TY - BOOK TI - Journal of Pharmacy Technology SN - 8755-1225 PY - 2022/// CY - Thousand Oaks, California PB - Sage Publishing N1 - Includes bibliographical references; The Pharmacogenetics of Opiates and Its Impact on Delirium in Mechanically Ventilated Adults: A Pilot Study -- A Retrospective Analysis of q12hr and q8hr Heparin for DVT/PE Prophylaxis in an Inpatient Rehabilitation Setting -- Health Care Providers’ Attitude and Satisfaction Toward Patient-Oriented Services Provided by Pharmacy Technicians at Three Faith-Based Hospitals -- Utility of On-Treatment Viral Loads During Treatment With Direct-Acting Antivirals in Patients Infected With Chronic Viral Hepatitis C -- Evaluating the Safety of Trough Versus Area Under the Curve (AUC)-Based Dosing Method of Vancomycin With Concomitant Piperacillin-Tazobactam -- Relationships Between Remote Asynchronous Lectures and Summative Assessment Performance in four Pharmacotherapeutics Courses -- A Reappraisal of Oxandrolone in Burn Management -- Once-Weekly Semaglutide for Weight Management: A Clinical Review -- A Possible Case of COVID-19 Booster Vaccine–Associated Rhabdomyolysis and Acute Kidney Injury -- Neurotoxicity Secondary to Valacyclovir N2 - [Article Title: The Pharmacogenetics of Opiates and Its Impact on Delirium in Mechanically Ventilated Adults: A Pilot Study/ C. Adrian Austin, Andy Szeto, Apoorva Gupta, Timothy Wiltshire, Daniel J. Crona and Christine Kistler, p. 195–201] Abstract: Background: Pharmacogenetics may explain a substantial proportion of the variation seen in the efficacy and risk profile of analgesosedative drugs and the incidence of delirium in critically ill adults. Objectives: Conduct a feasibility study to demonstrate the reliability of collecting and analyzing pharmacogenetic information from critically ill patients and to assess the impact of pharmacogenetics on intensive care unit (ICU) outcomes. Methods: We prospectively enrolled subjects from the Medical ICU at the University of North Carolina (UNC). DNA was obtained via a buccal swab and evaluated using the DNA2Rx assay. We collected data on demographics, daily cumulative psychoactive medication exposure, and severity of illness. We performed daily delirium assessments via the CAM-ICU. We analyzed associations between select single nucleotide polymorphisms (SNPs) and delirium. Results: From June, 2018 through January, 2019, we screened 244 patients and enrolled 50. The median age was 62.0 years old (range: 28-82 years old), and 27 (54%) of the subjects were female. In all, 49 (98%) samples were both high quality and sufficient quantity. In secondary analyses, we found that 80% (12/15) of patients with two 2 copies of a G allele at rs4680 on COMT experienced delirium, whereas 44% (4/9) of patients with 2 copies of an A allele at this location had delirium. In all, 44% (4/9) of patients with 2 T allele copies at rs7439366 on UGT2B7 experienced delirium compared to 73% (11/15) of patients with 2 C allele copies at this location. Conclusions: We can feasibly collect genetic information from critically ill adults. We were able to efficiently collect high quality DNA of sufficient quantity to conduct pharmacogenetic analysis in this critically ill population. Although the sample size of our current study is too small to conduct robust inferential analyses, it suggests potential SNP targets for a future larger study; [Article Title: A Retrospective Analysis of q12hr and q8hr Heparin for DVT/PE Prophylaxis in an Inpatient Rehabilitation Setting/ Adam Dashner and Erin Siders, p. 202–205] Abstract: Purpose: There is little clinical evidence comparing the safety and efficacy of prophylactic subcutaneous heparin given every 8 hours and every 12 hours. We performed a retrospective analysis incorporating these dosing intervals in an inpatient rehabilitation setting. Methods: Heparin usage data was collected and patient charts were analyzed for both therapeutic failure and bleeding events. A 2-tailed Fisher’s exact test was performed for both outcomes, with a P-value of less than 0.05 being considered significant. Odds ratios were also calculated with P-values less than 0.05 being considered significant. Study Population: A Cerner report was run to identify patients ordered prophylactic heparin in an inpatient rehabilitation setting from April 7, 2020, to October 27, 2021. One hundred patients receiving heparin every 8 hours and every 12 hours were randomly selected for chart review. These study groups were further stratified by Padua risk scores. Results: In both groups, 4 (4.0%) patients were identified as having a documented bleeding event and 2 (2.0%) patients from each group were identified as having a therapy failure. Conclusion: For both endpoints, no significant differences in bleeding rates or therapy failure rates were detected in any of the population stratifications.; [Article Title: Health Care Providers’ Attitude and Satisfaction Toward Patient-Oriented Services Provided by Pharmacy Technicians at Three Faith-Based Hospitals/ Suh Nsutebu Ntani and Ngong Ferdinand Tchue, p. 206–212] Abstract: Background: Pharmacists and pharmacy technicians often work together to provide optimal pharmacy services, however, some low-middle-income countries lack strong regulatory mechanisms and have an inadequate number of pharmacists, necessitating some hospitals to rely on pharmacy technicians providing direct patient care services. Objectives: This study sort to investigate health care providers’ attitudes and satisfaction toward patient-oriented pharmacy services offered by pharmacy technicians at 3 faith-based hospitals in Cameroon. Methods: A cross-sectional study was conducted from February to April 2021. Self-administered questionnaires were distributed to 159 health care providers (HCPs) in 3 institutions of the Cameroon Baptist Convention Health Services. The questionnaire was made up of 3 parts evaluating HCPs’ attitudes and satisfaction. Results: A total of 140 questionnaires were completed (88.1%) response rate. The majority of respondents were female (70%) and <35 years (60.7%). Almost all respondents showed a positive attitude toward pharmacy technicians’ role in patient education (90%) and provision of medication information (93.6%). However, only 46% agreed that pharmacy technicians should take medication histories. The majority of respondents were satisfied with overall pharmacy services (80.7%). Only 25% were satisfied with pharmacy technicians’ participation in ward rounds. Gender was associated with attitude of respondents (P = 0.02). Factors associated with satisfaction of respondents included profession (P = 0.047) and work experience (P = 0.008). Conclusions: Our results revealed a positive attitude and overall satisfaction with technician-led patient-oriented pharmacy services. Additional training, clear job descriptions, and direct pharmacist supervision could ensure the quality and safety of these services; [Article Title: Utility of On-Treatment Viral Loads During Treatment With Direct-Acting Antivirals in Patients Infected With Chronic Viral Hepatitis C/ Shila Mortazavi and Lauren M. Hynicka, p. 213–217] Abstract: Background: Direct-acting antiviral (DAA) agents have revolutionized the treatment of chronic hepatitis C virus (HCV) infection. Current data regarding the utility of on-treatment HCV viral load (VL) monitoring are conflicting and limited data are available in HIV-coinfected patients. Objective: The objective of the study was to determine whether on-treatment VLs are predictive of HCV cure in a real-world population. Method: A single-center, retrospective cohort study was conducted using patients who received a prescription for DAA therapy for HCV treatment at a large, tertiary ambulatory care clinic. Results: A total of 219 patients were included in the final analysis. The average age was 56 years. Most patients were male (64.4%), African American (73.1%), and insured by Medicaid (61.6%). Most patients were treatment-naive, noncirrhotic, and infected with HCV genotype 1a (73.1%). About 22.4% of patients were coinfected with HIV. The most common regimen was 12 weeks of ledipasvir/sofosbuvir (53.9%). On-treatment VLs were most commonly obtained at treatment week 4 (42.5%), of which 45.2% of patients were detectable. Sustained virologic response (SVR) was achieved in 96.8% of the total population and 95.9% of HIV-coinfected patients. Of the 7 patients who did not achieve SVR, 3 patients had undetectable on-treatment VLs in the first 8 weeks of therapy. Conclusion: Sustained virologic response rates were similar between HCV-monoinfected patients and HCV-HIV-coinfected patients. This research further supports that on-treatment VLs may not be a valuable indicator of treatment failure but may be helpful to engage patients in care and ensure treatment adherence and ultimately cure; [Article Title: Evaluating the Safety of Trough Versus Area Under the Curve (AUC)-Based Dosing Method of Vancomycin With Concomitant Piperacillin-Tazobactam/ Cassandra Karas, Kyle Manning, Darrell T. Childress, Elizabeth W. Covington and Melanie M. Manis, p. 218–224] Abstract: Background: Vancomycin and piperacillin-tazobactam (VPT) is a common antibiotic combination used in hospitals, and there has been increasing data indicating that the combination is associated with increased rates of acute kidney injury (AKI). It is unclear if the dosing method of vancomycin would mitigate the risk of AKI seen with VPT. Objective: To observe and compare incidence of AKI in patients on VPT when using the trough-based dosing method versus the area-under-the-curve (AUC)-based dosing method. Methods: This was a multi-center, retrospective, observational study at 3 community hospitals. Adults receiving at least 48 hours of VPT were included. Patients with severe renal dysfunction, pregnant patients, prisoners, and patients with central nervous system infections, or malignancy were excluded. The primary outcome was incidence of AKI as defined by the Infectious Disease Society of America (IDSA) criteria. Results: A total of 300 patients were included in the study; 150 patients in both the trough and AUC groups. A total of 23 patients (15%) in the trough group and 17 patients (11%) in the AUC group met the primary outcome (odds ratio [OR]: 0.7058, 95% confidence interval [CI]: [0.3603, 1.3826], P = .3098). Conclusion and Relevance: The incidence of AKI was lower in the AUC group compared with the trough group; however, this was not significant. The results of our study suggest that there is no difference between incidence of AKI when using trough- or AUC-based dosing in those receiving VPT. Because of the small sample size and retrospective nature of the study, more data are needed; [Article Title: Relationships Between Remote Asynchronous Lectures and Summative Assessment Performance in four Pharmacotherapeutics Courses/ Jordan Sedlacek, Paul M. Boylan and Antonio Perry, p. 225–231] Abstract: Background: Synchronous education describes when teaching, learning, and assessment occur concurrently and asynchronous education describes when teaching, learning, and assessment occur anytime. Remote learning is where teaching and learning occur via technological means. Objective: This report describes a remote, asynchronous learning method implemented in a 3-year, block curriculum, Doctor of Pharmacy degree program. Methods: Remote asynchronous lectures embedded with quizzes were delivered to pharmacy students at the end of their first professional year and beginning of their second professional year. Camtasia software and Screencast.com were utilized during portions of 4 pharmacotherapeutic-based courses. Students completed time-spaced quizzes embedded every 5 to 15 minutes throughout the videos and quiz scores were recorded. Discrete watches, number of total watches, and average number of video quiz questions correctly answered were examined for Spearman’s rank correlation coefficient (ρ) with end-of-course summative assessment scores. Results: There were no strong positive correlations between discrete watches, number of total watches, and average number of video quiz questions correctly answered and end-of-course assessment scores (ρ range: –0.47 to 0.25). There were weak to moderate correlations within the rheumatology and dermatology assessment scores based on the Screencast.com content questions and the number of unique video watches (ρ = 0.40), average number of total video watches (ρ = 0.28), and average percent of quiz questions correct (ρ = 0.40), all of which were statistically significant (P < 0.05). Conclusions: Remote asynchronous lectures including time-spaced quizzes were not associated with improvements in summative assessment performance. Mild positive correlations between remote asynchronous lectures and time-spaced quizzes may correspond with discrete questions on a summative assessment but those relationships may be influenced by the content within the remote asynchronous lectures. ; [Article Title: A Reappraisal of Oxandrolone in Burn Management/ Jonathan Kopel, Grant Sorensen and John Griswold, p. 232–238] Abstract: Objective: Burn injuries remain among the most severe traumatic injuries globally. With the discovery of cortisol, the use of steroids has become an essential therapy for the management of inflammatory and metabolic conditions. Several studies have shown the steroid oxandrolone improves burn injuries through stimulating anabolic and reducing catabolic processes. In this review, we examine the efficacy and applications of oxandrolone with regard to burn management and treatment. Data Sources: A literature search was performed using the PubMed database from January 1990 to May 2020 to identify articles on oxandrolone and burn management. A total of 18 studies were included in our review. Study Selection and Criteria: The keywords used in our search strategy for PubMed included “oxandrolone” and “burns.” Data Synthesis: The main benefit of oxandrolone is the improved long-term lean body, protein, and bone mineral mass of burn patients. In addition, 3 separate meta-analyses showed oxandrolone shortened length of hospital stay, donor-site healing time, reduced weight loss, and net protein loss. However, oxandrolone therapy did not affect mortality, infection, or liver function. Conclusion: Oxandrolone remains an effective therapy for reducing the hypermetabolic response and comorbidities from burn injuries. Future clinical trials are needed using larger sample sizes and long-term follow-up to determine whether oxandrolone in the context of rehabilitation programs can reduce mortality, lower treatment costs, and improve function outcomes among burn patients; [Article Title: Once-Weekly Semaglutide for Weight Management: A Clinical Review/ Abby Fornes, Jamie Huff, Roger Iain Pritchard and Miranda Godfrey, p. 239–246] Abstract: Objective: To review the efficacy, safety, and role of the glucagon-like peptide-1 (GLP-1) receptor agonist semaglutide for chronic weight management. Data Sources: A literature search of PubMed/MEDLINE and Google Scholar was performed using the search terms: semaglutide 2.4, weight, and obesity. Ongoing studies of semaglutide were identified utilizing clinicaltrials.gov. Study Selection and Data Extraction: All English-language articles evaluating the efficacy and safety of semaglutide 2.4 mg for weight management in humans were included. Data Synthesis: Once-weekly injectable semaglutide 2.4 mg is indicated as an adjunct to a reduced-calorie diet and increased exercise for chronic weight management in adults with a body mass index (BMI) ≥30 kg/m2 or ≥27 kg/m2 with at least one weight-related comorbidity, such as hypertension, type 2 diabetes mellitus, or dyslipidemia. Semaglutide 2.4 mg has consistently demonstrated clinically significant weight loss across all phase 3 STEP (semaglutide treatment effect in people with obesity) trials, and long-term efficacy and safety have been confirmed for up to 2 years. Gastrointestinal side effects were the most frequently reported side effects, including nausea, vomiting, constipation, and diarrhea. Safety data for semaglutide 2.4 mg were consistent with that reported previously for the GLP-1 receptor agonist class. Conclusions: Semaglutide 2.4 mg is a highly efficacious agent for weight management, with a safety profile similar to that of other GLP-1 receptor agonists. It is a feasible option for chronic weight management, with data for up to 2 years. It is currently the only once-weekly weight loss medication, although cost may limit its utilization; [Article Title: A Possible Case of COVID-19 Booster Vaccine–Associated Rhabdomyolysis and Acute Kidney Injury/ Kendra Unger, Charles D. Ponte and Dylan Anderson, p. 247–250] Abstract: Background: Nearly 10 billion doses of the various messenger ribonucleic acid (mRNA) and viral vector vaccines against Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) have been administered worldwide. Adverse drug reactions (ADRs) have been overwhelmingly mild to moderate in nature. Rare side effects have included myocarditis/pericarditis, thrombosis with thrombocytopenia syndrome (TTS), Guillain-Barré Syndrome (GBS), and death. However, vaccine-related ADR data are still being collected using a variety of reporting systems. Purpose: We will describe a case of suspected mRNA coronavirus disease 2019 (COVID-19) booster–related rhabdomyolysis in a woman who developed signs and symptoms 10 days after administration of the vaccine dose. With a Naranjo ADR probability score of 4, the vaccine was deemed to be a possible cause of our patient’s rhabdomyolysis. Methods: A search of the VAERS (Vaccine Adverse Event Reporting System) mined in November 2021 revealed 386 reported cases of COVID-19 vaccine–related rhabdomyolysis. However, system limitations make the utility of the information problematic. Conclusions: It is vitally important that clinicians, scientists, and patients are aware of rhabdomyolysis as a potential side effect of vaccination. Suspected vaccine-related ADRs should be promptly and accurately reported via VAERS or other surveillance systems to support the ongoing effort to ensure vaccine safety; [Article Title: Neurotoxicity Secondary to Valacyclovir/ Abaigeal E. Tarpey, Austin Loranger and Mark A. Malesker, p. 251–252] Abstract: Case Report A 79-year-old male with hemodialysis (HD)-dependent end-stage renal disease (ESRD) presented to the emergency department with acute encephalopathy. He had a recent diagnosis of herpes zoster and was prescribed valacyclovir 1 g three times daily. After taking 4 doses, his wife was concerned of new onset confusion. Labs and vitals on admission were unremarkable except for an elevated BP (blood pressure) of 160/82, SCr of 3.54 mg/dL, and a BUN (blood urea nitrogen) of 30 mg/dL. Neurologic examination was significant for disorientation but was otherwise nonfocal. Herpes encephalitis was ruled out as a cause of the patient’s confusion given lack of fever, headache, and neck stiffness. Poison control was consulted, and the leading differential was valacyclovir toxicity. The patient was admitted to the ICU (intensive care unit) where nephrology performed 2 intermittent, 6-hour dialysis sessions over 2 consecutive days for drug clearance based on valacyclovir’s half-life and the dosage received. Discussion Valacyclovir is administered as an oral prodrug that is rapidly converted to acyclovir, ultimately inhibiting DNA synthesis. Acyclovir is a purine nucleoside analogue with inhibitory activity against herpes simplex virus type 1, type 2, and varicella-zoster virus. Valacyclovir is eliminated 89% renally necessitating dose adjustment in renal impairment. After conversion to acyclovir, valacyclovir has a half-life of 2.5 to 3.3 hours in normal renal function, which increases to 14 to 20 hours in ESRD. In HD, a valacyclovir dose of 500 mg daily is recommended.1 The mechanism of neurotoxicity with valacyclovir is postulated that metabolism to 9-carboxymethoxymethylguanine (9-CMMG) inhibits mitochondrial DNA polymerase, which leads to mitochondrial toxicity and ultimately increased uremic toxicity. Limited case reports have implicated neurotoxicity with improper renal dosing. Cotard syndrome is linked with valacyclovir toxicity, presenting with delusions, anxiety, agitation, and sensory impairment.2 The standard treatment of valacyclovir neurotoxicity is supportive care as the medication is eliminated from the body. Hemodialysis can expedite valacyclovir drug clearance. A 4-hour session of HD reduces 9-CMMG levels by 64%.3 Signs of toxicity should subside with subsequent HD sessions. Peritoneal dialysis (PD) is traditionally not preferred for enhancing valacyclovir elimination, but in case studies it has been shown to be useful in expediting drug elimination in ESRD with baseline PD.4 Based upon the temporal relationship of valacyclovir dosing and the occurrence of neurotoxicity in this patient, the calculated Naranjo et al5 adverse drug reaction probability scale score was 4, suggesting valacyclovir as a possible cause. Based upon the clinical assessment and input from the family, the patient returned to baseline mental status after the first secession of HD. Improvement after HD supported the clinical suspicion that the supratherapeutic valacyclovir dose precipitated the patient’s neurotoxicity. The patient was discharged on renally adjusted 500 mg daily dose of valacyclovir to finish the course without neurologic sequelae. Health care professionals should be mindful of potential side effects when prescribing medications in patients with ESRD and HD. This case report is significant as it speaks to the importance for pharmacists and physicians to properly dose renally eliminated medications for safety and avoidance of adverse effects ER -