markie, R.N.,
David E. Newby, BA, [Link].(Hons), BM, MRCP, M.D., David J. Webb, M.D., Presented at the Annual Meeting of the American Heart Association, Chicago,
DSc, FRCP, FRSE, FMedSci; University of Edinburgh, Western General IL, November 12-15, 2006.
Hospital, Edinburgh, United Kingdom.
12. Early remodeling is associated with functional improvement after acute
Presented at ARTERY-6 Conference of the Association for Research into
candesartan treatment in stroke. David J. Rychly, Pharm.D.1, Anna Kozak,
Arterial Structure and Physiology, Athens, Greece, September 22-23, 2006.
M.S.1, Adviye Ergul, M.D., Ph.D.2, Azza El-Remessy, Ph.D.1, Livia S. Machado,
[Link]. 1 , Hazem F. Elewa, [Link]. 1 , Susan C. Fagan, Pharm.D. 1 ;
9. Does dosing intensity effect a statin's ability to reduce post-cardiac (1)University of Georgia College of Pharmacy, Veteran's Affairs Medical
surgery atrial fibrillation? Craig I. Coleman, Pharm.D.1, C. Michael White, Center, Augusta, GA; (2)Medical College of Georgia, Augusta, GA.
Pharm.D., FCCP, FCP1, Jeffrey Kluger, M.D.2, Kirkeith Lertsburapa, M.D.3,
Osman Faheem, M.D. 3 ; (1)University of Connecticut, Hartford, CT; PURPOSE: We have shown that acute treatment with candesartan in an
(2)Hartford Hospital, Division of Cardiology, Hartford, CT; (3)Hartford experimental model of stroke in rats resulted in improved neurovascular
Hospital, Hartford, CT. outcomes at 24 hours post stroke, but the long-term effects are unknown. We
PURPOSE: The ARMYDA-3 trial demonstrated that preoperative statin use now examine the 7-day outcomes using the same treatment paradigm and
can reduce postoperative atrial fibrillation (POAF), but the optimal statin measuring blood pressure (BP), neurobehavioral performance, and two
dosing intensity was not elucidated. Therefore, we sought to determine markers of vascular remodeling: matrix metalloproteinase (MMP) activity
whether different preoperative statin dosing intensities had varying effects on and vascular endothelial growth factor (VEGF) expression.
the development of POAF following cardiac surgery. METHODS: Male Wistar rats underwent 3 hours of middle cerebral artery
METHODS: Patients undergoing coronary artery bypass grafting (CABG) occlusion (MCAO). A single dose of candesartan 1 mg/kg was given
e12 PHARMACOTHERAPY Volume 27, Number 4, 2007
intravenously at reperfusion. BP was measured continuously by telemetry end points were rate of cardiovascular events and cerebrovascular events.
from 2 days before to 7 days after MCAO. Animals were given RESULTS: Final analysis included 3170 patients (EACA, n=1174; aprotinin,
neurobehavioral testing before MCAO, at 24 hours after MCAO, and at n=939; control, n=1057). Majority of aprotinin (73.8%) and EACA patients
7 days. Neurobehavioral testing included elevated-body swing test (EBST), (94.4%) were treated with high-dose therapy (> 4 million KIU and > 20 g,
Bederson, elevated beam walk, and paw grasp. respectively). Aprotinin was associated with significantly increased incidence
RESULTS: A single dose of candesartan 1 mg/kg administered at reperfusion of renal end points versus EACA and control during both primary CABG
significantly lowered BP for 3 days compared with saline controls. The (12.5% versus 7.4% and 8.2%, p<0.003) and complex CABG (20.9% versus
treatment group had no difference in infarct size at 7 days compared to 9.8% and 9.5%, p<0.001). Relative risk (RR) of renal events with aprotinin
controls. Treatment improved Bederson scores (2.1 vs. 2.9, p=0.0083), EBST was 2.34 (95% confidence interval {CI} = 1.87–2.93) and 0.61 (CI =
performance (22.9 vs. 39.4, p=0.021), and paw grasp (1.29 vs. 2.88, 0.48–0.78) with EACA. Renal end points were confirmed using STS
p=0.0001) at all time points. Beam walk was improved in the treatment group standards. Cardiovascular events were significantly higher with aprotinin (RR
at 24 hours (1.79 vs. 2.88, p=0.0001), but not at 7 days. MMP-2 activity and 1.45, CI = 1.14–1.83) than EACA (RR 0.96, CI = 0.76–1.22). Cerebrovascular
VEGF expression was significantly higher in the treatment group (p=0.035, events were not significant with either aprotinin (RR 1.17, CI 0.84-1.62) or
p=0.042, respectively). EACA (RR 0.75, CI = 0.54–1.05).
CONCLUSIONS: Acute blood pressure lowering with a single dose of CONCLUSIONS: These results are consistent with previously published data
candesartan after reperfusion provides long-term benefits as measured by a and confirm aprotinin renal dysfunction risk. STS definitions for renal
variety of neurobehavioral tests. The beneficial effects of candesartan may dysfunction are significantly more conservative yet are conclusive with these
involve enhancement of early angiogenic remodeling. results.

13. Do statins increase risk of hemorrhagic stroke? Nickole N. Henyan, 16. Reducing adverse drug events, inpatient length of stay, and hospital
Pharm.D.1, Pamela N. Gann, Pharm.D.2, Daniel M. Riche, Pharm.D.1; (1)The costs through an inpatient pharmacist anticoagulation program. Heath R.
University of Mississippi School of Pharmacy, Jackson, MS; (2)The University Jennings, Pharm.D., BCPS, Stacy A. Voils, Pharm.D., BCPS, Kevin L. Poe,
of Mississippi Medical Center, Jackson, MS. Pharm.D., BCPS, Anthony Morano, M.D.; Saint Joseph HealthCare,
Lexington, KY.
PURPOSE: Evidence from randomized, controlled trials suggests that low-
density-lipoprotein (LDL) reduction by statins in patients at high risk for PURPOSE: This interdisciplinary project was conducted to improve the use
cardiovascular disease reduces the incidence of ischemic stroke; however, data of anticoagulant medications and to evaluate the impact of clinical
from large epidemiologic observational studies suggest an inverse relationship pharmacists providing patient centered anticoagulation therapy.
between risk of hemorrhagic stroke and cholesterol levels. We performed a METHODS: Three-month evaluation of warfarin prescribing practices by
meta-analysis of randomized, controlled trials to assess the effect of statin physicians served as the historical control group. Clinical pharmacist-
therapy on total, ischemic, and hemorrhagic stroke. managed anticoagulant therapy consult service was then established.
METHODS: A systematic literature search of MEDLINE, EMBASE, CINAHL, Prospective comparisons between physician and pharmacist anticoagulation
and Web of Science was performed through September 2006 to identify management practices ensued for 12 months (active physician control group
randomized, controlled trials of statin therapy. Trials were included if they and pharmacist study group). Primary outcomes included occurrence of
met the following criteria: 1) Randomized, controlled trials versus placebo, major and minor bleeding and thrombotic reactions. Descriptive statistics and
2) Well described protocol, 3) Data reported on incidence of total, ischemic, multivariate analysis were used during data analysis. Economic analysis
and/or hemorrhagic stroke. All data were independently extracted by three evaluated hospital resource input costs and the cost-benefit ratio for the
investigators using a standardized data abstraction tool. Weighted averages pharmacist anticoagulant services.
are reported as Relative Risk (RR) with 95% confidence intervals (CI) using a RESULTS: In the historical physician control group, 629 managed patients
random effects model. were observed. A total of 1162 and 361 patients were managed in the active
RESULTS: A total of 29 trials (n=106,085) reported total stroke incidence. physician control group and pharmacist study group, respectively. Better
Six trials (n=46,206) reported incidence of ischemic stroke, and 12 trials anticoagulation outcomes were observed among patients managed by
(n=64,186) were included in the hemorrhagic stroke analysis. Statin therapy pharmacists versus physicians: occurrence of INR > 4.0 (6.6% versus 23.6%,
significantly reduced the risk of any stroke, RR 0.82 (95% CI=0.76–0.87). respectively); major and minor bleeding events (0.0% versus 3.3% and 0.8%
Statin therapy also significantly reduced the risk of ischemic stroke, RR 0.79 versus 3.5%, respectively); thrombosis (0.0% versus 3.9%); and length of stay
(95% CI=0.67–0.94). Statin therapy did not reduce risk of hemorrhagic stroke (5.2 ± 1.7 days versus 7.2 ± 2.3 days). Pharmacists were associated with
RR 1.07 (95% CI=0.77–1.47). Significant statistical heterogeneity was seen in significant reductions in bleeding risk (OR 0.09; 95% confidence interval {CI}
the ischemic stroke group (p=0.03), but not in the total or hemorrhagic = 0.01–0.6) and shortened length of stay (OR 0.4; CI = 0.2–0.8). Cost-benefit
stroke groups (p>0.2 for both). ratio for pharmacist anticoagulation services was 1 to 13.9 or a return of
CONCLUSIONS: Statin therapy significantly reduces overall stroke and $13.90 for every $1 invested in the program. Annual financial impact of the
ischemic stroke risk; however, it is associated with a non-significant increase consult service was $495,502 for adverse event avoidance. An additional
in risk of hemorrhagic stroke. $794,200 may be realized depending on length of stay capture.
CONCLUSIONS: A clinical pharmacist-managed anticoagulant service
14E. Controlled blood pressure lowering after experimental cerebral significantly improves patient care by reducing anticoagulant ADE and
ischemia provides neurovascular protection. Hazem F. Elewa, [Link].1, hospital length of stay. This cost-benefit analysis may assist pharmacy leaders
Anna Kozak, M.S.1, Adviye Ergul, M.D., Ph.D.1, Maribeth H. Johnson, M.S.2, in established support for expanded clinical pharmacy programs.
Susan C Fagan, Pharm.D. 1 ; (1)Univesity of Georgia, Augusta, GA;
(2)University of Georgia, biostatistics, Augusta, GA.
17. Dyslipidemia control in an indigent population with medication
assistance compared to an insured population. Joel C. Marrs, Pharm.D.1,
Published in Hypertension 2006;48:e25-e103. Joseph J. Saseen, Pharm.D.2; (1)Oregon State University College of Pharmacy,
Portland, OR; (2)University of Colorado Health Sciences Center, Denver, CO.
15. Confirmation of renal events following the use of antifibrinolytic
therapy during on-pump coronary artery bypass graft (CABG) surgery. PURPOSE: To compare dyslipidemia management in indigent patients
Alissa K. Langley, Pharm.D., Jennifer J. Oh, Pharm.D., M.S., Heather H. receiving medication assistance with insured patients.
Hesselson, Pharm.D., Stacy A. Voils, Pharm.D., BCPS, Heath R. Jennings, METHODS: This retrospective study evaluated patients with dyslipidemia
Pharm.D., BCPS; Saint Joseph HealthCare, Lexington, KY. who received statin-based therapy at the University of Colorado Hospital
(UCH) outpatient pharmacy. Prescription records identified 665 patients
PURPOSE: Mangano and colleagues recently postulated that the use of between October 1, 2004, and September 30, 2005; 40 UCH PacifiCare
aprotinin during coronary artery bypass grafting (CABG) is associated with insured patients and 625 Colorado Indigent Care Program (CICP) patients. A
increased incidence of renal events. Renal event rates in this study appeared sample of 200 CICP patients was randomly extracted using a block scheme.
higher versus national Society of Thoracic Surgeons (STS) benchmarks. This Primary study measurements were LDL-C goal attainment, and use of a
study was designed to evaluate the incidence of renal dysfunction and/or moderate potency lipid-lowering regimen capable of achieving 30% LDL-C
dialysis following intraoperative use of aprotinin and aminocaproic acid reduction, recommended by 2004 NCEP guidelines.
(EACA) during CABG and compare against STS quality databases. RESULTS: 240 patients met study criteria (200 CICP, 40 PacifiCare); 26
METHODS: This retrospective cohort study evaluated patients undergoing patients did not have baseline and on treatment LDL-C measurements. LDL-C
bypass during CABG from January 2004 to June 2006. Patients were stratified goal attainment was 68.9% (122/177) in the CICP group versus 78.4%
according to antifibrinolytic therapy per physician discretion: aprotinin, (29/37) in the PacifiCare group (p=0.34). Use of a moderate potency regimen
EACA, or none (control). Patients were further stratified by primary versus was 90.9% in the CICP and 85% in the PacifiCare groups (p=0.41). In
complex surgery. Primary outcome was incidence of renal dysfunction and/or patients classified as moderately high, high, or very high cardiovascular risk,
dialysis at 72 hours post-op and anytime during hospitalization. Secondary LDL-C goal attainment was 67.3% (103/153) in the CICP group versus 69.6%
 ACCP 2007 SPRING PRACTICE AND RESEARCH FORUM e13
(16/23) in the PacifiCare group (p=0.83). In this subgroup, use of a moderate Clinical Administration
potency regimen was 94.8% and 95.7% in the CICP and PacifiCare groups,
respectively (p=0.86). Among very high risk patients from both groups, an
LDL-C goal of < 70 mg/dL was attained in 52.6% (30/57), and use of a 20E. Clinical pharmacist activities in Riyadh City, Saudi Arabia. Yousef
moderate potency regimen was 96.5% (55/57). Ahmed Alomi, [Link]., [Link]., BCPS, Areej Melhani, [Link]., Naif Bakerman, [Link].,
CONCLUSIONS: Our data suggest that quality of dyslipidemia management Noura Albinyan, [Link].; Riyadh Medical Complex, Riyadh, Saudi Arabia.
is similar between indigent and insured populations. Overall LDL-C goal
attainment rates were higher than what has been reported in the literature. Of Presented at the 9th International Pharmaceutical Science Conference,
importance, the majority of patients with significant cardiovascular risk, Riyadh, Saudi Arabia, December 18-21, 2005.
including those at very high risk, were treated according to guidelines.

18. Identification and care of non-obese, non-diabetic patients with Critical Care
metabolic syndrome in a large, tertiary care center. Marcel D. Bizien,
Pharm.D.1, Tracy E. Macaulay, Pharm.D.2; (1)Mayo Clinic, Rochester, MN; 21E. Pharmacist intervention in critical care unit at Security Forces
(2)The Ohio State University Medical Center, Columbus, OH. Hospital, Riyadh, Saudi Arabia. Yousef Ahmed Alomi, [Link]., [Link]., BCPS;
Riyadh Medical Complex, Riyadh, Saudi Arabia.
PURPOSE: Metabolic syndrome (MS) criteria are considered modifiable risk
factors, and control of these risk factors could aid in preventing the Presented at the 1st International Symposium on Critical Care Medicine,
development of type II diabetes and resulting co-morbidities. Our primary Riyadh, Saudi Arabia, March 6-10, 2005.
aim was to quantify identification of MS in overweight individuals meeting
Adult Treatment Panel III (ATP III) criteria for the condition and seen in a
wide range of clinical settings. Secondary objectives included an assessment 22. Erythropoiesis-stimulating protein (ESP) prescribing practices in
of predictors of MS identification and an evaluation of lifestyle and intensive care unit (ICU) patients. Gretchen M. Brophy, Pharm.D.1, Spencer E.
pharmacologic interventions in both identified and unidentified subjects. Harpe, Pharm.D., Ph.D.1, Michael Pyles, Ph.D.1, David Holdford, Ph.D.1,
METHODS: We used the five qualification characteristics for MS to screen all Thomas Comstock, Pharm.D.2, Paul Audhya, M.D.2; (1)VCU Medical College
adult subjects aged 18–61 seen at the Mayo Clinic Rochester between 2001 of Virginia, Richmond, VA; (2)Amgen, Inc, Thousand Oaks, CA.
(immediately after publication of ATP III) and 2004. Electronic records of PURPOSE: To evaluate prescribing practices for the ESPs Epoetin alfa (EA)
qualifying subjects were searched for ICD9 codes or terms associated with MS and darbepoetin alfa (DA) in patients admitted to the ICU.
and lifestyle interventions. We documented all pharmacologic interventions METHODS: A retrospective study of 61,711 adult ICU patients admitted to
relevant to MS. the ICU between January 2004 and December 2005. Administrative discharge
RESULTS: Of the 16,338 qualifying subjects, only 369 (2.26%) were data were abstracted from the Solucient® ACTracker® database.
identified as having metabolic syndrome. Nominal logistic regression of RESULTS: Mean (SD) age was 65 (15.6) years, and 52.6% were men. The
available data revealed that of all 5 qualifying characteristics, BMI, fasting most common primary discharge diagnoses were congestive heart failure
blood glucose (FBG), high-density lipoprotein, and triglycerides were (8.4%), acute renal failure (4.4%), and acute respiratory failure (4.0%). The
statistically significant predictors of MS identification. FBG most strongly prevalence of chronic kidney disease was 37.4%. The median (IQR) ICU
predicted identification (OR = 3.35, 95% CI = 2.57–4.41, p<0.0001). Positive length of stay (LOS) was 7 (4–14) days and hospital LOS was 12 (7–22) days.
identification of MS did not significantly affect treatment of hyperlipidemia or The median time to first ESP dose from ICU admission was 4 days; 86.5% of
hypertension. In a smaller random sample of qualifying subjects (n=1281), patients received their first dose in the ICU. Of these patients, the median
we found essentially no record documenting lifestyle interventions. (IQR) dose per administration was 15,000 (10,000–39,000) Units for EA and
CONCLUSIONS: Identification of MS and care of associated cardiovascular 100 (60–150) µg for DA. The median (IQR) number of doses in the ICU was
risk factors in a wide range of clinical settings are less than optimal. Our 2 (1–3) for EA and 1 (1–2) for DA (p<0.001). Single doses of 40,000 Units for
findings indicate that prevention of diabetes and cardiovascular disease EA and 100 µg for DA were given to 21.6% and 39.7% of patients,
mandates continued education of all health professionals, systematic respectively. The duration of ESP therapy in the ICU was ≤ 1 week in 78.8%
recognition of MS, and more diligent insistence on lifestyle and therapeutic of patients. ESP therapy was not continued in 49% of patients after discharge
interventions. from the ICU.
CONCLUSIONS: In this retrospective analysis, ESP therapy was initiated in
patients a median of 4 days after ICU admission, and ESP dosing was not
19. Barriers to adherence with clopidogrel following placement of drug-
uniform. The duration of ESP therapy was ≤ 1 week and was limited to the
eluting stents. Maria Jose Pallares, Pharm.D., Eric R. Powers, M.D., FACC,
ICU setting in most cases. Considering that the median hospital LOS stay was
Peter L. Zwerner, M.D., Jean M. Nappi, Pharm.D., FCCP, BCPS; Medical
12 days, these utilization data suggest a need for ESP therapy practice
University of South Carolina, Charleston, SC.
guidelines for patients admitted to the ICU.
PURPOSE: Nonadherence with clopidogrel therapy after drug-eluting stent
(DES) placement may result in late in-stent thrombosis and adverse cardiac 23. Retrospective evaluation of recombinant activated factor VII in surgical
events. This study identified the incidence of nonadherence in patients patients with nonhemophilia-related hemorrhage. Lauren Barton, Pharm.D.1,
receiving DES and postulated that several barriers associated with Eric W. Mueller, Pharm.D.1, Neil E. Ernst, Pharm.D.1, Michelle M. Gearhart,
nonadherence could be identified. Pharm.D. 1 , Jay A. Johannigman, M.D. 2 ; (1)The University Hospital,
METHODS: All patients who received a DES between March 1, 2004, and Department of Pharmacy Services, Cincinnati, OH; (2)University of
August 31, 2005, were eligible. Telephone interviews were conducted using a Cincinnati, College of Medicine, Cincinnati, OH.
prespecified questionnaire. Multiple attempts were made to contact each
patient. Nonadherence was defined as premature discontinuation of PURPOSE: Review clinical characteristics and outcomes of surgical patients
clopidogrel or less than 80% adherence (missing 2 or more doses per week). administered recombinant activated factor VII (rFVIIa) for nonhemophilia-
Patients were asked to identify issues that were barriers to adherence. related coagulopathy or hemorrhage.
RESULTS: Of the 635 patients identified, 245 (39%) had either an invalid METHODS: All nonhemophilia surgical patients who received at least one
telephone number or could not be reached, 23 (4%) were deceased, and 125 dose of rFVIIa between November 2, 2003, and February 28, 2006, were
(20%) refused to participate, leaving 242 (38%) to participate. The overall included. Patient demographics, clinical characteristics, and outcomes were
nonadherence rate was 20%. Of those patients nonadherent, 54% recorded.
discontinued therapy prematurely and 46% frequently missed 2 or more doses RESULTS: Seventeen patients were identified. Mechanisms for coagulopathy
per week. For nonadherent patients, the overall incidence of experiencing at and hemorrhage were trauma (n=8), liver transplant (n=3), cardiac surgery
least 1 adverse effect was 42% (25% bleeding, 10% rash, 10% GI). Patients (n=4), and neurosurgery (n=2). The mean rFVIIa dose was 81.3 ± 24.7 µg/kg.
that did not recall receiving discharge counseling involving indication, Coagulopathy was reversed (INR < 1.5) within 8 hours in all trauma patients
benefit, or adverse effects of clopidogrel therapy accounted for 48% of and 6 (67%) nontrauma patients. Units of packed red blood cells and fresh
nonadherent patients. Difficulty paying for clopidogrel was reported by 46% frozen plasma 24 hours pre- and post-rFVIIa were 24 ± 16 vs. 1.5 ± 1 units
of nonadherent patients, despite 64% of these patients having medication and 21 ± 12 vs. 0.2 ± 0.4 units, respectively (p<0.001 for both). Seven (41%)
insurance. A lack of transportation to a pharmacy was reported by 13% of patients survived to hospital discharge (trauma, n=2; nontrauma, n=5), and
nonadherent patients. had significantly lower APACHE II scores (p=0.007) and higher temperatures
CONCLUSIONS: In our population, 20% of patients were nonadherent with at administration (p=0.018) compared with nonsurvivors. Overall, 3 (17.6%)
clopidogrel therapy following DES placement. Several barriers to adherence patients had documented thrombosis during hospitalization (splenic artery
were identified including adverse effects, lack of knowledge regarding thrombosis, n=1; sinus thrombosis, n=1; pulmonary embolus, n=1).
medication, and financial constraints despite having insurance. These data CONCLUSIONS: rFVIIa improved coagulopathy and was associated with a
suggest that more intense patient education prior to discharge may improve reduction in blood product requirements after administration. rFVIIa may be
adherence rates. most beneficial in patients with lower APACHE II scores and higher body
e14 PHARMACOTHERAPY Volume 27, Number 4, 2007
temperatures. Large comparison studies are needed to evaluate the safety and Pharm.D., Terence W. Joe, M.S., George A. Baklayan, M.S.; ISTA
efficacy of rFVIIa in nonhemophilia-related hemorrhage. Pharmaceuticals, Inc., Irvine, CA.

24. Octreotide versus octreotide and continuous infusion pantoprazole in Presented at the Annual Meeting of the Association for Research in Vision and
the treatment of variceal hemorrhage. Rima A. Mohammad, Pharm.D.1, Cesar Ophthalmology, Ft. Lauderdale, FL, April 30-May 4, 2006.
Alaniz, Pharm.D.2, Lynda S. Welage, Pharm.D.2; (1)University of Tennessee
College of Pharmacy, Knoxville, TN; (2)University of Michigan Health System 30. Evaluation of gender equality in publishing original research in
and College of Pharmacy, Ann Arbor, MI. pharmacy journals. Katie J. Suda, Pharm.D., Susannah E. Motl Moroney,
Pharm.D., Michael A. Haile, Pharm.D., Kimberly Walker, Pharm.D.
PURPOSE: Recommendations for controlling active variceal bleeding include Candidate, Marian K. Ores, Pharm.D., Candidate, Bhavin L. Patel, Pharm.D.,
intravenous octreotide with urgent endoscopic therapy. Continuous infusion Candidate; University of Tennessee Health Science Center, Memphis, TN.
proton pump inhibitor (PPI) therapy has been shown to be effective in the
management of bleeding peptic ulcers but has not been evaluated in the PURPOSE: A 2006 New England Journal of Medicine article suggested that
management of acute variceal hemorrhage. The primary objective of this women physicians have narrowed the gender gap as first or senior author in
study was to compare octreotide therapy with the combination of octreotide six prominent medical journals. Based on recent statistics from the American
and pantoprazole therapy with respect to control of bleeding in adult patients Association of Colleges of Pharmacy, female enrollment in Pharmacy
with acute variceal hemorrhage. programs is double that of males from 2000-2005, and female applicants are
METHODS: A retrospective review was conducted in 134 adult patients who 40%–50% greater than male applicants from 1998-2005. We question whether
received either octreotide monotherapy (53 patients) or combination the increasing number of women pharmacists is also adding to the published
octreotide with continuous infusion pantoprazole (81 patients). Data pharmacy literature. This analysis was accomplished by comparing the
collected included serum hemoglobin, hematocrit, indices of hepatic frequency of female Pharm.D.s that serve as first or senior authors in 5
function, octreotide and pantoprazole dosage regimens, duration of therapy, pharmacy specific journals in 1995 and 2005 for original research articles and
amount of blood products administered, and ICU and hospital length of stay. editorials.
RESULTS: The two treatment groups were similar at baseline with respect to METHODS: Authorship (i.e., sex and institutional affiliation) of all original
demographic data, bilirubin, albumin, hemoglobin, hematocrit and Child- research articles and editorials for the years 1995 and 2005 was evaluated for
Pugh score. The number of packed red blood cell transfusions was similar 5 pharmacy journals: AJHP, AJPE, Pharmacotherapy, Annals of
between the two groups (octreotide: 5.8 units vs. combination group: 6.4 Pharmacotherapy, and JAPhA. Chi-squared analyses were used to compare the
units, p=0.87). The combination group trended toward more fresh frozen frequency of male and female authors in 1995 and 2005. A p-value less than
plasma transfusion compared with the octreotide group (6.1 vs. 2.9 units, 0.05 was deemed statistically significant. Institutional affiliation was
p=0.054). Serum hemoglobin was similar between the two groups on ICU summarized.
discharge (octreotide: 10.6 vs. combination group: 10.8, p=0.58). The RESULTS: There were 388 original research articles and editorials published
octreotide group mortality rate was 17.3% compared with 13.2% for the in 1995 compared to 621 articles in 2005. Forty percent of the first authors
combination group (p=0.56). Lastly, ICU length of stay was greater in the were female in 1995 compared with 46.2% in 2005, and 30% of senior
combination group compared to the octreotide group (6.1 days vs. 3.3 days, authors were female in 1995 compared with 40% in 2005 (p=NS for both
p=0.01). comparisons). Additional analyses within journals did not reveal any
CONCLUSIONS: The addition of continuous infusion pantoprazole does not significant increases of female first or senior authors within the 10-year time
appear to improve outcome of patients admitted for acute variceal bleed with period (p-values ranged from 0.1 to 0.77). In 1995, JAPhA had the highest
respect to blood product transfusion, mortality, or length of ICU stay. percentage of female first authors (54.6%) whereas AJPE had the highest
(57.9%) in 2005.
25E. Treatment of moderate to severe acute hypocalcemia in critically ill CONCLUSIONS: Although the percentage of female pharmacists has
trauma patients. Roland N. Dickerson, Pharm.D., Laurie M. Morgan, R.N., increased over the past several years, this is not evident in pharmacy-specific
Martin A. Croce, M.D., Gayle Minard, M.D., Rex O. Brown, Pharm.D.; research literature.
University of Tennessee, Memphis, TN.
31. Drug information and pharmacy resource services in Egypt. Sheri
Presented at the 5th Annual Nutrition Week of the American Society for Kamal, BSC; Children’s Cancer Hospital, Cairo, Egypt.
Parenteral and Enteral Nutrition, Phoenix, AZ, January 29, 2007.
Most countries in the Middle East are struggling with providing chemo-
26E. Dose-dependent characteristics of intravenous calcium therapy for therapy medications and supportive treatment medications for their patients
hypocalcemic critically ill trauma patients. Roland N. Dickerson, Pharm.D., not only because of the lack of financial resources, but also because of: 1)
Laurie M. Morgan, R.N., Martin A. Croce, M.D., Gayle Minard, M.D., Rex O. lack of drug procurement procedures that would ensure the best quality drug
Brown, Pharm.D.; University of Tennessee, Memphis, TN. for the best price; 2) lack of preparation standards ensuring quality control,
batching and saving drugs; and 3) lack of long-term inventory and financial
Presented at the 5th Annual Nutrition Week of the American Society for planning for medications. Our team developed Oncology Clinical Pharmacy
Parenteral and Enteral Nutrition, Phoenix, AZ, January 29, 2007. settings in more than 15 hospitals across Egypt. Our biggest project is
developing the department of pharmaceutical services in the new Children’s
Cancer Hospital. We helped all oncology centers across the country to
27E. Low serum total calcium concentration as a risk factor for predicting
allocate their resources and introduced a lot of concepts into their daily
hypocalcemia in critically ill patients. Roland N. Dickerson, Pharm.D.,
practice starting from safety reaching pharmaceutical care plans and
Natohya Y. Henry, Pharm.D. candidate, Patrice L. Miller, Pharm.D. candidate, Gayle
pharmacoeconomic studies. The aim of this study is to provide a clear
Minard, M.D., Rex O. Brown, Pharm.D.; University of Tennessee, Memphis, TN.
guideline on how to implement a Drug Information and Pharmacy Resource
Service (DIPRS) in Egypt and the Middle East. This study is aiming to
Presented at the 5th Annual Nutrition Week of the American Society for provide: 1) a brief description of the DIPRS; 2) importance and benefits of
Parenteral and Enteral Nutrition, Phoenix, AZ, January, 2007. the DIPRS; 3) the problems that DIPRS will solve in daily health care
activities; and 4) the implementation plan of the DIPRS project.
28E. Risk factors for mortality in critically ill patients receiving appropriate
or inappropriate empiric antibiotic therapy for pneumonia or bacteremia.
Scott D. Hanes, Pharm.D.1, Dennis Hong, M.D.2, Allison S. Beck, Pharm.D., Education/Training
candidate1, Lynley S. Heinrich, Pharm.D., candidate1, Marlos Viana, Ph.D.3;
(1)University of Illinois at Chicago, College of Pharmacy, Chicago, IL;
(2)University of Illinois at Chicago, College of Medicine, Chicago, IL; 32. Research experiences and research-related coursework in the education
(3)University of Illinois at Chicago, Chicago, IL. of entry-level doctors of pharmacy: a 9-year update. John E. Murphy,
Pharm.D.1, Marion K. Slack, Ph.D.1, Kevin P. Boesen, Pharm.D.1, Duane M.
Kirking, Pharm.D., Ph.D.2; (1)University of Arizona College of Pharmacy,
Presented at the Annual Congress of the Society of Critical Care Medicine,
Tucson, AZ; (2)University of Michigan, Ann Arbor, MI.
Orlando, FL, February 18-21, 2007.
PURPOSE: Research is critical to the advancement of the pharmacy
Drug Information profession, and understanding the outcomes of research is important for all
clinicians in order to effectively apply the results to patient care. The purpose
of this study was to evaluate the current role of research-related coursework
29E. The compatibility of Vitrase® combined with Kenalog®. James A. Gow, and research experiences in Pharm.D. programs and to compare the results to
M.D., Bruce A. Aird, Ph.D., Timothy R. McNamara, Pharm.D., Clara K. Song, those found previously.
 ACCP 2007 SPRING PRACTICE AND RESEARCH FORUM e15
METHODS: A questionnaire patterned after one used in previous studies was combination therapy. Despite the higher medication cost of CIFN, greater
mailed to the 88 colleges of pharmacy in the United States (including Puerto SVR rates were achieved and the cost/cure was decreased.
Rico) in May 2006. An appropriate individual was identified to receive the
questionnaire. Non-respondents received a follow-up e-mail, and a second
individual was identified and sent a questionnaire if the first never responded. Hematology/Anticoagulation
Information was requested in four areas: 1) formal research-related
coursework (statistics, drug information, literature evaluation, and research
methods); 2) required student research experiences; 3) elective research 37. Quality of anticoagulation care in stable patients discharged from a
experiences; and 4) respondents' perceptions of the value of student- pharmacist-managed anticoagulation clinic. Candice L. Garwood, Pharm.D.1,
conducted research. Peter Dumo, Pharm.D.2, Stephanie Baringhaus, Pharm.D. Candidate1, Kristyn
RESULTS: There was an 88% response. 20% required students to conduct a Laban, Pharm.D. Candidate 1 ; (1)Wayne State University, Detroit, MI;
project, and the size of the student body didn't influence whether projects (2)Harper University Hospital, Detroit, MI.
were required. More private than public colleges required projects, and
students could often work in teams. Most colleges (> 90%) required PURPOSE: To determine whether transitioning patients experiencing “highly
biostatistics and drug information/literature evaluation whereas only about stable” anticoagulation from an anticoagulation clinic (AC) to their primary
half required research methods coursework. When research experiences were care provider (PCP) will alter anticoagulation control.
elective, < 10% of graduates took advantage of them at most colleges. METHODS: Retrospective chart review in an urban academic medical center
Respondents generally thought participation in research had some value for outpatient anticoagulation clinic. Forty-two patients seen in the AC met the
motivated students, but some thought it had no place in the training of definition of “highly stable” and were transitioned back to their PCP for
Pharm.D.s. Many identified lack of resources as the primary hindrance to warfarin management. Highly stable is defined as the last 5 out of 6 INR
requiring research experiences. values in range for target ranges covering 1.0 INR units and 4 out of 6 INR
CONCLUSIONS: Results are somewhat similar to the 1998 survey. The values in range for those with target ranges covering 0.5 INR units. Analysis
finding that increased class sizes didn't reduce the percent of colleges was performed on 40 patients.
requiring research and that students were often encouraged to work in teams RESULTS: Data were collected for 6 months before transition from the AC to
was positive. the PCP and 6 months after transition to PCP. Prior to transition, 76% of INRs
were in target versus 48% after transition (p<0.05 Chi-square). There was a
significant increase in number of INRs > 4.5 and < 1.5 (p<0.05 for both; Chi-
square). There was an increase in need for anticoagulation-related medical
Endocrinology care as follows: 1 emergency room visit prior to discharge from the AC
compared with 12 cases of additional medical care among 7 patients after
33E. Colesevelam HCl improves glycemic control in subjects with type 2 transition. Six of these cases required an office visit with the physician, 6
diabetes mellitus (T2DM) managed with insulin therapy. Ronald B. resulted in emergency room evaluation. None of these events resulted in
Goldberg, M.D.1, Kenneth Truitt, M.D.2, Jessa Ford, Pharm.D.3; (1)University hospitalization. Frequency of INR assessments over 6 months decreased
of Miami Miller School of Medicine, Miami, FL; (2)Daiichi Sankyo Pharma significantly from 8.9 assessments per patient to 5.1 per patient after
Development, Edison, NJ; (3)Daiichi Sankyo, Inc., Parsippany, NJ. discharge (p<0.05). Three patients continued to receive warfarin after
transition from the AC without a single INR determination during the 6
Presented at the Scientific Sessions of the American Heart Association, months post-transition.
Chicago, IL, November 12-15, 2006. CONCLUSIONS: The transition of “highly stable” patients on warfarin
therapy, managed in a pharmacist-run AC, back to their primary care
physician resulted in decreased control of INR and an increase in medical care
34E. Do plant sterols provide additional cholesterol reduction when added needed for anticoagulation-related problems.
to statin-based combination therapy? Sunny A. Linnebur, Pharm.D.1, Warren
H. Capell, M.D. 2 , Joseph J. Saseen, Pharm.D. 1 , Pamela Wolfe, M.S. 1 ;
(1)University of Colorado at Denver and Health Sciences Center, Denver, CO; 38. Warfarin-dose adjustment after orthopedic surgery. Petra Jacobsen,
(2)University of Colorado at Denver and Health Sciences Center, Aurora, CO. [Link].1, Gloria R. Grice, Pharm.D.2, Paul E. Milligan, [Link].1, Charles Eby,
M.D.1, Eric Millican, B.S.1, Susan Gatchel, CCRC1, John Clohisy, M.D.1, R.
Stephen J. Burnett, M.D.1, Robert L. Barrack, M.D.1, Elena Deych, M.S.1, Brian
Presented at the 56th Annual Scientific Session of the American College of
F. Gage, M.D.1; (1)Washington University, St. Louis, MO; (2)St. Louis College
Cardiology, New Orleans, LA, March 24-27, 2007.
of Pharmacy, St. Louis, MO.

PURPOSE: Warfarin is the most commonly prescribed anticoagulant to

Gastroenterology prevent thrombosis in the orthopedic population, but the approach to
warfarin-dose refinement is not systematic. Although many nomograms have
36. Cost effectiveness analysis of high-dose consensus interferon plus been proposed, none are commonly used partly because they do not allow for
ribavirin versus PEG-interferon afa-2a plus ribavirin in hepatitis C non- the dose-refinements to be customized to patient-specific clinical factors. Our
responders. Anthony S. Dalpiaz, Pharm.D., David M Peterson, Pharm.D.; goal was to develop such a nomogram.
University of Utah Hospitals and Clinics, Salt Lake City, UT. METHODS: We prospectively evaluated a cohort of 229 patients undergoing
total hip or knee replacement (median hospital length of stay 3–4 days). They
PURPOSE: This economic analysis was performed to compare the cost were prescribed warfarin beginning 24 hours prior to arthoplasty for a total of
effectiveness of treating patients with hepatitis C (HCV) who are non- 1 month and managed by our anticoagulation service for the duration of their
responders to combination PEG-interferon alfa-2a (PEG-IFN2a) and ribavirin prophylaxis. Initial warfarin doses were algorithm-based and usually given 24
with either re-treatment with PEG-IFN2a/ribavirin or high-dose consensus hours prior to surgery. From each participant we collected demographic
interferon (CIFN) plus ribavirin. variables, height, weight, smoking status, medical history (assessing for
METHODS: Literature values were used in the cost-effectiveness analysis to history of liver disease, hypertension, cancer, or GI bleeding), current
calculate the cost/cure of re-treating a non-responder with PEG-IFN2a/ medications, and pre- and post-operative laboratory values, such as INR and
ribavirin or CIFN/ribavirin. An Incremental Cost-Effectiveness Ratio (ICE-R) estimated blood loss (EBL) during surgery.
was calculated and sensitivity analysis was performed to test robustness of the RESULTS: We used a multiple regression model to develop our dose-
conclusions. A cure was defined as a sustained virologic response (SVR) or refinement nomogram. More than half of the variability in the therapeutic
negative HCV viral load 6 months post-treatment. This analysis was from an warfarin dose (R2adj of 55.5%) could be explained by the model. The INR
institutional perspective using acquisition costs. after 3 warfarin doses was associated with a 36% reduction in the therapeutic
RESULTS: Data from 3 trials (2 with CIFN and 1 with PEG-IFN2a) were dose per 0.25 unit increase in INR. Other significant (p<0.03) predictors of
used. Dosing regimens for CIFN were 9 µg/day x 48 weeks or 27 µg/day x 4 therapeutic dose were the first and second warfarin doses (+6.7% and +7.3%
weeks, 18 µg x 8 weeks, then 9 µg x 36 weeks in one trial and respectively, per 1 mg), fluvastatin or simvastatin use (-16%), EBL (which
15 µg/day x 12 weeks then 15 µg 3 times/week x 36 weeks in the other. The interacted with INR), and current smoking (+13%).
SVR in the trials was 23%, 27%, and 37% (7/30, 8/30, and 51/137) for CIFN CONCLUSIONS: By combining clinical and laboratory values, we developed
a nomogram to estimate the therapeutic dose after 3 warfarin doses. This
and 18% (109/604) for PEG-IFN2a. Estimated treatment costs for the
model could provide a safer, more effective process for adjusting warfarin
regimens were $220,332, $346,230, and $1,350,198, and the cost/cure was
therapy after orthopedic surgery. We are currently validating this model in
$31,476, $43,279, and $26,474, respectively. Treatment cost for PEG-IFN2a
additional orthopedic patients.
was $4,736,508, and the cost/cure was $43,454. The ICE-R showed it will
cost $117, $2, and $293 less for using CIFN (with the 3 treatment regimens,
respectively) over PEG-IFN2a. 39E. Corticosteroid therapy for immune thrombocytopenic purpura:
CONCLUSIONS: CIFN/ribavirin was more cost-effective than PEG- assessing the risks. Judith A. Smith, Pharm.D., FCCP, BCOP 1, Todd D.
IFN2a/ribavirin when re-treating HCV non-responders to previous Gadberry, Pharm.D. 2, Gary J. Okano, Ph.D. 3, Joseph A. Leveque, M.D. 3;
e16 PHARMACOTHERAPY Volume 27, Number 4, 2007
(1)The University of Texas, M.D. Anderson Cancer Center, Houston, TX; Infectious Diseases
(2)Alta Bates Summit Comprehensive Cancer Center, Berkley, CA; (3)Amgen,
Inc., Thousand Oaks, CA.
42. Response to oral metronidazole for Clostridium difficile-associated
Presented at the 47th Annual Meeting of the American Society of Hematology, diarrhea (CDAD). April D. Miller, Pharm.D., P. Shane Winstead, Pharm.D.,
Atlanta, GA, December 10-13, 2005. Kelly M. Smith, Pharm.D., Craig A. Martin, Pharm.D.; University of Kentucky
HealthCare, Lexington, KY.
40. Evaluation of intensive dietary education in patients receiving chronic PURPOSE: Recent outbreaks of highly toxigenic strains of C. difficile have led
oral anticoagulation. Jeremy L. Thomas, Pharm.D. 1 , Gale L. Hamann, to controversy on the appropriate initial treatment. Metronidazole has been
Pharm.D.2, Jennifer D. Campbell, Pharm.D. 1, David A. Kuhl, Pharm.D. 3, the primary treatment for CDAD due to both cost and vancomycin resistance
Laura R. Spraybery, M.D.1, Craig S. Dorko, M.D.2, Madeline S. Walker, M.S., concerns. This study compared the rates of metronidazole treatment failure
RD 2; (1)University of Tennessee Health Science Center, Memphis, TN; between the year 2000 and the year 2004 to determine whether a change in
(2)Regional Medical Center, Memphis, TN; (3)The Regional Medical Center response rates exists at our institution and to help guide initial treatment.
at Memphis, Memphis, TN. METHODS: Medical records for patients with positive toxin assays in 2000
and 2004 who received > 7 days of metronidazole therapy were reviewed. The
PURPOSE: The objective of our study was to evaluate the effect of education primary end point of treatment failure was defined as detection of C. difficile
on the level of knowledge regarding dietary vitamin K in patients receiving toxin or failure to improve clinically after > 7 days of metronidazole, need for
chronic oral anticoagulation. We also endeavored to evaluate the effect of this an additional drug, or recurrence of disease within 30 days. Additional data
education on time spent within the therapeutic range. on CDAD risk factors were collected.
METHODS: Patients followed by the Anticoagulation Clinic of the Regional RESULTS: Twenty-eight subjects in 2000 and 23 subjects in 2004 were
Medical Center completed an oral questionnaire evaluating their knowledge included in this study. Treatment failure rates were 31% in 2000 and 47.8% in
of dietary vitamin K and its role in anticoagulation. Patients were formally 2004 (p=0.22). The groups were similar except with regard to proton pump
educated on two separate occasions and provided with a patient-specific inhibitor and intravenous vancomycin use, which were both higher in 2004.
vitamin K diet. Following the dietary education, patients completed the There were no statistically significant differences in length of stay (LOS), ICU
questionnaire a second time. INR values were evaluated on the 3 clinic visits stay, or post-positive toxin LOS. A statistically significant difference in age
before study enrollment and the 3 clinic visits after the final questionnaire was observed in patients with treatment failure (average age- failure 60.15
was completed to determine time spent in the therapeutic range. years, non-failure 50.13 years; p=0.048).
RESULTS: One-hundred three patients completed the study. On a 16-point CONCLUSIONS: A trend in metronidazole failure rates has been observed.
scale, median test scores increased from a baseline of 13 ± 2.8 to 15 ± 1.3 Its role in initial treatment at our institution has not changed. However, the
(p<0.001). Eighteen percent of patients responded incorrectly when association between treatment failure and increased age has prompted
questioned regarding the effect of dietary vitamin K on warfarin therapy. clinicians to closely monitor elderly patients' response to metronidazole
Thirty-two percent and 43% responded incorrectly when questioned on the therapy.
appropriate frequency of consumption and serving size, respectively. Patients
frequently failed to identify mayonnaise, broccoli, and coleslaw as containing
43. Activation of transcriptional regulatory networks associated with azole
large amounts of vitamin K. Time spent in the therapeutic range increased
antifungal resistance in clinical isolates of candida glabrata. Kelly D.
from 43% ± 29.2 to 49%, ± 31.2 (p=0.1) post dietary vitamin K education.
Earhart, Pharm.D. 1, Kathy S. Barker, Ph.D. 1, Lijing Xu, Ph.D. 1, Ramin
CONCLUSIONS: In this study, intensive dietary education improved patients'
Homayouni, Ph.D.1, Thomas D. Edlind, Ph.D.2, Shelley S. Magill, M.D.3, P.
knowledge of dietary vitamin K and its effects on warfarin therapy. Our study
David Rogers, Pharm.D., Ph.D.1; (1)University of Tennessee, Memphis, TN;
did not show an increase in the time spent in the therapeutic range of
(2)Drexel University College of Medicine, Philadelphia, PA; (3)Johns
anticoagulation after intensive dietary education, possibly due to the short
Hopkins University School of Medicine, Baltimore, MD.
time frame of INRs examined.
PURPOSE: Recent reports have described the acquisition of azole resistance
in Candida glabrata clinical isolates from patients receiving hematopoietic
HIV/AIDS stem cell transplants, patients with AIDS, and patients receiving radiation for
head and neck cancer. In order to identify transcriptional regulatory networks
41. 48-week results of a stable switch study: changing combivir to associated with this phenotype, we examined changes in the gene expression
tenofovir/emtricitabine. James D. Scott, Pharm.D., [Link]., B.S.1, Bill Guyer, profile of a matched azole-susceptible and azole-resistant pair of clinical
Pharm.D.2, Jason Bethel, B.S.3, David Anderson, M.D.2, Robert K. Bolan, isolates obtained from a patient who experienced failure with fluconazole
M.D.3; (1)Western University of Health Sciences, Pomona, CA; (2)Gilead therapy for invasive candidiasis and candidemia.
Sciences, Foster City, CA; (3)Jeffrey Goodman Clinic, Los Angeles, CA. METHODS: Isolates used in this study were SM1 (fluconazole MIC =
8 mg/mL, itraconazole MIC = 1 mg/mL, voriconazole MIC = 0.25 mg/mL,
PURPOSE: Although Combivir has shown effectiveness as a NRTI backbone posaconazole MIC = 0.25 mg/mL) and SM3 (fluconazole MIC ≥ 64 mg/mL,
when combined with an NNRTI or a PI, tolerability and twice daily dosing itraconazole MIC = 8 mg/mL, voriconazole MIC = 4 mg/mL, and
often make it a less desirable option than other NRTI backbones, including posaconazole MIC = 8mg/mL). RNA was extracted for microarray analysis.
tenofovir and emtricitabine (TDF/FTC). This 48-week prospective, pilot RESULTS: Among genes differentially expressed in association with azole
study was conducted to assess the feasibility of switching from Combivir to resistance were those encoding the transcriptional regulators Pdr1p and
TDF/FTC, while maintaining the same NNRTI or PI. Upc2p. We identified 27 putative Pdr1p target genes and 18 putative Upc2p
METHODS: Subjects who were virologically stable (< 50 copies/ml ≥ú6 mos) target genes that were also up-regulated in the azole resistant isolate. Putative
on a PI (n=5) or NNRTI (n=2)-based regimen containing Combivir were Pdr1p targets included those encoding efflux pumps, proteins involved in
consented for this study. Baseline HIV labs, chemistries, liver function tests, lipid and sphingolipid biosynthesis, the transcriptional regulator gene RPN4,
and PDR1 itself. Putative Upc2p targets included those encoding the
CBC, and an adherence assessment were performed (using the AACTG
ergosterol biosynthesis genes and the sterol uptake transporter gene AUS1.
adherence assessment tool), and then monitored every 8 weeks for 48 weeks
CONCLUSIONS: Gain-of-function mutations in Pdr1p have been implicated
after switching Combivir to TDF/FTC (administered as Viread and Emtriva).
in azole resistance. Activation of Pdr1p and its target transporter genes likely
Quality of Life (QOL) was measured at baseline and at weeks 24 and 48 using
contribute to azole resistance in the isolates studied here. ERG11 encodes the
the FAHI questionnaire. Physical exam was performed at baseline and as per
target enzyme of the azole antifungals and is a putative target gene of Upc2.
standard of care.
Likewise, AUS1 is a putative Upc2p target gene and is associated with azole
RESULTS: 7 subjects enrolled (6 male, 1 female, average age 41yrs ± 2.8; 5-
resistance in S. cerevisiae. We hypothesize that a gain-of-function mutation in
PI-based and 2-NNRTI-based HAART). All patients completed the study. CD4
the UPC2 gene of isolate SM3 constitutively up-regulates ERG11 and AUS1
counts did change significantly between baseline (493 ± 169) and 48 weeks
and contributes to its resistance to azoles.
(518 ± 104). No significant changes in serum creatinine, hematocrit,
cholesterol, or triglycerides were observed. Although adherence did not
change over time, regimen satisfaction improved as early as week 8, and 44. Complications following elective and non-elective cesarean section: a
continued through week 48 (p<0.05). QOL did not change over the 48 weeks. neural network analysis approach and prediction of post-surgical febrile
4 subjects had VL blips > 50 copies/ml, 2 increased to > 400 copies/mL; all morbidity and infections. Loai M. Saadah, Pharm.D., [Link]., [Link].1, Ronald A.
subjects re-suppressed to < 50 copies/ml without changing therapy. Herman, Ph.D., [Link]., [Link].2, Samer M. Saadah, Ph.D., candidate, [Link].,
CONCLUSIONS: Changing Combivir to TDF/FTC maintained viral [Link].3; (1)Al Wasl Hospital Pharmacy Section—Department of Health and
suppression, and CD4 counts remained stable. Subjects reported a greater Medical Services, Dubai, United Arab Emirates; (2)Iowa Drug Information
level of satisfaction on the TDF/FTC combination. TDF/FTC appears to be a Network and the University of Iowa, Iowa City, IA; (3)Napier University,
viable alternative to Combivir, but larger studies will be needed to validate Edinburgh, United Kingdom.
this. PURPOSE: We used clinical data to train a neural network with the objective
 ACCP 2007 SPRING PRACTICE AND RESEARCH FORUM e17
of predicting cases where an infectious complication may occur, following 48E. Prevalence and mechanisms of carbapenem resistance in bloodstream
cesarean deliveries, and differentiate them from the majority that will have a isolates of Pseudomonas aeruginosa. Vincent H. Tam, Pharm.D.1, Kai-tai
normal course. Chang, Ph.D.1, Mark T. LaRocco, Ph.D.2, Amy N. Schilling, B.S.1, Keith Poole,
METHODS: The 9 factors included in the logistic multivariate analysis in our Ph.D.3, Kevin W. Garey, Pharm.D.1; (1)University of Houston College of
previous study were used to train an excel add-in neural network, Pharmacy, Houston, TX; (2)St. Luke's Episcopal Hospital, Houston, TX;
NeuralTools 1.0 (Palisade Corporation, UK). Data were preprocessed to (3)Queen's University, Kingston, ON, Canada.
exclude cases with missing information. We used one dichotomous output, 0
being no complication and 1 meaning a febrile morbidity, and 8 continuous Presented at the Interscience Conference on Antimicrobial Agents and
or categorical input nodes. Training was supervised and performed, in batch, Chemotherapy, San Francisco, CA, September 27-30, 2006.
with a probabilistic net. Testing was performed on 20% of the training set.
The net used a self-generated learning rate and we set the error limit to
0.01%. We used 6 scenarios, 2 with and 4 without the primary outcome, for Medication Safety
prediction. Moreover, we used the prevalence (5.3 percent) in our study
population, together with calculated sensitivity and specificity, to determine
positive and negative predictive values. 49. Safety and tolerability of C.E.R.A. (continuous erythropoietin receptor
RESULTS: A total of 419 cases were used to train the network with 335 cases activator) in patients with chronic kidney disease: pooled data from 10
actually used in the optimization algorithm and 84 cases for testing. The phase II-III trials. Steven Fishbane, M.D.1, Paula Dutka, R.N., MSN, CNN1,
neural net converged successfully after 63 trials and in less than 5 seconds. It Richard Beswick, Ph.D.2, Juliane Essig, M.D.3, Allen R. Nissenson, M.D.,
was able to predict 5 out of 6 new cases (83 percent) with a sensitivity of 50% FACP 4 ; (1)Winthrop University Hospital, Mineola, NY; (2)Roche
and a specificity of 100%. The positive and negative predictive values were Laboratories, Inc., Nutley, NJ; (3)F. Hoffmann-La Roche, Ltd, Basel,
100 and 97 percent, respectively. Switzerland; (4)David Geffen School of Medicine, UCLA, Los Angeles, CA.
CONCLUSIONS: We strongly recommend a revival of artificial intelligence
modeling in clinical pharmacy. We will use our trained network to predict PURPOSE: This analysis of 10 phase II-III clinical trials reviews the safety
outcomes for larger sets of data and to conduct a comparative study of the and tolerability of C.E.R.A. for treating anemia of chronic kidney disease.
predictive abilities of the network to those of skilled clinicians in the fields of METHODS: Pooled data from the 4 phase II and 6 phase III trials provided
obstetrics and infectious diseases. an overall safety population (n=2737) that was similar to previous studies in
this therapeutic area with respect to risk factor profiles, including the
prevalence of hypertension, diabetes, and chronic heart failure. Patients
45E. Increases in chitin production and expression of mitogen-activated received C.E.R.A. (n=1789) or a comparator drug (epoetin alfa/beta [EPO] or
protein kinase A are associated with attenuated caspofungin activity in darbepoetin alfa [DAR]; n=948). In phase III studies, C.E.R.A. was
Aspergillus fumigatus. Nathan P. Wiederhold, Pharm.D.1, Brian L. Wickes, administered every 2 weeks for 24 or 28 weeks (correction treatment;
Ph.D.2, Thomas F. Patterson, M.D.2; (1)University of Texas at Austin College hemoglobin [Hb] range 11-13 g/dL) or every 2 weeks or every 4 weeks for
of Pharmacy, San Antonio, TX; (2)University of Texas Health Science Center 36 or 52 weeks (maintenance treatment; Hb range 10–13.5 g/dL),
at San Antonio, San Antonio, TX. intravenously or subcutaneously. Comparator drugs were administered 1–3
times/week (EPO) or every week or every 2 weeks (DAR). In phase II studies,
Presented at the 46th Interscience Conference on Antimicrobial Agents and C.E.R.A. was administered every week, every 2 weeks, every 3 weeks, or
Chemotherapy, San Francisco, CA, September 27-30, 2006. every 4 weeks for 12–21 weeks. The phase II safety population had no
reference group.
46. The efficacy of vancomycin compared to metronidazole in the treatment RESULTS: The percentage of patients experiencing ≥ 1 AE was similar
of Clostridium difficile-associated diarrhea. Rania M. El-Lababidi, Pharm.D., between C.E.R.A. and reference groups (89% vs 91%). The majority of AEs
Corinne Chahine-Chakhtourah, M.S., Pharm.D., BCPS, Stephen M. Smith, were mild or moderate in intensity, and both groups averaged ~5 AEs per
M.D.; Saint Michael's Medical Center, Newark, NJ. patient. The most frequent (≥ 10%) AEs, common to both groups, were
hypertension, diarrhea, and nasopharyngitis. Rates of serious AEs (37% vs
40%) and AEs leading to withdrawal (3% vs 2%) were similar between
PURPOSE: It is uncertain whether vancomycin is more effective than C.E.R.A. and comparator groups. The most frequent (≥ 5%) AEs of special
metronidazole in the treatment of Clostridium difficile-associated diarrhea interest were hypertension, vascular access thrombosis, arrhythmia, and
(CDAD). This study compared the efficacy of both therapies in patients with congestive heart failure, which showed the same incidence between groups.
CDAD. No association was found between AEs and Hb level and rate of rise, except
METHODS: This was a prospective, randomized, open-label study. Adult for Hb levels > 13 g/dL and vascular access thrombosis in both treatment groups.
patients were eligible for inclusion if they presented with an acute diarrhea CONCLUSIONS: C.E.R.A. was well tolerated in phase II-III trials, with a
and a positive Clostridium difficile toxin assay, or other clinical findings safety profile similar to reference drugs.
consistent with CDAD. Eligible patients were randomized to either
vancomycin or metronidazole 250 mg orally 4 times/day for 10 days. The
primary outcome was clinical cure rate, defined as the resolution of diarrhea
and gastrointestinal symptoms after the third day of therapy. The secondary
Nephrology
outcome was clinical relapse rate at 30 days following the end of therapy.
During the treatment period, patients were monitored for treatment-related 50E. Evaluation of clinical methods to assess kidney function in African
adverse events. Patient demographics, co-morbidities, concomitant Americans. Darius L. Mason, Pharm.D., Kim Huch, M.D., Larry J. Hak,
medications, and other pertinent data were documented for each patient. Data Pharm.D., Joanna Q. Hudson, Pharm.D.; The University of Tennessee
analysis was performed using descriptive statistics and the Chi-Square test. Departments of Clinical Pharmacy and Medicine, Memphis, TN.
RESULTS: Twenty patients completed the 10-day treatment regimen: 10
patients in the metronidazole group (4 males, mean age 60.8 ± 17.9 years) Presented at the Annual Meeting and Scientific Exposition of the American
and 10 patients in the vancomycin group (5 males, mean age 57.1 ± 17.0 Society of Nephrology, San Diego, CA, November 16, 2006.
years). The cure rate was 50% (5/10 patients) in the metronidazole group and
100% (10/10 patients) in the vancomycin group (p≤0.01). At 30 days post-
treatment, the relapse rate was 60% (3/5 patients) in those who were cured 51. 2-Hydroxypropyl beta cyclodextrin transmembrane clearance during in
with metronidazole, and 20% (2/10 patients) in those who were cured with vitro continuous venovenous hemodialysis. Jignesh H. Patel, Pharm.D.1,
vancomycin (p≤0.20). Adverse events were similar between the study groups, Mariann D. Churchwell, Pharm.D.2, Julie Seroogy, B.S.3, Steven L. Barriere,
with minor gastrointestinal complaints being the most frequent. Pharm.D.3, Bruce A. Mueller, Pharm.D.1; (1)University of Michigan, College
CONCLUSIONS: Metronidazole therapy was associated with a significantly of Pharmacy, Ann Arbor, MI; (2)University of Toledo College of Pharmacy,
lower clinical cure rate than vancomycin in the treatment of CDAD. The Toledo, OH; (3)Theravance, Inc, South San Francisco, CA.
clinical relapse rate was similar in both treatment arms.
PURPOSE: 2-Hydroxypropyl beta cyclodextrin (HP-CD) is used to increase
solubility, improve bioavailability, resist degradation, or enhance safety profile
47E. The impact of multidrug resistance on the outcomes of critically ill of lipophilic drugs. HP-CD is renally eliminated; therefore, its use in acute
patients with Gram-negative bacterial pneumonia. Andrea L. Kwa, kidney injury (AKI) is not recommended. Clinicians using drugs containing
Pharm.D.1, Jenny G.H. Low, MBBS1, Erin Lee, [Link]. (Pharm)1, Asok Kurup, HP-CD have concerns about its accumulation in AKI, and there are no
MBBS1, Huei-Leng Chee, MBBS1, Vincent H. Tam, Pharm.D.2; (1)Singapore published data regarding HP-CD disposition during renal replacement
General Hospital, Singapore, Singapore; (2)University of Houston College of therapy. The purpose of this study was to determine HP-CD transmembrane
Pharmacy, Houston, TX. clearance using a validated continuous hemodialysis (CVVHD) in vitro
model.
Presented at the Interscience Conference on Antimicrobial Agents and METHODS: HP-CD 1.25 gm was added to 1L of bovine blood dialyzed with a
Chemotherapy, San Francisco, CA, September 27-30, 2006. Diapact CRRT machine. Experiments were run five times using new AN69
e18 PHARMACOTHERAPY Volume 27, Number 4, 2007
(M100, Gambro) and polysulfone (F160NR, Fresenius) hemofilters. Dialysate Neurology
flow rates (Qd) were 1, 2, 3 and 6 L/hr with sufficient blood flow (200–350
mL/min) to maintain appropriate transmembrane pressures. Blood samples
were collected from the pre-filter arterial and post-filter venous ports. 54. Rasgiline is safe and well tolerated in Parkinson's disease (PD) patients
Dialysate samples were obtained from a dialysate side port. Plasma and with levodopa-related motor fluctuations receiving serotonin reuptake
dialysate samples were assayed for HP-CD using qualified HPLC-fluorescence inhibitors (SSRIs). Jack J. Chen, Pharm.D.; Loma Linda University, Loma
detection methods, and clearance was determined using standard Linda, CA.
pharmacokinetic equations. Statistical analysis was performed using two-way
Analysis of Variance with post-hoc Scheffé analysis. PURPOSE: Interactions between non-selective MAO inhibitors and selective
RESULTS: The AN69 mean clearance of HP-CD at 1, 2, 3, and 6 L/hr was 18 serotonin reuptake inhibitors (SSRIs) can provoke a hyperserotonergic state
± 2.3, 33 ± 3.8, 47 ± 7.1, and 63 ± 4.3 mL/min, respectfully. Similarly, the with mild to serious sequelae, including death. Rasagiline mesylate is a novel,
mean clearances were 23 ± 3.6, 38 ± 5.2, 53 ± 2.8, and 103 ± 9.9 mL/min with selective, potent, and irreversible MAO-B inhibitor with demonstrated
the polysulfone membrane. No statistical differences in clearance between the efficacy in PD patients with levodopa-related motor fluctuations (PRESTO
two filter types were observed until Qd reached 6 L/hr (p<0.001). and LARGO studies). This evaluation assessed the safety and tolerability of
CONCLUSIONS: HP-CD was substantially cleared in our in vitro CVVHD rasagiline treatment in a subset of PRESTO patients who were also receiving
model. If similar CVVHD clearance is seen in vivo, given the small volume of an SSRI.
distribution of HP-CD, CVVHD may prevent HP-CD accumulation in METHODS: PRESTO was a randomized, placebo-controlled, double-blind,
critically ill patients with AKI. multicenter study of once-daily rasagiline 0.5 mg/day, 1 mg/day, or placebo in
472 patients with moderate to advanced PD who were “optimally” treated
with levodopa, with or without additional dopaminergic therapy. Patients
52. Continuous erythropoietin receptor activator (C.E.R.A.): efficacy
receiving stable doses of an SSRI (citalopram, sertraline, or paroxetine) before
results of six global phase III studies on anemia of chronic kidney disease
entry could participate. Safety was assessed by adverse event (AE) frequencies
(CKD). Nathan Levin, M.D.1, Rebecca Schmidt, D.O., FACP, FASN2, Steven
and vital signs, and tolerability was assessed by early discontinuation rates.
Fishbane, M.D.3; (1)Renal Research Institute, New York, NY; (2)West Virginia
RESULTS: Patients taking SSRIs (SSRI+; n=77) were more likely to be female
University School of Medicine, Morgantown, WV; (3)Winthrop University
and were more impaired at baseline as measured by UPDRS score than the
Hospital, Mineola, NY.
remainder of the study cohort (SSRI–; n=395). With the exception of
vomiting (5% vs 1%, respectively, p=0.02), there were no significant
PURPOSE: C.E.R.A. is a new anti-anemia agent with unique receptor activity differences between SSRI+ and SSRI– patients in incidence of AEs, nor were
and a prolonged half-life, allowing for extended dosing intervals. Six there consistent differences in vital signs between groups. Within the SSRI+
randomized, open-label, multicenter, parallel-group trials evaluated the cohort, there were no differences in AE incidences or vital sign changes in
efficacy of C.E.R.A. in correction and maintenance of hemoglobin (Hb) levels patients receiving rasagiline compared with those receiving placebo.
in patients with anemia of CKD. Proportions of patients discontinuing the study for any reason or due to an
METHODS: The AMICUS and ARCTOS correction studies enrolled patients AE did not significantly differ among treatment groups (p=0.85).
naïve to anemia therapy, whereas the MAXIMA, PROTOS, STRIATA, and CONCLUSIONS: This study showed no deleterious effects of concomitant
RUBRA maintenance studies enrolled patients previously maintained on SSRI (citalopram, sertraline, or paroxetine) use with rasagiline in patients
epoetin (EPO) or darbepoetin (DAR). with advanced PD taking levodopa and other dopaminergic therapies.
RESULTS: Per-protocol primary efficacy results are shown in the Table.
Primary efficacy
55. Rasagiline is effective and well tolerated as adjunct therapy in
Per-protocol Primary efficacy results
Parkinson's disease (PD) patients receiving levodopa and entacapone. Jack
Study population measure (per-protocol)
J. Chen, Pharm.D.; Loma Linda University, Loma Linda, CA.
AMICUS Dialysis C.E.R.A. Q2W, % pts with Hb 98.32%
IV 24-wk initiation 119 increase ≥1.0 g/dL
28-wk extension from baseline to PURPOSE: Rasagiline, a selective and irreversible MAO-B inhibitor, has
EPO TIW, 36 evaluation 97.22% demonstrated efficacy in PD patients with levodopa-related motor
ARCTOS Nondialysis C.E.R.A. Q2W, % pts with Hb 99.28% fluctuations. The catechol-O-methyltransferase (COMT) inhibitor,
SC 18-wk correction 139 % pts with Hb entacapone, is also commonly used for motor fluctuations. The efficacy and
10-wk evaluation from baseline to tolerability of rasagiline were assessed in subsets of patients receiving
24-wk extension evaluation optimized levodopa with and without the catechol-O-methyltransferase
DAR, 144 99.31% (COMT) inhibitor, entacapone.
MAXIMA Dialysis C.E.R.A. Q2W, Change of Hb from -0.10 ± 1.06 METHODS: PRESTO was a randomized, placebo-controlled, double-blind,
IV 28-wk titration 188 baseline to evaluation multicenter study of once-daily rasagiline 0.5 mg/day, 1 mg/day, or placebo in
8-wk evaluation (g/dL, mean ± SD) 472 PD patients with motor fluctuations. Before baseline, all patients were
16-wk safety C.E.R.A. Q4W, 172 0.01 ± 0.96 judged by investigators to be receiving optimal levodopa/carbidopa (LD/CD)
EPO, 180 -0.10 ± 0.92 doses; 165 patients (35%) were also taking entacapone. Efficacy end points
PROTOS Dialysis C.E.R.A. Q2W, Change of Hb from 0.00 ± 0.96 between entacapone(-) and entacapone(+) groups included change in total
SC 28-wk titration 154 baseline to evaluation daily “off” time (assessed by home diaries), investigator-rated global
8-wk evaluation (g/dL, mean ± SD) improvement, UPDRS ADL score while “off,” and UPDRS motor score while
16-wk safety C.E.R.A. Q4W, -0.11 ± 0.97 “on.” The UPDRS mental subscale scores and adverse events (AEs) were
153 measured to assess cognitive and behavioral changes.
EPO, 167 -0.12 ± 1.04 RESULTS: Overall, 34% (55/164), 33% (49/149), and 38% (61/159) of
STRIATA Dialysis C.E.R.A. Q2W, Change of Hb from 0.05 ± 0.96 patients in the rasagiline 0.5 mg/day, rasagiline 1.0 mg/day, and placebo
IV 28-wk titration 123 baseline to evaluation groups, respectively, were receiving concomitant entacapone with LD/CD.
8-wk evaluation (g/dL, mean ± SD) Benefits of rasagiline on daily “off” time and on secondary measures of
16-wk additional safety efficacy were similar within dose groups, regardless of concomitant
DAR, 126 -0.10 ± 0.92 entacapone use. Relative to placebo, rasagiline 1.0 mg/day reduced off time by
RUBRA Dialysis C.E.R.A. Q2W, Change of Hb from 0.14 ± 0.93 0.91 [95% CI: -1.64– -0.17] and 0.95 (95% CI: -1.5– -0.41) hours in the
IV or SC, pre-filled 123 baseline to evaluation entacapone(+) and entacapone(-) subgroups, respectively. There was no
syringes (g/dL, mean ± SD) significant worsening of UPDRS mental subscores or increased AEs in
28-wk titration rasagiline-treated patients receiving concomitant entacapone.
8-wk evaluation EPO, 133 -0.01 ± 1.03 CONCLUSIONS: Adjunct rasagiline therapy decreased daily “off” time in
patients receiving LD/CD and entacapone. Adverse effects, including mental
CONCLUSIONS: C.E.R.A. successfully corrected and maintained Hb levels impairment, were not increased when rasagiline was added to multiple
in dialysis and nondialysis patients with anemia of CKD. C.E.R.A.'s efficacy in dopaminergic agents. Because it is a selective MAO-B inhibitor, rasagiline may
Hb correction and maintenance mirrored that of EPO and DAR but required be combined with levodopa, with or without a COMT inhibitor.
less frequent administration.
56. Comparing the efficacy and tolerability of labetalol and nicardipine in
53E. Combined citrate anticoagulation and bicarbonate containing dialysate stroke patients. Jody L. Carswell, Pharm.D. 1, Sara Kauffman, Pharm.D.
in continuous veno-venous hemodiafiltration. Sheryl E. Doung, Pharm.D., Candidate 2, Christiana E. Hall, M.D. 3, David Rychly, Pharm.D. 2, Jill P.
Linda Awdishu, Pharm.D., Ravindra L. Mehta, M.D.; University of California, Williams, R.N.1, Susan C. Fagan, Pharm.D.2; (1)Medical College of Georgia
San Diego, Medical Center, La Jolla, CA. Health System, Augusta, GA; (2)University of Georgia College of Pharmacy,
Augusta, GA; (3)Medical College of Georgia, Augusta, GA.
Presented at the 39th Annual Meeting and Scientific Exposition of the
American Society of Nephrology, San Diego, CA, November 16-19, 2006. PURPOSE: Hypertension is the most important modifiable risk factor and a
 ACCP 2007 SPRING PRACTICE AND RESEARCH FORUM e19
major complication of stroke. Although there is some controversy about the Pharm.D., Tom Diamantidis, Pharm.D., Mathew Muramoto, B.S., Marianne
impact of hypertension on stroke outcome, there is a potential for worsening Opilla, R.N., Rod Okamoto, [Link].; Nutrishare, Inc, Elk Grove, CA.
with severe blood pressure elevations. In many situations immediate blood
pressure control is necessary. Both labetalol (L) and nicardipine (N) are Presented at the Clinical Nutrition Week of the American Society for
recommended as first line agents for blood pressure treatment after stroke Parenteral and Enteral Nutrition, Phoenix, AZ, January 28-31, 2007.
(AHA), but no randomized studies currently exist comparing the two drugs.
The purpose of this study was to retrospectively evaluate the efficacy and
tolerability of the two drugs in clinical practice. 60E. Aluminum exposure in adult patients with acute renal failure
METHODS: A chart review was conducted, examining all patients admitted requiring parenteral nutrition. Vilas Rajanna, B.S., Rex O. Brown, Pharm.D.,
to the neuroscience center from May 2004 to February 2006 with orders for Laurie M. Morgan, R.N., Syamal Bhattacharya, Ph.D., Patti L. Johnson, B.S.,
intravenous infusions of labetalol or nicardipine within 24 hours of Gayle Minard, M.D., Roland N. Dickerson, Pharm.D.; University of Tennessee
admission. Data were collected throughout the entire duration of the infusion. Health Science Center, Memphis, TN.
RESULTS: Twenty-four patients experiencing an intracerebral hemorrhage
(ICH) 58%; subarachnoid hemorrhage (SAH), 16.7%; or ischemic stroke, Presented at the Clinical Nutrition Week of the American Society for
12.5%, received labetalol (n=7), nicardipine (n=14), or both (n=3). Baseline Parenteral and Enteral Nutrition, Phoenix, AR, January 28-31, 2007.
demographics were similar except age: African American (L=85%, N=78.6%),
male (L=57%, N=50%), average age (L=48 yr, N=65 yr). Initial blood
pressures were similar (L= 205/108, N=206/98). Average length of infusion Oncology
was 46 hours for labetalol and 36 hours for nicardipine. The average number
of dose increases (L=4.6, N=5.2) and dose decreases (L=6.1, N=5.6) were
similar. The majority of patients had at least one target parameter ordered 61E. Safety, pharmacokinetics (PK), and activity of panitumumab
(L=85.7%, N=78.6%). Patients reached targets earlier with the labetalol group monotherapy in patients with advanced solid malignancies. Louis Weiner,
(L=2hr, N=6.4hr), but more nicardipine patients stayed below the target M.D.1, Arie Belldegrun, M.D.2, Jeffrey Crawford, M.D.3, Anthony Tolcher,
consistently (L=28.6%, N=50%). Both groups had 3 episodes of hypotension M.D.4, Bing-Bing Yang, Ph.D.5, Lynn Navale, M.S.5, Rafael G. Amado, M.D.5,
(SBP<90) noted during the infusions. Robert Figlin, M.D. 6 ; (1)Fox Chase Cancer Center, Philadelphia, PA;
CONCLUSIONS: Our findings demonstrate that nicardipine may have an (2)UCLA School of Medicine, Los Angeles, CA; (3)Duke University Medical
advantage in consistent blood pressure control, but we cannot conclude that Center, Durham, NC; (4)Cancer Therapy and Research Center, San Antonio,
nicardipine is superior to labetalol. Both agents were well tolerated. TX; (5)Amgen Inc., Thousand Oaks, CA; (6)City of Hope, Los Angeles, CA.

Published in J Clin Oncol 2005;23(16S):3059.

57. Delayed minocycline is an inhibitor of MMPs activated by stroke:
Implications for neurovascular protection. Livia S. Machado, [Link].1, Anna
Kozak, M.S.1, Hazem F. Elewa, [Link].1, Adviye Ergul, M.D., Ph.D.2, Susan 62E. The patient's experience of fatigue: a cross-sectional study of cancer
C. Fagan, Pharm.D.1; (1)University of Georgia College of Pharmacy and patients. David H. Henry, M.D.1, Hema N. Viswanathan, Ph.D.2, Shawn M.
Veteran's Affairs Medical Center, Augusta, GA; (2)Medical College of Georgia, Wade, Ph.D.3, Mariana Servin, [Link].3, David Cella, Ph.D.4; (1)Joan Karnell
Augusta, GA. Cancer Center, Philadelphia, PA; (2)Amgen Inc., Thousand Oaks, CA;
(3)Harris Interactive Inc., Claremont, CA; (4)Evanston Northwestern
PURPOSE: Minocycline has anti-inflammatory effects independent of its Healthcare and Northwestern University, Evanston, IL.
antimicrobial properties and is neuroprotective in multiple disease models of
brain injury. Matrix metalloproteinases 2 and 9 are proteolytic enzymes Presented at the 48th Annual Meeting of the American Society of Hematology,
responsible for degrading the extracellular matrix and are involved with the Orlando, FL, December 9-12, 2006.
development of hemorrhage after acute ischemic stroke. The purpose of this
study was to determine the effect of acute minocycline on MMP inhibition 63. Evaluation of guideline adherence and length of stay in the treatment of
and on outcome after acute ischemic stroke. febrile neutropenia in pediatric and adult patients. Phyllis Hemerson,
METHODS: Rat middle cerebral artery occlusion (MCAO) was performed by Pharm.D. Candidate1, Mark K. Sorenson, B.S.2, Erika J. Ernst, Pharm.D.1;
suture insertion. The protocol was 3 hours of occlusion and 21 hours
(1)University of Iowa, Iowa City, IA; (2)University of Iowa Hospitals and
reperfusion. The animals were divided into minocycline 45 mg/kg and
Clinics, Iowa City, IA.
phosphate-buffered saline groups. MMPs were studied with immunoblotting
and gelatin zymography. Hemorrhage formation was assessed by hemoglobin
ELISA. Infarcted tissue and edema were studied by image analysis after TTC PURPOSE: To compare guideline adherence for the treatment of neutropenic
staining. All animals were evaluated with the Bederson motor-behavior test. fever in pediatric and adult patients at a university hospital. We evaluated the
Minocycline selectivity for MMPs was studied by cell-free in vitro studies with applicability of adult febrile neutropenia guidelines to pediatrics and
recombinant enzyme. identified factors influencing guideline adherence, including patient factors
RESULTS: MMP-2 and MMP-9 were both strongly inhibited at all and use of preprinted orders. At our institution, preprinted febrile
concentrations studied, with MMP-9 being more sensitive to minocycline neutropenia admission orders are available for pediatrics but not adults.
inhibition at the micromolar concentrations (p<0.05). Minocycline also METHODS: All patients admitted between July 1, 2004, and June 30, 2005,
significantly inhibited enzymatic activity (p<0.0003) and protein expression with agranulocytosis as their primary diagnosis were included, because a
(p<0.05) of both MMPs 2 and 9 in the rat brain. Hemorrhage formation, diagnostic related group for neutropenic fever does not exist. Data were
edema, and infarct size were not improved by minocycline in this collected retrospectively, including among others, age, gender, absolute
experimental model. neutrophil count (ANC), temperature, and guideline adherence. Adult and
CONCLUSIONS: Minocycline affects the MMP proteolytic cascade generated pediatric groups were compared using paired t-test or chi square as
by ischemia after acute stroke. This inhibition does not translate in appropriate. Factors associated with guideline adherence and length of stay
neurovascular protection in our model. Minocycline should be further (LOS), were determined using regression analysis.
studied in a model of shorter occlusion time and different route of RESULTS: 64 pediatric and 72 adult patients were included in the analysis.
administration. Lastly, minocycline MMP inhibition is relevant for acute Guideline adherence at admission was higher for pediatrics, 90.6% compared
stroke because thrombolysis with tPA is a potentiating and independent factor to 77.8% for adults, p=0.042. At 24 hours, adherence was 87.5% for pediatrics
for MMP activation and vascular breakdown. Minocycline should be studied and 72.2% for adults (p=0.053). By 72 hours, adherence was similar between
in context of an adjuvant drug for tPA thrombolysis after experimental stroke. groups (57.8% vs. 47.8%, p=0.249). There was no difference in time to
defervescence between pediatrics (19.2 hours) and adults (22.5 hours),
p=0.58. LOS was significantly longer in adults than in pediatric patients (5.9
Nutrition vs. 4.1 days, p=0.036). Regression analysis revealed that positive blood
cultures, admission temperature, admission ANC, hours to defervescence and
following initial guidelines were correlated with LOS.
58E. Osteonecrosis of the jaw in chronic home parenteral nutrition patients CONCLUSIONS: Adult neutropenic fever guidelines were successfully
receiving intravenous pamidronate. Reid A. Nishikiawa, Pharm.D., John K. applied to pediatric patients. Use of preprinted admission orders increased
Siepler, Pharm.D., Frank Sasaki, B.S., Mathew Muramoto, B.S., Tom initial guideline adherence; however, this adherence was not maintained
Diamantidis, Pharm.D., Rod Okamoto, [Link].; Nutrishare, Inc, Elk Grove, CA. throughout hospitalization. Because following guidelines initially was
associated with decreased LOS, our results suggest that use of preprinted
Presented at the 28th Congress of the European Society for Clinical Nutrition neutropenic fever orders may increase adherence and decrease LOS. Further
and Metabolism, Istanbul, Turkey, October 19-22, 2006. study is needed to confirm these findings.

59E. Exit-site infections are more common in home parenteral nutrition 64. Outcomes in febrile neutropenia oncology patients with hyperglycemia.
patients with ostomies. John K. Siepler, Pharm.D., Reid A Nishikawa, Heather R. Frank, Pharm.D., B.S., Cindy L. O'Bryant, Pharm.D., Samuel Ellis,
e20 PHARMACOTHERAPY Volume 27, Number 4, 2007
Pharm.D.; University of Colorado at Denver Health Sciences Center, Denver, 67E. Efficacy and safety of panitumumab across five clinical studies in
CO. patients with metastatic colorectal cancer (mCRC). Jordan Berlin, M.D.1,
PURPOSE: This study documented outcomes in patients with febrile Eric Van Cutsem, M.D., Ph.D.2, Marc Peeters, M.D., Ph.D.3, J. Randolph
neutropenia oncology and hyperglycemia requiring inpatient admission. Hecht, M.D.4, Rolando Ruiz, M.D.5, Michael Wolf, M.S.5, Theresa Michelini,
METHODS: Medical records of 180 patients admitted for febrile neutropenia Pharm.D.5, Rafael G. Amado, M.D.5, Neal J. Meropol, M.D.6; (1)Vanderbilt
from January 2004 to January 2006 were reviewed. Patients were admitted to University Medical Center, Nashville, TN; (2)University Hospital
the University of Colorado Hospital, a 450-bed academic medical center. Gasthuisberg, Leuven, Belgium; (3)Ghent University Hospital, Ghent,
Additional review identified patients with hyperglycemia, defined as having a Belgium; (4)UCLA School of Medicine, Los Angeles, CA; (5)Amgen Inc.,
fasting blood glucose ≥ 126 mg/dL or random blood glucose ≥ 200 mg/dL. Thousand Oaks, CA; (6)Fox Chase Cancer Center, Philadelphia, PA.
Patients’ demographic and medical history, including oncologic diagnosis and
treatment, anti-infective therapy, microbiologic data, length of stay, time to Presented at the 31st Congress of the European Society for Medical Oncology,
absolute neutrophil count (ANC) recovery, and use of GCSF, time to Istanbul, Turkey, September 28–October 3, 2006.
defervescence and glycemic control were collected.
RESULTS: Hyperglycemia was identified in 16 patients admitted for febrile
neutropenia. The mean patient age was 51 years old (Range: 19–73 years). Pain Management/Analgesia
Seven (44%) patients were female, and subjects were included with a variety
of malignancies, including hematologic (56%) and solid tumors (44%). A 68. Concomitant ingestion of tested levels of alcohol with polymer-coated
control group of 12 patients without hyperglycemia was also identified. There extended-release morphine sulfate capsules: no significant impact on mean
was no difference between the groups in the following outcomes: time to morphine blood levels. Franklin Johnson, M.S., Stephen Sun, M.D., George
defervescence (2.3 vs. 2.7 days: NS), time to ANC recovery (3.7 vs. 4.1 days: Wagner, B.S., Joseph Stauffer, D.O.; Alpharma Branded Products Division, Inc,
NS) and length of stay (5.4 vs. 5.1 days: NS). A subgroup analysis of eight Piscataway, NJ.
patients with blood glucose > 200 mg/dL demonstrated a trend in increased
length of stay, 6.1 days vs. 5.1 days, but was not statistically different (p=0.47) PURPOSE: The removal of hydromorphone hydrochloride extended-release
when compared to non-hyperglycemic patients. capsules (PalladoneTM) from the market in 2005 due to data indicating that
CONCLUSIONS: Hyperglycemia was associated with a trend toward co-ingestion with 240 mL of 40% alcohol yielded dangerous increases in peak
increased length of stay in the setting of febrile neutropenia. Further data plasma hydromorphone concentrations1 has prompted studies of interactions
collection is needed to evaluate this outcome. of other extended-release products with alcohol. This study assessed single-
dose relative bioavailability of polymer-coated extended-release morphine
65E. Administration of panitumumab every 2 weeks (Q2W) as a 30-minute sulfate (P-ERMS) capsules2 taken with alcohol.
or 60-minute infusion: safety and pharmacokinetics (PK) from a phase 1 METHODS: In this open-label, randomized, single-dose, 3-way crossover
study in patients with solid tumors. Joseph Stephenson, M.D.1, Allen Cohn, study, 32 opioid-naïve, healthy male volunteers, aged 21–40 years, moderate
drinkers (7–21 drinks/week) took a 100 mg P-ERMS capsule along with 240
M.D.2, Jeffrey Crawford, M.D.3, Anne-Marie Maddox, M.D.4, Suzanne Jones,
mL of 40% alcohol (4 shots [101 mL] 190-proof Everclear®, 139 mL water,
Pharm.D.5, Peggy Lum, B.S.6, Xinqun Yang, M.S.7, Rafael G. Amado, M.D.6,
consumed within 20 minutes of dosing) fasted and fed, and with 240 mL of
Howard Burris, M.D.5; (1)Cancer Center of the Carolinas, Greenville, SC;
water (fasted) as a reference. Open-label arm of immediate-release 20 mg
(2)Rocky Mountain Cancer Center, Denver, CO; (3)Duke University Medical
morphine solution was included for comparison. Oral naltrexone
Center, Durham, NC; (4)University of Arkansas Medical Sciences, Little
hydrochloride was administered 12 hours and 2 hours before treatment to
Rock, AR; (5)The Sarah Canon Cancer Center, Nashville, TN; (6)Amgen Inc., counter morphine effects.
Thousand Oaks, CA; (7)Amgen Inc., South San Francisco, CA. RESULTS: Twenty-seven subjects had evaluable data for ≥ 1 treatment arm.
Eleven subjects vomited after taking P-ERMS+alcohol; none vomited after
Presented at the 2007 Gastrointestinal Cancer Symposiums, Orlando, FL, P-ERMS+water. Median Tmaxin subjects taking P-ERMS+alcohol fasted, with
January 19-21, 2007. alcohol fed, and with water fasted was 6.0, 8.0, and 8.0 hours, respectively,
consistent with maintenance of a sustained-release profile. Excluding patients
66. Administration of greater than 2 cycles of fludarabine (FLU) increases who vomited during the 12-hour dosing interval,3 means of log-transformed
the risk of infection independent of other risk factors. Sarah L. Scarpace, Cmax values were 16.7, 16.0, and 15.6 ng/mL, respectively. ANOVA showed
Pharm.D., BCOP 1, Nalini Ramanathan, M.D. 2, Jeyanthi Ramanarayanan, ratios of least square means for C max and AUC of both regimens of
M.D.2, Amy I. Jackson, R.N., OCN 2, Donald Pasquale, M.D. 2; (1)Albany P-ERMS+alcohol within 80%–125% confidence interval boundaries when
compared with P-ERMS+water. In contrast, the pharmacokinetic profile of
College of Pharmacy, Albany, NY; (2)Stratton Veterans Administration
20 mg solution was markedly different from the test treatments.
Medical Center, Albany, NY.
CONCLUSIONS: P-ERMS taken with 240 mL of 40% alcohol continued to
display extended-release characteristics, with no significant impact
PURPOSE: We reported individualized dosing of FLU results in less drug on mean morphine blood levels. References: 1
FDA 2005.
administered, lower incidence of NCI grade 3/4 infections (IN) (p=0.011), [Link]/cder/drug/InfoSheets/HCP/[Link].
and equivalent survival in patients with lymphoproliferative disorders (LD). 2
KADIAN®, PI. Piscataway, NJ: Alpharma Branded Products Division Inc.
This report extends these observations to assess whether risk factors such as 3
FDA. Guidance for Industry: Bioavailability and Bioequivalence Studies for
age, number of comorbidities, myelosuppression, and number of different Orally Administered Drug Products—General Considerations. Rockville, Md:
prior chemotherapies (PC) could account for this effect. CDER; 3/03.
METHODS: We conducted a retrospective chart review of LD patients who
received FLU treatment from 1992 to 2005, identified through the pharmacy
system. The number of cycles per treatment course is defined as the number 69. An evaluation of the bioavailability of methadone administered
of 5-day treatment courses of FLU 25 mg/m2 not interrupted by a > 3-month topically. Robert K. Sylvester, Pharm., D. 1, Caroline Schauer, R.N. 2, John
hiatus between treatment cycles. We individualize the number of monthly Thomas, M.D.2, Alan Weisenberger, Pharm., D.1; (1)College of Pharmacy,
North Dakota State University, Fargo, ND; (2)Hospice of the Red River Valley,
cycles of FLU based on response, usually 1 cycle of therapy when rapid and
Fargo, ND.
substantial response is obtained, or 1 cycle past best response. The number of
comorbidities, PC, and IN within 6 months of the last therapy was
determined. ALC and ANC were recorded at day 1 of each course for patients PURPOSE: To evaluate systemic absorption of methadone (MTD)
administered topically to hospice patients
without infection and at the time of infection.
METHODS: Two trough steady-state plasma MTD concentrations were
RESULTS: Twenty-eight patients (15 CLL, 9 low-grade lymphoma, 4
determined in hospice patients administered MTD topically or by mouth and
macroglobinemia) received a total of 44 treatment courses. Results are mean ±
in a healthy subject administered placebo gel. Topical doses were prepared by
SD.
dissolving MTD in ethoxy diglycol which was then incorporated into pluronic
With Infection Without Infection P value (x2) lecithin organogel (PLO) in concentrations of 5%–15%. MTD/PLO gel was
Age 68.2 ± 10.5 years 69.5 ± 11.5 years 0.087 applied to the inner surface of a patient's wrist 2–3 times daily. Doses of MTD
PC 0.9 ± 1.3 0.7 ± 0.9 0.400 were titrated to desired level of symptom control. Plasma samples were frozen
#Comorbidities 3.1 ± 1.8 2.0 ± 1.9 0.050 and later analyzed by gas chromatography. The reporting limit of the assay is
ALC 5800 ± 5600 /uL 2200 ± 4700 /uL 0.359 10 ng/mL.
ANC 3900 ± 5100 /uL 2900 ± 1100 /uL 0.367 RESULTS: Seventeen of 20 samples collected after topical MTD were
Survival 76.9 ± 64.2 months 76.3 ± 40.5 months 0.611 (Kaplan-Meier) identical to the MTD concentrations achieved in the placebo control
CONCLUSIONS: In our sample, age at diagnosis, number of different PC, (< 10 ng/mL). Measurable MTD concentrations were achieved in 2 patients
and ANC/ALC suppression did not influence the infections observed in administered topical MTD. None of the methadone levels achieved after
patients with LD treated with FLU. However, a higher number of MTD/PLO administration exceeded the lower limit of the reference range
comorbidities may increase risk. (50 ng/mL). All 5 patients administered oral MTD achieved plasma
 ACCP 2007 SPRING PRACTICE AND RESEARCH FORUM e21
concentrations > 50 ng/mL. Summary data are provided below. after diagnosis: the medical expenditures had another spike in the 7th year
mean dose/day mean concs. after diagnosis (over $9000), and again in the 9th year after diagnosis (over
group # (range) median concs. (range) $5,000).
topical MTD 10 19.5 mg <10 ng/ml 5.1 ng/ml CONCLUSIONS: The cost of treating childhood cancer patients and
(10–45 mg) (0–35 ng/ml) survivors is not limited to the first few years after diagnosis. It might be cost-
topical placebo 1 0 mg <10 ng/ml 0 mg effective if measures are taken to improve the health status and reduce health
oral MTD 5 30.5 mg 120.5 ng/ml 150.9 ng/ml expenditures among these individuals.
(15–40 mg) (62–393 ng/ml)
CONCLUSIONS: The topical application of a MTD/PLO gel in doses ≤ 45 72. The influence of assent document format on children's comprehension.
mg/day did not result in trough MTD concentrations associated with Kim G. Adcock, Pharm.D.1, Jennifer G. Ostrenga, Pharm.D. 2, Shirley M.
Hogan, Pharm.D.1, Jake H. Olivier, Ph.D.2; (1)University of Mississippi,
analgesia. A placebo response may explain perceived benefit of MTD applied
Jackson, MS; (2)University of Mississippi Medical Center, Jackson, MS.
topically as a PLO gel in doses ≤ 45 mg/day. The evaluation of systemic
absorption of MTD administered in doses > 45 mg/day in a PLO gel is
warranted. PURPOSE: Guidelines state that research protocols that involve children
must contain methods for obtaining a child's assent. Little direction is
available on how investigators and review committees should implement this
requirement in practice. Most standard assent documents are a simple form
Pediatrics written in paragraphs that the investigator reads with the child. An assent
booklet was created that used pictures and written information so that it
70. A pilot study comparing daily peak flow monitoring to weekly nitric resembled a storybook. The purpose of this study was to determine which of
oxide monitoring for asthma exacerbation in children. Holly J. Watson, these assent documents was preferred and which was better understood by
Pharm.D., Cliff Fuhrman, Ph.D.; South Carolina College of Pharmacy, the study population. A secondary analysis was conducted to determine a
Columbia, SC. correlation between demographic information and comprehension of either
document.
PURPOSE: Compare daily peak flow monitoring to weekly exhaled nitric METHODS: This prospective, randomized, crossover study evaluated the
oxide (FENO) monitoring to determine which parameter is the earliest comprehension of children, 7 to 12 years of age, who reviewed two different
predictor of asthma exacerbation in children. types of assent forms. Participants were randomized as to which document
METHODS: Five children with asthma and five healthy controls were they received first to decrease bias. The participant was shown the first
followed for 5 months. FENO samples were obtained weekly for the asthma document as it was read to them by the investigator. A short quiz was then
group and every 2 weeks for the control group. The children in the asthma administered that consisted of 6 questions. This process was then repeated for
group maintained a daily peak flow diary. FENO samples were collected using the second document. After both documents were read and both sets of
an off-line method of exhalation into a collapsible bag of nonreacting material questions answered, the participants were asked which they preferred and
and analyzed with a Sievers NO analyzer model 280i. These measurements which was easier to understand.
were based on a chemiluminescence reaction between NO and ozone. Asthma RESULTS: Thirty-four participants were enrolled. The average quiz score for
exacerbation was determined by weekly chest exam, medication changes, and the standard form was 86.8 ± 14.1% correct, and the average score for the
patient-reported symptoms (wheeze, activity, nocturnal cough). Daily home booklet was 85.8 ± 16.0% correct. All of the participants (100%) responded
peak flow monitoring was compared to weekly FENO monitoring to that they preferred the booklet to the standard form (95% CI=0.899–1), while
determine the earliest marker of asthma exacerbation. 21 reported that the booklet was easier to understand than the standard form
RESULTS: Five children with asthma (mean age 8 years; range 6–12 years) (61.8%).
and five controls (mean age 7.2 years; range 4–11 years) were prospectively CONCLUSIONS: Not finding a significant difference in quiz scores would
monitored for 5 months. The mean FENO level in the control group was 16.1 indicate that the style of the document is not the most important factor for
± 15.3 ppb and in the asthmatic group was 24.3 ± 17.9 ppb (p=0.020). Two participant understanding, but it is the document is explained.
children were excluded from further analysis due to noncompliance with
home peak flow monitoring. The remaining three children experienced three 73E. Effect of omalizumab on measures of control in adolescents with
moderate and four mild asthma exacerbations during the monitoring period. moderate-severe persistent asthma. Stephen J. Pollard, M.D.1, Robert J.
The FENO levels and peak flow levels were graphed over time for these three Maykut, M.D.2, Marc Massanari, Pharm.D.2, Farid Kianifard, Ph.D.2, Robert K.
patients. The graphs include the time and severity of each patient's Zeldin, M.D. 2, Gregory P. Geba, M.D. 2; (1)Family Allergy and Asthma,
exacerbations. Louisville, KY; (2)Novartis Pharmaceuticals Corporation, East Hanover, NJ.
CONCLUSIONS: A significant difference in FENO was observed between
children with asthma and healthy controls. Further longitudinal studies are Presented at the Annual Meeting of the American Academy of Allergy, Asthma
needed to determine whether FENO is an earlier marker of airway and Immunology, San Diego, CA, February 23-27, 2007.
inflammation than reduction in airway caliber as measured by a decrease in
peak flow.
74. Utilization of prescription records to assess the risk of developing
community-acquired methicillin-resistant Staphylococcus aureus infections
71. The medical expenditures among childhood cancer patients/survivors at in children. Peter N. Johnson, Pharm.D.1, Robert P. Rapp, Pharm.D., FCCP2,
different time since diagnoses. Junling Wang, Ph.D., Zhiyong Dong, M.S.; Christopher T. Nelson, M.D.2, J.S. Butler, Ph.D.3, Robert Kuhn, Pharm.D.2;
University of Tennessee, Memphis, TN. (1)University of Oklahoma College of Pharmacy, Oklahoma City, OK;
(2)University of Kentucky Chandler Medical Center, Lexington, KY;
PURPOSE: Since 1960, an increasing number of childhood cancer patients (3)University of Kentucky College of Pharmacy, Lexington, KY.
enjoy sustained cures or remission. This study has the following study aims:
(1) to document the medical expenditures among childhood cancer patients PURPOSE: To document prior antibiotic therapy (PAT) from prescription
or survivors; (2) to determine the relationship between the expenditures and records 3 months prior to hospital/clinic admission between patients < 18
the duration of time since diagnoses. years of age (YOA) with community-acquired methicillin-resistant
METHODS: Children (younger than age 20) with diagnosis of cancer in the Staphylococcus aureus (CA-MRSA) as defined by the Centers for Disease
Medical Expenditure Panel Survey (MEPS; 1996 to 2003) were included in Control and control to 1) compare the number of antibiotic courses between
the analysis. Consumer price indices for medical care released by the groups and 2) evaluate the risk of developing CA-MRSA as a function of age
Department of Labor were used to convert cost from all years to 2003 dollars. and PAT.
The cost categories included (1) total health care expenditures, (2) METHODS: Patients with CA-MRSA were identified in 2004-2005; the
expenditures on office-based visits, (3) outpatient visits, (4) hospitalization control included patients in the hospital/clinic without Staphylococcus aureus
and emergency room visits, (5) home health care, (6) prescription drugs, and infections. Data collection included demographics, antibiotic courses and
(7) visual, dental, and other health care expenditures. classes, and description of antibiotic susceptibilities in patients with CA-
RESULTS: There were 149 (weighted to 1,327,754) childhood cancer MRSA. Linear regression corrected for heteroscedasticity was used for
patients or survivors in the study sample. The annual health care assessment of the dependent variable (e.g., risk of developing CA-MRSA)
expenditures of treating childhood cancer patients or survivors were controlling for age, PAT, and interaction between age and PAT.
$2488.92 for each patient/survivor. Of this amount, expenditures on office- RESULTS: PAT was reviewed in nine patients with CA-MRSA and 17 control
based visits accounted for the highest percentage (42.66%), and patients. The median age was 1.75 (0.08–14) years in the CA-MRSA group
hospitalization and emergency room visits accounted for the second-highest and 2.75 (0.005–15) years in the control. A statistical difference was noted in
percentage (15.77%). Individuals who survived the most years since diagnosis PAT in patients with CA-MRSA versus control [8 (88.9%) versus 6 (35.3%),
had their cancers diagnosed 23 years ago. The years with highest respectively (p=0.01)], but not in the number of antibiotic courses. b-lactam
expenditures were the year of diagnosis ($12,898) and the year after diagnosis antibiotics represented 60% of antibiotics prescribed in both groups. Only
($17,655). However, the medical expenditures were still high several years one CA-MRSA isolate was not 100% susceptible to all antibiotics tested.
e22 PHARMACOTHERAPY Volume 27, Number 4, 2007
Antibiotic exposure was a significant independent risk factor (p=0.005; 95% days to have similar CER as linezolid. In the microbiologic evaluation, total
CI=0.167–0.846) for the development of CA-MRSA. The interaction between direct costs and average CER for linezolid and vancomycin treatment were
PAT and age < 3 was the most significant predictor of CA-MRSA (p=0.019; $8,441.58 and $11,120.96 per patient and $10,497.34 and $20,984.17 per
95% CI=0.139–1.40). microbiologic cure, respectively. The ICER(ME) for linezolid compared to
CONCLUSIONS: The results suggest both PAT in addition to age < 3 years vancomycin indicated a dominant strategy. One-way sensitivity analysis
are risk factors for the development of CA-MRSA. Further larger prospective varying microbiologic cure rates indicated that the efficacy of vancomycin
studies should clarify the utility of objective methods for gathering PAT, such must increase by 35 percent to have equal CER to linezolid. Additional one-
as pharmacy prescription records, and their utility to explain antibiotic way sensitivity analysis for drug costs and LOS for microbiologic cure did not
susceptibility patterns. show any sensitivity across the range. The cost-effectiveness analysis of the
microbiologic cure mirrored those of the clinical cure.
CONCLUSIONS: Based on this decision model, linezolid was a more cost-
75. Empiric monotherapy for febrile neutropenia in children: a meta-
effective strategy compared with vancomycin primarily because of improved
analysis. Renee M. St. Germain, Pharm.D., Jennifer M. Ellis, Pharm.D., BCPS;
clinical and microbiologic cure and lower LOS.
University of Connecticut/Conn Children's Med Center, Hartford, CT.

PURPOSE: Children with febrile neutropenia are at high risk for infection 78E. Hematologic outcomes and erythropoiesis-stimulating therapy (EST)
and mortality. Early appropriate antibiotic therapy has led to decreased costs in epoetin alfa (EPO)- and darbepoetin alfa (DARB)-treated cancer
morbidity and mortality. Only small studies have compared empiric patients: results of the dosing and outcomes study of ESTs (D.O.S.E.
monotherapies for pediatric febrile neutropenia. As such, a meta-analysis was registry). Er Chen, MPP1, Cyrus Peake, M.S.2, Erminia Buscaino, -2, Jamie
conducted to determine whether any monotherapy was associated with a Forlenza, Pharm.D., M.S.3, Brahim Bookhart, MBA, MPH3, R. Scott McKenzie,
higher rate of treatment success without antibiotic modification (TSWOM) M.D.3; (1)Abt Associates - HERQuLES, Bethesda, MD; (2)Abt Associates -
between 72 and 96 hours. HERQuLES, Lexington, MA; (3)Ortho Biotech Clinical Affairs, LLC,
METHODS: A systematic literature search of MEDLINE and EMBASE was Bridgewater, NJ.
conducted from 1966 to October 2006 by two independent investigators. All
studies were reviewed for the following inclusion criteria: 1) prospective, PURPOSE: National Comprehensive Cancer Network (NCCN) anemia
randomized controlled trial or prospective, observational trial 2) two empiric treatment guidelines recommend maintenance of hemoglobin (Hb) between
monotherapies compared in children for febrile neutropenia and 3) TSWOM 11 g/dL and 12 g/dL. To investigate hematologic outcomes and costs of ESTs,
assessed between 72 and 96 hours. Any antibiotic that included at least 200 data were analyzed from the D.O.S.E. Registry, an ongoing, prospective
patients and 4 studies was evaluated independently against all other registry collecting real-world practice patterns and outcomes in cancer
monotherapies, using a random effects model. patients treated with ESTs.
RESULTS: Seven trials were identified that met the inclusion criteria for the METHODS: Data from U.S. hospital and community-based outpatient
meta-analysis. These trials included 711 pediatric febrile neutropenia practices were assessed from 1/04 to 6/06. Adults with a non-myeloid
episodes treated with ceftazidime (n= 279), cefepime (n=221), imipenem malignancy and receipt of ≥ 2 doses of either EPO or DARB were included.
(n=129), meropenem (n=57), and piperacillin/tazobactam (n=25). Both Outcomes assessed included mean treatment duration; mean cumulative
ceftazidime and cefepime were evaluated independently. No significant dose; Hb maintenance of 11–12 g/dL; mean Hb level at Weeks 4, 8, 12, and
differences in TSWOM were shown between ceftazidime and all other 16; and proportion of patients receiving blood transfusions. EST costs were
monotherapies [odds ratio (OR) 0.98 (95% CI=0.66–1.47)] or cefepime when based on 5/2006 wholesale acquisition costs.
compared to all other monotherapies [OR 0.94, (95% CI=0.62–1.43)]. RESULTS: 861 patients (312 EPO, 549 DARB) from 45 sites were identified.
Further, upon subgroup analysis, no difference in TSWOM was identified Mean baseline characteristics were similar between groups (entire cohort: age
between the two most common monotherapies, cefepime and ceftazidime 62.4 years, 64.1% women, weight 75.9 kg, and Hb 10.4 g/dL) except a
[OR 1.08, (95% CI=0.63–1.85)]. significantly higher iron supplementation in the DARB-treated group (EPO
CONCLUSIONS: Meta-analysis showed no differences between either 18%, DARB 29%, p<0.01). Both groups had similar mean treatment duration
ceftazidime or cefepime when compared to all other empiric monotherapies (about 8 weeks), number of Hb assessments (about 8) and proportion of
combined for TSWOM between 72 and 96 hours. Further, no differences patients requiring blood transfusion following the initial four weeks of
were found between ceftazidime and cefepime for TSWOM between 72 and treatment (EPO 9%, DARB 11%, p=0.32). Mean cumulative doses of EPO
96 hours. (373,827 Units) and DARB (1,185 µg) were associated with EST costs of
$4,550 for EPO and $5,267 for DARB, (p<0.001). Mean Hb level was
≥ 11g/dL at all post-baseline timepoints in the EPO-treated group; however, it
Pharmacoeconomics/Outcomes was < 11g/dL in the DARB-treated group at Weeks 12 and 16. Mean Hb level
was significantly higher in the EPO-treated group at Week 12 (EPO
11.3 g/dL, DARB 10.8 g/dL, p=0.03).
76E. Use of medication coverage methodology in measurement of patient. CONCLUSIONS: In this prospective observational study, EPO-treated
Lee Stern, M.S., John J Doyle, DrPH, Lisa R Siegartel, MPH, Laura M Katz, patients achieved and maintained NCCN target Hb levels at all timepoints.
MPH, Margarita Dolgitser, B.S.; Analytica International, New York, NY. Also, EST cost was observed to be 16% higher in the DARB-treated group
than in the EPO-treated group.
Presented at the 11th Annual International Meeting of the International Published in Blood 2006;108(11):Abstract 3340.
Society for Pharmacoeconomics and Outcomes Research, Philadelphia, PA,
May 23, 2006.
79. Drug utilization and cost considerations of erythropoietic stimulating
agents in cancer patients from a large managed-care database. Francis
77. Evaluation of the cost-effectiveness of vancomycin and linezolid in Vekeman, M.A.1, Patrick Lefebvre, M.A.1, Samir H. Mody, Pharm.D., MBA2,
Methicillin-resistant Staphylococcus aureus (MRSA) skin and soft tissue Brahim Bookhart, MBA, MPH 2 , R. Scott McKenzie, M.D. 2 ; (1)Groupe
infection using a decision analysis (DA) model. Mark Bounthavong, d'Analyse, Ltée., Montreal, QC, Canada; (2)Ortho Biotech Clinical Affairs,
Pharm.D., Mark P. Okamoto, Pharm.D., Donald Hsu, Pharm.D.; Western LLC, Bridgewater, NJ.
University of Health Sciences, Pomona, CA.
PURPOSE: Erythropoietic stimulating agent (ESA) resource use in cancer
PURPOSE: To evaluate the cost-effectiveness of vancomycin versus linezolid patients is of importance to managed care organizations (MCOs). To
in skin and soft tissue infections with Methicillin-resistant Staphylococcus understand current real-world use of ESAs, this study examined epoetin alfa
aureus (MRSA) using a decision analysis (DA) model. (EPO) and darbepoetin alfa (DARB) treatment patterns (dosing and treatment
METHODS: A decision model was created to evaluate the cost-effectiveness duration), dose ratio, and ESA treatment costs.
of vancomycin and linezolid in the treatment of MRSA infections. Outcome METHODS: A medical claims analysis from January 2004 through December
probabilities were determined from published clinical trials. The main 2005 using the PharMetrics Patient-Centric database of more than 85 health
dependent variables of interest were clinical outcomes (clinical cure and plans was conducted. Patients included in the study were ≥ 18 years of age,
microbiologic cures), total direct costs of treatment, cost-effectiveness ratios had ≥ 1 claim for cancer within 90 days before ESA treatment initiation, were
(CER), and incremental cost-effectiveness ratios (ICER). Sensitivity analyses newly initiated on EPO or DARB, and received ≥ 2 doses. Mean cumulative
were conducted for drug costs, efficacy, and length of stay (LOS). ESA dose was used to calculate drug cost (based on September 2006 WAC)
RESULTS: In the clinical evaluation, total direct costs and average CER for and dose.
linezolid and vancomycin treatment were $9,330.00 and $10,547.43 per RESULTS: 2,072 EPO patients and 1,675 DARB patients met inclusion
patient and $14,268.45 and $16,822.56 per clinical cure, respectively. The criteria and formed the study population. EPO-treated patients were slightly
ICER for linezolid compared to vancomycin indicated a dominant strategy older (years: EPO 55, DARB 53, p<0.0001). A greater proportion of women
(less costly and more effective). One-way sensitivity analyses varying the was observed in the DARB-treated group (EPO 67%, DARB 73% p<0.0001).
efficacy (clinical cure) or LOS indicated sensitivity across the range. There was no significant difference in the mean treatment duration between
Vancomycin would have to increase in efficacy by 5.7% or decrease LOS by 3 the two groups (days: EPO 59, DARB 57, p=0.1378). The mean (SD) dose
 ACCP 2007 SPRING PRACTICE AND RESEARCH FORUM e23
per injection was 42,645 (11,527) Units for EPO and 234 (108) µg for DARB. PURPOSE: Clopidogrel is a standard therapy for the prevention of subacute
The mean (SD) cumulative ESA dose administered was EPO 317,599 stent thrombosis after cardiac catheterization and for the management of
(275,513) Units and DARB 1,164 (922) µg, resulting in a dose ratio of 273:1 acute coronary syndromes. It is a prodrug primarily activated by cytochrome
(Units EPO: µg DARB). Drug cost was significantly higher, $1,311 per P4503A (CYP3A). SNPs in CYP3A may reduce the enzymes' activity, and
treatment episode, in the DARB group (EPO $3,865; DARB $5,176; therefore reduce the activation of clopidogrel. The purpose of this research
p<0.0001). was to assess the frequency of SNPs in the gene coding for CYP3A enzymes in
CONCLUSIONS: This study of 3,747 cancer patients reported a dose ratio of a group of patients receiving clopidogrel and experiencing a repeat acute
273:1 (Units EPO: µg DARB) and 34% DARB price premium. The findings coronary event.
from this study are similar to those in previously published clinical trials and METHODS: Patients were prospectively enrolled upon admission with a
real-world utilization studies. repeat acute coronary event. Inclusion criteria included a minimum of
3 months of prior or current clopidogrel treatment before admission and a
documented history of cardiac interventions. Informed consent and a buccal
Pharmacoepidemiology swab sample were obtained. Cardiovascular disease history and demographic
information were also collected. Genotyping was performed using real-time
PCR and TaqMan® allelic discrimination assays. A case control group of
80E. Predictors of ESP use in patients with chronic kidney disease (CKD) patients with atrial fibrillation and not receiving clopidogrel were used for
and anemia. Brian Bradbury, Ph.D., Q. Shan Qian, Ph.D., Reshma allelic frequency comparisons.
Kewalramani, M.D., Denise Globe, Ph.D., Arie Barlev, Pharm.D., Catherine RESULTS: Patients (n=100) were enrolled over a 3-month period, and
Stehman-Breen, M.D.; Amgen Inc., Thousand Oaks, CA. complete data were obtained for 92 patients. The allelic frequencies of
CYP3A*1F, *16B, and CYP3A5*10 were 8.8% 15.1% and 12.4%, respectively,
Presented at the 39th Annual Meeting and Scientific Exposition of the in the clopidogrel group compared to 6.5%, 9.2% and 7.4% in the control
American Society of Nephrology, San Diego, CA, Nov 16-19, 2006. group. In addition, at least one CYP3A variant allele was found in 46.7% of
the clopidogrel patients, but in only 29.8% of the control subjects.
81. Characterization of an Ecuadorian medical mission brigade. Melody CONCLUSIONS: Patients on clopidogrel that presented with repeat acute
Ryan, Pharm.D., Douglas T. Steinke, Ph.D.; University of Kentucky College of coronary events have a high frequency of CYP3A variant alleles. Decreased
Pharmacy, Lexington, KY. activation of clopidogrel due to the presence of CYP3A variant alleles may
contribute to the observed clopidogrel resistance.
PURPOSE: Medical missions have become a popular way for health care
professionals to provide care to underserved populations in developing
countries. However, there is only scant descriptive information regarding Pharmacokinetics/Pharmacodynamics/Drug
these missions in the literature. The goal of this research is to conduct a Metabolism/Drug Delivery
limited health needs assessment in communities visited in South Quito,
Ecuador by analyzing data from a medical brigade and comparing household
public health indicators to those from the 2001 census data for Quito. 85. Morphine release profile is not altered in a formulation containing
METHODS: A medical record was completed for each patient. Demographics, polymer-coated extended-release morphine sulfate plus sequestered
vital signs, symptoms, diagnosis, and treatments were collected and entered naltrexone. Franklin Johnson, M.S., Stephen Sun, M.D., George Wagner, B.S.,
into a spreadsheet for analysis. A representative from each household Joseph Stauffer, D.O.; Alpharma Branded Products Division, Inc, Piscataway,
attending the clinic was asked questions regarding living conditions (water NJ.
source, human waste disposal, cooking fuel, home ownership, electricity,
telephone, and number of people in the home). PURPOSE: Concern over misuse, abuse, and diversion of prescription pain
RESULTS: During the 5-day brigade, 959 patients were seen. The mean age relievers has created a demand for pharmaceutical products with reduced
was 21.68 ± 21.11 years. Sixty percent of participants were children. Females abuse liability.1 This study assessed the morphine pharmacokinetics of an
made up 64% of the sample. A total of 1692 diagnoses were recorded; the extended-release abuse deterrent product containing morphine sulfate around
mean number of diagnoses per patient was 1.76 ± 0.95. The most common a sequestered core of naltrexone, an opioid antagonist, which is released if
diagnoses were parasites, body aches, and headaches. A total of 2254 product tampering occurs by crushing, chewing, or dissolving.
prescriptions were dispensed to the participants; the mean number of METHODS: This was an open-label, two-period crossover (fed and fasting)
prescriptions per patient was 2.35 ± 1.11. The most commonly dispensed study in which eight healthy subjects (four men, four women) ages 21–45
medications were vitamins, antiparasites, and analgesics. In all public health years fasted overnight, then either received study drug (containing 60-mg
and economic indicators except for owning a home, the residents of the morphine sulfate) or consumed a standard high-calorie, high-fat breakfast
neighborhoods visited by the medical brigades were disadvantaged compared and took the study drug 30 minutes later. Blood samples for pharmacokinetic
to the residents from all areas of Quito (p=0.0001). analysis of morphine were drawn prior to dosing and at intervals from 0.5 to
CONCLUSIONS: The results from this study are an important first step in 168.0 hours postdose.
conducting a needs analysis of the neighborhoods visited by the brigades. RESULTS: Mean morphine Tmax was 7.50 hours for patients in the fasted
They will be useful for recruiting medical personnel and planning the types of state and 8.75 hours for the fed state, consistent with an extended-release
medications needed for future brigades. profile and with prescribing information for a morphine sulfate extended-
release product which does not contain a sequestered core of naltrexone by
the same manufacturer.2 Cmax of this 60-mg oral dose was 10.70 ng/mL fasted
82E. Documentation pattern of clinical pharmacist interventions, Riyadh, and 9.18 ng/mL fed, and AUCinf was 260.6 and 246.0 hr*ng/mL. Adverse
Saudi Arabia. Yousef Ahmed Alomi, [Link]., [Link]., BCPS, Areej Melhani, [Link]., events, reported in five subjects, were either mild or moderate in intensity
Naif Bakerman, [Link]., Noura Albinyan, [Link].; Riyadh Medical Complex, and resolved.
Riyadh, Saudi Arabia. CONCLUSIONS: Extended-release characteristics of morphine in this abuse
deterrent product were similar to characteristics demonstrated in the current
Presented at the 9th International Pharmaceutical Science Conference, formulation of polymer-coated extended-release morphine sulfate. The study
Riyadh, Saudi Arabia, December 18-21, 2005. formulation was well tolerated. References: 1Wright C IV, Kramer ED, Zalman
MA, Smith MY, Haddox JD. Risk identification, risk assessment, and risk
83E. Prescribing errors at inpatient pharmacy, Riyadh, Saudi Arabia. Yousef management of abusable drug formulations. Drug Alcohol Depend
Ahmed Alomi, [Link]., [Link]., BCPS, Manal Bashihab, [Link].; Riyadh Medical 2006;83(suppl 1):S68–S76. 2KADIAN ® [package insert]. Piscataway, NJ:
Complex, Riyadh, Saudi Arabia. Alpharma Branded Products Division Inc.

Presented at the 9th International Pharmaceutical Science Conference, 86E. Population pharmacokinetic analysis of varenicline in adult smokers.
Riyadh, Saudi Arabia, December 18-21, 2005. Hélène M. Faessel, Ph.D.1, Patanjali Ravva, M.S.1, Marc Gastonguay, Ph.D.2,
Kevin D. Rohrbacher, M.S.1, Thomas G. Tensfeldt, M.S.1; (1)Pfizer Clinical
Research and Development, Groton/NL, Groton, CT; (2)Metrum Research
Pharmacogenomics/Pharmacogenetics Group LLC, Avon, CT.

Presented at the 108th Annual Meeting of the American Society for Clinical
84. Frequency of CYP3A4 variant alleles in cardiovascular patients on
Pharmacology and Therapeutics, Anaheim, CA, March 21–24, 2007.
clopidogrel that experience repeat acute coronary events. Marcia L.
Brackbill, Pharm.D. 1, Robert S. Kidd, Pharm.D, M.S. 1, April D. Abdoo,
student1, James G. Warner, M.D.2, Arthur F. Harralson, Pharm.D., BCPS1; 87. Using modeling and simulation to assess topotecan dosage and
(1)Shenandoah University School of Pharmacy, Winchester, VA; schedule in pediatric neuroblastoma. Paula S. Schaiquevich, Ph.D.1, John C.
(2)Winchester Cardiology and Internal Medicine, Winchester, VA. Panetta, Ph.D.2, Victor M. Santana, M.D.3, Clinton F. Stewart, Pharm.D.2;
e24 PHARMACOTHERAPY Volume 27, Number 4, 2007
(1)Department of Pharmaceutical Sciences, St. Jude Children's Research RESULTS: 44 RA patients with active disease (DAS > 3,2) were included in
Hospital (SJCRH), Memphis, TN; (2)Dept. Pharmaceutical Sciences, St. Jude our study. These patients failed at least 2 disease-modifying anti-rheumatic
Children's Research Hospital (SJCRH). Dept. Pharmaceutical Sciences, Univ. drugs (DMARDS). The DAS median reduction was 1.9 for infliximab, 1.5 for
of Tennessee, Memphis, TN; (3)Department of Oncology, St. Jude Children's etanercept, and 1.4 for adalimumab. Before the anti-TNF-a therapy the
Research Hospital (SJCRH), Memphis, TN. median of swollen and tender joints was 6.8 and 14.5 for infliximab, 5.3 and
7.7 for etanercept, and 2.8 and 8.1 for adalimumab. After therapy, the values
PURPOSE: The antitumor activity of topotecan observed in neuroblastoma is were 2.5 and 5.4 for infliximab, 1.5 and 3.6 for etanercept, and 0.4 and 4.6 for
dependent upon systemic exposure and schedule. When topotecan was adalimumab, which represents a 58% and 69% reduction for infliximab, 54%
administered with a protracted schedule (i.e., 10 doses over 12 days) using a and 42% for etanercept, and 51% and 41% for adalimumab. 25% of the
pharmacokinetically guided dosing approach, unlike traditional dosages given patients switch anti-TNF-a therapy due to ineffectiveness or adverse effects.
over shorter schedules (i.e., 5 days) promising antitumor results in The most common adverse effects are respiratory and urinary tract infections
chemotherapeutic-naïve children were observed. However, significant toxicity, and allergy.
including neutropenia and thrombocytopenia was reported. CONCLUSIONS: The three currently licensed biologic anti-TNF-a drugs
The objective of this analysis was to develop a pharmacokinetic/pharmaco- have all been clearly shown to suppress disease activity in RA, showing a DAS
dynamic model to assess the contributions of topotecan systemic exposure reduction > 1.2, which according to EULAR (European League Against
and schedule on the antitumor activity in pediatric patients with Rheumatism) criteria is a good level of response. Our data indicate, as in
neuroblastoma while accounting for myelosuppression. many other studies, that some patients with RA may respond to one anti-
METHODS: Pharmacokinetic and pharmacodynamic data were obtained TNF-a agent but not to another, suggesting that patients failing one anti-
from children with untreated high-risk neuroblastoma. In this Phase II study, TNF-a drug may still benefit from another.
patients received topotecan as a 30-min infusion daily for 5 days over
2 consecutive weeks for two cycles. Tumor volume was determined before
and after topotecan therapy and myelosuppression data was obtained Substance Abuse/Toxicology
2 times/week. Four mathematical models were developed for describing
topotecan plasma pharmacokinetics, the kinetics of tumor growth and the
kinetics of neutrophil and platelet dynamics. 91. Meta-analysis of nicotine replacement therapy (NRT) for smoking
RESULTS: the results showed that daily doses for 5 days over 2 consecutive cessation in patients with a history of alcohol problems. Ayana K. Rowley,
weeks had significantly more complete and partial responses compared with Pharm.D.1, Gyorgy Csako, M.D.2, Robert Wesley, Ph.D3, Karen G. Smith,
the schedule of daily doses for 5 days even if the systemic exposure of the M.L.S4, Jacqueline Hersh, B.A.5, Frank Pucino, Pharm.D.1, David Herion,
latter schedule was 1.5 times higher (69% vs. 5%, p<0.001). In addition, M.D.5; (1)Pharmacy Dept., Clin. Ctr., NIH, Bethesda, M.D.; (2)Dept. of Lab.
given the same total systemic exposure, the more protracted schedule of daily Med., Clin. Ctr., NIH, Bethesda, MD; (3)Biostatistics and Clin. Epidemiol.
doses for 3 days repeated 3 times over 2 consecutive weeks had significantly Service, Clin. Ctr., NIH, Bethesda, MD; (4)Office of Res. Services, NIH,
more clinical responses compared with the daily doses for 5 days over 2 Bethesda, MD; (5)NIAAA, NIH, Bethesda, MD.
weeks schedule (69% vs 77%, p<0.01). Myelosuppression toxicity was
equivalent across regimens and was clinically acceptable. PURPOSE: To compare the efficacy of NRT for smoking cessation outcomes
CONCLUSIONS: the use of pharmacokinetic/pharmacodynamic modeling in individuals with and without a history of alcohol problems and in those
and simulation can be helpful to determine effective treatment strategies for currently receiving treatment for alcohol dependence.
topotecan to treat children with high-risk neuroblastoma. METHODS: Criteria for meta-analysis included prospective randomized
controlled trials (RCTs) of NRT in smokers with a history of alcohol
problems. Data regarding smoking cessation rates were extracted from
88E. Evaluation of factors influencing enoxaparin bioavailability in qualified studies using 11 biomedical literature databases (1966 to October
critically ill patients. Philippe Vincent, [Link]., [Link]. 1, Marie-Christine 2006). The primary outcomes included smoking abstinence rates (a) in
Champagne, BPharm, MSc2, Théodora Zikos, [Link]., [Link].2, Martin Albert, individuals either with or without a history of alcohol problems (alcoholics
M.D., FRCPC2, Isabelle Boulanger, [Link]., [Link].2, Lucie Blais, Ph.D.2, vs. non-alcoholics), and (b) among patients currently being treated for
David R. Williamson, [Link]., [Link]., BCPS 2 ; (1)Hôpital Louis-H. alcohol dependence and receiving NRT either concurrently or after at least 6
Lafontaine, Montreal, QC, Canada; (2)Hôpital du Sacré-Coeur de Montréal, weeks of alcohol treatment (concurrent vs. delayed group). Combined odds
Montreal, QC. ratios were estimated using a random effects model.
RESULTS: Of 10 relevant studies, 6 were eligible with 2168 subjects for
Presented at the Toronto International Symposium on Acute Care, Totonto, meta-analysis. Overall, the weighted pooled smoking abstinence rates were
ON, Canada, October 25-27, 2006. 10–20%. There was no significant difference in long-term (26–52 weeks)
smoking cessation outcomes with NRT between alcoholics and non-
alcoholics (4 studies; OR 0.76, 95% CI=0.43–1.32, I-squared 37). However,
Pulmonary short-term (8–12 weeks) smoking cessation rates were significantly higher in
the concurrent group compared with the delayed group (3 studies; OR 2.43,
95% CI=1.10–5.46, I-squared 46).
89E. Assessment of physician prescribing for primary care patients with CONCLUSIONS: There have been few large RCTs for NRT in patients with
chronic obstructive pulmonary disease (COPD) in a national electronic alcohol problems, and the smoking abstinence rates reported in these studies
medical research (EMR) database. Carl V. Asche, Ph.D.1, Diana I. Brixner, are generally low. Because the available evidence suggests that a history of
[Link]., Ph.D1, Craig S. Conoscenti, M.D., FCCP2, David C. Young, Pharm.D.1, alcohol dependence does not affect long-term smoking abstinence rates and
Hemal Shah, Pharm.D.2, Amy L. Phillips, Pharm.D.2; (1)University of Utah the abstinence rates are higher with early NRT in patients currently receiving
College of Pharmacy, Salt Lake City, UT; (2)Boehringer Ingelheim treatment for alcohol dependence, concomitant treatment for both nicotine
Pharmaceuticals, Inc., Ridgefield, CT. and alcohol dependence appears to be reasonable. Larger prospective RCTs
are needed for validation, especially as newer treatment strategies for nicotine
Funded by Boehringer Ingelheim Pharmaceuticals, Inc. Published in Chest dependence are being developed.
2006;130(4):175S.

92. Impact of elevated percent carbohydrate-deficient transferrin at hospital

Rheumatology admission on outcomes in trauma patients. Brian McKinzie, Pharm.D., Cathy
L. Worrall, BSN, Pharm.D., E Douglas Norcross, M.D., Stuart Leon, M.D.;
Medical University of South Carolina, Charleston, SC.
90. Assessment of effectiveness and safety of anti-TNF-alpha therapies in
rheumatoid arthritis (RA). Catarina Penteado Rodrigues, Doctor, Ana Paula PURPOSE: The prevalence of alcohol use disorder (AUD) has been
Santos, Doctor, Maria José Santos, Doctor, José Antonio Canas Silva, Doctor, documented to be as high as 46% in trauma patients. AUD has been shown to
Armando Alcobia, Doctor; Hospital Garcia de Orta, Almada, Portugal. increase ICU and hospital length of stay (LOS), and has been linked to
numerous post-operative complications. The percent carbohydrate-deficient
PURPOSE: The choice of biological treatment for RA may depend transferrin (%CDT) test, a biological marker of chronic heavy alcohol
pragmatically on a number of factors, including patient preference, the consumption, may help identify trauma patients at risk for these
tolerability of methotrexate, and day-case infusion facilities. The anti-TNF-a complications.
therapies have subtly different adverse-effect profiles, all associated with an METHODS: The records of 356 adult trauma patients admitted through our
increase in infection, which may be serious and a cause to stop treatment. emergency trauma unit over 12 weeks were reviewed. The primary outcome
Our objective was to assess the effectiveness of biologics in reducing the evaluated was ICU LOS. Secondary outcomes included ventilator days,
Disease Activity Score (DAS) in patients with RA and additionally its safety. hospital LOS, hospital charges, and postoperative complications. Outcomes
METHODS: A retrospective and comparative study of effectiveness of Anti- were compared in patients with a LOS ≥ 2 days who presented with and
TNF-a therapies (infliximab, etanercept, adalimumab). without %CDT elevation. Statistical tests included t test and chi square for
 ACCP 2007 SPRING PRACTICE AND RESEARCH FORUM e25
continuous and categorical variables, respectively. Logarithmic transformation kidney transplant desensitization protocol using two different intravenous
and ordinary least squares regression were also used. immunoglobulin products.
RESULTS: Demographics between the groups were similar. Drinking METHODS: This is a retrospective review of patients who were transplanted
histories were more significant in the elevated %CDT group (p=0.0006). The following participation in the desensitization protocol. Patients received
mean %CDT was 1.7 vs. 3.9 in the normal and elevated %CDT groups, plasmapheresis and IVIG (Caramune® NF 1 g/kg) or CMVIG (Cytogam®
respectively (p<0.0001). Patients with elevated %CDT had significantly 100 mg/kg) until the DSA was undetectable and transplantation was
longer ICU and hospital LOS (3.9 vs. 5.1 days, p=0.01; 7.1 vs. 8.7 days, performed. Plasmapheresis and IVIG therapy were continued after transplant
p=0.0052), and ventilator days (1.5 vs. 2 days, p=0.0286). Complications and per protocol. Graft survival, acute rejection rates, cytomegalovirus infection
hospital charges were similar between groups. However, when charges were rates, mortality, and adverse effects were compared between the two groups.
analyzed controlling for the number of packed red blood cell transfusions, the RESULTS: Twelve patients were treated with IVIG, and 12 patients received
additional cost per patient with elevated %CDT was expected to average CMVIG. Fifty eight percent of the patients in the IVIG group and 42 percent
$10,000–$25,000. of the CMVIG patients experienced an acute rejection episode within the first
CONCLUSIONS: The %CDT test is an easy way to identify patients that year after transplant (p=0.68). Mortality rates and graft function at 1 year
should be targeted for interventions aimed at improving care for patients with were similar between the two groups. There was no difference in rate of
AUD. Further study is needed to assess the relationship between elevated cytomegalovirus infection. The most common adverse events associated with
%CDT and postoperative complications in trauma patients. both IVIG products were nausea, vomiting, pain, fever, and chills.
CONCLUSIONS: There is no difference in rates of acute rejection, mortality,
and graft function when IVIG or CMVIG is used in the kidney transplant
93E. A pooled-analysis of Varenicline, a nicotinic receptor partial agonist, desensitization protocol. Larger studies are warranted to determine whether
vs. Bupropion, for smoking cessation. Elbert D. Glover, Ph.D.1, Mitchell there is a significant difference in these parameters when using different IVIG
Nides, Ph.D.2, Clare B. Billing Jr., M.S.3, Karen R. Reeves, M.D.3, Kathryn products in kidney transplant desensitization. Product selection may be based
Williams, Ph.D. 3; (1)University of Maryland, College Park, MD; (2)Los on cost, availability, or ease of administration rather than differences in
Angeles Clinical Trials, Los Angeles, CA; (3)Pfizer Global Research & clinical outcome.
Development, Groton, CT.

Presented at the 12th Annual Meeting of the Society for Research on Nicotine 96. Associations of characteristics of renal transplant recipients with
and Tobacco, Orlando, FL, February 15-18, 2006. clinicians' perceptions of adherence to immunosuppressant therapy. Marie
A. Chisholm, Pharm.D.1, W. Jacqueline Kwong, Pharm.D., Ph.D.2, Christina A.
Spivey, Ph.D.3; (1)University of Georgia College of Pharmacy and Medical
94. Cost comparison of intravenous versus oral N-acetylcysteine for the College of Georgia School of Medicine, Augusta, GA; (2)University of Georgia
treatment of acetaminophen toxicity in a community public hospital. Erik College of Pharmacy, Athens, GA; (3)University of Georgia College of
D. Maki, Pharm.D.1, Geoffrey C. Wall, Pharm.D.1, Tyler Schwiessow, MD2; Pharmacy, Augusta, GA.
(1)Drake University College of Pharmacy and Health Sciences, Des Moines,
IA; (2)Iowa Methodist Medical Center, Des Moines, IA. PURPOSE: To determine a profile of renal transplant recipients (RTRs) who
are at highest risk for immunosuppressant therapy (IST) non-adherence.
PURPOSE: Intravenous (IV) N-acetylcysteine (NAC) recently became METHODS: Retrospective analysis was performed on follow-up non-
commercially available in the U.S. for the treatment of acetaminophen adherence data routinely reported by transplant centers to the United
toxicity. When compared with oral NAC therapy, intravenous NAC has a Network for Organs Sharing in the United States Renal Data System. Those
significantly higher acquisition cost. This cost may be offset by a shorter who received transplants on or after January 1, 1995, who had at least 36
treatment course and length of hospital stay (LOS). A retrospective chart months of follow-up data, and who did not receive a second renal transplant
review of all patients who received oral or intravenous NAC in a community were included in the analyses. Random effects logit regression was used to
public hospital was undertaken to assess the difference in total hospital costs estimate risk of non-adherence while controlling for age, race, education, donor
between these regimens. type, primary insurance, and IST including cyclosporine (CSA), tacrolimus
METHODS: Medical records of patients who received NAC for (TAC), azathioprine (AZA), mycophenolate mofetil (MMF), and steroids.
acetaminophen toxicity between January 2004 and May 2006 were reviewed. Association between IST non-adherence and graft failure was also examined.
Patients' medical history, laboratory values, drug management of RESULTS: 53,997 individuals met the inclusion criteria. Mean age at time of
acetaminophen toxicity, adverse reactions, outcomes, hospital and drug transplant was 44 years (SD =15). Sixty percent were male, 74% were
charges were documented. Caucasian, 29% had college education, and 39% had living donor transplants.
RESULTS: Forty-two patients received NAC of which 19 (45%) received oral, At time of transplant, 5% were on Medicaid and 44% were on Medicare. CSA,
16 (38%) received intravenous, and 7 (17%) received both. Significant TAC, AZA, MMF and steroids were used by 61%, 34%, 13%, 72%, and 97% of
variability was found in dosing regimens of patients who received both oral RTRs, respectively. About 5.5% of RTRs were reported as non-adherent, and
and intravenous NAC. Excluding patients who received both therapies, there 3% had graft failure within 36 months post-transplant. Non-adherence risk
were no statistically significant differences between groups in age, admission increased with time and decreased with age (p<0.001). RTRs who were male,
acetaminophen level, and pre/post-treatment AST/ALT levels. Length of stay non-Caucasian, not on Medicare, or who used MMF or TAC had higher risk
(1.8 vs. 4.2 days), total drug cost ($160 vs. $1428) and total hospital cost for non-adherence, with odds ratios (OR) of 1.4, 2.0, 1.6, 1.1, and 1.3
($3620 vs. $11580) were all significantly higher in patients who received respectively (p<0.05), while RTRs who used CSA, steroids or AZA had lower
intravenous therapy (p<0.05). This statistical significance was maintained risk (OR=0.8, 0.5 and 0.7 respectively, p<0.001). Non-adherent RTRs had
when several outliers were excluded. Nine patients receiving oral NAC higher risk for graft failure (OR=5.2, p<0.001).
developed nausea and vomiting while two significant adverse reactions (IV CONCLUSIONS: Interventions aimed at improving adherence should target
infiltration and bronchospasm) occurred in patients who received intravenous younger RTRs, male RTRs, non-Caucasian RTRs, and those not on Medicare
NAC. Acute liver toxicity occurred in two patients who recovered fully. to reduce risk of graft failure.
CONCLUSIONS: Despite a shorter treatment course, intravenous NAC was
not associated with a shorter hospital stay or reduced hospital costs in a small 97E. Preliminary results from a randomized controlled trial to evaluate the
community hospital. Selection bias may account for the differences seen. A effect of corticosteroids on tacrolimus and mycophenolate mofetil
protocol for treating acetaminophen toxicity should be developed to pharmacokinetics. Nihar Bhakta, M.D. 1, Theodore M. Sievers, Pharm.D. 2,
standardize treatment. Curtis Holt, Pharm.D.2, Margaret Holloway, R.N.1, Stephanie Okimoto, B.S.1,
Minnie Sarwal, MD3, Oscar Salvatierra, M.D.3, Albin Gritsch, M.D.1, Robert
Ettenger, M.D.1; (1)Mattel Children's Hospital at UCLA, Los Angeles, CA;
Transplant/Immunology (2)Dumont-UCLA Transplant Center, Los Angeles, CA; (3)Lucille Packard
Children's Hospital at Stanford, Palo Alto, CA.
95. A comparison of two intravenous immunoglobulin preparations in
Presented at World Transplant Congress, Boston, MA, July 22-26, 2006.
kidney transplant desensitization. Holli A. Winters, Pharm.D., Caron George,
Pharm.D., Jerry Siegel, Pharm.D.; The Ohio State University Medical Center,
Columbus, OH.
CLINICAL PHARMACY FORUM
PURPOSE: A high level of donor-specific alloantibody (DSA) traditionally
has been a contraindication for kidney transplant. Plasmapheresis and 98. Voriconazole-sirolimus interaction in kidney transplant patients.
intravenous immunoglobulin have been shown to decrease DSA and allow for Jaewook Yang, Ph.D., Pharm.D1, David I. Min, Pharm.D.2, Tariq Shah, M.D.3;
successful transplantation. Due to a change in the intravenous (1)Western University of Health Sciences, College of Pharmacy and National
immunoglobulin product used in our protocol, patients have received either Institute of Transplantation, Los Angeles, CA; (2)Western University of
intravenous immune globulin (IVIG) or cytomegalovirus immunoglobulin Health Sciences, College of Pharmacy, Pomona, CA; (3)St. Vincent Medical
(CMVIG). The purpose of this study is to compare the outcomes of the Center and National Institute of Transplantation, Los Angeles, CA.
e26 PHARMACOTHERAPY Volume 27, Number 4, 2007
PURPOSE: Azole antifungal agents are well known inhibitors of CYP3A and respiratory condition. Information related to FEV1, ACT scores, and patient
P-glycoproteins. Drug interactions between antifungal azoles and calcineurin demographics were reported using descriptive statistics. The baseline FEV1
inhibitors such as cyclosporine and tacrolimus have been reported. However, values and ACT scores were compared to the follow-up values using paired
interaction between sirolimus and voriconazole in kidney transplant patients t-tests. The association between FEV1 values and ACT scores were analyzed
is not well documented. The objective is to report significant drug interaction using Pearson correlation.
between voriconazole and sirolimus in two kidney transplant patients. RESULTS: There was no difference in FEV 1 from baseline to follow-up.
CASE REPORT: The first case was a 64-year-old Hispanic gentleman who was However, there was a statistically significant improvement in the ACT score
admitted for severe diarrhea. His immunosuppression included sirolimus (3 (p=0.028). No differences were observed in the other secondary outcomes.
mg/day orally), mycophenolate mofetil (500 mg orally 2 times/day) and There was a low correlation between FEV1 and ACT scores at baseline and a
prednisone 20 mg daily. Three days after admission, voriconazole (200 mg slight correlation at follow-up. Appropriateness of asthma medication
orally 2 times/day) was started to treat his Aspergillus infection. On day 2 in regimens improved following the clinical pharmacist's assessment at the
voriconazole therapy, his sirolimus trough concentration was raised from 13.2 baseline visit.
ng/mL to 44.9 ng/mL (therapeutic range 5–15 ng/mL). Sirolimus was CONCLUSIONS: Use of the ACT and in-clinic spirometry by a clinical
discontinued; however, sirolimus level was still 13.4 ng/mL 9 days after pharmacist was feasible and led to improvements in asthma medication
voriconazole was discontinued. The second case was a 54-year-old Caucasian regimens. There was a significant improvement in the ACT score at the
female who was admitted for diarrhea. The patient had been on sirolimus follow-up visit but no change in FEV1. ACT score and FEV1 correlation
(2 mg/day orally) and fluconazole (200 mg/day orally) before admission with results were consistent with previously published reports.
stable sirolimus level 10.5–13.4 ng/mL. After fluconazole was replaced by
voriconazole (300 mg orally 2 times/day) for treatment of possible pulmonary 101. The contribution of a pharmacy clinic on productivity in a private
Aspergillus infection, her sirolimus level went up to 26.9 ng/mL and 49.2 physician practice. Jeanna A. Miller, Pharm.D.1, Jeffrey M. Brewer, Pharm.D.2,
ng/mL on day 2 and day 5 in voriconazole therapy. Sirolimus was Gary Noronha, M.D. 3 ; (1)University of Pennsylvania Health System,
discontinued on day 5; however, sirolimus concentration remained high with Philadelphia, PA; (2)The Johns Hopkins Hospital, Baltimore, MD; (3)Johns
42.6 ng/mL on day 7. In both cases, there were mild adverse effects including Hopkins Hospital, Baltimore, MD.
nausea, vomiting, and reduced WBC and platelet counts.
CONCLUSIONS: Voriconazole appears to be a more potent inhibitor of
PURPOSE: Pharmacists have long been established practitioners in academic
CYP3A and P-glycoprotein than fluconazole. When voriconazole is used with
outpatient clinics. Outpatient clinics routinely measure the productivity of
sirolimus, even in patients who have been stable in fluconazole, sirolimus
practitioners to determine their contribution towards the practice.
concentration should be monitored carefully because it increases sirolimus
Pharmacists as practitioners have not measured their contribution toward the
blood concentration approximately four times and it prolongs elimination of
practice in terms of productivity. Measures of productivity examine the types
sirolimus. and number of patient encounters. The primary purpose of this project was to
calculate productivity of a pharmacy disease management clinic at a private
99. A pharmacy-run vaccine screening program improves the immunization physician practice.
rate of high-risk adults. Jamie L. Cronin, Pharm.D., M. Delight Joslyn, RNC, METHODS: A retrospective, descriptive study reviewing the billing report for
MSN, Carolyn Corey, B.A., James A. Raczek, M.D.; Eastern Maine Medical the pharmacy disease management clinic from Jan. 1, 2004 to Dec. 31, 2005.
Center, Bangor, ME. All completed encounters were analyzed based on CPT codes associated with
each encounter. All encounters were stratified by year and CPT code tallied.
PURPOSE: Systems that require physician intervention for vaccine orders fall The quantity was converted to a productivity value based on the relative value
short of meeting quality guidelines. Our objective was to develop a system to unit for the CPT code.
identify, screen, and administer pneumococcal and influenza vaccine to high- RESULTS: The quantity of completed encounters for the pharmacy disease
risk patients over age 65 years with an admitting diagnosis of community management clinic increased by about 20% from 2004 to 2005. The
acquired pneumonia (CAP) without a physician's prescription. productivity increased by about 25% during this time frame.
METHODS: Medicare's core measure standards (CMS) evaluate hospitals on CONCLUSIONS: The Pharmacy Disease Management Clinic made a positive
their compliance with the quality indicators. Failure to meet the standards contribution on productivity in a private physician practice. Productivity
affects the rating and reputation of a providing hospital. A computer- increased with increased volume and complexity of patient encounters.
generated report identifies high-risk patients by age, co-morbid conditions,
and antibiotics prescribed. A trained pharmacy technician screens and obtains 102. A pharmacist-managed smoking cessation program in an ambulatory
patient consents for vaccine. Vaccine orders and the consent tool are entered care clinic: a pilot program. Kathy E. Fit, Pharm.D.; Midwestern University -
into the electronic medical record. The vaccines are scheduled for adminis- Chicago College of Pharmacy, Downers Grove, IL.
tration by nursing. A nurse will administer the immunizations and document
administration in the electronic medication administration record (MAR). PURPOSE: Tobacco-related illnesses are the No. 1 preventable causes of
Prior to initiating our program, our compliance with vaccination was at 8% of premature death. The objectives of this study are to describe the smoking
eligible patients with an admitting diagnosis of CAP being vaccinated prior to cessation success rates for patients enrolled in a pharmacist-managed smoking
discharge. After just 6 months, our compliance rose to 93% of eligible cessation program and to describe patient satisfaction with the program.
patients vaccinated. METHODS: In this practice site, a pharmacist-managed smoking cessation
CONCLUSIONS: Busy physicians often forget to prescribe vaccines for program was piloted. This study documents the point prevalence and
eligible patients. Our pharmacy-run program identifies, screens, obtains continuous abstinence rates for participating patients. The program was
consents, and generates vaccine orders for high-risk patients without designed to see patients in a group class for the initial visit and then
physician oversight. Our program has yielded tremendous success and has individually. All patients received phone follow-up. Patients were called
elevated us to the status of the top 10% of Joint Commission of Accredited within 1 week, 3 weeks, 2 months, 3 months, 6 months, and 1 year after their
Hospitals (JCAHO) on that core measure. quit date. The abstinence rates were determined from self-reports during
these phone calls. Point prevalence was defined as abstinence for at least 7
100. An evaluation of the Asthma Control Test (ACT)™ as a tool to days prior to the time point. Continuous abstinence was defined as abstinence
monitor asthma in a VA primary care clinic. Amanda Keller, Pharm.D.1, Sona since the quit date. Patients were provided with satisfaction surveys 6 weeks
S. Hepfinger, Pharm.D., BCPS1, Michelle S. Wilhardt, Pharm.D.1, Karen A. after their quit date. Descriptive statistics were employed to describe the
Sauer, Pharm.D., MSPH2, Charley Hepfinger, Pharm.D., BCPS1, Joseph Yusin, abstinence rates and patient satisfaction.
M.D., FAAAAI 1 ; (1)Carl T. Hayden VA Medical Center, Phoenix, AZ; RESULTS: During the first year, 82 patients participated. The mean patient
(2)University of Arizona College of Pharmacy, Tucson, AZ. age was 53.9 (± 11.34) years old and 63.4% were female. The 1-week,
3-month, and 6-month point prevalence rates were 50%, 44.4%, and 46.3%,
PURPOSE: The purpose of this study was to prospectively evaluate the respectively. The 1-week, 3-month, and 6-month continuous abstinence rates
Asthma Control Test (ACT), in conjunction with spirometry, as a tool to were 50%, 22.2%, and 19.5%, respectively. About 86% (n=30) stated they
facilitate communication between patient and clinician and to identify were “very satisfied” with the program, and 46.1% stated the phone calls were
the most beneficial.
veterans with uncontrolled asthma. The primary objective of this study was to
CONCLUSIONS: This pilot program provided data to support pharmacists
compare the change in forced expiratory volume at 1 second (FEV1) from
who are effective providers of smoking cessation. Abstinence rates were
baseline to 3 months following asthma medication adjustment. Secondary
sustained long-term and may have been the result of continuous phone
objectives were to compare changes in: 1) ACT score, 2) asthma medication
follow-up, which was highly rated by the patients. The efficacy and patient
adherence based on the medication possession ratio (MPR), 3) the number of
satisfaction data support the continued operation of this program.
asthma-related urgent/emergent health care visits, and 4) asthma medications
based on the pharmacist's assessment.
METHODS: Veteran patients with asthma were included in the study. 103. Documentation of student pharmacists' interventions from medication
Patients were excluded if they were enrolled in the pulmonary/asthma histories in ambulatory care. Kathy E. Fit, Pharm.D.; Midwestern University -
specialty clinic, co-managed for asthma by non-VA providers, or had an acute Chicago College of Pharmacy, Downers Grove, IL.
 ACCP 2007 SPRING PRACTICE AND RESEARCH FORUM e27
PURPOSE: Medication safety is a major concern in primary care. Student resolution of identified barriers. Pharmacists' interventions were performed
pharmacists can assist by identifying and offering solutions to drug-related through telephone visits, physician office visits, and pharmacists' specialty
problems. The objectives of this study were to describe the number and types clinics every 1–6 weeks depending on the level of glycemic control.
of interventions made by student pharmacists following a medication history RESULTS: One hundred and one patients were enrolled in the program
and to describe physician acceptance rates. between August 2005 and August 2006. Baseline and post intervention data
METHODS: This prospective study documents the interventions from were available in 56 of 101 (55%) patients. There was an average decrease in
medication histories of 2 student pharmacists in their final year of training. In A1c from 10.9% ± 1.7 to 9.4% ± 2.2. The average reduction in A1c was 1.5% ±
this new practice site, students assist with clinical services, such as smoking 2.6 (p<0.0001). Of the 56 patients, 30 (54%) completed the program defined
cessation and anticoagulation management. In addition, the students, with as a reduction in A1c to less than 9%. There was an average decrease in A1c in
faculty supervision, perform medication histories and vital signs prior to this group from 10.9% ± 1.9 to 7.8% ± 0.8. The average reduction in A1c was
physician appointments. This is done about 1.5 days per week. At the time of 3.1% ± 2.0. Five of these 30 (16.6%) patients obtained their goal A1c of < 7%.
the medication history, the students review the chart and provide needed Fifty-four patients are currently being treated in the program, and 17 patients
patient education. Recommendations to the physician are made before the were lost to follow-up.
exam. Type of recommendation, patient demographics, and physician CONCLUSIONS: The Diabetes Initiative Program demonstrates the value of
acceptance were documented on a paper form by the student and submitted a pharmacist-managed diabetes consultative service within an internal
to the faculty member. All interventions were entered into a PDA with a medicine clinic targeting patients with diabetes resistant to usual care.
Pendragon Forms® database, developed for this project. Descriptive statistics
were employed to describe the type and frequency of interventions with the
physician acceptance rates. 106. Evaluation of the appropriate use of proton pump inhibitor therapy in
RESULTS: Over 6 weeks, 109 interventions were documented. The mean an ambulatory Medicaid population. Kristie Ramser, Pharm.D., Gale Hamann,
patient age was 61.8 (± 14.94) years, and 63.3% were female. The mean Pharm.D., BCPS, CDE, Laura Sprabery, M.D., Christa George, Pharm.D.,
number of prescriptions was 4.43 (± 2.99) per intervention. The most BCPS, CDE; Regional Medical Center, Memphis, TN.
common interventions documented were lab monitoring (22.1%), drug
information (17.4%), patient education (14.7%), and indication without drug PURPOSE: The State of Tennessee Medicaid Program implemented formulary
(12.8%). Of the applicable interventions, 69% (49/71) were accepted by the changes regarding the use of proton pump inhibitors (PPIs) requiring patients
physician. to have experienced a failed trial of histamine 2 blocker therapy (H2B) or
CONCLUSIONS: Student pharmacists in this private physician's office obtain prior authorization for PPI therapy depending on the indication. The
provided a variety of recommendations following provision of medication purpose of this study was to evaluate the use of PPIs in a group of Medicaid
histories. A majority of the interventions were accepted. Such data document patients and adjust therapy as indicated.
the benefit of student pharmacists and the significant role they play in patient METHODS: A list of Medicaid patients who were prescribed PPI therapy was
care. generated from a pharmacy database. Indications for PPI therapy were
verified through chart review and patient interview. PPI therapy was
discontinued if no indication was identified. Prior authorization for PPI
104. Utilization of a group clinic for the management of dyslipidemia.
therapy was obtained if the indication met Medicaid qualifications. PPI
Kristen E. Locke, Pharm.D., Philip J. Schmitt, M.D., Judy A. Monroe, B.S.N.;
therapy was changed to an H2B for documented indications that did not meet
Cincinnati Veterans Affairs Medical Center, Cincinnati, OH.
Medicaid qualifications for PPI therapy. Another chart review and patient
interview were conducted 6 months after PPI therapy was discontinued or
PURPOSE: The Cincinnati VAMC had the highest use of high-cost, non-
changed to an H2B. Patients were interviewed regarding the effectiveness of
formulary lipid lowering agents in its network, without corresponding
the current acid-suppression therapy.
improvement in LDL goal achievement. Also, non-formulary lipid medication
RESULTS: There were 149 patients evaluated. PPI therapy was discontinued
requests were evaluated inconsistently, especially if the patient was not
in 19% of patients. Prior authorization was obtained in 30% of patients. PPI
referred to a clinical pharmacy clinic. A multidisciplinary group lipid clinic
therapy was changed to an H2B in 51% of patients. Six months after the
was established to 1) improve lipid goal achievement, particularly in patients
intervention, 34% of patients whose PPI therapy was discontinued remained
on high cost, non-formulary lipid medications, 2) use time, personnel, and
controlled without medication. Acid suppression was restarted in 10% of
medication resources more efficiently, and 3) improve patient satisfaction and
patients, and 55% of patients were lost to follow-up. Of the 76 patients whose
access to care.
PPI therapy was changed to H2B therapy, 46% remained on H2B therapy, 5%
METHODS: Primary care providers and clinical pharmacy specialists (CPS)
refer patients to the group lipid clinic. The CPS evaluates group patients to were restarted on PPI therapy, 14% discontinued acid suppression therapy,
identify coronary heart disease (CHD) risk factors, determine lipid goals, and and 34% were lost to follow-up.
develop a treatment plan. Nursing staff check vital signs, screen for adverse CONCLUSIONS: PPI therapy was changed or discontinued in 70% of
drug events, complete all pertinent health maintenance evaluations, and patients. Of patients successfully contacted, 89% remained off PPI therapy,
document the visit in the electronic medical record. The CPS, dietician, and demonstrating the potential over use of PPIs.
physician co-facilitate a group discussion to educate patients on a low
cholesterol diet, their lipid medications, CHD risk factors, and individual 107. Implementation of a pharmacist-run lipid clinic in a Veterans Affairs
lipid goals. medical center. Mary Choy, Pharm.D.; St. John's University, Queens, NY.
RESULTS: The 90-minute group lipid clinic meets monthly and has a current
capacity of 12 patients, doubling the number of patients that could be seen by PURPOSE: To describe the implementation of a pharmacist-run lipid clinic
individual practitioners. Seventy percent of the patients have achieved their within a primary care medical setting and review the results.
LDL goal. In addition, patients have reported a high level of satisfaction with METHODS: A pharmacist-run lipid clinic was implemented at the Veterans
the group lipid clinic, averaging 4.5 on a 5-point Likert scale. Affairs New York Harbor Healthcare System. Potential patients were identified
CONCLUSIONS: The group lipid clinic has improved the management of by screening the primary care physician's appointment list. Patients were then
dyslipidemia at the Cincinnati VAMC. contacted via telephone 1 week prior to their primary care appointment. In
addition to the facilitation of these operational issues, clinical activities and
105. Implementation and evaluation of a pharmacist-managed diabetes barriers to the clinic will also be discussed. For study inclusion, patients were
consultative service in an internal medicine teaching clinic. Kristie Ramser, required to have an initial pharmacist intervention and baseline lipid panel,
Pharm.D., Christa George, Pharm.D., BCPS, CDE, Gale Hamann, Pharm.D., followed by at least 1 follow-up lipid panel. The interventions of the
BCPS, CDE, Laura Sprabery, M.D., Craig Dorko, M.D., Dave Kuhl, Pharm.D., pharmacist during the initial patient visit included counseling non-compliant
Ellen Taylor, Pharm.D., Jennifer Campbell, Pharm.D., CDE; The Regional patients, optimizing drug dose, and recommending additional therapy. The
Medical Center, Memphis, TN. changes in lipid panel were then reviewed in the follow-up visit. The Veterans
Affairs Hyperlipidemia Treatment Algorithm used in the clinic was based on
PURPOSE: The Diabetes Initiative Program is a pharmacist-managed diabetes the National Cholesterol Education Program – Adult Treatment Panel III
consultative service that was implemented in August 2005 with the aim of guidelines and incorporated medications that were on the formulary.
evaluating the impact of individualized education and medication RESULTS: 18 patients were enrolled in the study between January 15, 2006,
management in patients with uncontrolled diabetes who failed to respond to and June 9, 2006. The interventions of the pharmacist had an effect on the
usual care. lipid panel, and it was observed that low-density-lipoprotein cholesterol
METHODS: Inclusion criteria were diagnosis of diabetes for at least 1 year decreased by 25%, high-density-lipoprotein cholesterol increased by 11%,
and an A1c > 9%. Once identified, a comprehensive interview was performed triglycerides decreased by 22%, and total cholesterol decreased by 13%.
to review medical history, baseline laboratory values, medication compliance, Interventions included counseling non-compliant patients (61%), optimizing
blood glucose monitoring routine, psychosocial issues, and nutrition and drug dose (22%), and recommending additional therapy (17%).
exercise habits. Data were collected regarding potential barriers to obtaining CONCLUSIONS: A pharmacist-run lipid clinic can be implemented and
medications and attending clinic visits. Interventions included individualized integrated into a primary care setting. Pharmacists can effectively manage
diabetes education, optimization of pharmacotherapy, and options for lipid therapy and have a definitive impact on the patient lipid panels.
e28 PHARMACOTHERAPY Volume 27, Number 4, 2007
108. Development of an asthma shared medical appointment. Teresa B. reconciliation is composed of five steps: 1) creation of a current medication
Klepser, Pharm.D.; Ferris State University, Kalamazoo, MI. list; 2) listing of medications to be prescribed; 3) comparison of those
medication lists; 4) development of clinical recommendations; and 5)
PURPOSE: Asthma guidelines emphasize the importance of classification, communication with appropriate caregivers and the patient. Incorporation of
provision of controller medications, and self-management skills. A planned- a pharmacist in the CPC was intended to increase patient/caregiver
care visit is a proactive clinical encounter that focuses on patient goals and medication knowledge, improve accuracy of the electronic medication record
aspects of care not delivered during an acute-care visit. The National Heart (including prescription, over-the-counter, and dietary supplements), improve
Lung and Blood Institute recommends planned visits at intervals ranging evaluation of drug therapies for efficacy and toxicity, and enhance provider
from 3 months to 12 months depending on the asthma classification. The awareness of drug therapy concerns.
objectives of the asthma shared medical appointment (SMA) model are to METHODS: The CPC is a multidisciplinary clinic including a pediatrician,
increase patient asthma knowledge, use of asthma action plans, use of anti- orthopedic physician, physical therapist, occupational therapist, social
inflammatory medications in persistent asthma, and clinic revenue. Secondary worker, dietician, and nurse. In 2005 a clinical pharmacist joined the team.
objectives are to decrease emergency department visits and hospital The pharmacist performs about 30 medication histories monthly and
admissions. recommends drug interventions on 16% of those patients. Adaptability: This
METHODS: Potential patients for the SMA were identified by reviewing clinic may be adapted to other ambulatory care clinic settings and applied to a
asthma claims in our billing system. Components of the SMA were based on variety of chronic diseases.
the National Asthma Education and Prevention Program Guidelines and CONCLUSIONS: Previous published cerebral palsy clinics have not used a
patient needs. The SMA targets various processes of care including patient clinical pharmacist as a team member to perform accurate and complete
assessment and disease and medication knowledge. The SMA is a 90-minute medication reconciliation to prevent prescribing and administration errors.
session for 5–8 adults with asthma. Providers include a pharmacist, nurse
practitioner (NP), and nursing staff. At the SMA patients join a session with 111. The role of the pharmacist in an ambulatory pain management clinic.
other patients and the providers. Each patient completes an asthma status Tibb F. Jacobs, Pharm.D., Emily W. Evans, Pharm.D.; University of Louisiana at
questionnaire and is seen by an NP and pharmacist. Following a physical Monroe, Shreveport, LA.
assessment, the pharmacist and NP educate the patients on signs and
symptoms of worsening asthma, measures to control asthma triggers, written
PURPOSE: To describe the development and implementation of pharmacy
asthma action plans, monitoring of b2-agonist inhaler use, appropriate use of
services for non-cancer chronic pain management within an academic Family
peak flow meters, and proper inhaler technique. Evaluation: A seven-point
Medicine Clinic. Pharmacists have long held a role in inpatient and oncology
quality assurance review will be conducted annually. Adaptability: This SMA
pain management. There is very little literature regarding the role of clinical
model may be adapted to other ambulatory care clinic settings or outpatient
pharmacy in managing chronic pain in an outpatient setting.
retail settings and applied to a variety of chronic diseases.
METHODS: October 2005: A College of Pharmacy (COP) faculty member
CONCLUSIONS: Previous published SMA models have not used a clinical
placed in an academic hospital's Family Medicine Clinic (FMC) became
pharmacist as a team member.
involved in the Pain Management Clinic (PMC). Pharmacy (faculty member
or Pharm.D. student) took medication histories, sat in on physician
109. Pharmacist managed dietary supplement clinic. Teresa B. Klepser, interviews, and counseled patients. Recommendations were made verbally
Pharm.D.; Ferris State University, Kalamazoo, MI. regarding drug dosing, interactions, adverse effects (ADEs), and therapeutic
alternatives. Summer 2006: FMC implemented a new electronic medical
PURPOSE: Use of dietary supplements has grown exponentially in the last records (EMR) system, allowing for new pharmacy capabilities, including pre-
decade. It is estimated that one in five patients is at risk for drug-dietary appointment medication review and formal intervention documentation. An
supplement interactions. This is a particular concern among the elderly who additional 2 COP faculty members were added to FMC. October 2006:
are at the greatest risk for polypharmacy. In 2002, a dietary supplement Formal pharmacy participation process in the PMC was implemented. Prior
consultant was added to the Bronson Center for Integrative Medicine (BCIM). to appointment: Pharmacy reviews patient medications/notes and documents
Dietary supplement consultation provides evidence-based guidance to concerns in EMR. During appointment: Pharmacy completes medication
patients regarding the safe and effective use of dietary supplements. The history and pain assessment, addressing concerns that arose during
primary objective for dietary supplement consultation is to ensure that the medication review, assuring accuracy of records, and further assessing efficacy,
patient is safely taking dietary supplements. Incorporation of a pharmacist at ADEs, and regimen appropriateness. Recommendations regarding drug-
the BCIM was intended to increase patient/caregiver dietary supplement related problems (DRP) are made in the EMR, which is checked by the
knowledge, improve medication reconciliation (particularly dietary physician prior to the patient interview/examination. Patients are counseled
supplements), improve evaluation of dietary supplements for efficacy and by pharmacy on medications prior to departure. After appointment:
toxicity, and enhance provider awareness of dietary supplement concerns. Physician co-signs pharmacy note, which becomes a permanent medical
METHODS: Patients are either self-referred or provider-referred to BCIM. record.
Patients bring all dietary supplements consumed to the clinic, if possible in CONCLUSIONS: The paucity of literature regarding pharmacy involvement
the original containers, to aid in identification. The clinical pharmacist in ambulatory pain management necessitates further research. Data
evaluates each dietary supplement for potential drug and disease interactions, concerning the types of interventions made by pharmacy and physician
counsels on potential side effects, and recommends laboratory tests for acceptance of recommendations are being collected via the EMR. A survey
monitoring of safety and efficacy. Patients are given written and verbal regarding patient satisfaction with pharmacy services is also being
consultation. The patient typically pays, out of pocket, $50/hour of administered.
consultation. Adaptability: This clinic may be adapted to other ambulatory
care clinic or retail pharmacy settings.
112. Clinical and economic benefits of monitoring unfractionated heparin
CONCLUSIONS: Compiling dietary supplement histories can be challenging
therapy using antifactor Xa activity compared to activated partial
and time consuming, as many of the individual products contain multiple
thromboplastin time testing. Bryan K. Robinette, Pharm.D., BCPS, (AQ-
constituents and patients commonly use multiple supplements. Because
Cardiology); NorthEast Medical Center, Concord, NC.
patients do not routinely use dietary supplements according to accepted
dosing strategies, accurate usage patterns can be difficult to ascertain. A
clinical pharmacist can perform accurate and complete dietary supplement PURPOSE: Patient outcomes in venous and arterial thromboembolic
medication histories to help prevent potential adverse outcomes. disorders are correlated with heparin serum concentrations. The medical
literature consistently shows problems with using activated partial
thromboplastin time (aPTT) to monitor therapeutic unfractionated heparin
110. Medication reconciliation by a clinical pharmacist in a cerebral palsy therapy (UFH). Variability in pharmacokinetic and pharmacodynamic
clinic. Teresa B. Klepser, Pharm.D., Sarah E Raguckas, Pharm.D.; Ferris State parameters with UFH makes precise predictions of heparin concentrations
University, Kalamazoo, MI. using aPTT testing inaccurate. Using a specific heparin assay such as
antifactor Xa (HA) to monitor UFH offers many potential advantages.
PURPOSE: In July 2004, the Joint Commission announced 2005 National METHODS: Retrospective, unmasked, cohort, single-center studying in a
Patient Safety Goal No. 8 to "accurately and completely reconcile medications 457-bed, private, community teaching hospital. Ninety-two patients were
across the continuum of care." Accredited organizations were required to treated with therapeutic UFH therapy for arterial or venous thrombo-
develop and implement processes to meet this goal by January 2006. In embolism using adjusted body weight (70 units/kg bolus, 15 units/kg/hour
response, the Kalamazoo Center for Medical Studies Pediatric Subspecialty initial infusion). HA was implemented as the standard monitoring test for
Cerebral Palsy Clinic (CPC) requested a clinical pharmacist to join the team. UFH in March 2006. A random sample of 50 patients prior and post
Medication reconciliation is the process of comparing a patient's medication initiation of HA was selected to assess the quality of heparin therapy
orders to all medications that the patient has been taking to avoid medication including: achievement of therapeutic anticoagulation at 6 and 24 hours,
errors such as omissions, duplications, dosing errors, or drug interactions. number of tests performed per 24 hours, number of dosage adjustments per
Reconciliation should be conducted at every transition of care in which new 24 hours, and bleeding complications. A cost analysis was also performed.
medications are ordered or existing orders are rewritten. Medication RESULTS: Both groups were comparable in baseline patient characteristics.
 ACCP 2007 SPRING PRACTICE AND RESEARCH FORUM e29
The HA group had fewer laboratory tests and dosage adjustments per 24 prescribed in 13 (36%) patients. At time of initial assessment 50% were
hours, and achieved a therapeutic level of anticoagulation more frequently at exhibiting signs and symptoms of potential sotalol toxicity (bradycardia,
6 and 24 hours after initiation of therapy. There was no difference in bleeding. shortness of breath, fatigue, weakness, QT prolongation). Clinical
The cost of monitoring heparin therapy with HA was slightly more than aPTT pharmacists provided recommendations regarding discontinuation or dosage
testing. adjustment on 32 patients with a 50% acceptance rate. Readmission rates for
CONCLUSIONS: Monitoring therapeutic UFH using HA improves the patients receiving appropriate therapy, including those after pharmacist
quality of anticoagulation therapy with only a slightly increased cost recommendations were accepted (Group A), were compared to those
compared to aPTT testing. It is likely that the increased cost of the HA is remaining on inappropriate therapy (Group B). Patients requiring at least one
outweighed by improved quality of anticoagulation, reduced nursing time, readmission within 6 months were not similar between groups (30.8% Group
and reduced risk for dosage errors that accompany frequent dosage A; 52.4% Group B). Patients in Group A were admitted 0.308 times during
adjustments. the 6 months compared to 1.43 times in Group B, which was 4.64 times more
often.
CONCLUSIONS: Sotalol was found to be inappropriately prescribed in the
113E. Metoprolol succinate usage by PCMs at an Army community
majority of patients with RI. Dosage adjustment or avoidance in patients with
hospital. Cathy Dement, Pharm, D, BCPS; Martin Army Community Hospital,
relative contraindications such as HF is often necessary. Clinical pharmacist
Cataula, GA.
evaluation of patients on sotalol is important and beneficial by reducing
readmissions and avoiding potential toxicity.
Published in abstract form in the September/October 2006 issue of the
Journal of the American Pharmacists Association.
117. Iloprost improves cardiac hemodynamic parameters of pulmonary
hypertension in open heart surgery. Teena Abraham, M.S., Pharm.D., BCPS,
114E. Evaluation of osteoporosis prevention in chronic users of Charles Oribabor, M.D., Larry Bernstein, M.D., Nasser Saad, Pharm.D.,
glucocorticoids at an Army community hospital. Cathy Dement, Pharm, D, Fabienne Vastey, Pharm.D., Eric Balmir, M.S.; New York Methodist Hospital,
BCPS1, Azra Khan, Pharm, D2; (1)Martin Army Community Hospital, Cataula, Brooklyn, NY.
GA; (2)Martin Army Community Hospital, Fort Benning, GA.
PURPOSE: This study evaluated the systemic and hemodynamic effects of
inhaled iloprost using the SERVO-I ventilator via ultrasonic nebulization in
Published in abstract form in the September/October 2006 issue of the acutely ill postoperative open-heart surgery patients. In addition, the cost
Journal of the American Pharmacists Association. difference between iloprost and standard nitric oxide therapy was evaluated.
METHODS: Patients with elevated mean pulmonary artery pressure (mPAP)
115. Utilization of bivalirudin plus eptifibatide in patients undergoing received iloprost (40 µg) administered via ultrasonic nebulization with
elective percutaneous coronary intervention. Mytrang K. Le, Pharm.D., Abir SERVO-I ventilators postoperatively. MPAP, pulmonary artery systolic
O. Kanaan, Pharm.D., Matthew A. Silva, Pharm.D., BCPS; Massachusetts pressure, pulmonary artery diastolic pressure, cardiac index (C.I.), and
College of Pharmacy and Health Sciences, Worcester, MA. pulmonary artery occlusion pressure (PAOP) were measured with a
pulmonary artery catheter. Pulmonary and systemic vascular resistance (PVR
PURPOSE: This retrospective, observational cohort evaluated drug therapy and SVR) was calculated. In addition, the average cost of iloprost to nitric
utilization in patients undergoing elective percutaneous coronary intervention oxide was calculated.
(PCI) at a community teaching hospital to 1) compare characteristics of RESULTS: Ten patients with similar demographic data received inhaled
patients receiving bivalirudin or bivalirudin plus eptifibatide (concurrent or iloprost. Iloprost achieved peak effect of pulmonary vasodilation within
provisional) and 2) evaluate blood transfusion, length of stay (LOS), and drug 20 minutes of ultrasonic nebulization. This effect lasted about 90 minutes and
acquisition costs. then wore off slowly over the next 30 minutes. Iloprost reduced mPAP (32 vs.
METHODS: Medical records of 255 patients undergoing elective PCI between 20 mm Hg, p<0.0001), pulmonary artery systolic pressure (70 vs. 45 mm Hg,
January and December 2005 were reviewed. Medical history, drug therapy, p=0.0001), pulmonary artery diastolic pressure (37 vs. 23 mm Hg, p=0.0001),
target vessels, blood transfusion, and LOS were evaluated. PVR (550 vs 220 dynes•sec X cm-5, p=0.022), with no effect on SVR. An
RESULTS: Bivalirudin (B) and bivalirudin plus eptifibatide (BE) were used in additional improvement of ventricular performance with an increase in CI
138 (54%) and 117 (46%) patients, respectively. Drug costs doubled in the BE (2.32 vs. 2.75 L/min/m 2) and a decrease in PAOP (25 vs. 15 mm Hg,
vs. B group ($723.21 vs. $354.11). More patients in the BE vs. B group had p=0.0001) was observed after inhalation of iloprost. Cost savings for iloprost
diabetes (41.9% vs. 27.5%, p=0.019). More blood transfusion occurred in the versus nitric oxide is about $9000 per patient.
B vs. BE group (range: 1–8 vs. 1–3 units, p=0.038). There were no differences CONCLUSIONS: Iloprost administered via ultrasonic nebulization with
between B and BE groups in LOS (2.62 vs.3.56, p=0.908), average units of SERVO-1 ventilators in critically ill patients resulted in statistically significant
blood transfusion per patient (3.4 vs. 4.3, p=1.0), age greater than 75 years reductions in mPAP and PVR with an increase in CI. Cost savings for
(34.8 % vs. 35%, p=1.0), hypertension (75.9% vs. 76.1%, p=0.121), inhalation iloprost versus nitric oxide provides another advantage for its use.
dyslipidemia (73.2% vs. 75.2%, p=0.331), renal failure/dialysis (5.1% vs.
6.8%, p=1), chronic ASA (34.1% vs. 37.6%, p=0.554), prior MI (30.4% vs. 118. Implementation of a hospital protocol for the use of perflutren lipid
29.9%, p=0.662), prior PCI (28.3% vs. 25.6%, p=1.0), prior CABG (18.1% vs. microspheres (Definity®) in echocardiographic procedures. Kimberly C.
6%, p=0.347), balloon use (41.3% vs. 37.7%, p=0.079, drug-eluting stents Mason, Pharm.D., Anjali Arora Todd, Pharm.D.; University of Tennessee
(81.9% vs. 78.6%, p=0.153), and bare metal stents (20.3% vs. 23.1%, Medical Center, Knoxville, TN.
p=0.108).
CONCLUSIONS: Interventionalists use bivalirudin with provisional or PURPOSE: Regulatory standards require that pharmacists review all
concurrent eptifibatide more frequently with diabetes at baseline and double medication orders. Therefore, this protocol was necessary to maintain control
the cost of procedural antiplatelet and antithrombin pharmacotherapy. Other of purchasing and use of contrast-related media, such as perflutren lipid
patient risk features were not associated with the choice of provisional or microspheres.
combination therapy during elective PCI. METHODS: Nurses, pharmacists, sonographers, and physicians contributed
to the development of a written protocol for the use of this novel product to
116. Inappropriate use of sotalol in renal insufficiency: a need for clinical improve visualization during echocardiographic studies. Included in the
pharmacist intervention. Shannon W. Finks, Pharm.D.1, Kelly C. Rogers, protocol are criteria for use, dosing tables, administration information,
Pharm.D.1, Amy H. Manguso, Pharm.D.2; (1)University of Tennessee College precautions, and adverse effects. Refrigeration and activation requirements, as
of Pharmacy, Memphis, TN; (2)Baptist Memorial Healthcare - Memphis, well as expense of the product precluded storage on each nursing unit. These
Memphis, TN. obstacles presented logistical concerns related to timely delivery to the nurse
and sonographer.
RESULTS: The protocol was approved by the Pharmacy and Therapeutics
PURPOSE: Due to risk of adverse drug events (ADE) sotalol use is limited in
Committee as well as the Medical Executive Committee, and appropriate
renal insufficiency (RI) and heart failure (HF). In addition, sotalol use in HF
education was provided to hospital staff. Sonographers have begun to use this
is not supported by evidence-based guidelines. To reduce potential life
protocol for suboptimal echocardiograms in this institution.
threatening ADEs, avoidance or dose adjustment may be necessary.
CONCLUSIONS: With the expanded definition of what is considered a
METHODS: We evaluated patients receiving sotalol in a community hospital
medication, hospital pharmacies must now acquire and control nontraditional
over a 6-week time period. Information was collected on indication, dosing,
drug products. Prospective pharmacist review of IV contrast is a growing
concomitant disease states, symptoms of toxicity, and readmissions. Clinical
issue among hospitals throughout the United States. This protocol facilitates
pharmacist recommendations were made when necessary and were followed
compliance with the new JCAHO standard and allows multiple professionals
to determine outcomes.
to provide better patient care.
RESULTS: All patients (n=36) were prescribed sotalol for either atrial or
ventricular tachyarrhythmias. Thirty-two (89%) were dosed inappropriately
per renal function. Twenty (56%) had significant left ventricular dysfunction 119. Job sharing in pharmacy: an innovative opportunity in academia.
as defined by an ejection fraction < 40%. Amiodarone was concomitantly Kelly C. Rogers, Pharm.D.1, Shannon W. Finks, Pharm.D.1, David K. Solomon,
e30 PHARMACOTHERAPY Volume 27, Number 4, 2007
Pharm.D.2, Richard A. Helms, Pharm.D.1; (1)University of Tennessee College learning process. Pharmacy staff also participate in medication checks twice a
of Pharmacy, Memphis, TN; (2)Veterans Affairs Medical Center, Memphis, day, during which they monitor the administration of medications, perform
TN. peak flow measurements, critique administration techniques, and quiz
children on medication knowledge. The students are also available to answer
Although 67% of pharmacy students in 2004 were female, only 40% of full drug-related questions from other medical staff. Students answered post-camp
time faculty positions were filled by women. Pharmacist shortages and an questions regarding their goals, satisfaction, preparedness, confidence, and
increasing number of female pharmacists are reasons to develop unique work attitudes and empathy towards children with respiratory illnesses.
arrangements for women who wish to work part-time. Between 2000 and RESULTS: Since 2004, two residents and four pharmacy students have
2004 the percentage of pharmacists working part-time increased. Most part- attended camp. Pharmacy involvement has been well accepted. The students
time pharmacists are women who care for children or family members. felt they had met all of their goals, stated they had a better overall
Opportunities are available to job share in health care; however, outside of the understanding of respiratory illnesses, felt more confident about making
retail setting these opportunities are limited for pharmacists. We describe an recommendations, and felt that they were more empathetic toward the children.
innovative practice model for clinicians in an academic setting who wish to CONCLUSIONS: Adding pharmacists and pharmacy students to the medical
job share. Because of an increased class size and the need for more clinical team at a camp has been a positive experience for all involved, has allowed
practice sites in the Memphis area, a job share position was proposed to the students to gain hands on experience with children to learn more about their
administrators at The University of Tennessee College of Pharmacy and the disease states, and more importantly has given the campers an opportunity to
VA Medical Center (VAMC) in Memphis. An integrated model was developed learn more about their medications.
to provide a year-round clinical pharmacy teaching service on an adult
cardiology team at the VAMC. Including a selective rotation, this allowed for 122. The impact of a pharmacist-assisted anticoagulation protocol on INR
a 68% increase in cardiology rotation sites available to Pharm.D. students in control in a family medicine residency program. Cathleen Edick, Pharm.D.1,
the Memphis area. Job sharing works best when common goals are shared Allison Bernknopf, Pharm.D. 2; (1)Ferris State University, Lansing, MI;
between partners. In addition, regular ongoing communication, flexibility (2)Ferris State University, Kalamazoo, MI.
with scheduling, and appropriate division of workload is necessary for
PURPOSE: In the Sparrow family medicine residency (SFMR) program,
success. Benefits to the employee include greater professional fulfillment
patients on anticoagulation therapy are managed primarily through telephone
while maintaining the flexibility for personal responsibilities. Benefits to the
follow-up. This study was designed to evaluate whether collaborative care,
employer include continuity of patient care and retaining experienced
including a pharmacist, can use guideline-based protocols to improve INR
practitioners while also meeting the increasing demands of pharmacy
goal attainment, even when telephone follow-up is used. A secondary
services. Job sharing can be successful for pharmacists with advanced clinical
objective of the study was to examine whether INR goal attainment has any
training who wish to continue their practice in a part-time capacity.
relation to a physician's “comfort level” in using collaborative care for
Administrators should consider the benefit of alternative work schedules in
anticoagulation management.
recruiting and retaining women in academic pharmacy.
METHODS: Prior to this study, pharmacists did not assist with anticoag-
ulation management. Because SFMR is a medical residency program, we
120. A survey of community pharmacy practices related to care of Spanish- sought to find a collaborative solution to the current system of monitoring
speaking patients in Alabama. Grady L. Pearson Jr., Pharm.D., Mary A. anticoagulation therapy using telephone follow-up. A protocol was
Worthington, Pharm.D., Kim W. Benner, Pharm.D., Jennifer Beall, Pharm.D., developed, whereby pharmacists were involved in the follow-up for
Teresa Wilborn, Pharm.D., Ph.D.; McWhorter School of Pharmacy Samford anticoagulation management. Two chart reviews will be completed to assess
University, Birmingham, AL. the effectiveness of this protocol. The first will assess INR results obtained
between July 2005 and March 2006, prior to the implementation of the
PURPOSE: To assess local pharmacy practices related to the care of, and pharmacist-driven protocol. The second chart review will be completed in
services provided to, Spanish-speaking patients in a metropolitan area in December 2006, and will include 6 months of data following implemen-
Alabama. tation. Chart reviews will assess the percentage of time anticoagulation
METHODS: A three-page survey was developed and mailed to 250 patients remain within their desired INR range, and data from pre- and post-
pharmacies in the Jefferson County area of Alabama. A single pharmacist was protocol implementation will be compared. In addition to the chart reviews, a
asked to complete the 26-question survey, which was divided into three medical resident questionnaire will also be conducted pre- and post-protocol
sections: background pharmacy information, interpretive methods used by implementation. The resident questionnaire will evaluate the medical
the pharmacy, and cultural competency. residents' “comfort level” with the protocol and use guidelines for INR
RESULTS: Out of 227 surveys, 117 were returned, giving a response rate of management. Resident “comfort level” and INR goal attainment will then be
52%. Two-thirds of the pharmacies surveyed were chain pharmacies with 108 analyzed to determine whether there is a correlation between the two
pharmacies reported to have less than 10 percent of patients who primarily variables.
speak Spanish. About 72% reported some need to speak and/or understand RESULTS: Data collection is ongoing. Currently all of the retrospective data
Spanish; however, 49.6% reported that the pharmacy staff was unable to are collected. Post protocol data were collected in December of 2006. Results
speak and/or understand Spanish. The ability to print Spanish labels and will be presented at the Spring Practice and Research Forum.
counseling sheets was noted by 77.8% of responders. Pharmacy employees
were used as interpreters by 23.9% of the pharmacies while approximately 123. Gaining efficiency in a family medicine residency program through
two-thirds of the respondents reported using a family member to serve as an appropriate formulary utilization. Cathleen Edick, Pharm.D.1, Chris Beaver,
interpreter. Of the times a family member was used only 24.8% reported R.N., MPA2, George Smith, M.D.2; (1)Ferris State University, Lansing, MI;
never using a minor with 6% of all pharmacies reporting solely using a minor. (2)Michigan State University Family Medicine Residency Program, Lansing,
Fifty-four (46.2%) respondents reported that the pharmacy was not culturally
MI.
competent. In comparison, when asked how often the pharmacist asks
questions about a Spanish-speaking patient’s culture, 70.1% responded that
PURPOSE: Medication formularies are used to control costs, but often vary
they never asked questions about the patients’ culture, which is similar to the
according to the patient's individual health plan. Failure to consult the
percentage who were completely unfamiliar with folk remedies, 80.3%.
CONCLUSIONS: There is a need for pharmacists to develop an appropriate formulary before prescribing often results in patient or pharmacy
understanding of the Spanish language, interpretation, and culturally “call-backs” requesting medication substitution and/or prior authorization for
competent care in order to optimally serve this growing minority group. non-preferred or off-formulary medications. Such “call-backs” are
inconvenient and time consuming for the patient, pharmacy and medical
practice. The purpose of this study was to evaluate whether appropriate
121. Pharmacy involvement in camp huff n' puff. Kendra A. Keeley, provider education and easy formulary access at the point of care
Pharm.D., Donna G. Beall, Pharm.D., BCPS; University of Montana, Missoula, substantially reduces the need for unnecessary “call-backs.”
MT. METHODS: An initial analysis of “call-backs” was conducted prior to
provider education and improved formulary access. Following this initial data
PURPOSE: To involve pharmacists as part of a multidisciplinary health care collection, each of the major insurance carriers accepted at the Family
team at a camp for children with respiratory illnesses. The goal of the camp is Medicine clinics were contacted and current formularies were obtained.
to educate children in an active learning environment. Formulary folders were created for each exam room, as well as the resident
METHODS: A pharmacist first attended camp in 2004 and became the precepting room. A one-page list of tier 1 agents common to each plan for the
director of the camp the following year. The director is responsible for the most frequent disease states was also created. Throughout the study period,
development and implementation of all activities as well as staff coordination. formulary changes were received and formulary packets updated. Providers
The director trains pharmacy students and residents in preparation for their were also educated and made aware of “call-backs” that could have been
involvement at camp. Prior to camp, students set 3–5 goals and keep a daily averted by following the new guidelines. Six months after implementation,
reflective journal. The “Asthma Adventures” Asthma Camp Activities Manual the number of “call-backs” was reanalyzed.
is used as a key tool for education. Students educate the children by RESULTS: Prior to implementation, the clinic received an average of 170
incorporating games such as LUNGO and the asthma challenge to the “call-backs” per month over a 3-month period of time. This resulted in 8.5
 ACCP 2007 SPRING PRACTICE AND RESEARCH FORUM e31
“call-backs” per day. Six months after implementation of this new process, judgement or heuristics for DRP coding. These findings suggest that quality-
“call-backs” decreased to 9 per month. This resulted in 0.45 “call-backs” per improvement efforts are needed to achieve consistency between reviewers.
day or fewer than three per week.
CONCLUSIONS: The formulary folders and education allowed providers to
126. Comparison of adherence to fixed dose combination versus free-
make appropriate medication decisions at the point of care, resulting in time
prescribed therapy. Libby Black, Pharm.D., Sandra E Talbird, MSPH;
saved, increased efficiency and increased patient, staff, and pharmacist
GlaxoSmithKline, Research Triangle Park, NC.
satisfaction.
PURPOSE: A literature review was conducted of studies comparing
124. Acid-suppressive agents use in the general medicine unit. Corinne adherence to fixed dose combination (FDC) therapy versus adherence to free-
Chahine-Chakhtoura, M.S., Pharm.D., BCPS, Humberto Jimenez, Pharm.D., prescribed individual components to assess whether adherence/ compliance
Manisa Tanprayoon, Pharm.D., Ashmi Anand, Pharm.D., Mini Varghese, advantages have been demonstrated for FDC products.
Pharm.D.; Saint Michael's Medical Center, Newark, NJ. METHODS: OVID and PUBMED databases were searched using the
following terms: “fixed dose combination” and [“adherence” or
PURPOSE: To assess the prevalence and appropriateness of using acid- “compliance”]. No restrictions on language of study were employed. Studies
suppressive agents on inpatients in the general medicine unit. using patient-reported measurements of adherence, which can be unreliable,
METHODS: The data were collected prospectively over a period of 2 months were excluded. This initial analysis focused on comparisons of 1 product
on non-critical patients receiving acid-suppressive drugs or sucralfate in the (FDC) vs. 2 products (free-prescribed individual components).
general medicine unit. Relevant medical history and type of drug used were RESULTS: Five studies between 1980 and 2006 met our inclusion criteria.
documented. We assessed the appropriateness of therapy indication, dosing Four of the studies were retrospective analyses of prescription claims data,
frequency, and route of administration. The appropriateness was based on and one was a prospective crossover study. Medications studied included
internally developed criteria derived from standard published guidelines. antihypertensives and antihyperglycemics. A variety of methods were used to
During data collection, recommendations for therapy adjustments were made measure adherence, with the medication possession ratio (MPR) being the
as needed. most common. Four out of five studies found a statistically significant higher
RESULTS: A total of 200 patients (94 males, mean age 59.5 ± 16.1 years) rate of adherence for patients on the FDC product compared with free-
were enrolled. Sixty-one patients received acid-suppressive agents before prescribed individual components.
hospital admission, with 56 (91.8%) being on proton-pump inhibitors (PPIs), CONCLUSIONS: Relative to the number of FDC products on the market, few
4 (6.6%) on histamine-2 receptor antagonists, and 1 (1.6%) on sucralfate. studies have assessed whether the FDC improves adherence over treatment
Upon admission, 195 patients (97.5%) received PPIs and 5 (2.5%) received regimens including each component individually. The results of this analysis
sucralfate. The indications were for stress ulcer prophylaxis (79%), provide preliminary evidence to support an improvement in adherence with
gastroesophageal reflux disorder (6.5%) and a history of gastrointestinal bleed FDCs over free-prescribed components in the management of the evaluated
or peptic ulcer disease (14.5%). Based upon our criteria, the indication was chronic illnesses. Additional studies should be conducted to further evaluate
appropriate in 101 patients (50.5%), the dosing frequency appropriate in 185 this topic.
patients (92.5%), and the route of administration appropriate in 168 patients
(84%). For the non-appropriate indications, 76 patients (75.2%) received 127. Diagnosing and testing for heparin-induced thrombocytopenia.
PPIs for stress ulcer prophylaxis. The remaining 23 patients (22.8%) had no Marybeth Boudreau, Pharm.D., Loretta Chiu, Pharm.D., Astrid Andreescu,
discernable indication. A total of 112 recommendations were made for M.D., Irwin Gross, M.D.; Eastern Maine Medical Center, Bangor, ME.
therapy adjustment; 60 (53.6%) were accepted. Post-pharmacist
interventions, the usage of acid-suppressive drugs decreased to 144 patients. PURPOSE: Direct thrombin inhibitors (DTIs) are paramount for the
If all recommendations to discontinue inappropriate indications were treatment of heparin-induced thrombocytopenia (HIT). To minimize the risk
accepted, the usage would have decreased to 101 patients. of bleeding, ensure patient safety, and reduce cost, it is important that DTIs be
CONCLUSIONS: The usage of acid suppressive agents in the general prescribed appropriately. It is equally important that the testing for HIT be
medicine unit is excessive, particularly for inappropriate stress ulcer timely, sensitive and specific. The purpose of this study was to determine
prophylaxis. Pharmacists' interventions play an important role in reducing whether two different HIT testing methods (the AHAT platelet aggregation
the overusage. test and the PF4 ELISA test) correlated with a clinical diagnosis of HIT.
METHODS: A retrospective chart review included all adult patients in 2005
125. Identification and categorization of drug-related problems among who had an AHAT and PF4 ELISA test simultaneously performed. Patients
Medicaid patients: variability between pharmacist reviewers. Joanne with negative AHAT and PF4 ELISA results were excluded.
LaFleur, Pharm.D., MSPH, CarrieAnn McBeth, Pharm.D., Carin Steinvoort, RESULTS: From January through December 2005, 134 AHAT tests were
Pharm.D., Lynda Oderda, Pharm.D., Marianne Paul, Pharm.D., Karen performed. Of these 134 patients, 58 patients went on to have a PF4 ELISA
Gunning, Pharm.D., Gary M. Oderda, Pharm.D., MPH; Pharmacotherapy test performed. There was a direct correlation between a clinical diagnosis of
Outcomes Research Center, Salt Lake City, UT. HIT and the PF4 ELISA test results (r=0.66; p<0.001). However, the AHAT
platelet aggregation test revealed no correlation (r= -0.065; p=0.677). The
PURPOSE: As part of ongoing efforts to improve drug utilization among Utah AHAT test demonstrated 93% sensitivity and only 4.7% specificity for HIT.
Medicaid patients, drug-related problems (DRPs) were identified by clinical Conversely, the PF4 ELISA was 80% sensitive and 88% specific. Many of the
pharmacists for patients exceeding seven medications per month in 2004- patients evaluated (60%; n=35) had positive AHAT test results without any
2005. Before implementation of quality-assurance efforts, baseline variability clinical evidence of HIT. Of those patients, 57% (n=20) went on to receive
between pharmacists for identifying and coding DRPs was analyzed. HIT treatment including IV DTI therapy for 5.6 days. In addition,
19 patients were discharged home with a documented heparin allergy. Sadly,
METHODS: Pharmacists retrospectively reviewed drug regimens for
these patients did not have a heparin allergy, nor did they have HIT.
Medicaid patients and identified DRPs in 12 predetermined categories,
CONCLUSIONS: Accurate HIT testing directly affects the administration of
including therapeutic duplications, drug-drug interactions, and untreated
DTI therapy, hospital length of stay, and patient safety. The AHAT platelet
indications. Logistic regression was used to estimate odds ratios (ORs) for
aggregation test is sensitive but not specific and does not correlate with a
differences in DRP identification between pharmacists, adjusting for patient-
clinical diagnosis of HIT.
specific characteristics (age, gender, nursing home status, and reviewed
medications). Pseudo R2 statistics were compared to determine the proportion
of modeled variance due to 1) pharmacist variability, 2) patient-specific 128. Defining an argatroban therapeutic range in a large community
characteristics, or 3) shared variance. hospital. Stephanie A. Baumhover, Pharm.D., Stephanie B. Hollowell,
RESULTS: A total of 5,174 patients were reviewed; 75.7% had ≥ 1 DRP. The Pharm.D.; CJW Medical Center - Chippenham Campus, Richmond, VA.
median number of DRPs per patient was 2 (range 0–15). The mean age was
57.6 (SD 17.4). A total of 30.7% were nursing home residents, and 74.5% PURPOSE: A retrospective medication use evaluation was conducted to
were female. The adjusted OR for the pharmacist with the highest probability evaluate the efficacy and safety of an argatroban protocol using a facility-
of identifying ≥ 1 DRP versus lowest was 3.1 (95% CI=1.2–8.2); the model defined therapeutic range 1 year after protocol implementation.
accounted for 14.1% of the differences in DRPs of which 2.5% was attributed METHODS: All patients receiving argatroban from January 1, 2006, through
to pharmacist variability and 45.1% to patient characteristics. Within specific August 31, 2006, were reviewed. Indications for use, patient baseline PTT
DRP categories, adjusted ORs for the pharmacist with the highest probability data, and heparin-induced thrombocytopenia (HIT) diagnostic testing were
versus the lowest ranged from 2.7 (95% CI=1.4–5.4) for excessive durations obtained. In addition, all PTT values and dose adjustments were recorded and
of therapy to 95.5 (95% CI=18.5–492.6) for untreated indications. The analyzed. Adverse events were compiled as well as overall efficacy. Each
models accounted for 3.8%–24.9% of the variability, of which 3.7%–44.6% patient's goal range as defined by the manufacturer (1.5–3 x patient's
was attributed to pharmacist variability and 35.5%–91.3% to patient-specific baseline) was compared with the facility therapeutic range (45–65 seconds).
characteristics. RESULTS: Twelve patients received argatroban during this 8-month period.
CONCLUSIONS: Pharmacists exhibited high variability in DRP identification All patients had suspected HIT, with subsequent diagnostic testing performed.
or categorization; variability could be attributed to differences in clinical Only 17% of patients had confirmed HIT. Eighty-three percent of patients had
e32 PHARMACOTHERAPY Volume 27, Number 4, 2007
baseline PTTs drawn prior to initiation of argatroban (range 23.4–46.4 showed 23% (n=29) and 44% (n=55) of indicated vaccines were prescribed
seconds, mean 30 seconds). The laboratory control PTT value was 24–33 and documented as being administered, respectively. Audit 4 (n=34) showed
seconds, with a mean of 28 seconds. The starting dose and ending argatroban 59% of indicated vaccines documented as being administered.
dose for each patient was calculated. The average dose of all patients was 0.78 CONCLUSIONS: Implementation of the multidisciplinary program has
µg/kg/minute. Adverse reactions were infrequent. For all PTT values drawn increased the assessment and prescribing of pneumococcal vaccines for MCG
for all patients, the time within the facility's therapeutic range was 59%. For inpatients ≥ 65 years old. This program has also greatly increased the
all 12 patients, using the facility target range, the range of dosing was documentation of vaccine administration. Future efforts will concentrate on
0.86–2.8 x baseline. The majority of patients (80%) ended with a lower dose physician education about this Core Measure, education of nursing staff on
than the starting dose. proper and complete administration documentation, and expansion of this
CONCLUSIONS: The manufacturer of argatroban recommends dosing program to other patients at risk of pneumococcal infections.
patients to a goal PTT of 1.5–3 x patient's baseline (not to exceed 100 seconds
or 10 µg/kg/min). At this facility, using a defined therapeutic range of 45–65 131. Application of failure mode effect and criticality analysis and its
seconds lead to a lower dosing target of 0.86–2.8 x baseline. There did not impact on surgical site infections. Mark A. Newnham, Pharm.D., BCPS,
appear to be any impact on efficacy, with 80% of patients exhibiting BCNSP, Diane Spicer, R.N., B.S., CIC; Lawnwood Regional Medical Center
improvement of HIT/absence of new thrombus at completion of therapy. and Heart Institute, Fort Pierce, FL.
The hospital formed an interdisciplinary task force to decrease the occurrence
129. Anticoagulation clinic workflow analysis. Sara R. Vazquez, Pharm.D.1, rate of surgical site infections. The task force applied quality improvement
Jennifer Campbell, Pharm.D., CDE2, Gale Hamann, Pharm.D., CDE, BCPS2, methodologies, including a Failure Mode Effect and Criticality Analysis, to
Christa George, Pharm.D., CDE, BCPS2; (1)University of Utah Hospitals and identify common failure modes and to prepare mitigation strategies. The task
Clinics, Salt Lake City, UT; (2)The Regional Medical Center at Memphis, force determined that a cultural change was needed. Rather than administer
Memphis, TN. the antibiotic on the floor on-call, the facility determined that the operating
room staff in the holding and outpatient surgical areas would be responsible
PURPOSE: Data evaluating the workflow efficiency of anticoagulation clinics for documenting the antibiotic administration and justify that the timing was
are limited. This study documented workflow efficiency parameters and correct for the operating room schedule. The pharmacy service implemented
subsequent interventions with the objective of streamlining patient automated dispensing technology and pre-manufactured antibiotic
appointments in an anticoagulation clinic treating primarily indigent patients. preparations to improve delivery of antibiotics to these preoperative areas.
METHODS: For 7 weeks, three pharmacist providers documented patient The Infection control nurse and a pharmacist audited the timing of pre-
visit length and presence of predefined factors affecting visit length such as operative antibiotic doses and retrospectively reviewed all surgical site
overbooking, decreased staffing, and physician availability. Also, types of infections for antibiotic prescribing failure modes. Timing of antibiotic
problems addressed during the visit were classified as anticoagulation- or administrations meeting absolute criteria (< 120 minutes pre incision)
nonanticoagulation-related. Guided by results from the data analysis, changes improved from 71% to 96% during the measurement period while those
were implemented in clinic workflow. Post-intervention data were collected meeting optimal timing criteria (< 30 minutes) increased from 7% to 83%
for 7 weeks to assess the impact of these changes on clinic efficiency. over the same period. The number of antibiotic prescribing failure modes was
RESULTS: Interventions included implementing a signed patient-provider reduced from 25 per year (2002) to 11 per year (2005). For 2002, 2003,
agreement, scheduling changes, and referrals to physicians for nonanticoag- 2004, and 2005 the hospital has reported 52, 44, 28, and 18 SSI reports
ulation-related problems. The overall mean patient visit length was 96 ± 43 respectively. Comparing 2002 to 2005, this result is a 46% reduction in actual
minutes post-intervention (n=246 patient visits), which was not significantly SSI and reaches statistical significance (p<0.001). Controlling for clean and
different when compared with pre-intervention (94 ± 46 minutes, n = 240 clean contaminated procedures, the reported infection rate (infections per
patient visits). However, significant improvements were made in the 100 cases) was 1.23, 1.07, 0.68, and 0.43 respectively. This represents a 65%
incidence of provider-specific factors affecting patient visit length such as reduction in SSI per 100 cases from 2002 through 2005 (p<0.001). Improved
overbooking (p<0.0001) and physician availability (p=0.0047). Issues antibiotic timing and selection, and reduced antibiotic prescribing failure-
unrelated to anticoagulation such as uncontrolled hypertension and insurance modes, have been associated with a statistically significant decrease in
problems were addressed in 18.3% of visits pre-intervention and were not reported surgical site infections.
improved by the attempted interventions (25.6% post-intervention, p=0.09).
CONCLUSIONS: The data indicate that the most successful interventions to 132E. Evaluation of empiric antibiotic use in the treatment of health care-
clinic workflow are those that target a specific problem, such as, in this study, associated pneumonia. Jennifer Le, Pharm.D., Ji Young Kim, Pharm.D.,
overbooking and physician availability. The broader problem of addressing Samantha Taing, Pharm.D., Carl Kildoo, Pharm.D.; Long Beach Memorial
unrelated issues during anticoagulation clinic visits negatively affects the Medical Center, Long Beach, CA.
efficiency of the clinic. The pharmacist providers must often address the
factors concerning the indigent patient population such as multiple medical Presented at the Midyear Clinical Meeting of the American Society of Health-
and financial problems, transportation, and educational hardships. Regardless System Pharmacists, Anaheim, California, December 5, 2006.
of the clinic setting and patient population, this evaluation can be used as a
tool to assess and improve workflow efficiency.
133. A multidisciplinary approach in developing a policy for the proper
handling of oral chemotherapy agents and pregnancy category X
130. Analysis of a multidisciplinary approach to pneumococcal vaccine medications. Agnieszka Koniecka, Pharm.D.1, Antonia Alafris, B.S., Pharm.D.,
screening and administration at a teaching hospital. John C. Kuth, Pharm.D.1, CGP1, Henry Cohen, M.S., Pharm.D., FCCM, BCPP, CGP1, Jane Lederer, R.N.,
Michael Basile, Pharm.D.Candidate2, Daniel Dauner, Pharm.D., MSPH1, Tad Ed.D.2, Kurt Kodroff, M.D2, Gemma Moore, R.N.2, Mary Anne Rose, B.S.2;
A. Gomez, [Link]., M.S.1, Dianne B. Williams, Pharm.D., BCPS1; (1)Medical (1)Kingsbrook Jewish Medical Center, Arnold and Marie Schwartz College of
College of Georgia Health System, Augusta, GA; (2)University of Georgia Pharmacy and Health Sciences, Brooklyn, NY; (2)Kingsbrook Jewish Medical
College of Pharmacy, Augusta, GA. Center, Brooklyn, NY.

PURPOSE: The Joint Commission on Accreditation of Healthcare PURPOSE: To avoid potentially dangerous exposures to health care workers
Organizations' PN-2 Core Measure focuses on reducing pneumococcal directly involved with handling oral chemotherapy and oral pregnancy
infections. This study analyzed the effectiveness of a newly implemented category X medications, the departments of pharmacy, nursing, and risk
pneumococcal vaccine screening and administration process at the Medical management collaborated to develop a policy on the proper handling of these
College of Georgia Health System (MCG) that was initiated to meet this Core agents.
Measure. METHODS: A search using primary and secondary literature was conducted
METHODS: Inpatients ≥ 65 years old were identified through the hospital to identify pregnancy category X and oral chemotherapy agents. Then, the
information system. Medical and pharmacy records were examined for use of package inserts of all those agents identified were reviewed to confirm their
a pneumococcal vaccine assessment and order form, ordering of the vaccine, pregnancy category and obtain manufacturer guidance on the proper
and nursing documentation of administration of the vaccine. An audit by the handling of these medications. All information was communicated to the
MCG Quality Department from the second quarter of 2005 was used as a department of nursing to design a policy on the proper handling of these
baseline reference. Four separate audits were conducted during the following agents.
time periods: audit 1 (February 2006); audit 2 (April 1, 2006, through May RESULTS: We identified 19 oral chemotherapy agents and 50 oral
19, 2006); audit 3 (August 17, 2006, through September 17, 2006); and medications classified as pregnancy category X. From the oral chemotherapy
audit 4 (October 17, 2006, through October 31, 2006.) agents, only 9 of 19 (47.4%) package inserts listed administration
RESULTS: The baseline audit (n=56) showed 14% and 9% of indicated precautions. The manufacturers state that procedures for proper handling
vaccines were prescribed and documented as being administered, respectively. should be considered, and although guidelines have been published, there is
Audit 1 (n=75) showed 60% and 52% of indicated vaccines were prescribed no general agreement that all of the procedures recommended in the
and documented as being administered, respectively. Audit 2 (n=189) showed guidelines are necessary or appropriate. Only the package insert for
83% of indicated vaccines were documented as being administered. Audit 3 hydroxyurea provides detailed instruction that includes the use of gloves and
 ACCP 2007 SPRING PRACTICE AND RESEARCH FORUM e33
mask. From the oral pregnancy category X medications, only 2 of 50 (4%) (1/06 to 5/06) protocol patients were randomly selected to compare
package inserts [finasteride, dutasteride] provided administration precautions replacement frequency. Patients on dialysis or receiving Ca infusions were
or detailed recommendations to avoid handling capsules or crushed or excluded. The effectiveness evaluation included all patients receiving protocol
broken tablets. In order to limit health care workers’ exposure when handling doses 1/06 to 5/06. Fishers exact test was used to compare patients receiving
these agents, the departments of pharmacy and nursing created a policy doses pre- and post-protocol implementation; otherwise, descriptive statistics
requiring the use of a facial mask and surgical gloves. were used.
CONCLUSIONS: Regulatory guidelines for the proper handling of oral RESULTS: In the pre-protocol group 18/30 patients (60%) received
chemotherapy agents and pregnancy category X medications are nebulous replacement; mean pre dose iCa, when available, was 4.15 ± 0.35 mmol/L.
and lacking. We suggest that all institutions create a hospital-wide policy that 3 different doses and 3 different Ca salts were given. In the post protocol
includes wearing a facial mask and surgical gloves when handling these group 1/30 patients (3.3%) received replacement (p<0.0001); predose iCa was
agents. 3.5 mmol/L. Compliance with the protocol was 97%. The only patient
violating the protocol did not receive maintenance doses. Only three patients
required replacement between 1/06 and 5/06. The Ca protocol was effective
134. Impact of a customized cPOE model for enoxaparin ordering in an
for 2/3 patients. The third patient received multiple blood transfusions and
urban medical center. Alina Youssef, Pharm.D. 1 , Christopher McCoy,
eventually required a continuous IV Ca infusion.
Pharm.D., BCPS 2 , Margarita DiVall, Pharm.D., BCPS 3 , Katherine
CONCLUSIONS: The implementation of a standard Ca replacement regimen
Cunningham, Pharm.D., BCPS2, David Feinbloom, MD2, Kevin Afonso, BS2; in our ICU significantly decreased the number of replacement doses and
(1)South Shore Hospital, South Weymouth, MA; (2)Beth Israel Deaconess patient exposure to a potentially toxic drug while simplifying replacement
Medical Center, Boston, MA; (3)Northeastern University School of Pharmacy, procedures. Based on our results, patients receiving multiple blood transfu-
Boston, MA. sions need to be replaced more aggressively than our current protocol.
PURPOSE: Ordering of anticoagulants in computerized Provider Order Entry
(cPOE) systems is often complicated by a wide range of indications, dosing 139. Clinical pharmacy in Egypt. Sherif Kamal, [Link]., Sherif Aboulenaga,
protocols, drug interactions, and safety precautions. The purpose of this study Professor of Pediatric Oncology, Patricia Pruden, Nurse, Consultant;
is to assess the impact of a customized cPOE model on prescribing practices Children’s Cancer Hospital, Cairo, Egypt.
of enoxaparin and bleeding complications associated with the use of this
anticoagulant. Most countries in the Middle East are struggling with providing chemo-
METHODS: In phase I of this study, a prospective medication use evaluation therapy medications and supportive treatment medications for their patients
(MUE) of the formulary low-molecular-weight heparin, enoxaparin, revealed not only because of the lack of financial resources but also because of: 1) lack
inconsistent prescribing practices with regard to indications, dosing, and of drug procurement procedures that would ensure the best quality drug for
monitoring of anti-factor Xa levels in patients with obesity and/or renal the best price; 2) lack of preparation standards ensuring quality control,
impairment. In addition, bleeding complications were observed in renal batching and saving drugs; and 3) lack of long-term inventory and financial
patients who had been dosed inappropriately. As a result, a customized entry planning for medications. Our team developed Oncology Clinical Pharmacy
pathway in cPOE was created and implemented for enoxaparin in phase II of settings in more than 15 hospitals across Egypt. Our biggest project is
this study. The intent of the model was to incorporate patient weight, renal developing the department of pharmaceutical services in the new Children’s
function, and indication for use to ensure appropriate dose and schedule of Cancer Hospital. We helped oncology centers across the country to allocate
enoxaparin, as well as monitoring of anti-factor Xa levels in high-risk their resources and introduced a lot of concepts into their daily practice
patients. In phase III, a retrospective medication use evaluation of enoxaparin starting from safety reaching pharmaceutical care plan and Pharmacoeconomic
was conducted using data generated from the customized cPOE model. Data studies. The aim of our presentation is to share with you our experience and
collected were compared with original MUE data. the challenges of working in Egypt.
RESULTS: Patient demographics were similar in both groups. Percent of
patients prescribed enoxaparin for off-label indications decreased in the post- 140. Successful treatment of invasive aspergillosis (IA) utilizing
cPOE model group. Percent of patients dosed appropriately increased in the combination antifungal therapy (CAT) in a pediatric patient with
post-cPOE group. Number of bleeding complications was similar in both hematologic malignancy (HM). Jennifer L. Costello, Pharm.D., Monica Shah,
groups; however, in the post-cPOE group, patients with renal insufficiency Pharm.D., Stacey Rifkin-Zenenberg, M.D., Rafael Barilari, M.D.; Newark Beth
were not more likely to be dosed inappropriately or experience more bleeding Israel Medical Center, Newark, NJ.
complications.
CONCLUSIONS: A customized cPOE entry pathway helps facilitate PURPOSE: IA is often a devastating complication in immunocompromised
appropriate dosing of enoxaparin in patients with renal impairment and/or patients. Despite availability of new antifungal agents, mortality rates remain
obesity. A customized cPOE entry pathway may reduce off-label prescribing of high and little is known about appropriate antifungal regimens, especially in
enoxaparin. pediatric patients. We report a case in which salvage CAT resulted in
complete resolution of IA in a pediatric patient with acute myelogenous
135E. Enhancing diabetes patient safety with standardized sliding scale leukemia (AML).
insulin. Kerry Wilbur, BScPharm, ACPR, Pharm.D., Christine Yu, [Link]., CASE DESCRIPTION: A 17-year-old male diagnosed with AML was admitted
ACPR; Vancouver General Hospital - CSU Pharmaceutical Sciences, for consolidation chemotherapy, which included idarubicin, cytarabine,
Vancouver, BC, Canada. etoposide, thioguanine, daunomycin, and dexamethasone. The second
chemotherapy cycle, consisting of the same regimen, was started 7 days later.
Presented at at the BC Branch Residency Presentation Night of the Canadian On day 14 of consolidation, patient became febrile neutropenic and was
Society of Hospital Pharmacy, Vancouver, BC, Canada, May 31, 2006. started on vancomycin, cefepime, and fluconazole. Because patient remained
febrile neutropenic despite antibacterial and fluconazole therapy, ambisome
was started and fluconazole discontinued. Patient had multiple episodes of
137E. A nutrition support service Web application to manage parenteral hematemesis, which prompted a Computed Tomography (CT) scan of chest
nutrition patients. Kim D. Hawksworth, [Link]., Jennifer L. Hanje, Pharm.D, to rule out fungal pneumonia. The CT scan showed multiple cavitary lesions
Brett A. Payne, R.D, L.D., Jay M. Mirtallo, M.S., [Link].; The Ohio State bilaterally, most likely representing IA. Cytology from bronchial bushings
University Medical Center, Columbus, OH. revealed presence of fungal organisms suggestive of aspergillosis. Based on
these findings the diagnosis of probable aspergillosis was made (per
Presented at Nutrition Week 2007 of the American Society for Parenteral and EORTC/MSG criteria). Ambisome therapy was discontinued, and CAT with
Enteral Nutrition, Phoenix, AZ, January 28–31, 2007. IV voriconazole and caspofungin was initiated. The patient received CAT for
more than 2 weeks and was discharged home on oral voriconazole. A repeat
138. Evaluation of an ICU calcium replacement protocol. Mary Beth Shirk, CT scan, which was obtained 3 months after initial positive CT, showed
complete resolution of cavitary lesions. The patient was treated with
Pharm.D., Kevin Donahue, B.S., Kelly Reilly, B.S.; The Ohio State University
voriconazole as an outpatient for a total of 9 months with no adverse events.
Medical Center, Columbus, OH.
CONCLUSIONS: Combination antifungal therapy appears promising when
used as salvage treatment for invasive aspergillosis in pediatric patients with
PURPOSE: The decision to treat hypocalcemia intravenously, especially AML.
asymptomatic, must consider risks, such as tissue injury and necrosis with
extravasation and benefits. The objectives of this project were to compare the
frequency of prn calcium (Ca) replacement pre and post protocol 141. Development and implementation of a pharmacist-managed clinical
implementation and to evaluate protocol compliance and effectiveness. pharmacogenetics service. Kristine R. Crews, Pharm.D., Richard E. Mullins,
METHODS: A Ca replacement protocol was developed based on published Ph.D., John McCormick, Pharm.D., Mary V. Relling, Pharm.D.; St. Jude
literature and local expert opinion and implemented in our 25 bed MICU. 4g Children's Research Hospital, Memphis, TN.
Ca gluconate IVPB X1 and 950 mg Ca citrate q12 hours X 6 doses were given
if an ionized Ca (iCa) was < 3.6 mmol/L. 30 pre (1/05 to 5/05) and 30 post This abstract describes the rationale, development, and implementation of a
e34 PHARMACOTHERAPY Volume 27, Number 4, 2007
pharmacist-managed Clinical Pharmacogenetics service at St. Jude Children's study. Forty-four adults who participated in Phase II-III industry-sponsored
Research Hospital. The goal of the service is to provide clinical pharmaco- chronic disease clinical trials were recruited. Scale reliability was evaluated by
genetic testing for gene products important to the pharmacodynamics of calculating the coefficient alpha for each subscale performing item analysis to
medications for our patient population: children with catastrophic diseases. eliminate items that did not contribute meaningfully to the subscale. Linear
The service is an extension of the therapeutic drug monitoring (TDM) regression was subsequently used to model the satisfaction domain as a
function of our clinical pharmacokinetics laboratory. Based on medication function of other domains.
usage and evidence-based criteria, we chose to implement genotyping for 5 RESULTS: Coefficient for seven of the retained eight subscales ranged from
genes as clinical tests: thiopurine methyltransferase (TPMT), cytochrome 0.65 to 0.95. The resulting 38 survey items were found to be psychometrically
P450 2D6 (CYP2D6), CYP2C9, CYP2C19, and uridine glucuronosyl- important. Results of linear regression showed that three domains, informed
transferase 1A1 (UGT1A1), all enzymes that metabolize medications relevant consent, community support, and volunteerism (consisting of 8 items), were
to our patient population. In Fall 2005 we conducted a series of educational significant predictors of satisfaction (2 items) (r2=0.78, p<0.0001).
seminars for our pharmacists to establish competencies in providing CONCLUSIONS: In this pilot project, informed consent, community values
pharmacogenetic consults for these 5 polymorphic genes. We announced to and norms, and volunteerism were predictive of subject satisfaction.
the institution's clinical staff the availability of the pharmacogenetic tests, and Validation using both a 40-item and 10-item survey is currently under way in
the pharmacists' involvement in the ordering, interpretation, and reporting of a larger prospective trial. The goal of the work is to create a validated
results. Insurance reimbursement was established according to the American 3–5-item screening tool to be used by research personnel, to predict the
Medical Association's Current Procedural Terminology codes. Each test volunteer's satisfaction with research at the time of study enrollment.
requires 2–10 mL of whole blood, which is sent to a third-party laboratory for
genotyping. As for all TDM tests at St. Jude, test results are placed in the
electronic medical record accompanied by a patient-specific clinical pharmacy RESIDENTS AND FELLOWS RESEARCH IN
consult. Each consult includes the genotype results, interpretation, and any
recommendations for changes to drug therapy. In the first year of the service, PROGRESS
66 clinical pharmacogenetic tests have been performed, and the service has
been well-received. In the era of personalized drug therapy, clinical 144. Propofol-induced torsades de pointes: a case report. Cindy Chen,
pharmacogenetics services will assist in identifying the most effective and Pharm.D., Bishoy Luka, Pharm.D., Henry Cohen, Pharm.D., Rajat Muckherji,
safest dose of a drug from the outset of therapy. Clinical pharmacists are well- M.D.; Kingsbrook Jewish Medical Center, Brooklyn, NY.
positioned to run these services.

145. Irreversible tenofovir-induced fanconi syndrome. Margarita Gambetta,

142. A multidisciplinary approach to maximize successful weaning of Pharm.D., Catherine Millares, Pharm.D., Bishoy Luka, Pharm.D., Henry
mechanically ventilated patients. Steven B. Levy, Pharm.D., BCPS, CGP1, Cohen, Pharm.D., Sonia Borra, M.D., Constantine Badea, M.D.; Kingsbrook
Carren Samuel, MPA, RRT1, Wilfrid Herard, M.D.1, Maria Arias, RNC, BSN1, Jewish Medical Center, Brooklyn, NY.
Henry Cohen, M.S., Pharm.D., FCCM, BCPP, CGP2; (1)Kingsbrook Jewish
Medical Center, Brooklyn, NY; (2)Arnold & Marie Schwartz College of
Pharmacy and Health Sciences, Brooklyn, NY. 146. Evaluation of vitamin K use and impact on patient care. L. Kathleen
Hamby, Pharm.D, Anne B. Reaves, Pharm.D, Carrie S. Oliphant, Pharm.D,
PURPOSE: To determine how a hospital-wide, multidisciplinary approach to BCPS, Frances Greene-Tate, Pharm.D; Methodist University Hospital,
mechanical ventilation (MV) weaning would have an impact on the number Memphis, TN.
of patients weaned off MV, the total number of ventilatory days, the number
of tracheotomy procedures, and all-cause mortality.
147. Medication-related QTc prolongation in an academic medical center.
METHODS: In January 2006, we implemented a hospital-wide, multi-
Angela R. Wills, Pharm.D., David J. Ritchie, Pharm.D., James M. Hollands,
disciplinary approach for weaning patients from MV. The multidisciplinary
Pharm.D., Scott T. Micek, Pharm.D.; Barnes Jewish Hospital, Saint Louis, MO.
MV weaning team (MVWT) meets weekly and consists of a pulmonologist,
respiratory therapist, clinical nurse manager, and a clinical pharmacist. A
cohorting system was designed for managing MV patients at two specific 148. Assessment of venous thromboembolism prophylaxis utilization and
locations, the intensive care unit and a ventilatory support unit. adherence in an acedemic medical center. Angela R. Wills, Pharm.D., Eli N.
Communication between the MVWT and clinicians providing daily care was Deal, Pharm.D., James M. Hollands, Pharm.D., Scott T. Micek, Pharm.D.;
optimized through co-joint weekly rounds and meticulous daily follow-up Barnes Jewish Hospital, Saint Louis, MO.
from the MVWT. Candidates for weaning were carefully selected and closely
monitored. The most up-to-date, evidence-based guidelines for weaning and
discontinuation of MV were implemented. Strategies included replacement of 149. An observational assessment of the effect of propofol on the incidence
synchronized intermittent mandatory ventilation (SIMV) to continuous of adverse cardiovascular events as compared to benzodiazepines. Jessica L.
positive airway pressure (CPAP) with pressure support ventilation (PSV) Chang, Pharm.D., Keri Roberts, Pharm.D., Toby Trujillo, Pharm.D., BCPS;
and/or daily spontaneous breathing (SB) trials using multiple SB trials Boston Medical Center, Boston, MA.
through a t-piece. All eligible patients received deep vein thrombosis and
stress ulcer prophylaxis. We ensured head elevation to prevent pneumonia, 150. Evaluation of serum biomarkers during ultrafiltration for acute
daily sedation holidays, and daily attempts at ventilator weaning. We decompensated heart failure. Patricia Schuler, Pharm.D., Kerry Pickworth,
compared 5-month outcomes data prior to and after implementing the Pharm.D., Todd Yamokoski, M.S., R.N., CNS, Sondra Sierawski, [Link]., MBA;
MVWT (2005 vs. 2006). The Ohio State University Medical Center, Columbus, OH.
RESULTS: After implementing the MVWT, 44 more patients were weaned
from MV (p=0.035), there were 1,064 less ventilatory days (p=0.004), the
number of tracheotomies decreased by 23 procedures (p>0.05), and all-cause 151. Evaluation of angiotensin converting enzyme-inhibitors' effect on
mortality decreased by 6% (p>0.05). cardiovascular risk reduction in post-myocardial infarction patients with
CONCLUSIONS: Successful weaning from mechanical ventilation can be normal versus elevated cholesterol. Sarah A. Saft, Pharm.D. 1, Sarah T.
maximized by implementing a proactive multidisciplinary team approach Nordmeyer, Pharm.D.2, Julie M. Koehler, Pharm.D.1, Whitney M. Daniel,
using CPAP with PSV and/or daily and multiple SB trials as opposed to SIMV, Pharm.D. Candidate2; (1)Clarian Health Partners, Indianapolis, IN; (2)Butler
and managing ventilator bundles for preventing common comorbid sequelae. University, Indianapolis, IN.

143. A model to predict overall satisfaction of clinical research volunteers: 152. Effect of inappropriate empiric antibiotic therapy on patient morbidity
a pilot study. Jacqueline S. Marinac, Pharm.D.1, Julie Wright, Pharm.D.2, Karen in the treatment of critically ill patients with pneumonia or bacteremia.
B. Williams, Ph.D.2; (1)Kansas City University of Medicine and Biosciences, Jaclyn M. Sauve, Pharm.D., Scott D. Hanes, Pharm.D., Daniel R. Touchette,
Kansas City, MO; (2)University of Missouri at Kansas City, Kansas City, MO. Pharm.D., M.A.; University of Illinois at Chicago, Chicago, IL.

PURPOSE: Being able to meet clinical trial volunteer recruitment and 153. Evaluation of glycemic control following discontinuation of an
retention goals is difficult. Little is known about what motivates adults to intensive insulin protocol. Quinn A. Czosnowski, Pharm.D., Bob Lobo,
volunteer and how they view the experience at the trials' end. The purpose is Pharm.D., BCPS, Joyce Broyles, Pharm.D., BCNSP, Paul Deaton, M.D., Chris
to identify factors predictive of participant satisfaction with clinical research Finch, Pharm.D., BCPS; Methodist Healthcare, Memphis, TN.
using a 5-point Likert scale questionnaire.
METHODS: The 70-item telephone survey used a Likert scale to assess the
eight domains: attitude toward research; knowledge of study methods; 154. Treatment of heparin-induced thrombocytopenia: adherence to ACCP
informed consent; perceived benefits and risks; volunteerism; locus of health guidelines. Amanda M. Howard-Thompson, Pharm., D., Christopher K Finch,
control; community support; religiosity; and, overall satisfaction with the Pharm D., BCPS, Timothy H Self, Pharm D., BCPS, Frank White, M.D., Bob L
 ACCP 2007 SPRING PRACTICE AND RESEARCH FORUM e35
Lobo, Pharm D, BCPS; Methodist University Hospital and University of treatment of hypertension at two outpatient indigent-care clinics. Rebecca C.
Tennessee, Memphis, TN. Boustani, Pharm.D., Kira R. Brice, [Link], Alissa M. Smith,
Pharm.D., Eric F. Schneider, Pharm.D., Stacy L. Martin, Pharm.D.; Carolinas
Healthcare System, Charlotte, NC.
155. A retrospective study of the lipid-lowering efficacy and safety of
switching within non-nucleoside reverse transcriptase inhibitors in HIV-
infected patients. Amy Bain, Pharm.D.1, Kenna Payne, Pharm.D.1, Anita P.
Rahman, Pharm.D.1, Roger Bedimo, M.D., M.S.2, Anthony J. Busti, Pharm.D., STUDENT SUBMISSIONS
BCPS1; (1)Texas Tech University Health Sciences Center, Dallas VA Medical
Center, 4500 South Lancaster Rd, Dallas, TX; (2)The University of Texas 166. Effects of amiodarone on argatroban dosing. Diana Wells, Pharm.D.,
Southwestern Medical Center, Dallas, Texas and the Dallas Veterans Affairs candidate1, Kevin Flynn, Pharm.D., candidate2, Robert L. Page III, Pharm.D.,
Medical Center, Dallas, Texas, Dallas, TX. BCPS2, Anne P. Spencer, Pharm.D., BCPS3; (1)Medical University of South
Carolina, Charleston, SC; (2)University of Colorado School of Pharmacy,
156. A retrospective study of the lipid lowering efficacy and safety of Denver, CO; (3)South Carolina College of Pharmacy, Medical University of
ezetimibe added to HMG-CoA reductase therapy in HIV-infected patients South Carolina campus, Charleston, SC.
with hyperlipidemia. Lisa M. Chastain, Pharm.D.1, Amy Bain, Pharm.D.1,
Krystal L. Edwards, Pharm.D., BCPS1, Roger Bedimo, M.D., M.S.2, Anthony J. 167. A probable decrease in INR with concomitant warfarin and isoniazid
Busti, Pharm.D., BCPS1; (1)Texas Tech University Health Sciences Center therapy. Gabrielle Schicchi, Pharm.D., Candidate, Roda Plakogiannis, B.S.,
School of Pharmacy Dallas/Fort Worth Regional Campus, Dallas, TX; (2)The Pharm.D., BCPS; Arnold & Marie Schwartz College of Pharmacy, Brooklyn, NY.
University of Texas Southwestern Medical Center, Dallas, Texas and the Dallas
Veterans Affairs Medical Center, Dallas, TX.
168. Retrospective analysis of the interaction of warfarin and macrolide
antibiotics. Misty N. Jones, B.S., Pharm.D., candidate 1, Karissa Y. Kim,
157. Impact of a hospital-acquired/ventilator-associated/healthcare- Pharm.D.2; (1)University of Cincinnati College of Pharmacy, Augusta, KY;
associated pneumonia practice guideline on outcomes in surgical trauma (2)University of Cincinnati College of Pharmacy, Cincinnati, OH.
patients. Brian P. Anger, Pharm.D., Cathy L. Worrall, Pharm.D., BCPS, BCNSP,
FAPhA; Medical University of South Carolina, Charleston, SC.
169. A retrospective study of adverse drug reaction causality determination
using electronic vs. hardcopy medical records. Obed M. Nyarenchi, Pharm.D.,
158. Evaluation of ciprofloxacin-resistance among Escherichia coli urinary Student; Texas Southern University College of Pharmacy and Health Sciences,
isolates. Karri Bauer, Pharm.D., Debra Goff, Pharm.D., FCCP; The Ohio State Pearland, TX.
University Medical Center, Columbus, OH.

170. Retrospective analysis of the interaction between warfarin and

159. Antibiotic utilization in children diagnosed with acute otitis media. ciprofloxacin, levofloxacin, and moxifloxacin. Shannon J. Benner-Davis, M.S.,
Michelle L. Mayne, Pharm.D.1, Christopher T. Owens, Pharm.D.2, Tracy K. B.S., Karissa Y. Kim, Pharm.D., CACP; University of Cincinnati College of
Pettinger, Pharm.D. 2, Brooke Pugmire, Pharm.D. 3, Camille M. Nulph, Pharmacy, Cincinnati, OH.
Pharm.D.4, Rex W. Force, Pharm.D., FCCP, BCPS1; (1)Departments of Family
Medicine and Pharmacy Practice and Administration Sciences College of
Pharmacy, Idaho State University, Pocatello, ID; (2)Idaho State University 171. Prescribing practices for maintaining bone health in patients on long-
College of Pharmacy, Pocatello, ID; (3)Departments of Family Medicine and term antiepileptic medications. Jennifer L. Tan, Pharm.D., candidate, Jennifer
Pharmacy Practice, Idaho State University, Pocatello, ID; (4)Departments of Lee, Pharm.D., Devra K. Dang, Pharm.D.; University of Connecticut, Storrs,
Family Medicine and Pharmacy Practice and Administrative Sciences College CT.
of Pharmacy, Idaho State University, Pocatello, ID.
172. Patient satisfaction at a pharmacist-managed anticoagulation clinic
160. Assessment of safety with abbreviated, weight-based bevacizumab compared with physician-managed anticoagulation care. Stephanie
infusions. Jim W. Hart, Pharm.D., Jose R. Murillo, Jr., B.S., Pharm.D., Michael Baringhaus, [Link] 1 , Kristyn Laban, [Link] 1 ,
S. Oholendt, Pharm.D., BCOP, H. Alejandro Preti, M.D., P.A.; The Methodist Candice L. Garwood, Pharm.D.1, Peter Dumo, Pharm.D.2; (1)Wayne State
Hospital, Houston, TX. University, Detroit, MI; (2)Harper University Hospital, Detroit, MI.

161. Predictive factors for ifosfamide-induced neurotoxicity in soft tissue 173. Pharmacists' perceived knowledge and level of comfort with selected
sarcoma: a case-control study. Karen I. Sweiss, Pharm.D., Rakesh Beri, pediatric issues. Stephanie Baringhaus, [Link] 1 , Paul J.
Pharm.D., BCOP, Stacy Shord, Pharm.D., BCOP; University of Illinois at Munzenberger, M.S., Pharm.D. 1, Victoria Tutag Lehr, Pharm.D. 1, Ronald
Chicago College of Pharmacy, Chicago, IL. Thomas, Ph.D.2; (1)Eugene Applebaum College of Pharmacy and Health
Sciences, Wayne State University, Detroit, MI; (2)Department of Pediatrics,
Children's Hospital of Michigan, Detroit, MI.
162. Evaluation of hypertension induced by bevacizumab in oncology
patients. Patricia A. Rayner, Pharm.D., Chin Y. Liu, Pharm.D., BCOP;
Karmanos Cancer Center, Detroit, MI. 174. A retrospective analysis of the safety of aprotinin use in patients
undergoing coronary artery bypass grafting surgery. Charles P. Lawrence,
Pharm.D., Candidate, Jessica Starr, Pharm.D., BCPS; Auburn University,
163. Erythropoietin for anemia of prematurity and the risk of severe Birmingham, AL.
retinopathy of prematurity in extremely low birth weight infants. Jacqueline
K. Schneider, Pharm.D., Debra K. Gardner, Pharm.D., Leandro Cordero, M.D.;
The Ohio State University Medical Center, Columbus, OH. 175. An evaluation of the effects of over-the-counter triglyercide-lowering
agents on LDL concentration, particle size, and particle number. Dawn
Harris, Pharm.D., candidate, Kristal Williams, Pharm.D.; Butler University
164. Vancomycin dosing in the pediatric population aimed at achieving College of Pharmacy and Health Sciences, 1520 N Senate Ave, Indianapolis, IN.
trough concentrations of 10–20 µg/ml. Rachel B. Sykes, Pharm.D., Elizabeth
A. Farrington, Pharm.D., FCCP, BCPS; University of North Carolina
Hospitals, Chapel Hill, NC. 176. Patient outcomes associated with adherence to national clinical
performance measures for hospitalized patients with acute myocardial
infarction. Glenn F. Woning II, Pharm.D., Candidate, Jason M. Cota, Pharm.D.,
165. Off-label use of a long-acting inhaled corticosteroid/b2 -agonist BCPS, Monica L. Miller, Pharm.D., Christopher R. Frei, Pharm.D., [Link].,
combination in a Medicaid population. Camille M. Nulph, Pharm.D.1, Brooke BCPS, Robert L. Talbert, Pharm.D., FCCP, BCPS; The University of Texas at
Pugmire, Pharm.D.2, Michelle L. Mayne, Pharm.D.1, Christopher T. Owens, Austin College of Pharmacy and The University of Texas Health Science
Pharm.D., BCPS3, Rex W. Force, Pharm.D., FCCP, BCPS1; (1)Departments of Center at San Antonio, San Antonio, TX.
Family Medicine and Pharmacy Practice and Administrative Sciences College
of Pharmacy, Idaho State University, Pocatello, ID; (2)Departments of Family
Medicine and Pharmacy Practice, Idaho State University, Pocatello, ID; 177. The pharmacist shortage in California: the aggregate demand index
(3)Idaho State University College of Pharmacy, Pocatello, ID. by county. Crystal J. Canlas, B.S., Charlene K. Chiu, B.S., Ani Deukmedjian,
B.S., James Dinh, B.S., Sandeep Kaur, B.S., Daria Kusior, B.S., Kelly D. Le, B.S.,
Vinhkhoa Nguyen, B.S., Joshua Speck, B.S., Laura Valencia, B.S.; Touro
206. Drug use evaluation: evaluating the use of amlodipine for the University - College of Pharmacy, Mare Island, CA.
e36 PHARMACOTHERAPY Volume 27, Number 4, 2007
178. Development and implementation of an interprofessional team case virulence and treatment failure. Sonya Chhatwal, [Link],
competition among health professional students. R. Mackenzie Turner, Vanthida Huang, Pharm.D.; Mercer University College of Pharmacy and
Pharm.D., candidate, Brianne Dunn, Pharm.D. candidate, Alexander C. Health Sciences, Department of Clinical and Administrative Sciences, Atlanta,
Whitley, Ph.D, Cathy L. Worrall, Pharm.D., BSN; Medical University of South GA.
Carolina, Charleston, SC.
190. Influence of anti-emetic guidelines on anti-emetic prescribing for
179. Thiazolidinedione durability in the treatment of type 2 diabetes chemotherapy patients in a community hospital. Jimmy Emmanuel, B.S.,
mellitus. Andrea Searle, Student1, Michael P. Kane, Pharm.D.1, Robert S. Pharmacy1, Kathy Fuller, Pharm.D.2, Adel Eltantawy, Pharm.D.1; (1)Memorial
Busch, M.D.2, Gary Bakst, M.D.2, Robert A. Hamilton, Pharm.D.1, Jeffrey Hospital West, Pembroke Pines, FL; (2)Nova Southeastern University, College
Stroup, Pharm.D.3; (1)Albany College of Pharmacy, Albany, NY; (2)The of Pharmacy, Ft. Lauderdale, FL.
Endocrine Group, Albany, NY; (3)University of Oklahoma College of
Pharmacy, Tulsa, OK.
191. Incidence of Candida infections in pediatric patients receiving
parenteral nutrition. Megan R. Stapleton, B.S., Chasity M. Shelton, Pharm.D.,
180. Evaluation of adherence rates to American Diabetes Association Catherine M. Crill, Pharm.D.; The University of Tennessee Health Science
(ADA) treatment guidelines for use of angiotensin converting enzyme Center, Memphis, TN.
inhibitors or angiotensin receptor blockers in patients with type-1 diabetes
and microalbuminuria or macroalbuminuria. Kimberly J. Seidman, M.S.,
Kathy E. Fit, Pharm.D.; Midwestern University - Chicago College of 192. Developing a protocol for the initial evaluation of HIV/AIDS
Pharmacy, Downers Grove, IL. medication therapy management service pilot program in California. Ashley
Rosenquist, Pharm.D., Candidate, Jan D. Hirsch, Ph.D..; University of
California, San Diego Skaggs School of Pharmacy and Pharmaceutical
181. Physicians' habits pertaining to late life depression assessment. Sheena Sciences, San Diego, CA.
Sanders, Pharm.D., Candidate, Kristal Williams, Pharm.D.; Butler University
College of Pharmacy and Health Sciences, Indianapolis, IN.
193. Comparison of drug-related problems in nursing home residents
versus non-nursing home Medicaid patients. Abril S. Atherton, B.S.1, Joanne
182. Implementation of medication therapy management services (MTMS) LaFleur, Pharm.D., MSPH2, Brian Mayeda, B.S.3, Lynda Oderda, Pharm.D.2,
in a rural family medicine Alabama practice. Jacqueline T. Pham, B.S.1, Gary M. Oderda, Pharm.D., MPH2; (1)University of Utah, Taylorsville, UT;
Heather P. Whitley, Pharm.D., BCPS2; (1)Auburn University, Harrison School (2)Pharmacotherapy Outcomes Research Center, Salt Lake City, UT;
of Pharmacy, Birmingham, AL; (2)Auburn University, Harrison School of (3)University of Utah, Salt Lake City, UT.
Pharmacy, Tuscaloosa, AL.
194. Pharmacoeconomic impact of ropivacaine and fentanyl epidurals.
183. Influences of International Normalized Ratio fluctuation in African Brandon Deterding, Pharm.D., candidate1, Vijaya L. Duggirala, M.D.2, John D.
Americans taking warfarin. Jonathan L. Aston, B.S.1, Kathryn M. Momary, Bridges, [Link]. 2, Cindy Nettle, Pharm.D. 2; (1)University of Mississippi,
Pharm.D.2, Nancy L. Shapiro, Pharm.D.2, Larisa H. Cavallari, Pharm.D.2; Oxford, MS; (2)Baptist Memorial Hospital for Women, Memphis, TN.
(1)University of Illinois at Chicago College of Pharmacy, Oak Park, IL;
(2)University of Illinois at Chicago College of Pharmacy, Chicago, IL.
195. Serotonin-norepinephrine reuptake inhibitor utilization for non-
depression indications. Jesse Owen, Pharm.D., Candidate, Christopher T.
184. Multivariate analysis of factors influencing the pharmacokinetics of Owens, Pharm.D., BCPS, Brooke Pugmire, Pharm.D.; Idaho State University
nevirapine in HIV-1 infected children receiving highly active anti-retroviral College of Pharmacy, Pocatello, ID.
therapy. Elizabeth M. Sarles, BS1, Akihiko Saitoh, M.D.1, Francesca Aweeka,
Pharm.D.2, Andrea Kovacs, M.D.3, Sandra Burchett, M.S., M.D.4, Andrew
Wiznia, M.D.5, Sharon Nachman, M.D.6, Terence Fenton, Ed.D.7, Stephen A. 196. Utilization of migraine prophylaxis in a Medicaid population. Kimball
Spector, M.D.1, Edmund Caparelli, Pharm.D.1; (1)University of California San Owens, Pharm.D., Candidate, Christopher T. Owens, Pharm.D., BCPS, Brooke
Diego, La Jolla, CA; (2)University of California San Francisco, San Francisco, Pugmire, Pharm.D.; Idaho State University College of Pharmacy, Pocatello, ID
CA; (3)University of Southern California, Los Angeles, CA; (4)Harvard
Medical School, Boston, MA; (5)Jacobi Medical Center, Bronx, NY; (6)State 197. Cost-analysis of anti-epileptic drugs (AED): Impact of addition of
University of New York at Stony Brook Health Science Center, Stony Brook, pregabalin to a Medicaid preferred drug list (PDL). Michael E. Bolin, M.S.;
NY; (7)Harvard School of Public Health, Boston, MA. Florida A&M University, Tallahassee, FL.

185. Pharmacokinetic evaluation of weight-band dosing strategy for 198. Analysis of cardiovascular events among patients with diabetes:
lopinavir/ritonavir in a simulated pediatric HIV population. Ivy J. Beck, Implications of removing atorvastatin from the Florida Medicaid preferred
B.S.1, Edmund Capparelli, Pharm.D.2, Mark W. Kline, M.D.3, Elaine J. Abrams, drug list (PDL). Michael E. Bolin, M.S.; Florida A&M University, Tallahassee,
M.D. 4 ; (1)Skaggs School of Pharmacy and Pharmaceutical Sciences, FL.
University of California, San Diego, La Jolla, CA; (2)Pediatric Pharmacology
Research Unit, University of California at San Diego, La Jolla, CA; (3)Baylor
College of Medicine, Houston, TX; (4)Columbia Univeristy, New York, NY. 199. Changes in utilization patterns for lipid lowering agents following
removal of atorvastatin from a medicaid preferred drug list (PDL). Michael
E. Bolin, M.S.; Florida A&M University, Tallahassee, FL.
186. The impact of levofloxacin exposure on the likelihood of resistance
emergence in Pseudomonas aeruginosa. Amy N. Schilling, B.S., Kai-Tai Chang,
Ph.D., Vincent Tam, Pharm.D.; University of Houston College of Pharmacy, 200. Evaluation of intravenous immunoglobulin utilization in King Khalid
Houston, TX. University Hospital, Riyadh, Saudi Arabia. Mohammed H. Abutaleb, [Link].,
Candidate1, Ahmed A. Albarraq, Pharm.D.2, Abdullatif A. Al-Dhowailie,
Ph.D..1; (1)King Saud University, College of pharmacy, Riyadh, Saudi Arabia;
187. Antimicrobial use among hospitalized patients: a pilot pharmaco- (2)King Saud University Hospital, Riyadh, Saudi Arabia.
epidemiologic study. Christine U. Oramasionwu, Pharm.D., Candidate,
Christopher R. Frei, Pharm.D., [Link]., BCPS; The University of Texas at
Austin College of Pharmacy and The University of Texas Health Science 201. The evaluation of prescribing patterns of mirtazapine for weight gain.
Center at San Antonio, San Antonio, TX. Carmela Avena, [Link], [Link], Lisa Charneski, Pharm.D.,
BCPS, Olga Hilas, Pharm.D., BCPS; St. John's University, Queens, NY.
188. Relationship between clarithromycin minimum inhibitory concen-
tration and survival in a pneumococcal murine lung infection model. 202. An evaluation of benzodiazepine prescribing for the treatment of
Stephanie A. Knechtel, Pharm.D., Candidate1, Michael E. Klepser, Pharm.D.1, alcohol withdrawal. Lena Kuruvilla, [Link], Lisa Charneski,
Erika J. Ernst, Pharm.D.2, Douglas Keele, D.O.2, Ellen Roling, D.O.2, Loai Pharm.D., BCPS, Olga Hilas, Pharm.D., BCPS; St. John's University, Queens,
Sa'adah, M.S.2, Gary V. Doern, M.D.3; (1)Ferris State University, Kalamazoo, NY.
MI; (2)Universiy of Iowa, Iowa City, IA; (3)University of Iowa, Iowa City, IA.
203. Herbal and dietary supplement use in older American women. Linda L.
189. Evaluate the prevalence of heteroresistance in community-associated Chang, Pharm.D., Candidate1, Claudine W. Shinoff, Ph.D.2, Lily Lui, N/A2,
methicillin-resistant Staphylococcus aureus isolates in an era of increased Francesmary Modugno, Ph.D., M.P.H.3, Doug C Bauer, M.D.2; (1)University of
 ACCP 2007 SPRING PRACTICE AND RESEARCH FORUM e37
California, San Francisco, San Jose, CA; (2)San Francisco Coordinating 205. Comparison of ritonavir adherence in HIV-infected children as
Center, San Francisco, CA; (3)University of Pittsburgh Graduate School of estimated by population pharmacokinetics and by a patient questionnaire.
Public Health, Pittsburgh, PA. Xiaoying Quan, Pharm.D., Candidate, 2009 1, Jame R. Lane, Pharm.D. 2,
Edmund Capparelli, Pharm.D.3, Sandra Burchett, M.S., M.D.4, Andrea Kovacs,
M.D.5, Vincent Carey, Ph.D.6; (1)University of California, San Diego, Skaggs
204. Thiopurine methyltransferase genotype predicts thiopurine School of Pharmacy and Pharmaceutical, La Jolla, CA; (2)UC San Diego
metabolites in children with acute lymphoblastic leukemia. Danielle M. Medical Center - Hillcrest, San Diego, CA; (3)University of Calfornia, San
Briones, Pharm, D., candidate1, John McCormick, Pharm.D.2, Mary V. Relling, Diego, Skagg's School of Pharmacy & Pharmaceutical Sciences, La Jolla, CA;
Pharm.D.2, William E. Evans, Pharm.D.2, Ching-Hon Pui, M.D.2, Kristine R. (4)Harvard Medical School, Boston, MA; (5)University of Southern
Crews, Pharm.D.2; (1)University of Tennessee College of Pharmacy, Memphis, California, Los Angeles, CA; (6)Harvard School of Public Health, Boston, MA.
TN; (2)St. Jude Children's Research Hospital, Memphis, TN.
e38 PHARMACOTHERAPY Volume 27, Number 4, 2007
2007 ACCP Spring Practice and Research Forum Abstracts

Index of Corresponding Authors

-A- for lipid lowering agents following removal of prevention of infectious complications following
atorvastatin from a medicaid preferred drug list. cardiac surgery. 10
Abraham Teena: Iloprost improves cardiac 199 Costello Jennifer L: Successful treatment of
hemodynamic parameters of pulmonary Bolin Michael E: Cost-analysis of anti-epileptic invasive aspergillosis utilizing combination
hypertension in open heart surgery. 117 drugs: impact of addition of pregabalin to a antifungal therapy in a pediatric patient with
Abutaleb Mohammed H: Evaluation of Medicaid preferred drug list. 197 hematologic malignancy. 140
intravenous immunoglobulin utilization in King Boudreau Marybeth: Diagnosing and testing for Cota Jason M: Patient outcomes associated with
Khalid University Hospital, Riyadh, Saudi heparin induced thrombocytopenia. 127 adherence to national clinical performance
Arabia. 200 Boustani Rebecca C: Drug use evaluation: measures for hospitalized patients with acute
Adcock Kim G: The influence of assent document evaluating the use of amlodipine for the myocardial infarction. 176
format on children’s comprehension. 72 treatment of hypertension at two outpatient Crews Kristine R: Development and implemen-
Aird Bruce A: The compatibility of Vitrase ® indigent-care clinics. 206 tation of a pharmacist-managed clinical
combined with Kenalog®. 29E Brackbill Marcia L: Frequency of CYP3A4 variant pharmacogenetics service. 141
Alafris Antonia: A multidisciplinary approach in alleles in cardiovascular patients on clopidogrel Crill Catherine M: Incidence of Candida infec-
developing a policy for the proper handling of that experience repeat acute coronary events. 84 tions in pediatric patients receiving parenteral
oral chemotherapy agents and pregnancy Bradbury Brian: Predictors of ESP use in patients nutrition. 191
category X medications. 133 with chronic kidney disease and anemia. 80E Cronin Jamie L: A pharmacy-run vaccine
Alomi Yousef Ahmed: Clinical pharmacist Brewer Jeffrey M: The contribution of a pharmacy screening program improves the immunization
activities in Riyadh City, Saudi Arabia. 20E rate of high-risk adults. 99
clinic on productivity in a private physician
Alomi Yousef Ahmed: Documentation pattern of Czosnowski Quinn A: Evaluation of glycemic
practice. 101
clinical pharmacist interventions, Riyadh, Saudi control following discontinuation of an
Briones Danielle M: Thiopurine methyltransferase
Arabia. 82E intensive insulin protocol. 153
genotype predicts thiopurine metabolites in
Alomi Yousef Ahmed: Pharmacist intervention in
children with acute lymphoblastic leukemia.
critical care unit at Security Forces Hospital,
204 -D-
Riyadh, Saudi Arabia. 21E
Brophy Gretchen M: Erythropoiesis-stimulating
Alomi Yousef Ahmed: Prescribing errors at
protein prescribing practices in intensive care Dalpiaz Anthony S: Cost effectiveness analysis of
inpatient pharmacy, Riyadh, Saudi Arabia. 83E
unit patients. 22 high-dose consensus interferon plus ribavirin
Aston Jonathan L: Influences of International
Brown Rex O: Aluminum exposure in adult versus PEG-interferon afa-2a plus ribavirin in
Normalized Ratio fluctuation in African
patients with acute renal failure requiring hepatitis C non-responders. 36
Americans taking warfarin. 183
Atherton Abril S: Comparison of drug-related parenteral nutrition. 60E Dement Cathy: Evaluation of osteoporosis
problems in nursing home residents versus non- prevention in chronic users of glucocorticoids at
nursing home Medicaid patients. 193 -C- an Army community hospital. 114E
Avena Carmela: The evaluation of prescribing Dement Cathy: Metoprolol succinate usage by
patterns of mirtazapine for weight gain. 201 Carswell Jody L: Comparing the efficacy and PCMs at an Army community hospital. 113E
tolerability of labetalol and nicardipine in stroke Deterding Brandon: Pharmacoeconomic impact of
patients. 56 ropivacaine and fentanyl epidurals. 194
-B- Chahine-Chakhtoura Corinne: Acid suppressive Dickerson Roland N: Dose-dependent charac-
agents use in the general medicine unit. 124 teristics of intravenous calcium therapy for
Bain Amy: A retrospective study of the lipid
Chang Jessica L: An observational assessment of hypocalcemic critically ill trauma patients. 26E
lowering efficacy and safety of switching within
the effect of propofol on the incidence of Dickerson Roland N: Low serum total calcium
non-nucleoside reverse transcriptase inhibitors
adverse cardiovascular events as compared to concentration as a risk factor for predicting
in HIV-infected patients. 155
benzodiazepines. 149 hypocalcemia in critically ill patients. 27E
Baringhaus Stephanie: Patient satisfaction at a
Chang Linda L: Herbal and dietary supplement Dickerson Roland N: Treatment of moderate to
pharmacist-managed anticoagulation clinic
use in older American women. 203 severe acute hypocalcemia in critically ill
compared with physician-managed
anticoagulation care. 172 Chastain Lisa M: A retrospective study of the lipid trauma patients. 25E
Baringhaus Stephanie: Pharmacists’ perceived lowering efficacy and safety of ezetimibe added Doung Sheryl E: Combined citrate anticoagulation
knowledge and level of comfort with selected to HMG-CoA reductase therapy in HIV-infected and bicarbonate containing dialysate in
pediatric issues. 173 patients with hyperlipidemia. 156 continuous venovenous hemodiafiltration. 53E
Bauer Karri: Evaluation of ciprofloxacin- Chen Cindy: Propofol-induced torsades de Draper Heather M: Adherence with advanced
resistance among Escherichia coli urinary pointes: a case report. 144 cardiac life support guidelines during in-
isolates. 158 Chen Jack J: Rasagiline is effective and well hospital cardiac arrest: a role for clinical
Baumhover Stephanie A: Defining an argatroban tolerated as adjunct therapy in Parkinson’s pharmacy. 4
therapeutic range in a large community hospital. disease patients receiving levodopa and
128 entacapone. 55 -E-
Beck Ivy J: Pharmacokinetic evaluation of weight- Chen Jack J: Rasagiline is safe and well tolerated
band dosing strategy for lopinavir/ritonavir in a in Parkinson’s disease patients with levodopa- Earhart Kelly D: Activation of transcriptional
simulated pediatric HIV population. 185 related motor fluctuations receiving serotonin regulatory networks associated with azole
Benner-Davis Shannon J: Retrospective analysis of reuptake inhibitors. 54 antifungal resistance in clinical isolates of
the interaction between warfarin and Chisholm Marie A: Associations of characteristics Candida glabrata . 43
ciprofloxacin, levofloxacin, and moxifloxacin. of renal transplant recipients with clinicians’ Edick Cathleen: Gaining efficiency in a family
170 perceptions of adherence to immunosuppressant medicine residency program through appropriate
Bizien Marcel D: Identification and care of non- therapy. 96 formulary utilization. 123
obese, non-diabetic patients with metabolic Chiu Charlene K: The pharmacist shortage in Edick Cathleen: The impact of a pharmacist-
syndrome in a large, tertiary care center. 18 California: the aggregate demand index by assisted anticoagulation protocol on INR control
Black Libby: Comparison of adherence to fixed county. 177 in a family medicine residency program. 122
dose combination versus free-prescribed Choy Mary: Implementation of a pharmacist-run El-Lababidi Rania M: The efficacy of vancomycin
therapy. 126 lipid clinic in a Veterans Affairs medical center. compared to metronidazole in the treatment of
Bolin Michael E: Analysis of cardiovascular events 107 Clostridium difficile-associated diarrhea. 46
among patients with diabetes: implications of Coleman Craig I: Does dosing intensity effect a Elewa Hazem F: Controlled blood pressure
removing atorvastatin from the Florida statin’s ability to reduce post-cardiac surgery lowering after experimental cerebral ischemia
Medicaid preferred drug list. 198 atrial fibrillation? 9 provides neurovascular protection. 14E
Bolin Michael E: Changes in utilization patterns Coleman Craig I: Preoperative statins for the Ellis Jennifer M: Empiric monotherapy for febrile
 ACCP 2007 SPRING PRACTICE AND RESEARCH FORUM e39
neutropenia in children: a meta-analysis. 75 -I- Levin Nathan: Continuous erythropoietin
Emmanuel Jimmy: Influence of anti-emetic receptor activator: efficacy results of six global
guidelines on anti-emetic prescribing for Ilyas Bushra S: Arterial stiffness and renal phase III studies on anemia of chronic kidney
chemotherapy patients in a community hospital. function in patients with coronary artery disease. 52
190 disease. 8E Levy Steven B: A multidisciplinary approach to
Ernst Erika J: Evaluation of guideline adherence maximize successful weaning of mechanically
and length of stay in the treatment of febrile ventilated patients. 142
neutropenia in pediatric and adult patients. 63 -J- Linnebur Sunny A: Do plant sterols provide
additional cholesterol reduction when added to
Jacobs Tibb F: The role of the pharmacist in an statin-based combination therapy? 34E
-F- ambulatory pain management clinic. 111 Lobo Bob: Incidence and risk factors for upper
Jennings Heath R: Confirmation of renal events extremity thrombosis in hospitalized patients
Finks Shannon W: Inappropriate use of sotalol in
following the use of antifibrinolytic therapy with peripherally inserted central catheters. 2
renal insufficiency: a need for clinical
during on-pump coronary artery bypass graft Locke Kristen E: Utilization of a group clinic for
pharmacist intervention. 116
surgery. 15 the management of dyslipidemia. 104
Fishbane Steven: Safety and tolerability of
C.E.R.A. (continuous erythropoietin receptor Jennings Heath R: Reducing adverse drug events,
activator) in patients with chronic kidney inpatient length of stay, and hospital costs
through an inpatient pharmacist anticoagulation -M-
disease: pooled data from ten phase II-III trials.
49 program. 16
Machado Livia S: Delayed minocycline is an
Fit Kathy E: A pharmacist-managed smoking Johnson Franklin: Concomitant ingestion of
inhibitor of MMPs activated by stroke:
cessation program in an ambulatory care clinic: tested levels of alcohol with polymer-coated
implications for neurovascular protection. 57
a pilot program. 102 extended-release morphine sulfate capsules: no
Maki Erik D: Cost comparison of intravenous
Fit Kathy E: Documentation of student significant impact on mean morphine blood
versus oral n-acetylcysteine for the treatment of
pharmacists’ interventions from medication levels. 68
acetaminophen toxicity in a community public
histories in ambulatory care. 103 Johnson Franklin: Morphine release profile is not hospital. 94
Frank Heather R: Outcomes in febrile neutropenia altered in a formulation containing polymer- Marrs Joel C: Dyslipidemia control in an indigent
oncology patients with hyperglycemia. 64 coated extended-release morphine sulfate plus population with medication assistance
Franks Amy M: Pharmacist-provided metabolic sequestered naltrexone. 85 compared to an insured population. 17
syndrome screening and educational program Johnson Peter N: Utilization of prescription Mason Kimberly C: Implementation of a hospital
reduces prevalence of cardiometabolic risk records to assess the risk of developing protocol for the use of perflutren lipid
factors. 7E community-acquired methicillin-resistant microspheres (Definity®) in echocardiographic
Frei Christopher R: Antimicrobial use among Staphylococcus aureus infections in children. 74 procedures. 118
hospitalized patients: a pilot pharmaco- Jones Misty N: Retrospective analysis of the Massanari Marc: Effect of omalizumab on
epidemiologic study. 187 interaction of warfarin and macrolide measures of control in adolescents with
antibiotics. 168 moderate-severe persistent asthma. 73E
Jones Suzanne: Administration of panitumumab Mayne Michelle L: Antibiotic utilization in
-G- every two weeks as a 30-minute or 60-minute children diagnosed with acute otitis media. 159
infusion: safety and pharmacokinetics from a McKenzie R Scott: Drug utilization and cost
Gambetta Margarita: Irreversible tenofovir-
phase 1 study in patients with solid tumors. 65E considerations of erythropoietic stimulating
induced Fanconi syndrome. 145
Garwood Candice L: Quality of anticoagulation agents in cancer patients from a large managed-
care in stable patients discharged from a -K- care database. 79E
pharmacist-managed anticoagulation clinic. 37 McKenzie R Scott: Hematologic outcomes and
Goldberg Ronald B: Colesevelam HCl improves Kamal Sheri: Drug information and pharmacy erythropoiesis-stimulating therapy costs in
glycemic control in type 2 diabetes mellitus resource services in Egypt. 31 epoetin alfa and darbepoetin alfa-treated cancer
subjects managed with insulin therapy. 33E Kamal Sherif: Clinical pharmacy in Egypt. 139 patients: results of the dosing and outcomes
Grice Gloria R: Warfarin-dose adjustment after Kane Michael P: Thiazolidinedione durability in study of ESTs (D.O.S.E. registry). 78E
orthopedic surgery. 38 the treatment of type 2 diabetes mellitus. 179 McKinzie Brian: Impact of elevated percent
Keeley Kendra A: Pharmacy involvement in camp carbohydrate-deficient transferrin at hospital
huff n’ puff. 121 admission on outcomes in trauma patients. 92
-H- Keller Amanda: An evaluation of the Asthma Michelini Theresa: Efficacy and safety of
Hamby L Kathleen: Evaluation of vitamin k use Control Test (ACT™) as a tool to monitor panitumumab across five clinical studies in
and impact on patient care. 146 asthma in a Veteran’s Affairs primary care clinic. patients with metastatic colorectal cancer. 67E
Hanes Scott D: Risk factors for mortality in 100 Miller April D: Response to oral metronidazole
critically ill patients receiving appropriate or Klepser Teresa B: Development of an asthma for Clostridium difficile-associated diarrhea. 42
inappropriate empiric antibiotic therapy for shared medical appointment. 108 Min David I: Voriconazole-sirolimus interaction
pneumonia or bacteremia. 28E Klepser Teresa B: Medication reconciliation by a in kidney transplant patients. 98
Harris Dawn: An evaluation of the effects of over- clinical pharmacist in a cerebral palsy clinic. Mohammad Rima A: Octreotide verses octreotide
the-counter triglyceride: lowering agents on 110 and continuous infusion pantoprazole in the
LDL concentration, particle size, and particle Klepser Teresa B: Pharmacist managed dietary treatment of variceal hemorrhage. 24
number. 175 supplement clinic. 109 Mueller Eric W: Retrospective evaluation of
Hart Jim W: Assessment of safety with abbre- Knechtel Stephanie A: Relationship between recombinant activated factor VII in surgical
viated, weight-based bevacizumab infusions. clarithromycin minimum inhibitory concen- patients with nonhemophilia-related hemorrhage.
160 tration and survival in a pneumococcal murine 23
Hawksworth Kim D: A nutrition support service lung infection model. 188 Murphy John E: Research experiences and
Web application to manage parenteral nutrition Kuruvilla Lena: An evaluation of benzodiazepine research-related coursework in the education of
patients. 137E prescribing for the treatment of alcohol entry-level doctors of pharmacy: a nine year
Henry David H: The patient’s experience of withdrawal. 202 update. 32
fatigue: a cross-sectional study of cancer Kuth John C: Analysis of a multidisciplinary
patients. 62E approach to pneumococcal vaccine screening
-N-
Howard-Thompson Amanda M: Treatment of and administration at a teaching hospital. 130
heparin-induced thrombocytopenia: adherence Newnham Mark A: Application of failure mode
to ACCP guidelines. 154 -L- effect and criticality analysis and its impact on
Huang Vanthida: Evaluate the prevalence of surgical site infections. 131
heteroresistance in community-associated LaFleur Joanne: Identification and categorization Nulph Camille M: Off-label use of a long-acting
methicillin-resistant Staphylococcus aureus of drug-related problems among Medicaid inhaled corticosteroid/‚2-agonist combination in
isolates in an era of increased virulence and patients: variability between pharmacist a Medicaid population. 165
treatment failure. 189 reviewers. 125 Nyarenchi Obed M: A retrospective study of
Hudson Joanna Q: Evaluation of clinical methods Le Mytrang K: Utilization of bivalirudin plus adverse drug reaction casualty determination
to assess kidney function in African-Americans. eptifibatide in patients undergoing elective using electronic vs. hardcopy medical records.
50E percutaneous coronary intervention. 115 169
e40 PHARMACOTHERAPY Volume 27, Number 4, 2007
-O- converting enzyme-inhibitors’ effect on Sykes Rachel B: Vancomycin dosing in the
cardiovascular risk reduction in post-myocardial pediatric population aimed at achieving trough
Okamoto Mark P: Evaluation of the cost- infarction patients with normal versus elevated concentrations of 10 to 20 mcg/mL. 164
effectiveness of vancomycin and linezolid in cholesterol. 151 Sylvester Robert K: An evaluation of the
Methicillin-resistant Staphylococcus aureus skin Sandherr Alison: Double blind, randomized bioavailability of methadone administered
and soft tissue infection using a decision clinical trial to evaluate the effectiveness of topically. 69
analysis model. 77 ezetimibe 5 mg versus ezetimibe 10 mg when
added to statin therapy. 6E
-T-
-P- Sarles Elizabeth M: Multivariate analysis of
factors influencing the pharmacokinetics of Taing Samantha: Evaluation of empiric antibiotic
Pallares Maria Jose: Barriers to adherence with nevirapine in HIV-1 infected children receiving use in the treatment of health care-associated
clopidogrel following placement of drug eluting highly active anti-retroviral therapy. 184 pneumonia. 132E
stents. 19 Sauve Jaclyn M: Effect of inappropriate empiric Tam Vincent H: Prevalence and mechanisms of
Patel Jignesh H: 2-Hydroxypropyl beta antibiotic therapy on patient morbidity in the carbapenem resistance in bloodstream isolates
cyclodextrin transmembrane clearance during in treatment of critically ill patients with of Pseudomonas aeruginosa. 48E
vitro continuous venovenous hemodialysis. 51 pneumonia or bacteremia. 152 Tam Vincent H: The impact of multi-drug
Pham Jacqueline T: Implementation of Scarpace Sarah L: Administration of greater than resistance on the outcomes of critically ill
medication therapy management services in a 2 cycles of fludarabine increases the risk of patients with Gram-negative bacterial
rural family medicine Alabama practice. 182 infection independent of other risk factors. 66 pneumonia. 47E
Phillips Amy L: Assessment of physician Schicchi Gabrielle: A probable decrease in INR Tan Jennifer L: Prescribing practices for
prescribing for primary care patients with with concomitant warfarin and isoniazid maintaining bone health in patients on long-
chronic obstructive pulmonary disease in a therapy. 167 term antiepileptic medications. 171
national electronic medical research database. Schilling Amy N: The impact of levofloxacin Thomas Jeremy L: Evaluation of intensive dietary
89E exposure on the likelihood of resistance education in patients receiving chronic oral
Pugmire Brooke: Serotonin-norepinephrine emergence in Pseudomonas aeruginosa. 186 anticoagulation. 40
reuptake inhibitor utilization for non-depression Schneider Jacqueline K: Erythropoietin for Thompson Amy N: Evaluation of patient
indications. 195 anemia of prematurity and the risk of severe perceptions and outcomes related to
Pugmire Brooke: Utilization of migraine retinopathy of prematurity in extremely low anticoagulation point-of-care testing in
prophylaxis in a Medicaid population. 196 birth weight infants. 163 ambulatory care clinics. 5
Schuler Patricia: Evaluation of serum biomarkers
during ultrafiltration for acute decompensated
-Q- -V-
heart failure. 150
Quan Xiaoying: Comparison of ritonavir Scott James D: 48-Week results of a stable switch
Vazquez Sara R: Anticoagulation clinic workflow
adherence in HIV-infected children as estimated study: changing combivir to tenofovir/
analysis. 129
by population pharmacokinetics and by a emtricitabine. 41
Vincent Philippe: Evaluation of factors
patient questionnaire. 205 Seidman Kimberly J: Evaluation of adherence
influencing enoxaparin bioavailability in
rates to American Diabetes Association (ADA)
critically ill patients. 88E
treatment guidelines for use of angiotensin
-R- converting enzyme inhibitors or angiotensin
receptor blockers in patients with type-1 -W-
Ramser Kristie: Evaluation of the appropriate use
diabetes and microalbuminuria or
of proton pump inhibitor therapy in an Wang Junling: The medical expenditures among
macroalbuminuria. 180
ambulatory Medicaid population. 106 childhood cancer patients/survivors at different
Shah Chhaya: Lipoprotein particle size,
Ramser Kristie: Implementation and evaluation of time since diagnoses. 71
concentration and lipid ratio effects of
a pharmacist-managed diabetes consultative Watson Holly J: A pilot study comparing daily
colesevelam HCl in combination with ezetimibe
service in an internal medicine teaching clinic. peak flow monitoring to weekly nitric oxide
and simvastatin. 11E
105 monitoring for asthma exacerbation in children.
Shirk Mary Beth: Evaluation of an ICU calcium
Ravva Patanjali: Population pharmacokinetic 70
replacement protocol. 138
analysis of varenicline in adult smokers. 86E Wiederhold Nathan P: Increases in chitin
Siepler John K: Exit-site infections are more
Rayner Patricia A: Evaluation of hypertension production and expression of mitogen-activated
common in home parenteral nutrition patients
induced by bevacizumab in oncology patients. protein kinase A are associated with attenuated
with ostomies. 59E
162 caspofungin activity in Aspergillus fumigatus.
Siepler John K: Osteonecrosis of the jaw in
Riche Daniel M: Do statins increase risk of 45E
chronic home parenteral nutrition patients
hemorrhagic stroke? 13 Wilbur Kerry: Enhancing diabetes patient safety
receiving intravenous pamidronate. 58E
Robinette Bryan K: Clinical and economic with standardized sliding scale insulin. 135E
Sievers Theodore M: Preliminary results from a
benefits of monitoring unfractionated heparin Williams Kathryn: A pooled-analysis of
randomized controlled trial to evaluate the
therapy using antifactor Xa activity compared to varenicline, an · 4‚ 2 nicotinic receptor partial
effect of corticosteroids on tacrolimus and
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