Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2031-01-01

Evaluation of the Pulmonary Ambulatory Care Clinic at David Grant Medical Center was an attempt to explore several questions that surround the care of patients with chronic obstructive pulmonary disease (COPD) and to assess the role and impact of pharmacists providing pharmaceutical care in an Air Force Medical Center. Four experimental designs were implemented. Thirty-eight ambulatory patients with COPD were randomized into a control group or into a program where pharmacists resolved drug-related problems (DRPs) and educated patients about optimal drug use and management of exacerbations. The groups were evaluated prospectively at baseline, three months and six months for the presence of DRPs, quality of life (QOL) scores, and health care resource utilization (HCRU) parameters. Significant improvements in Health Status Questionnaire scores of study group were at three (F = 4.56, p = 0.04) and six months (F = 3.84, p = 0.05). Chronic Respiratory Disease Index questionnaire scores significantly improved in study group at three months in fatigue category (F = 5.35, p = 0.02). Disease State Knowledge Test scores significantly improved at three (F = 3.90, p = 0.04) and six months (F = 13.37, p = 0.001) in study group. Twenty-two DRPs were resolved. The study group realized significant reductions in mean numbers of physician visits (F = 8.12, p $<$ 0.05), and emergency room visits (F = 5.41, p $<$ 0.05) at three and six months respectively. Mean number of physician visits in study group during six-month period was significantly lower prospectively than retrospectively (T = 3.56, p = 0.003) in the single subject design study. Retrospective study of seventy patients showed that mean numbers of chronic medications (F = 6.57, p $<$ 0.05) and pulmonary hospitalizations (F = 4.08, p $<$ 0.05) were significantly lower in mild patients than severe patients. These results of this four-part study design, showed that patient education and resolution of DRPs improved patients' QOL and increased their knowledge about their disease states. Teaching patients how to manage exacerbation resulted in a decrease in health care visits in this patient population. Categorization of severity by pulmonologist coincided with patients' utilization of HCRs.

The presence of pharmaceuticals in the environment is becoming an increasing regulatory and scientific concern. Thus, the metabolic profile and bioconcentration potential of diazepam, a model benzodiazepine, were examined, as well as effects on the endocrine system in channel catfish. Through the use of specific and non-specific cytochrome P450 (CYP450) inhibitors, it was determined that CYP3A-like enzymes may play a role in the biotransformation of diazepam into temazepam; however, the isoform(s) required for the formation of other metabolites is still unknown. Overall, only around 7-8% of diazepam is biotransformed into two known metabolites. Due to the lack of inherent metabolism of diazepam in channel catfish, further analysis was conducted to determine the tissue-specific bioconcentration potential of diazepam in catfish. Various tissues were analyzed for the presence of diazepam as well as metabolites and bioconcentration factors (BCF) were calculated, which were all well below regulatory threshold values (> 2000). Additionally, modulation of the endocrine system by diazepam was examined by measuring steroid hormone concentrations and analyzing mRNA expression of selected steroidogenic enzymes and receptors. Two steroidogenic enzymes were modulated following diazepam exposure, indicating potential endocrine disrupting properties of diazepam. Together, these data suggest that diazepam exhibits low metabolic transformation rates in channel catfish, which may lead to accumulation of benzodiazepine compounds that may negatively affect the endocrine system. However, further studies should be aimed at identifying other steroidogenic enzymes and/or receptors that may be modulated following diazepam exposure.

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