Class of 2017 Abstract / Objectives: To assess the perceived confidence level of community pharmacists in utilizing weight-based dosing, dispensing prescriptions, counseling, and recommending over-the-counter medications for the pediatric population in rural and non-rural settings. Methods: A 33-item questionnaire generated through REDCap was distributed to 11,280 pharmacists registered with the Arizona State Board of Pharmacy via email from March 14 to April 4 of 2017. The survey collected information on the participants’ experiences in managing pediatric prescriptions and demographics. Results: Of the 11,280 surveys distributed, a total of 857 responses were submitted by the end of the survey period (7.6%) and 482 responses were included in the analysis; 49 (10.2%) were practicing in rural areas and 433 (89.8%) were practicing in non-rural areas (including urban and suburban) in Arizona. There was no significant difference in the rural group compared to the non-rural group regarding experiences with dispensing pediatric medications. In regards to the confidence level, there was a significant difference between the two groups in calculating and recommending weight-based dosing for prescription and OTC pediatric medications (p = 0.022 and 0.031, respectively) and identifying a dosing error in pediatric prescriptions (p = 0.016). Conclusions: Community pharmacists practicing in rural and non-rural settings in Arizona had similar experiences with dispensing pediatric medications and confidence levels in managing medications for pediatric patients.

Cryoprecipitate is commonly used outside guidelines. In trauma, the appropriate cryoprecipitate dose and its impact on plasma fibrinogen levels are unclear. This retrospective study aims to evaluate: (1) the appropriateness of cryoprecipitate transfusion in trauma; and (2) the plasma fibrinogen response to cryoprecipitate transfusion during massive transfusion in trauma. Fibrinogen levels of < 1.0 g/L within 2 and 6 hours of cryoprecipitate transfusion were used for assessing appropriateness. Out of 394 events, 238 (60%) and 259 (66%) were considered appropriate using 2 and 6 hour criteria, respectively. A dose of 8.7 (±1.7) units caused a mean increase in fibrinogen levels of 0.55 (±0.24) g/L, or 0.06g/L per unit. In our hospital, where transfusion guidelines and policies for rapid blood product and laboratory turnaround times exist, it is possible to achieve high rates of appropriateness for cryoprecipitate transfusion in trauma. The current recommended dose causes a modest increase in fibrinogen levels.

Cryoprecipitate is commonly used outside guidelines. In trauma, the appropriate cryoprecipitate dose and its impact on plasma fibrinogen levels are unclear. This retrospective study aims to evaluate: (1) the appropriateness of cryoprecipitate transfusion in trauma; and (2) the plasma fibrinogen response to cryoprecipitate transfusion during massive transfusion in trauma. Fibrinogen levels of < 1.0 g/L within 2 and 6 hours of cryoprecipitate transfusion were used for assessing appropriateness. Out of 394 events, 238 (60%) and 259 (66%) were considered appropriate using 2 and 6 hour criteria, respectively. A dose of 8.7 (±1.7) units caused a mean increase in fibrinogen levels of 0.55 (±0.24) g/L, or 0.06g/L per unit. In our hospital, where transfusion guidelines and policies for rapid blood product and laboratory turnaround times exist, it is possible to achieve high rates of appropriateness for cryoprecipitate transfusion in trauma. The current recommended dose causes a modest increase in fibrinogen levels.

Class of 2014 Abstract / Specific Aims: To assess the prevalence of mothers asking pharmacists for pediatric dosing and mothers’ knowledge of pediatric OTC use. Subjects: Mothers with ≥ one child under 6 years old in a local mothers’ support group in Tucson. Methods: Questionnaires were sent out weekly for a month by the group’s listserv and social media website to determine the prevalence of mothers that ask pharmacists questions and assess their knowledge of OTC medications and what medical sources they use. Data on ages, ages of children, number of children, race/ethnicity, pharmacy visited, education, insurance coverage, and children’s chronic diseases were collected. Main Results: Twenty-six people responded. About 46% of the participants were 30 - 34 years old. Forty-six percent of mothers had 2 children; 42% had 1 child. About 54% of mothers have asked a pharmacist for pediatric OTC dosing. The reasons mothers gave for not asking pharmacists dosing information were that they hadn’t needed to ask (25%), they asked a doctor (16%), they used an online resource (8%), and they didn’t think about asking (8%). Three questions assessed OTC knowledge; 50% of participants got all questions correct, 38.5% got two questions correct, and 11.5% got one question correct. There wasn’t a difference in OTC knowledge and whether they asked a pharmacist questions (p=0.373). Conclusion: More than half of mothers asked pharmacists dosing information, but this percentage could still be higher. Fifty percent got all three questions right, 38.5% got two questions correct, and 11.5% of mothers got only 1 question correct.

Class of 2015 Abstract / Objectives: To characterize the types of renal dosing recommendations provided in the prescribing information (aka package insert) before and after the FDA guidance for industry document regarding renal dosing, released in 1998. Methods: The prescribing information (PI) for all new molecular entities (NMEs) for three time periods was collected from the FDA website. Time period 1 was January 1995 to December 1997 and represents dosing recommendations prior to the FDA guidance statement. Time period 2 was January 2000 to December 2002 and time period 3 was January 2011 to December 2013. These represent recommendations after the FDA guidance statement. The renal dosing recommendations for each NME were reviewed and classified as either specific (includes CrCl, serum creatinine), nonspecific (mild, moderate, or severe impairment), caution, unnecessary, no information or other by two investigators independently. A further analysis was conducted for NMEs in time periods 1 and 2 with LexiComp and the most recent PIs located on FDA or company website. Presence of dialysis (hemodialysis or peritoneal) dosing recommendations was also recorded. Results: Time period 1 had significantly less NMEs characterized as No information in Lexicomp in comparison to original PIs (p= 0.02). A statistically significant decrease in original PIs characterized as Caution was observed between time periods 2 and 3 (p= .0004) and time periods 1 and 3 (p= 0.001). Conclusions: Terminology used in renal dosing recommendations in PIs does not seem to be clearer over the past years. There remains a need for improved quality of dosing information within PIs.

Dose tolerance and pharmacokinetic studies of pseudoephedrine sustained action capsules were performed in thirty-three adult male subjects who received either 120 mg or 150 mg capsules every twelve hours for seven consecutive days in a double-blind parallel design study. Although only one subject in the 150 mg group was discontinued prematurely from this study, a large number of side effects typical of CNS stimulation were seen. A placebo effect might account for a portion of these complaints, however symtoms evaluated as being due to drug were significantly more severe and persistent in the 150 mg group. Pulse rates showed a persistent and significant increase while systolic and diastolic blood pressure fell from the baseline values in both groups. A pharmacokinetic analysis of the pseudoephedrine plasma concentration-time data provided estimates of half-life and the volume of distribution/availability ratio. The values obtained were in good agreement with values reported by others. Half-life was not influenced by urine pH probably as a result of the narrow range of urine pHs observed in the subjects. Calculations of relative bioavailability suggest that the 120 mg capsule formulation has a 30% greater bioavailability compared to the 150 mg capsule.

Methadone hydrochloride is an old drug that has been in vogue off and on. It has complex pharmacodynamics and can be potentially fatal in inexperienced settings. Drug switching from an opioid to methadone or vice versa requires knowledge of equianalgesic dosing. It is critical when using the drug to monitor for signs and symptoms of toxicity so that overdosing or toxicity can be identified in a timely manner. This review discusses these important topics so that methadone can be used safely and effectively.

BACKGROUND: The Modification of Diet in Renal Disease (MDRD) formula and a modified version of the Cockcroft-Gault (CGm) formula adjusting for body surface area have been found to more accurately estimate glomerular filtration rate (GFR) compared with the original CG equation in specific patient populations. To date, the use of these formulas in determining drug dosage and estimating drug elimination has not been thoroughly investigated. OBJECTIVE: To evaluate the ability of the MDRD and CGm formulas to predict aminoglycoside elimination rate and clearance. METHODS: A 6-month prospective, noninterventional, pharmacokinetic study was conducted at a university teaching hospital. Patients receiving aminoglycoside antibiotics (amikacin, gentamicin, or tobramycin) were eligible for study inclusion. Predicted elimination rate and aminoglycoside clearance were calculated for each patient using the MDRD and CGm formulas. Actual (patient-specific) elimination rate and aminoglycoside clearance were calculated for each patient using measured aminoglycoside serum concentrations. Predictive ability of the formulas was compared through Spearman correlations and Student's t-tests. Accuracy of formula estimates was also evaluated. RESULTS: Seventy-one patients met study inclusion criteria; the majority (82%) were in an intensive care unit. The 6-variable MDRD formula was found to be a significantly better predictor of aminoglycoside clearance (p = 0.035) compared with CGm. There was no statistically significant difference between the 2 methods in predicting patient-specific elimination rates (p = 0.167). Among subgroups, the MDRD formula was a significantly better predictor of aminoglycoside clearance for patients with an estimated GFR less than 60 mL/min (p = 0.027). CONCLUSIONS: The 6-variable MDRD performs better than the CGm formula in predicting aminoglycoside clearance and may be considered as a tool in aminoglycoside dosing recommendations.

For delivery, dosing and pressure control of fluids in mobile and stationary applications electromagnetically operated piston pumps are an established solution. The volume per stroke is exactly defined by the geometry. Nevertheless cavitation, more likely with the new fuel blends containing a high proportion of ethanol /1/, deteriorates the dosing precision of the liquid portion. One important criterion of precise metering is the transport of the liquids through the reciprocating piston pump without transferring bubbles. Especially, pumping in the range of vapour pressure of gasoline fuels implies challenges for precision. The objective of this work is revealing potential sources of reduced cavitation by optimising the design. For doing so, optical investigations have been applied. In addition to this, cavitation can be diminished controlling the piston’s travel externally. The second important item covers pumping of degenerated fluids even without negative effects on the pump’s performance. Up to now, wide, inefficient gaps or high force surplus are necessary. A new helix-design /2/ has been investigated and built up in order to reduce the described effort. The effects coming with the helix allow a permanent rinsing of the stressed surfaces, leading to lubrication and lower temperature loads. The results are shown in simulation, fundamental tests and is validated in practical pump operation.

No description available.