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Learning Objectives: Describe the rationale for the belief that opioids have no maximum dose Describe the data supporting the rationale that high doses of opioids increase toxicity Describe the data supporting the rationale that high doses of opioids do not improve outcomes Identify potential safety concerns with patients taking high doses of opioids

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Objectives: To determine misuse of prescription stimulant medications among future health care providers at an Academic Health Sciences Center. Method: Data were collected via a 62-item anonymous online survey distributed to medical, pharmacy, and rehabilitative health (RT) students at a large Academic Health Sciences Center. The survey instrument collected demographic information related to the respondent’s healthcare discipline, year(s) in professional program, and if the participant had been diagnosed with a disorder requiring a prescription stimulant medication. Nonmedical prescription stimulant use, motivation for nonmedical use, deceptive practices, frequency of use, consequences of nonmedical use, and peer group nonmedical use were also collected. Results: In aggregate, 11.3% of responders reported misuse of prescription stimulants. The rate of misuse was similar for pharmacy (9.7%) and medicine (10.9%) students with a trend towards an increased rate of misuse in RT students (26.3%) (p 5 0.08) The response rates were 70.5% (225/319) for pharmacy, 47.6% (128/269) for medical, and 54.3% (19/33) for respiratory therapy students. The most common reasons for misusing prescription stimulants were to improve academic performance (25/44; 56.7%) and increase alertness/energy (29/44; 65.9%). The most commonly reported adverse reactions were lack of appetite (30/44; 68.2%) and difficulty sleeping (24/44; 54.5%). Implications: Given the stigma associated with prescription stimulant misuse, it is difficult to assess the breadth and depth of this problem. Physical and/or psychological dependence, altered clinical judgment, and violation of misconduct policies and laws are possible consequences of prescription stimulant misuse. This is the first survey to assess misuse by multiple disciplines on a single Academic Health Sciences campus.

Primary Objective: To confirm the findings of several small studies conducted in the southeastern United States showing hypersensitivity infusion reaction (HIR) rates as high as 22% with the monoclonal antibody, cetuximab. Although well known for a risk of HIRs, early clinical studies showed much lower reaction rates of 3%.

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1. Evaluate the mechanisms by which hyperglycemia and hypothyroidism occur in patients on certain targeted chemotherapy agents.2. Develop treatment recommendations for patients who develop these endocrine toxicities while on therapy.3. Establish appropriate monitoring guidelines for patient receiving certain targeted chemotherapy agents.

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