Journal of Pharmacy Technology

Includes bibliographical references.

Beyond the Classroom: An Observational Study to Assess Student Pharmacists’ Confidence and Perception of a High-Fidelity Manikin Chemotherapy Infusion Reaction Simulation -- Prescribing Patterns of Antihypertensive Agents and Blood Pressure Control Among Patients With Incident Stage 2 Hypertension -- Safety and Efficacy of Indomethacin for Reducing Chest Tube Duration After Coronary Artery Bypass Grafting Surgery -- Evaluation of Current Hazardous Drug Exposure Control in Community Pharmacy -- Potential Drug Interactions Between Psychotropics and Intravenous Chemotherapeutics Used by Patients With Cancer -- Evaluation of Monoclonal Antibodies in Preventing Hospitalizations, Emergency Department Visits, and Mortality in High-Risk COVID-19 Patients -- Awareness, Familiarity, and Pharmacist Trust: A Structural Equation Model Analysis -- Development of Community Pharmacy Competencies -- Multiorgan Failure After Phentermine Overdose.

[Article Title: Beyond the Classroom: An Observational Study to Assess Student Pharmacists’ Confidence and Perception of a High-Fidelity Manikin Chemotherapy Infusion Reaction Simulation/ Jeremiah K. Jessee, Akera Miller and Alex M. Ebied, p. 135–141]

Abstract:

Objective: To assess the impact of a high-fidelity manikin chemotherapy infusion simulation on student pharmacists’ confidence in applying clinical knowledge and perception of oncology pharmacy practice.

Methods: One cohort of third professional year student pharmacists completed a high-fidelity manikin simulation during the last week of their didactic training. The 10-minute manikin experience simulated an acute paclitaxel infusion reaction, requiring students to apply their knowledge on how to provide patient care during a chemotherapy-induced infusion reaction. A pre- and post-survey was administered to determine whether there was a change in students’ confidence and perception.

Results: Thirty-three student pharmacists (62%) completed the pre- and post-surveys and manikin simulation. A statistically significant improvement was seen in median confidence scores when comparing pre- and post-questions of all 10 survey items (P < 0.001). Students’ perception of oncology pharmacy and the manikin simulation had mean of 4.4 on a 0- to 5-point Likert scale.

Conclusion: The high-fidelity manikin experience improved student pharmacists’ post-survey confidence of applying clinical skills. In addition, students’ perception of oncology pharmacy improved and the use of a manikin simulation to support didactic learning was seen as an additional avenue for delivering didactic curriculum. This study explored the feasibility of introducing a manikin simulation into the oncology pharmacy curriculum and the benefit of providing hands-on application of clinical skills to support didactic concept-based learning.

https://doi.org/10.1177/87551225211073570

[Article Title: Prescribing Patterns of Antihypertensive Agents and Blood Pressure Control Among Patients With Incident Stage 2 Hypertension/ Micah V. Helms, Ashley L. Edwards, Taylor H. Suszynsky and Andrew Y. Hwang, p. 42–147]

Abstract:

Background: Initiation of appropriate antihypertensive therapy is crucial, particularly among patients with stage 2 hypertension, whom initiation of dual antihypertensive agents is suggested. Little is known regarding real-world prescribing of antihypertensive agents for patients with incident stage 2 hypertension.

Objective: The primary objective was to describe prescribing patterns of antihypertensive therapy among patients with incident stage 2 hypertension. The secondary objectives included determining association of blood pressure (BP) control with initial multiple antihypertensive agents.

Methods: Retrospective cohort analysis was conducted using electronic medical records from 6 primary care clinics between January 2014 and June 2019. Included patients were ≥18 years with an initial diagnosis of stage 2 hypertension, defined as BP ≥160/100 mm Hg Primary analysis was characterizing prescribing patterns of antihypertensive agents among patients with incident stage 2 hypertension. Investigation of BP control (<140/90 mm Hg) at 3 months of diagnosis was also performed.

Results: We identified 261 patients with incident stage 2 hypertension (mean age, 52 years; 53.2% males; mean baseline BP, 162.1/100.1 mm Hg). Approximately 72% of patients were initiated on single antihypertensive agent, with the most common being angiotensin receptor blockers (ARBs; 25.7%) and angiotensin-converting-enzyme (ACE) inhibitors (24.6%). Commonly initiated multiple antihypertensive agents were ACE-inhibitor + thiazide-like diuretic (52.7%), followed by an ARB + thiazide-like diuretic (21.6%). Multiple antihypertensive therapy was associated with improved BP control at 3 months (adjusted odds ratio [OR], 3.54; 95% confidence interval [CI], 1.55-8.06).

Conclusion: Majority of patients with incident stage 2 hypertension were prescribed initial single antihypertensive therapy, though better BP control at 3 months was seen among those initiated on multi-antihypertensive therapy.

https://doi.org/10.1177/87551225211069802

[Article Title: Safety and Efficacy of Indomethacin for Reducing Chest Tube Duration After Coronary Artery Bypass Grafting Surgery/ Caitlin M. Gibson, Brenton Hall, Hyanggi Irene Kwon, Sondra Davis, Darien Bradford and Meredith L. Howard, p. 148–154]

Abstract:

Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) contain a boxed warning for use in coronary artery bypass graft (CABG) surgery due to increased risk of thrombotic events, but recent research has challenged the assumption that these risks are a class effect. One anecdotal indication for NSAIDs in CABG is reducing chest tube output.

Objective: The primary objective of this retrospective study was to determine whether indomethacin was associated with reduced duration of chest tube insertion after CABG surgery, defined as total chest tube duration in controls versus duration of chest tube insertion after the first dose of indomethacin in the treatment group. Secondary objectives were comparisons of daily reductions in chest tube output volume, length of stay, and safety between groups.

Methods: In this retrospective, single-center case-control review, adult patients who received indomethacin after CABG were matched 1:1 to control patients based on age, sex, concomitant valve surgery, and, when possible, diabetes status.

Results: Thirty-two patients were included. The mean age was 56 years and 75% were men. The primary outcome measure was 94 hours among control patients and 82.8 hours among indomethacin patients (P = 0.041). Insignificant mean reductions in daily chest tube output were observed prior to and after indomethacin initiation (38.7 vs 87.7 mL/day, P > 0.05).

Conclusion: In this small, single-center study, indomethacin appeared safe and possibly effective for reducing chest tube duration after CABG surgery. Future large, prospective, randomized studies should be conducted to confirm the results.

https://doi.org/10.1177/87551225221074588

[Article Title: Evaluation of Current Hazardous Drug Exposure Control in Community Pharmacy/ John Papastergiou and Tom Smiley, p. 155–158]

Abstract:

Purpose: To evaluate effectiveness of current hazardous drug exposure control practices in community pharmacies through identification of commonly contaminated surfaces. We also assessed the decontamination effectiveness of 5 different cleaning agents.

Methods: This study was prospective and nonrandomized and conducted in 2 phases. In phase 1, 15 common areas used in the dispensing process were tested at each of 4 pharmacies in Toronto Ontario, Canada. Testing was conducted using the BD® HD Check System, a rapid, point-of-care, hazardous drug detection system that is able to identify contamination with methotrexate (MTX) and cyclophosphamide (CYP) and doxorubicin. In phase 2, 5 different cleaning agents (70% isopropyl alcohol, Lysol® spray, Ecolab® retail multiquat sanitizer, Ecolab retail multisurface and glass cleaner with peroxide, and Ecolab QSR heavy-duty degreaser) were tested for their ability to eliminate contamination.

Results: All 4 pharmacies tested positive for contamination with MTX (25.8% of surfaces). Contamination with CYP was less frequent, with only 3 sites and 18.2% of surfaces testing positive. Of the 5 cleaning agents tested, only Ecolab QSR heavy-duty degreaser was able to eliminate contamination with MTX. None of the agents were successful against CYP.

Conclusions: The results illustrate an unacceptable prevalence of hazardous drug contamination in community pharmacy settings. The BD HD Check System can serve to rapidly detect common high-risk areas for surface contamination. Decontamination protocols against MTX may include Ecolab QSR heavy-duty degreaser. Novel agents must be identified to remove contamination caused by CYP.

https://doi.org/10.1177/87551225211072743

[Article Title: Potential Drug Interactions Between Psychotropics and Intravenous Chemotherapeutics Used by Patients With Cancer/ Eric Diego Turossi-Amorim, Bruna Camargo, Diego Zapelini do Nascimento and Fabiana Schuelter-Trevisol, p. 159–168]

Abstract:

Introduction: Patients undergoing cancer treatment usually have comorbidities, and psychiatric disorders are commonly seen in these patients. For the treatment of these psychiatric disorders, the use of psychotropic drugs is common, turning these patients susceptible to untoward drug interactions. Therefore, the aim of this study was to estimate the prevalence of clinically relevant drug–drug interactions (DDI) between chemotherapeutic and psychotropic agents in patients with cancer treated at an oncology service in southern Brazil.

Methods: An observational epidemiological study with a cross-sectional census-type design was carried out between October and December 2020. The drug-drug interactions were identified through consultation and analysis of the Medscape Drug Interaction Check and Micromedex databases. The interactions were classified as major, when the interaction can be fatal and/or require medical intervention to avoid or minimize serious adverse effects and moderate, when the interaction can exacerbate the patient’s condition and/or requires changes in therapy.

Results: A total of 74 patients was included in the study among the 194 patients seen in the oncology service during the period studied. A total of 24 (32.4%) DDIs were found, 21 (87.5%) of which were classified as being of major risk and 3 (12.5%) as moderate risk. According to the mechanism of action, 19 (79.1%) were classified as pharmacodynamic interactions and 5 (20.9%) as pharmacokinetic interactions.

Conclusion: It was shown that a considerable percentage of patients undergoing intravenous chemotherapy are at risk of pharmacological interaction with psychotropic drugs. Thus, it is essential that the oncologist considers all psychotropic drugs and other drugs used by patients in order to avoid drug-drug interactions.

https://doi.org/10.1177/87551225211073942

[Article Title: Evaluation of Monoclonal Antibodies in Preventing Hospitalizations, Emergency Department Visits, and Mortality in High-Risk COVID-19 Patients/ Ashlee N. Milam, Diana T. Doan, Darrell T. Childress and Spencer H. Durham, p. 169–173]

Abstract:

Background
The coronavirus disease 2019 (COVID-19) is a novel coronavirus that has caused an unprecedented global pandemic, with few treatment options currently available. Neutralizing monoclonal antibodies (mAbs) are a promising treatment approach to reduce hospitalizations in high-risk patients with mild-to-moderate COVID-19 infections.

Objective
The primary objective is to compare hospitalization rates of high-risk patients who tested positive for COVID-19 within 28 days between those who received mAb infusions versus those who did not. Secondary objectives were emergency department (ED) visits and mortality within 28 days of a positive test.

Methods
This single-center, institutional review board–approved, retrospective, observational cohort study included patients aged 19 years and older who tested positive for COVID-19 between December 2, 2020 and February 28, 2021. Patients who received the mAbs bamlanivimab or casirivimab/imdevimab were compared with patients who did not receive mAb infusions to examine hospitalization rates, ED visits, and mortality within 28 days of the positive COVID-19 test.

Results
A total of 2780 patients were evaluated for inclusion using electronic chart review via Cerner. Of the 1612 patients who met inclusion criteria, 568 received an mAb infusion (mAb group) and 1044 did not (non-mAb group). Baseline characteristics were similar between the 2 groups. Of the patients in the mAb group, 34 (6%) were hospitalized versus 397 (38%) in the non-mAb group. Patients with ED visits included 111 (20%) and 672 (64%) in the mAb and non-mAb groups, respectively. Finally, 5 patients in the mAb group experienced mortality (0.9%) versus 83 (8%) in the non-mAb group. Each endpoint achieved statistical significance with a P value of <0.0001.

Conclusion
Monoclonal antibody infusions are effective in preventing hospitalization, ED visits, and mortality in high-risk patients with mild-to-moderate COVID-19.

https://doi.org/10.1177/87551225221080027

[Article Title: Awareness, Familiarity, and Pharmacist Trust: A Structural Equation Model Analysis/ Bobbi Morrison and Thomas Mahaffey, p. 174–182]

Abstract:

Background: Trust in health care professionals is critical in the health care system and is needed for a patient to seek care, reveal sensitive information, and follow a specified treatment plan, among other things.

Objective: To better understand trust in community pharmacists, this research develops a model of how patient awareness of the different community pharmacy roles (role awareness) and pharmacist familiarity influences pharmacist trust.

Methods: A survey of pharmacy patients in Nova Scotia, Canada, occurred in November and December 2019, with quota sampling used to achieve representativeness by age, gender, and household income. A total of 640 usable surveys were obtained. Consistent partial least squares was deployed to test and refine the model.

Results: Overall, the final model highlights that both role awareness and pharmacist familiarity influence patient assessments of pharmacist trust and explains 38.7% of its variance. Pharmacist familiarity has a stronger influence than role awareness on pharmacist trust. Results of the consistent partial least squares multigroup analysis found no statistically significant differences in the model based on patient gender.

Conclusion: This research provides a means to capture interpersonal trust in community pharmacists and identifies 2 key determinants of such trust. This research also provides guidance on how to assess pharmacist trust, the value of patients knowing their pharmacist, and the value of patient awareness of the roles of the various professionals behind the counter. Such knowledge will help pharmacy managers, associations, and regulatory authorities develop evidence-informed plans to assess, rebuild, and sustain trust.

https://doi.org/10.1177/87551225211052411

[Article Title: Development of Community Pharmacy Competencies/ Pantira Parinyarux, Teerapon Dhippayom, Payom Wongpoowarak and Nantawarn Kitikannakorn, p. 183–190]

Abstract:

Objective
This study aimed to develop a consensus statement of competencies for community pharmacists in Thailand.

Methods
A 2-round modified Delphi process was used to develop consensus among a panel of community pharmacy experts. A total of 18 experts from 6 stakeholders represented a panel of each pharmacy organization in Thailand. In the first experts were asked to rate their degree of agreement on whether a competency was essential using a 7-point Likert scale (1 = “not essential competency” to 7 = “the most essential competency”). Also, in the second round, they were asked to rate the competencies from a scale of “must be included” to “must be excluded.” Competencies considered “must be excluded” by a consensus of 80% or more of experts were removed from the community pharmacy competency list.

Results
Nearly half the experts had experience in their position for more than 10 years. The expert panels were typically committee members of the Community Pharmacy Association (Thailand) and community pharmacy clerkship preceptors (29.4% and 23.5%, respectively). The number of community pharmacy competencies on the initial list was 55 competencies. None of them was eliminated after the first round. Of 55 competencies, 11 were eliminated after the second round. The final list of competency statements was 44 competencies divided into 4 domains: personal competencies, pharmacy professional competencies, patient care competencies, and management competencies.

Conclusion
Community pharmacy competencies include having a positive attitude and being accountable for individual patient care, providing disease prevention and health promotion, and addressing morality and ethics in business.

https://doi.org/10.1177/87551225221081370

[Article Title: Multiorgan Failure After Phentermine Overdose/ Gia Thinh D. Truong, Zachary A. Creech, Shraddha Narechania and Mark A. Malesker, p. 191–192]

Abstract:

Phentermine is the most prescribed anorexiant in the United States. There is a paucity of literature on consequences of phentermine overdose.1 We present a case of multiorgan failure secondary to phentermine self-overdose in an elderly male.

A 69-year-old man with a history of epilepsy, major depressive disorder, prior methamphetamine abuse, schizophrenia, suicidal ideation, and cerebrovascular accident presented to the emergency department following intentional overdose of approximately 750 mg of phentermine. His home medications included quetiapine, aspirin, lisinopril, and phentermine. Urine drug analysis was positive for amphetamines, tricyclics, and bupropion. Acetaminophen, salicylate, and alcohol were not detected in the toxicology screen. A phentermine blood level was not ordered. Upon presentation, the patient was alert and able to follow commands while endorsing excessive muscle twitching and spastic movements. Vital signs upon presentation revealed a temperature of 36.7°C, heart rate of 135 beats/minute, respiratory rate of 24 breaths/minute, blood pressure of 185/125 mm Hg, and oxygen saturation of 94% on room air. He was tachycardic, tachypneic, and hypertensive. An electrocardiogram demonstrated atrial fibrillation followed by regular, narrow complex supraventricular tachycardia with a right bundle branch block. Atelectasis was seen in the left lung base. Initial labs were significant for leukocytosis, acute kidney injury, rhabdomyolysis, metabolic acidosis, and transaminitis. Computed tomography of the head and chest was unremarkable. An echocardiogram revealed an ejection fraction of 10% to 15%, akinetic apex, and multiple areas of hypokinesis consistent with stress cardiomyopathy. He subsequently became more agitated requiring intubation and ICU admission. Emergent hemodialysis was required given worsening acidosis, kidney injury, hyperkalemia, and rhabdomyolysis. The patient also received brief use of vasopressors. The creatine kinase peaked at 14 000 U/L, and troponin concentration peaked at 38 ng/mL before trending down. The patient’s acute renal failure and anion gap metabolic acidosis were corrected after 2 rounds of dialysis. He was extubated after 5 days of ventilation. On day 11, the patient was discharged to a skilled nursing facility.

Phentermine is a centrally acting sympathomimetic amine that suppresses appetite and assists with short-term weight loss.1 Phentermine has a high potential of misuse. Adverse effects of tachycardia, decreased visual acuity, nausea, sleeplessness, anxiety, psychosis, and manic-like episodes are linked with phentermine therapy.2 Cardiac complications can arise due to enhanced AV nodal conduction effects from a similar structure to amphetamine.3 Case reports have described the development of prolonged QT interval and polymorphic ventricular tachycardia, supraventricular tachycardia, and recurrent ventricular fibrillation with cardiac vasospasm.3 One case report described the onset of rhabdomyolysis in a patient who took double the recommended amount of phentermine over 1 week.4
To our knowledge, this is the first case that reports multiorgan failure associated with a phentermine overdose. Our patient’s clinical course was a probable result of phentermine overdose. Use of the Naranjo Scale revealed a score of 6 based on the patient’s presentation, onset, and resolution of symptoms after phentermine consumption.5 Generally, phentermine is prescribed to the younger female population in conjunction with an established diet plan. In our case, an older male was prescribed phentermine to aid with his weight loss. Prior amphetamine abuse and psychiatric history were factors that may have increased the patient’s risk of phentermine abuse.

https://doi.org/10.1177/87551225221088980