Biologically-Based Complementary and Alternative Medicine (CAM) Use in Cancer Patients: The Good, the Bad, the Misunderstood.

As complementary and alternative medicine (CAM) becomes more popular, it is being used in cancer patients to aid in recovery or to treat symptoms associated with the current chemotherapy. Numerous papers exist that discuss patients using CAM with cancer chemotherapy and their outcomes-both positive and negative. However, in the case of the negative outcomes, the reason for the dangers or interactions with drugs are not made clear.

Amphetamine promotes cortical Up state: Role of adrenergic receptors.

Cortical neurons oscillate synchronously between the Up and Down state during slow-wave sleep and general anesthesia. Using local-field-potential recording in the rat prefrontal cortex (PFC), we have shown that systemic administration of methylphenidate promotes PFC Up states and reduces PFC slow oscillation, suggesting a depolarizing effect of the drug on PFC neurons. Here, we report that systemic injection of d-amphetamine produced similar effects.

Report of the 2018-2019 Student Affairs Standing Committee.

The 2018-2019 Student Affairs Standing Committee addressed charges related to examining the institutional leadership models and professional development needs of faculty and staff to optimize achievement of Strategic Priority #1 on the applicant pipeline. The report provides five recommendations to AACP and twelve suggestions for colleges and schools of pharmacy. The committee focused on the need to develop tailored leadership training and mentoring programs for admissions personnel on relevant topics, including change management, holistic thinking, leadership, problem solving, technical knowledge, professional development, paths for promotion, conflict resolution, networking, persuasive communication, and strategic planning.

Retrospective Analysis of Adverse Drug Events Between Nafcillin Versus Cefazolin for Treatment of Methicillin-Susceptible Infections.

Nafcillin or cefazolin are drugs of choice for methicillin-susceptible (MSSA) infections. Prior studies indicate a higher incidence of acute kidney injury (AKI) with nafcillin, although AKI classification and time to occurrence is not well described. To characterize the incidence and time to adverse drug events for nafcillin versus cefazolin in the inpatient setting.

Childhood Hypertension and Effects on Cognitive Functions: Mechanisms and Future Perspectives.

Pediatric hypertension is currently one of the most common health concerns in children, given its effects not only on cardiovascular but also cognitive functions. There is accumulating evidence suggesting neurocognitive dysfunction in hypertensive children that could persist even into adulthood. Identifying the precise mechanism(s) underlying the association between childhood hypertension and cognitive dysfunction is crucial as it could potentially lead to the discovery of "druggable" biological targets facilitating the development of treatments.

Beating non-communicable diseases in primary health care: The contribution of pharmacists and guidance from FIP to support WHO goals.

According to the World Health Organization (WHO), more than 36 million people die annually from non-communicable diseases (NCDs), representing over 60% of deaths worldwide, 15 million of which occur before the age of 70 years. Prevention and control of NCDs and their risk factors require interventions that are therapeutically cost-effective, affordable by the patient and/or health systems and feasible, based upon local resources. This commentary paper sets a basis of global evidence to advocate, nationally and internationally, for an expanded role for pharmacists in NCD management by compiling best practices and examples.

Aromatase inhibitors and risk of cardiovascular events in breast cancer patients: a systematic review and meta-analysis.

Background: Cardiovascular events (CVEs) was considered as one of the primary cause to reduce the quality of life in breast cancer patients with aromatase inhibitors (AIs) treatment, which has not been sufficiently addressed. The aim of this study was to assess the correlation between risk of CVEs and AIs in patients with breast cancer.

Methods: Included studies were obtained from the databases of Embase, Pubmed, Cochrane Library, Clinical Trials.

Optimizing utilization of beta-lactam surgical prophylaxis through implementation of a structured allergy assessment tool in a presurgical clinic.

In patients with β-lactam allergies, administration of non-β-lactam surgical prophylaxis is associated with increased risk of infection. Although many patients self-report β-lactam allergies, most are unconfirmed or mislabeled. A quality improvement process, utilizing a structured β-lactam allergy tool, was implemented to improve the utilization of preferred β-lactam surgical prophylaxis.

Antibiotic Exposure Profiles in Trials Comparing Intensity of Continuous Renal Replacement Therapy.

Objectives: To determine whether the probability of target attainment over 72 hours of initial therapy with beta-lactam (cefepime, ceftazidime, piperacillin/tazobactam) and carbapenem (imipenem, meropenem) antibiotics were substantially influenced between intensive and less-intensive continuous renal replacement therapy groups in the Acute Renal Failure Trial Network trial and The RENAL Replacement Therapy Study trial.

Design: The probability of target attainment was calculated using pharmacodynamic targets of percentage of time that free serum concentrations (fT): 1) were above the target organism's minimum inhibitory concentration (≥ fT > 1 × minimum inhibitory concentration); 2) were above four times the minimum inhibitory concentration (≥ % fT > 4 × minimum inhibitory concentration); and 3) were always above the minimum inhibitory concentration (≥ 100% fT > minimum inhibitory concentration) for the first 72 hours of antibiotic therapy. Demographic data and effluent rates from the Acute Renal Failure Trial Network and RENAL Replacement Therapy Study trials were used.

Cultural Sensitivity and Global Pharmacy Engagement in Africa.

Global engagement between schools and colleges of pharmacy in the United States and Africa is increasing. For a balanced and fruitful engagement, sensitivity towards the cultural and clinical needs of the people and professionals of the African region is critical. In this paper, we have divided the discussion into Southern, East, Central, and West Africa.

Management of Hyperkalemia With Insulin and Glucose: Pearls for the Emergency Clinician.

Background: Hyperkalemia is a common, potentially lethal clinical condition that accounts for a significant number of emergency department (ED) visits. Insulin and dextrose are frequently used to manage patients with hyperkalemia.

Objective: This narrative review evaluates several myths concerning hyperkalemia treatment with insulin and dextrose in the ED and provides recommendations based on the current evidence.

Vitamin C, Hydrocortisone, and Thiamine for the Treatment of Severe Sepsis and Septic Shock: A Retrospective Analysis of Real-World Application.

A recent study suggested mortality benefits using vitamin C, hydrocortisone, and thiamine combination therapy (triple therapy) in addition to standard care in patients with severe sepsis and septic shock. In order to further evaluate the effects of triple therapy in real-world clinical practice, we conducted a retrospective observational cohort study at an academic tertiary care hospital. A total of 94 patients (47 in triple therapy group and 47 in standard care group) were included in the analysis.

Assessment of literacy and numeracy skills related to non-steroidal anti-inflammatory drug labels.

Background: Non-steroidal anti-inflammatory drugs are widely used and have a potential for over-the-counter misuse. Limited health literacy is associated with poor health outcomes. Identification of new strategies to assess literacy and numeracy could be useful in targeting effective education initiatives.

Safety of Peripheral Line Administration of 3% Hypertonic Saline and Mannitol in the Emergency Department.

Background: Hypertonic saline (HTS) and mannitol are frequently utilized in the emergency department (ED) to manage elevations in intracranial pressure (ICP).

Objective: The objective of this study was to compare the incidence of extravasation injury when HTS or mannitol was administered via peripheral i.v.

Coadministration of intramuscular olanzapine and benzodiazepines in agitated patients with mental illness.

Introduction: Intramuscular antipsychotics are commonly used to manage agitated patients. In 2005, Eli Lilly placed a warning on olanzapine's prescribing information following post-marketing reports of fatal drug reactions when intramuscular olanzapine was used in the setting of benzodiazepines. Data is lacking examining this drug combination.

Evaluation of Home Medication Reconciliation by Clinical Pharmacists for Adult and Pediatric Cystic Fibrosis Patients.

Medication reconciliation is an important aspect of a patient's care process that is ideally performed by clinical pharmacists. Despite literature supporting this process in other patient populations, cystic fibrosis (CF) lacks research in this area. To address this, we designed a retrospective, multi-centered, non-controlled, cross-sectional study at four CF Foundation-accredited centers in the United States to evaluate the medication reconciliation process for adult and pediatric CF patients by documenting the number of home medications reconciled by clinical pharmacists and the number of patients with home medications that did not align with the current CF guidelines published in 2013.

Ex vivo Rezafungin Adsorption and Clearance During Continuous Renal Replacement Therapy.

Background/aims: To determine adsorption and transmembrane clearances (CLTM) of rezafungin, a novel long-acting echinocandin, in continuous venovenous hemofiltration (CVVH).

Methods: A validated ex vivo bovine blood CVVH model using polysulfone and AN69 hemodiafilters was used to evaluate urea and rezafungin CLTM at 3 different ultrafiltrate flow rates. Rezafungin adsorption to the CRRT apparatus was determined for each hemodiafilter.

Individualized Pharmacokinetic Dosing of Vancomycin Reduces Time to Therapeutic Trough Concentrations in Critically Ill Patients.

Dosing vancomycin in critically ill patients often results in subtherapeutic and supratherapeutic trough concentrations. In this retrospective study, we compared the time to goal trough attainment and incidence of acute kidney injury in intensive care unit (ICU) patients whose vancomycin was dosed by a pharmacy pharmacokinetic (PK) dosing and monitoring service to the standard of care. Three-hundred fifty adult ICU patients at a Level 1 trauma, teaching hospital who received vancomycin for >24 hours from February 1, 2016, to November 30, 2016, were screened.

Pharmacokinetics of Continuous Infusion Beta-lactams in the Treatment of Acute Pulmonary Exacerbations in Adult Patients With Cystic Fibrosis.

Background: Several clinical trials have shown the efficacy of continuous infusion beta-lactam (BL) antibiotics in patients with cystic fibrosis (CF); however, little is known about pharmacokinetic changes during the treatment of an acute pulmonary exacerbation (APE). Identifying and understanding these changes may assist in optimizing antibiotic dosing during APE treatment.

Methods: This study was a retrospective cohort study of 162 adult patients with CF admitted to the University of Utah Hospital between January 1, 2008, and May 15, 2014, for treatment of an APE with both a continuous infusion BL and IV tobramycin.

Effects of Low Doses of Ketamine on Pyramidal Neurons in Rat Prefrontal Cortex.

Indirect evidence suggests that low doses of ketamine disinhibit (excite) pyramidal neurons in the prefrontal cortex (PFC). In this study, we directly examined the effect of ketamine on PFC pyramidal neurons using simultaneous single-cell and local-field-potential (LFP) recording in chloral hydrate-anesthetized rats. In all animals studied, PFC LFPs showed oscillations (0.

Nutrition and Clinical Outcomes of Nutrition Support in Multidisciplinary Team for Critically Ill Patients.

Background: To examine the outcomes of the implementation of a multidisciplinary nutrition support team (NST) that included a pharmacist for critically ill patients in the intensive care unit (ICU).

Methods: Data were retrospectively collected from electronic medical records and compared between the pre-NST group (n = 73) and post-NST group (n = 75). Patients were included if they received enteral or parenteral nutrition support for at least 72 hours in the ICU of an approximately 900-bed, top-tier university medical center.

Usefulness of Statins for Prevention of Venous Thromboembolism.

Venous thromboembolism (VTE), including deep venous thrombosis and pulmonary embolism, is common with an annual incidence of 1 to 5 per 1,000, resulting in major morbidity, mortality, and increased health care costs. It is more common in the elderly, obese, those with cancer, those undergoing surgery, and those with previous VTE. Strategy to reduce its occurrence has important public health implications.

Two-Year Trends of Taxane-Induced Neuropathy in Women Enrolled in a Randomized Trial of Acetyl-L-Carnitine (SWOG S0715).

Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a common and disabling side effect of taxanes. Acetyl-L-carnitine (ALC) was unexpectedly found to increase CIPN in a randomized trial. We investigated the long-term patterns of CIPN among patients in this trial.

The Report of the 2016-2017 Professional Affairs Standing Committee: Formally Embracing and Engaging Preceptors in the Academy - The Time Has Come.

The 2016-2017 AACP Professional Affairs Committee (PAC) was charged to examine strategies to include adjunct/affiliate preceptors as AACP members and to determine the value proposition of AACP membership for this group of educators. The PAC defined adjunct/affiliate preceptors as preceptors who are neither full-time employees nor have a primary employment commitment (≥50% of the preceptor's work salary) at a school/college of pharmacy. Specific charges to the PAC included: recommend an approach to increase the number of adjunct/affiliate preceptors as AACP members, examine AACP membership from an adjunct/affiliate preceptor value perspective, and prepare a concise summary of available literature describing value-added contributions of student pharmacists and pharmacy preceptors to pharmacy practice models, interprofessional education (IPE) and interprofessional practice (IPP).