Advances in Pharmacy

Persistent link for this collection

https://hdl.handle.net/11299/202581

Advances in Pharmacy: Journal of Student Solutions to Pharmacy Problems (AiP) was an open access, online publication dedicated to disseminating student research relevant to pharmacy practice. The aim of this publication was to provide an accessible outlet and a learning environment to encourage student participation in rigorous research. AiP is not a peer-reviewed publication; however all papers published in AiP underwent a rigorous review process by expert reviewers. Work submitted to AiP was reviewed by participating University of Minnesota College of Pharmacy faculty with expertise in basic and clinical research, and pharmacy practice. AiP was an experimental publication and was open only to students in the University of Minnesota College of Pharmacy.

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Opioid Use In Pregnant Women and its Effect on the Development of Neonatal Abstinence Syndrome in Newborns
(University of Minnesota Libraries Publishing, 2017-06) Qiao Yang, Yue; Ding, Viki
The current guidelines for chronic noncancer pain management by the American Pain Society rec- ommends opioids as the therapeutic choice to lessen pain and/or recover physical and psychological functioning. However, misuse of opioids during pregnancy has become an alarming concern across the United States impacting the health of both the mother and newborn. Infants experiencing opioid with- drawal symptoms, also known as neonatal abstinence syndrome (NAS), are at higher morbidity risk and other long-term developmental risks that are yet to be understood. In this review, five quality studies were assessed and analyzed to make recommendations on methadone and morphine-derivative opioid use for chronic pain management in pregnant women. Methadone has proven to be an effective option for moderate to severe pain and relatively safer than other opioid choices if prescribed at a reduced dose of 30 mg daily for 7 weeks. Codeine can be selected for mild to moderate chronic pain management and should not exceed 60 mg every 4 hours for patients in the third trimester. However, it is inferior for pain relief compared to morphine, whereas methadone is comparable. Both dosing recommendations are expected to have decreased risk of NAS development compared to dosing used in literature.
An Investigation Into the Evidence Behind Budesonide/Formoterol (Symbicort®) Usage in the Outpatient Setting as Reliever Medication for Asthma
(University of Minnesota Libraries Publishing, 2017-06) Walek, Stephanie; McDonald, Ashley; Wolff, Robert
Objective: To review the available scientific evidence behind the use of budesonide/formoterol for maintenance and reliever therapy for the outpatient control of asthma exacerbation. Data sources: The Medline database was searched using the terms albuterol, asthma, budesonide for- moterol fumarate drug combination, exacerbation, formoterol fumarate, guidelines, long acting beta 2 agonist, randomized control trial, reliever, and Symbicort. Articles cited in the 2016 GINA guidelines were also assessed for relevance and included in this literature review. Methods: Studies evaluating the clinical efficacy of budesonide/formoterol for maintenance and reliever therapy in patients ≥ 12 years old with diagnosed asthma were included. Acceptable study designs included RCTs, retrospective analyses, prospective analyses, and post hoc analyses published in English no earlier than 2002. All titles and abstracts were initially reviewed for relevance. Articles remaining after initial review were divided equally among authors for in-depth review and data extraction. The quality of evidence of each study was assessed using the 2011 Oxford Levels of Evidence table. Results: Fourteen of the nineteen articles supported using budesonide/formoterol as both a reliever and maintenance medication. Four articles found no difference in time to first severe asthma exacerbation and one article found no significant difference in number of asthma control days. Conclusions: The evidence of this review supports the use of budesonide/formoterol as both a mainte- nance and reliever therapy in adults with uncontrolled, persistent asthma. SMART (Single Maintenance and Reliever Therapy) improves a number of asthma control measures, deeming it a favorable option for inclusion in future NHLBI guideline revisions
Smoking and its effects on postpartum depression.
(University of Minnesota Libraries Publishing, 2017-06) Swanson, Elizabeth; Scott, Elizabeth; Thomas, Meredith
An estimated 10 to 15% of new mothers experience symptoms of postpartum depression (PPD), and while it has been estimated that up to 10% of women smoke tobacco during the last 3 months of pregnancy(1), there has been limited research into the effects this behavior has on the development of PPD. To establish if a relationship exists between the two, a literature search of published research studies was completed to gather data for examination. Of the pertinent articles, there were 11 that supported an association between smoking before or during pregnancy and postpartum depression, and the results of these were examined in depth. All studies found some sort of correlation, however not all findings were statistically significant. One of the biggest remaining questions is that of the causality between the relationship. No one has yet been able to establish whether postpartum depression is caused by smoking at any point during a mothers lifetime, or whether having depression is a risk factor for continued smoking.
The Benefits of Raloxifene Use in Postmenopausal Women with Alzheimer’s Disease
(University of Minnesota Libraries Publishing, 2017-06) Sobota, Sara
This qualitative systematic review aims to compile evidence to assess potential cognitive benefit with raloxifene use in postmenopausal women with Alzheimers disease. PubMed, EMBASE, and Cochrane Library databases were searched using the terms raloxifene, Evista, postmenopausal, Alzheimers, demen- tia, cognitive, and cognition. Reviewed studies were limited to human subjects written in the English language between 2002 and January 2017. Of 36 studies, only four articles were included in the as- sessment. The most reliable results come from the MORE trial which describes a dose-dependent (120 mg/day) reduction in cognitive impairment and lower risk of developing Alzheimers disease after three years of raloxifene use in postmenopausal women who were considered cognitively normal at baseline. The other three articles reviewed in this study showed no significant cognitive benefit associated with raloxifene treatment. However, all three of these studies showed high potential for bias based on this review of the cognitive assessment method, intervention, study duration, and population. Two of these three studies utilized a dose that was too low (60 mg/day) in cognitively normal women. The third study showing bias had the smallest total population (n=42) but it used an appropriate dose of 120 mg/day and it was the only study to include participants with an established diagnosis of Alzheimers disease. Based on the results of this database search and analysis, there appears to be insufficient available liter- ature that includes an appropriate raloxifene dose, study duration, assessment method, and population. This suggests justification for future clinical trials to properly evaluate the potential cognitive benefit of raloxifene in postmenopausal women with Alzheimers disease.
Pharmacy Services in Telepharmacy: how’s it working, where it’s working, and what’s required to practice in this new setting.
(University of Minnesota Libraries Publishing, 2017-06) Skrei, Aimee; Rundquist, Michelle M.
Telepharmacy is a rapidly growing area of communication within pharmaceutical care delivery, es- pecially in rural areas. The purpose of this literature review was to determine where telepharmacy is currently being practiced within community and ambulatory pharmacy settings and the effectiveness of it. Additionally, state rules and regulations for the upper Midwest region were compared and con- trasted to analyze how specific states are addressing the use of telepharmacy practice within the specified settings. A systematic literature review was performed using PubMed, Ovid Medline, and the Google Scholar search engine. State specific rules were researched using board of pharmacy and legislative online resources. Overall, telepharmacy was found to be an effective and safe delivery method to communi- cate with patients regarding their medications. It has been successfully implemented within community pharmacy settings through the creation of remote dispensing sites, which is evident through literature analysis. The focus of state regulations on telepharmacy services and practices shows the growth and ac- ceptance of this modality of pharmacy practice. There is wide variation among Midwest state regulations pertaining to the setup and operation of telepharmacies. Trends in telemedicine show that telepharma- ceutical care is likely to continue to expand as it allows for a better allocation of resources and access to more patients. Further primary research needs to be completed to specifically analyze telepharmacy cost-effectiveness.
Effects of Tacrolimus Pharmacokinetic Variability on Acute Rejection and Long-Term Graft Function after Kidney Transplantation
(University of Minnesota Libraries Publishing, 2017-06) Seibert, Stephan
Tacrolimus (TAC) is used for immunosuppression after kidney transplantation. Non-optimal TAC therapy contributes to renal toxicity, graft damage, and rejection. This paper reviews publications associating TAC intra-patient pharmacokinetic variability with long- and short-term transplant outcomes. The literature was reviewed performing systematic searches of MEDLINE and EMBASE databases from 1990 to May 2016 using appropriate Medical Subject Headings (MeSH) and key words. Titles and abstracts of hits were scanned for relevance, resulting in nine articles included in this analysis. Included articles were evaluated for content and relevance, and summarized. All studies were relatively small (N <400) non-randomized retrospective chart reviews. Only two articles did not show significant association between variability of TAC trough concentrations and at least one outcome after kidney transplantation. Four studies analyzing acute rejection (AR) showed significant association, while two did not. All studies analyzing graft loss or composite outcomes including graft loss showed significant association. Other studies showed association with donor-specific-antibody (DSA) development, but no association with renal function decline or overall patient survival. This review indicates an overall trend towards worse transplant outcomes in patients with higher TAC pharmacokinetic variability, however the size and design of the studies limit generalizability. Larger studies with more robust design are needed and should include genetic subgroup analysis and identification of sources of TAC variability to come to a definitive conclusion. Ideally, a dosing protocol incorporating wide varieties of genetic and clinical factors should be developed to optimize TAC dosing in transplant patients.
Impact of Pharmacist-Delivered Patient Education on Tuberculosis Drug Therapy Adherence
(University of Minnesota Libraries Publishing, 2017-06) Schmitz, Dylan M.; Fleissner, Dan; Tran, Amy
Treatment of tuberculosis poses unique clinical challenges that make successful completion of treat- ment traditionally low compared with other infectious diseases. Specifically, patient adherence to the long medication regimen is crucial for the success of treatment. Are pharmacists, the medications experts, being optimized with their clinical knowledge to assist in the management of tuberculosis treatment and does their impact provide a benefit to the patient? In order to determine the pharmacists impact on adherence to therapy for tuberculosis treatment, a systematic literature review utilizing OVID Medline was conducted. A search term criteria was formulated then used to generate literature pertaining to the clinical question. The initial search resulted in 21 hits, which were subsequently screened using the predetermined exclusion and inclusion criteria. Of the 21 initial results 17 were excluded from the review. The included studies demonstrated positive impact pharmacists had on the adherence and completion of prescribed tuberculosis medications. This trend presents an opportunity for pharmacists to provide clinical services that utilize their strength and ensure positive therapeutic outcomes for patients. Al- though the findings are encouraging, the included studies have drawbacks that while addressed, present the direction for future study.
Adherence to Drug Therapies in TB/HIV Patients: A Systematic Review of Fixed Dosed Combination Drug Therapy vs. Directly Observed Therapy
(University of Minnesota Libraries Publishing, 2017-06) Nguyen, Larry; Vazquez-Deida, Axel A.; Chak, Veasna M.
The objective of this paper was to discern if there was a difference in adherence between fixed dose combination drug therapy (FDCT) and directly observed therapy (DOT) when treating patients with both tuberculosis (TB) and human immunodeficiency virus (HIV). Various search terms were used resulting in 1,646 related articles. 1,637 articles were eliminated using further screening and elimination criteria. A total of 8 peer-reviewed publications and reports classified either as primary or secondary were used for data extraction. These articles studied HIV/TB patients receiving either FDCT or DOT and included extractable data on the number of non-adherent patients versus total number of patients for their respective therapy. Information obtained during data extraction included: article definition of adherence, reasons for non-adherence, number of patients in the trial, and number of patients adherent to therapy. The results showed 70.2% of patients were adherent to directly observed therapy, and 92.5% of patients were adherent to fixed dosed combination drug therapy. This paper concluded that patients are more adherent to FDCT than DOT.
Comparing the effects of transdermal hormone therapy to oral hormone therapy on gallbladder disease, cholecystectomy, and gallbladder cancer
(University of Minnesota Libraries Publishing, 2017-06-30) Hersi, Faid; Onwonga, Esther B.; Horst, Jenna
Objective: To determine whether transdermal hormone therapy produces less effects on the development of gallbladder disease and cancer than oral hormone therapy. Data sources: OVID, PubMed, Medline, and NIH Study selection: Studies that included women who are 40 -75 years of age who were naive to hormone therapy. Studies chosen had to include both transdermal and oral routes of hormone administration as well as findings related to gallbladder disease, cancer, or markers that affect these conditions. Reviews were not included in our study criteria. The primary outcome was incidence of gallbladder disease and cholecystectomy. Data synthesis: Of the 98 articles, 5 articles were included in the assessment. 2 studies assessed gallbladder disease/cholecystectomy, 2 assessed biomarkers for gallbladder stone, and 1 assessed gallbladder disease as a risk for gallbladder cancer. Prospective data suggests that transdermal hormone therapy has a lower risk of gallbladder disease and cholecystectomy. Evidence also suggests a positive correlation between gallbladder disease and gallbladder cancer. Conclusions: The preliminary evidence suggests that transdermal hormone therapy has a lower risk of gallbladder cancer. There is a strong association between gallbladder cancer and cholelithiasis, chronic cholecystitis, and inflammation. Based on the evidence, transdermal therapy may have a lower risk of gallbladder disease and cholecystectomy. In addition, transdermal has a more favorable lipid panel. The evidence also suggests some correlation between hypercholesterolemia and risk of cholecystectomy.