Objective: To review the place in therapy of isavuconazole, the active metabolite of isavuconazonium sulfate, via a review of the available literature on drug chemistry, spectrum of activity, pharmacokinetic/pharmacodynamic profile and trials assessing clinical efficacy and safety. Methods: Relevant data, original research articles and reviews, were gathered primarily through the use of a PubMed database search. The search was conducted without date restrictions in order to collect both historical and recent data regarding isavuconazole. Key findings: Isavuconazole is a triazole currently approved not only for use in invasive aspergillosis and mucormycosis but also has demonstrable activity against Candida species and other common fungal pathogens. This drug has features which make it more clinically appealing compared to other azoles with similar indications. In specific, isavuconazole does not require a cyclodextrin vehicle due to its water solubility, and at present, does not require therapeutic drug monitoring. Moreover, isavuconazole has displayed improved safety and tolerability compared to voriconazole. Available data from Phase III clinical trials shows isavuconazole to be a possible therapeutic option to currently available therapies for which it is approved; however, clinical conclusions should be reserved until results have been published and more data from clinical use is reported. Conclusions: Isavuconazole is a new triazole with broad‐spectrum antifungal activity including invasive aspergillosis and mucormycosis.

Purpose: Drug interactions are a concern in oncology with the shift toward oral antineoplastics (OAs). Using electronic databases to screen for drug interactions with OAs is a common practice. There is little literature to guide clinicians on the reliability of these systems with OAs. The primary objective of this study was to explore the sensitivity of commonly available drug interaction databases in detecting drug interactions with OAs. Methods: A list of 20 drug interactions with OAs was developed by two Board-certified oncology pharmacists. The list included multiple types of drug interactions. The sensitivity in detecting these interactions by MicroMedex, Facts & Comparisons, Lexi-Interact, and Epocrates were evaluated. These databases were chosen based on their local availability and widespread use in practice. Drugs.com was evaluated as a surrogate for a patient-accessible drug interaction database. The Cochran Q test was used to assess the sensitivity distribution across the five groups. Results: Lexi-Interact and Drugs.com had a sensitivity of 95% for the 20 tested drug interaction pairs. Epocrates had a sensitivity of 90%, and both Micromedex and Facts & Comparisons had a sensitivity of 70%. There was a statistically significant difference (P = .016) in the distribution across the databases in detecting clinically significant drug interactions. Conclusion: Commonly used databases for identifying drug interactions with oral antineoplastics vary significantly in their sensitivity. Clinicians should not rely on a single database and should consider using multiple resources as well as sound clinical judgment. Further work is needed in this area.

Sunitinib, an oral vascular endothelial growth factor receptor, is a first-line option for metastatic renal cell carcinoma and widely used in clinical practice. Despite the proven benefit of sunitnib in metastatic renal cell carcinoma, patients may suffer from a variety of adverse events including hypertension, fatigue, hypothyroidism, hand?foot skin reactions, rash, depigmentation, and myelosuppression. Myelosuppression is usually mild, transient and resolves during the two weeks at the end of each cycle where no drug is taken. We present a case of severe and early grade 3 neutropenia and thrombocytopenia occurring two weeks into a six-week cycle. Because of the extreme nature of the toxicity, CYP 3A4 polymorphisms were explored. The patient was found to be heterozygous for CYP 3A4*22, at least partially explaining the early-onset and severity of myelosuppression. This pharmacogenetics information resulted in a rechallenge of dose-reduced sunitinib, which was well tolerated by the patient. The current state of pharmacogenomics concerning sunitinb is also presented, and the need for greater research in this area is highlighted.

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Objectives: To determine if a flipped classroom improved student end of module exam performance in a pharmacotherapy oncology module. Method: Third year pharmacy students in the Class of 2013experienced the Pharmacotherapy Oncology Module (15 contact hours) as traditional lectures with optional case studies as supplemental homework (ungraded). The Class of 2014 experienced the same module content with a flipped classroom approach. The middle 10 contact hours were flipped as follows: 10 Vodcasts (8 hours total time) and 6 hours of in-class case studies in place of optional case studies. Students were instructed to watch Vodcasts before in-class case studies, but were not held accountable (i.e. quizzed) for pre-class preparation. The exam questions were identical in both cohorts. Performance on exam questions covered with the flipped approach was compared between the two cohorts using ANCOVA with prior academic performance variables (GPA) as covariates. Results: The students experiencing the flipped classroom approach performed poorer on exam questions covering flipped topics than the cohort that received traditional lecture with optional case studies with previous GPA used as a covariate (p , 0.05). Implications: A flipped classroom approach to incorporate active learning does not necessarily improve student performance. Limitations of this flipped classroom experiment include long vodcasts (30 to 50 minutes) and lack of student accountability for watching vodcasts. Further research is needed to determine optimal classroom flipping techniques that result in improved student performance.

Objectives: To characterize the preferred learning styles of pharmacy students at two colleges of pharmacy in the southeastern United States. Method: The Pharmacists’ Inventory of Learning Styles (PILS) was developed and validated as an instrument specific to pharmacists. We administered the PILS via email using Survey Monkey. Pharmacy students at the Medical University of South Carolina (MUSC) or South Carolina College of Pharmacy (SCCP-MUSC campus) were surveyed in 2007. Pharmacy students at the Gatton College of Pharmacy (GCOP) at East Tennessee State University (ETSU) were surveyed in 2010. An email was sent to each student on a Monday in the fall semester, followed by reminder emails each of the following three weeks. Students were not allowed to take the survey twice and participation was voluntary. Results: Response rates from MUSC and ETSU students were 48% and 71%, respectively. Pharmacy students at both MUSC and ETSU displayed similar preferred learning styles. The most common learning style at each institution was the Producer (61%), while the second most common learning style at each institution was the Director (30.5%), as defined by Austin. Implications: These results are the first to characterize the preferred learning styles of pharmacy students using the PILS. The almost identical results between both schools support the idea that the majority of pharmacy student in the southeastern United States prefer structured learning environments, which is true of both Producers and Directors. Future research assessing the relationship between preferred learning style and educational outcomes in different learning environments is warranted.

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