Background: Malignancy is a significant risk factor for venous thromboembolism (VTE), conferring a 4- to 7-fold increased risk in patients with cancer. Because of its effect on certain tumors, low-molecular-weight heparin (LMWH) has been evaluated as a treatment option for cancer and as an alternative to traditional warfarin therapy in patients with active cancer. LMWH is associated with a reduced recurrence of VTE, fewer adverse bleeding events, and, in some instances, decreased mortality. The American College of Chest Physicians/American Society of Clinical Oncology has recommended LMWH for at least the initial 3 to 6 months when treating VTE in patients with cancer, based on the positive outcomes associated with LMWH. Objective: The purpose of this study was to evaluate physician prescribing patterns for LMWH or warfarin in patients with acute VTE and active cancer. Methods: We conducted a retrospective chart review of hospitalized patients at a community teaching hospital with an affiliated regional cancer center located in a rural area of the United States. Patients included in the analysis had an International Classification of Diseases, Ninth Revision code indicative of any cancer type and a concomitant code for any VTE. The primary outcome was the drug prescribed at discharge for the treatment of VTE. Secondary outcomes included specialty of the prescribing physician, adverse bleeding events, and the need for transfusion. VTE treatment regimen was evaluated using the binomial test, and logistic regression analysis was used to determine correlation of the prescriber’s specialty with the patient’s prescribed regimen. Results: Of 129 patients included in the analysis, 107 (82.9%) were prescribed warfarin compared with 9 (7%) who were prescribed LMWH. Hematologists and oncologists were more likely to prescribe LMWH than general practitioners (odds ratio, 7.8; 95% hazard ratio, 1.5-42). Seven patients had a documented adverse bleeding event and 2 patients required a transfusion. Four of the 7 adverse bleeding events and 1 of the 2 transfusions occurred in the group receiving vitamin K antagonist therapy. Conclusion: Physicians in our system were significantly more likely to prescribe warfarin for acute treatment of VTE in patients with active cancer—despite consistent evidence and multiple evidence­-based guidelines recommending treatment with LMWH in this patient population. This was lower than other observations in Canadian populations but may more accurately represent nonteaching centers in the United States, particularly those in rural areas. Specialists in oncology were significantly more likely to prescribe LMWH than generalists.

In recent years, several new oral anticancer drugs have been approved, many via an accelerated approval process. These new agents have the potential for drug interactions, but lack of familiarity with these drugs by clinicians may increase the risk for drug interactions. We describe an interaction between the new anticancer agent idelalisib (CYP 3A4 inhibitor) and diazepam (CYP 3A4 substrate) that resulted in altered mental status and type II respiratory failure resulting in hospitalization. After discontinuation of both agents, the patient recovered quickly. Idelalisib was reinitiated after discharge. Lorazepam was substituted for diazepam since it is not metabolized via CYP 3A4. Both agents were tolerated well thereafter. This interaction was only flagged by two of four commonly used drug interaction databases. Clinicians should exercise caution with initiating new oral anticancer agents and consider the potential for drug interactions without solely relying on drug interaction databases.

Background: The aim of this study was to design and evaluate a laboratory activity based on scientific inquiry to educate first-year pharmacy students in the U.S. about vaccination theory and the attributes of common pathogens. Methods: The laboratory activity had two principal sections. The first consisted of an interactive game during which students rolled a die to determine outcomes based on a set of pre-determined criteria. In the second section, students generated and tested hypotheses about vaccine theory using a computer simulation that modeled disease transmission within a large population. In each section students were asked to evaluate epidemiological data and make inferences pertinent to vaccination effectiveness. Results: Mean scores on a knowledge-based assessment given immediately before and immediately after the activity increased from 46% to 71%. Discussion: A laboratory activity designed to stimulate scientific inquiry within pharmacy students enabled them to increase their knowledge of common vaccines and infectious diseases.

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No description available.

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Prescription drug abuse is a major public health problem in United States. Research showing 70% of nonmedical prescription drug users obtain drugs from friends and family has sparked discussion over disposal of unused or expired medications. Tennessee experienced a 250% increase in overdose deaths from 2001 to 2010. In response to this increase, permanent drug donation receptacles have been installed in multiple law enforcement offices across the state; however, the extent to which the public utilizes these receptacles is not well known. In partnership with Drug Enforcement Administration and local law enforcement, drop box donations were analyzed in six Northeast Tennessee locations from June 2012 to October 2013. The objectives of this research were to: 1) quantify controlled substances (CS) donated, and 2) evaluate time lapse between dispensing date and donation across CS schedules as well as potency rankings for opioids. Over the 18-month collection period, 3,113.5 lbs. of pharmaceutical waste was donated; 5.14% or 160lbs were CS, totaling 65,430 individual doses. Analysis of dispensing dates for CS medications indicated a median of 34 months lapsed from dispensing to donation (range 1 to 484 months). Comparison of means between Schedule II and Schedule III/IV indicated that Schedule II drugs were donated within fewer months than Schedule III/IV drugs (t-test = -4.37, p-value <0.0001). These results quantify the potential impact of permanent drug donation boxes on the prevention of CS diversion in Northeast Tennessee. Further study is warranted to examine the effect of targeted public health messages on increasing CS donation.

Introduction: Community pharmacists in the United States routinely serve as intermediaries in the process of providing (i.e., dispensing) prescription opioids (POs) to patients for whom they are prescribed. Similar to most states, Tennessee (TN) has experienced exponential increases in PO dispensing, abuse and overdose deaths over the past decade. A multifaceted approach has been put forth by the United States National Drug Control Strategy to combat PO abuse, one aspect of which is expanding the extent to which health care professionals detect and address substance use disorders. Despite little exploration of pharmacist provided PO abuse/misuse interventions, our previous research reveals that 26% of TN community pharmacists have provided addiction treatment facility information to one or more patients in the past, and 13% of pharmacists have addiction treatment facility information in their pharmacies. The objective of this study is to investigate the associations between community pharmacist and community pharmacy characteristics and the provision of addiction treatment facility information to pharmacy patients. Methods: A survey was administered to a stratified random sample of licensed TN pharmacists in 2012 using Dillman’s Tailored Design Method. The survey instrument assessed community pharmacists’ attitudes, beliefs and behaviors specific to prescription drug abuse communication. Logistic regression techniques were used to identify correlates of provision of addiction facility information by pharmacists. Results: A response rate of 40% was obtained. Univariate logistic regression analysis indicated the provision of addiction treatment information was associated with being male, increased average number of hours worked per week, having addiction treatment information readily available in the pharmacy, higher self-efficacy beliefs regarding ability to discuss addiction treatment facility options, discuss perceived PO abuse, and discuss perceived PO addiction with patients, participation in PO abuse specific continuing education (CE), and employment in an independent pharmacy setting. Multiple logistic regression analysis indicated that being male (OR = 2.2; 95% CI = 1.4-3.6), having high task-specific self-efficacy beliefs (OR = 4.2; 95% CI = 2.7-6.5), working more hours (OR = 1.00; 95% CI = 1.02-1.05), participating in prescription drug abuse-related CE (OR = 2.9; 95% CI = 1.7-5.0), and having treatment facility information in the practice setting (OR = 8.2; 95% CI = 4.4-15.4) were statistically significant predictors of information provision. Implications: As interventions and models are developed that expand prevention and treatment efforts, factors should be considered that influence health care providers’ prescription drug abuse/misusedeterrent behaviors. Our research has the potential to inform these interventions and thereby expand the extent to which community pharmacists engage in the detection and care of patients with substance use disorders.

Naloxone has received increased public health attention in recent years given its effectiveness in the reversal of opioid overdoses. Despite continued increases in overdose death rates attributable to opioids, approaches to naloxone dissemination, prescribing and dispensing are quite variable across states. On the public health prevention continuum, naloxone dissemination and use could be considered quaternary prevention —actions taken to identify individuals at risk of over-medication, protect them from new medical invasion and suggest interventions which are ethically acceptable. This presentation will describe approaches to overdose death prevention with naloxone in four states: Maine, Tennessee, Texas and Virginia. Particular emphasis will be placed on the role of community pharmacies in increasing naloxone dissemination. Attendees will be informed about recent legislative, educational and profession-specific prevention strategies and will thereafter engage in active learning to apply prevention strategies in their respective states. In addition to discussing barriers to and suggestions for increased naloxone uptake, presenters will describe assessments that can be used to evaluate overdose risk and subsequent naloxone co-prescribing/dispensing.

Controlled substance stewardship, much in the same vein as antimicrobial stewardship, is a professional obligation for prescribers and pharmacists alike in today’s practice environment. This presentation will introduce this concept and present a model for pharmacist-led controlled substance prescribing interventions in a primary care clinic. The Controlled Substances Initiative (CSI) at Penobscot Community Health Care in Bangor, Maine, was implemented in 2013. The interprofessional CSI Committee meets weekly to review patient cases involving controlled substances and communicate best practice recommendations to prescribers. All committee operations are sustained by pharmacists participating in a postgraduate residency training program. To assess the organization-wide impact of the initiative, presenters will share data on controlled substance dose reductions and mortality trends. They will offer pearls for application of this model to other practice settings, including community pharmacies.