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Class of 2012 Abstract / Specific Aims: To determine pharmacy students' knowledge and attitudes towards herbal medicine, and to identify factors that have the most influence on herbal knowledge. Subjects: Students in the 1st, 2nd, 3rd, or 4th years of the Doctor of Pharmacy program at the University of Arizona. Methods: Questionnaires administered during regularly scheduled classes and email collected knowledge, attitudes, and demographic data. This included age, gender, highest level of education, completion of herbal medication/OTC course, practice site, availability of herbals and herbal information at the practice site, and use of herbal medication in a family member. Main Results: Questionnaires were completed by 270 out of the 395 students enrolled in pharmacy school. An average of 4.8 ± 3.02 out of the 14 questions (34%) were answered correctly on the knowledge section. Pharmacy students agreed that providing information about herbal medication is a pharmacist's professional responsibility and that an elective course on herbal medications would be useful (mean = 3.31 ± 1.52 and 3.73 ± 1.32 respectively on a scale of 0-5 where 5 = strongly agree and 0 = do not agree). Pharmacy school year and completion of an herbal/OTC course were the largest contributing factors to higher scores on the knowledge portion. Conclusions: With an average knowledge score of less than 50% and average rating of less than 2.5 out of 5, pharmacy students have a weak understanding and a low confidence level in recommending and counseling patients on herbal medications. Requiring a course that includes herbal medications may be beneficial.

Hoy en día las consecuencias tóxicas del uso de algunos medicamentos generan especial preocupación entre los pacientes, los médicos prescriptores, los dispensadores y las autoridades reguladoras, pues las reacciones adversas de los medicamentos son una causa importante no solo de consulta médica sino también de ingreso hospitalario, y, en ocasiones, de la muerte del paciente. Además, en los últimos años se han retirado del mercado numerosos medicamentos que fueron detectados durante su comercialización. El propósito de este proyecto de tesis es desarrollar e implementar un sistema de información para la gestión de reacciones adversas de medicamentos. A partir de dicho objetivo se realizaron las actividades que corresponden al ciclo de desarrollo del software según rup, tomando como base los requerimientos de la organización siendo estos asociados a sus objetivos estratégicos y a cumplir la ley ante los entes reguladores del estado peruano. De este modo, se concluyó que teniendo un sistema integrado entre las empresas farmacéuticas y el estado se reducirá las incidencias de reacciones adversas de los medicamentos en la población peruana. / Today the toxic consequences of the use of some medications generate special concern among patients, prescribing doctors, dispensers and regulatory authorities, as adverse drug reactions are an important cause not only of medical consultation but also of hospital admission , and, sometimes, of the death of the patient. In addition, in recent years numerous medications that were detected during marketing have been recalled. The purpose of this thesis project is to develop and implement an information system for the management of adverse drug reactions. Based on this objective, the activities that correspond to the software development cycle according to rup were carried out, based on the requirements of the organization being these associated with its strategic objectives and to comply with the law before the regulatory entities of the Peruvian state. Thus, it was concluded that having an integrated system between pharmaceutical companies and the state will reduce the incidence of adverse drug reactions in the Peruvian population. / Tesis

A growing body of literature has linked atypical antipsychotics (AAPs) to an increased propensity for weight gain and metabolic disturbances, including type 2 diabetes. While weight gain is a leading risk factor for diabetes, evidence suggests that AAPs may influence glucose homeostasis independently of changes in adiposity. These ‘direct’ drug effects have been consistently supported by animal models, where following even a single dose of certain AAPs immediate effects are observed with noted perturbations on insulin sensitivity, and insulin secretion. However, the mechanisms underlying these effects remain poorly understood. Also, the translational value of the acute dosing rodent model has not been established in humans. As such, we set out to first elucidate mechanisms of these ‘direct’ effects by deconstructing antipsychotic receptor binding profiles using selective antagonists and gold standard clamping techniques to examine effects on glucose metabolism. We also investigated antipsychotic administration directly into the brain in rodents to tease out central vs. peripheral effects on glucose metabolism. Finally, we examined whether the effects of a single dose of olanzapine on glucose metabolism could be replicated in healthy humans, independently of adiposity or the confounding effects of the illness of schizophrenia. Our findings suggest that cholinergic, serotonergic, and dopaminergic pathways may be involved in antipsychotic-induced glucose dysregulation. We also suggest that such effects may be mediated in part through the central nervous system. Our results in humans suggest that acute drug effects may be less pronounced than in rodents, failing to note an effect on insulin sensitivity or secretion, but observing other early perturbations in lipid and glucose metabolism. Taken together, the work here begins to elucidate mechanisms underlying the diabetogenic risk associated with AAPs, findings which have important implications given the widespread use of these drugs, as well as the increased mortality attributable to cardiovascular disease that defines those with schizophrenia.

A growing body of literature has linked atypical antipsychotics (AAPs) to an increased propensity for weight gain and metabolic disturbances, including type 2 diabetes. While weight gain is a leading risk factor for diabetes, evidence suggests that AAPs may influence glucose homeostasis independently of changes in adiposity. These ‘direct’ drug effects have been consistently supported by animal models, where following even a single dose of certain AAPs immediate effects are observed with noted perturbations on insulin sensitivity, and insulin secretion. However, the mechanisms underlying these effects remain poorly understood. Also, the translational value of the acute dosing rodent model has not been established in humans. As such, we set out to first elucidate mechanisms of these ‘direct’ effects by deconstructing antipsychotic receptor binding profiles using selective antagonists and gold standard clamping techniques to examine effects on glucose metabolism. We also investigated antipsychotic administration directly into the brain in rodents to tease out central vs. peripheral effects on glucose metabolism. Finally, we examined whether the effects of a single dose of olanzapine on glucose metabolism could be replicated in healthy humans, independently of adiposity or the confounding effects of the illness of schizophrenia. Our findings suggest that cholinergic, serotonergic, and dopaminergic pathways may be involved in antipsychotic-induced glucose dysregulation. We also suggest that such effects may be mediated in part through the central nervous system. Our results in humans suggest that acute drug effects may be less pronounced than in rodents, failing to note an effect on insulin sensitivity or secretion, but observing other early perturbations in lipid and glucose metabolism. Taken together, the work here begins to elucidate mechanisms underlying the diabetogenic risk associated with AAPs, findings which have important implications given the widespread use of these drugs, as well as the increased mortality attributable to cardiovascular disease that defines those with schizophrenia.

Background. Little is known about longitudinal prescribing practices for psychoactive medications for individuals with intellectual disabilities and developmental disabilities (IDDD) who are living in community settings. Methods. Computerized pharmacy records were accessed for 2344 community-based individuals with IDDD for whom a total of 3421 prescriptions were written during a 17-month period of study. Forty-two psychoactive medications were rank ordered in terms of prescription frequency. Results. Fifty-two per cent (52%) of all prescriptions written during the study period were for psychoactive medications. Anticonvulsant, antipsychotic and antidepressant medications were the most commonly filled prescriptions among psychoactive medications. Sixty per cent (62%) of the study population was given prescriptions for more than one psychoactive medication and 36% received three or more psychoactive medications. During the study period there was a statistically significant increase in prescriptions filled for olanzapine, risperidone, valproic acid, and clonazepam whereas prescriptions filled for thioridazine, haloperidol, and benzotropine showed a significant decline (P < 0.05-0.001). Distribution of psychoactive drug class by age showed that the majority of prescriptions were filled for individuals between 20 and 50 years with the exception of prescriptions for psychostimulants which peaked for individuals prior to 20 years. Conclusions. (1) Analysis of pharmacy billing records provides a method for assessing prescribing patterns of psychoactive medications in community-based individuals with IDDD. (2) Polypharmacy for psychoactive medications is prevalent in this setting. (3) The second-generation antipsychotic medications are prominently represented by an increasing number of filled prescriptions during the study period.

Class of 2008 Abstract / Objectives: To assess pharmacists’ and celiac patients’ knowledge and awareness about gluten in medications. Methods: People diagnosed with celiac disease were eligible to participate in the study. Patient questionnaires were administered at two of the quarterly Southern Arizona Celiac Support group meetings. Patients were surveyed regarding how to check the gluten-free status of prescription medications. Pharmacists from Tucson and Phoenix were included in the study. They were contacted by e-mail and invited to participate in the website questionnaire. Pharmacists were surveyed regarding their knowledge and comfort level of gluten content in medications. Both the patient questionnaires and pharmacist questionnaires utilized a rating scale of 0 to 5 (0=not at all, 5=very much). All other questions were multiple-choice. Results: Patient questionnaires were completed by 20 patients diagnosed for <5 years and 19 patients diagnosed ≥5 years. Seventy percent of patients reported that one of the ways they determine a medications’ gluten content is by asking a pharmacist which was significantly higher than any other method reported (p ≤ .010). Pharmacist questionnaires were completed by 40 clinical/hospital pharmacists and 25 community pharmacists. There were no significant differences in the two pharmacist groups’ reported level of knowledge (2.0±1.4 and 2.2±1.3, p=0.50), confidence in counseling (1.6±1.3 and 1.9 ±1.5 p= 0.41), or willingness to determine gluten content in medications (3.4±1.4 and 3.5±1.5). Conclusions: Celiac patients rely on pharmacists to determine the gluten content in medications. Pharmacists are willing to help patients determine gluten content, but are unconfident in their ability to do this.

Class of 2012 abstract / Specific Aims: To determine pharmacy students' knowledge and attitudes towards herbal medicine, and to identify factors that have the most influence on herbal knowledge. Subjects: Students in the 1st, 2nd, 3rd, or 4th years of the Doctor of Pharmacy program at the University of Arizona. Methods: Questionnaires administered during regularly scheduled classes and email collected knowledge, attitudes, and demographic data. This included age, gender, highest level of education, completion of herbal medication/OTC course, practice site, availability of herbals and herbal information at the practice site, and use of herbal medication in a family member. Main Results: Questionnaires were completed by 270 out of the 395 students enrolled in pharmacy school. An average of 4.8 ± 3.02 out of the 14 questions (34%) were answered correctly on the knowledge section. Pharmacy students agreed that providing information about herbal medication is a pharmacist's professional responsibility and that an elective course on herbal medications would be useful (mean = 3.31 ± 1.52 and 3.73 ± 1.32 respectively on a scale of 0-5 where 5 = strongly agree and 0 = do not agree). Pharmacy school year and completion of an herbal/OTC course were the largest contributing factors to higher scores on the knowledge portion. Conclusions: With an average knowledge score of less than 50% and average rating of less than 2.5 out of 5, pharmacy students have a weak understanding and a low confidence level in recommending and counseling patients on herbal medications. Requiring a course that includes herbal medications may be beneficial.

Class of 2016 Abstract / Objectives: The goals of this study were: to assess patients’ knowledge of grapefruit interactions when taking statin class (dyslipidemia) medications, to identify any pertinent demographic characteristics that may influence knowledge of grapefruit statin interactions, and to identify patient preferred sources of health information. Methods: Questionnaires were administered at community health fairs during the academic school year 2014 through 2015. The survey addressed grapefruit consumption, frequency and amount, for both whole fruit and juice; examined knowledge of the potential for harmful interactions of grapefruit juice with statin medications; and how or where the participant learned this information. Results: A total of 74 participants completed surveys, of which, 72 submitted fully completed surveys, mean age was 64 (SD=+/- 15.6), 71.2% were female (N=52), and 78.1% were white. Of those surveyed, 63.5% (N= 47) reported consuming grapefruit in the past 12 months, and 36.1% (N=26) reported taking a statin. Those taking statins, 50% (N=13) reported consuming grapefruit as well. The majority of people, 61.3% (N=45), reported obtaining health related information from healthcare sources. Those with a college education were more likely to have consumed grapefruit in the last 12 months (X2=4.88, p=0.027) and to have ever consumed grapefruit (X2 =4.40, p=0.036). Conclusions: The majority of the health fair attendees surveyed were highly educated, reported having health insurance, had consumed grapefruit in the past year, and had heard about grapefruit-drug interactions.

Unauthorized reproduction of this article is prohibited. Background:Mental health conditions are common among persons with HIV (PWH). An understanding of factors associated with prescription medication use for these conditions and clinical impact of the prescription medications may improve care of mental health disorders in PWH.Methods:Psychotropic medication use was examined among PWH within the AIDS Clinical Trials Group A5322 (HAILO) study. Multivariable logistic models and Cox regression models estimated the association between psychotropic medications (any/none) with baseline and incident slow gait (>1 s/m) and neurocognitive impairment (NCI) for more than 4 years.Results:Of 1035 participants, the median age was 51 years.81% were men, 30% black, non-Hispanic, and 20% Hispanic. Psychotropic medication use was similar between men (34%) and women (38%; P = 0.19). PWH using psychotropic medications had greater odds of baseline slow gait {odds ratio 1.61, [95% confidence interval (CI): 1.23 to 2.10]; P < 0.001}. Men but not women using psychotropic medications had an increased risk of developing slow gait [hazard ratio 1.85; (1.29 to 2.65) vs 0.77; (CI: 0.35 to 1.68), P interaction = 0.045]. The sex-specific odds ratios for medication use and NCI were qualitatively but not statistically different [men: 1.79; (1.14-2.80); women: 1.27; (0.56-2.90); P interaction = 0.47]. Psychotropic medication use was associated with an increased risk of incident NCI [hazard ratio 2.18; (95% CI: 1.23 to 3.84), P = 0.007] in both men and women.Conclusions:Psychotropic medications are associated with impairment in functional outcomes of aging, with a greater risk of baseline NCI and incident slow gait among men. Further investigation is needed to optimize outcomes in PWH and prescription of psychotropic medications among both men and women.