Class of 2012 Abstract / Specific Aims: To determine pharmacy students' knowledge and attitudes towards herbal medicine, and to identify factors that have the most influence on herbal knowledge. Subjects: Students in the 1st, 2nd, 3rd, or 4th years of the Doctor of Pharmacy program at the University of Arizona. Methods: Questionnaires administered during regularly scheduled classes and email collected knowledge, attitudes, and demographic data. This included age, gender, highest level of education, completion of herbal medication/OTC course, practice site, availability of herbals and herbal information at the practice site, and use of herbal medication in a family member. Main Results: Questionnaires were completed by 270 out of the 395 students enrolled in pharmacy school. An average of 4.8 ± 3.02 out of the 14 questions (34%) were answered correctly on the knowledge section. Pharmacy students agreed that providing information about herbal medication is a pharmacist's professional responsibility and that an elective course on herbal medications would be useful (mean = 3.31 ± 1.52 and 3.73 ± 1.32 respectively on a scale of 0-5 where 5 = strongly agree and 0 = do not agree). Pharmacy school year and completion of an herbal/OTC course were the largest contributing factors to higher scores on the knowledge portion. Conclusions: With an average knowledge score of less than 50% and average rating of less than 2.5 out of 5, pharmacy students have a weak understanding and a low confidence level in recommending and counseling patients on herbal medications. Requiring a course that includes herbal medications may be beneficial.

Class of 2012 Abstract / Specific Aims: The purpose of this study was to assess the attitudes, beliefs and knowledge of pharmacy students regarding geriatric care. Methods: A questionnaire was administered to first, second and third year pharmacy students to assess the impact of geriatric curriculum on students at the University of Arizona College of Pharmacy. The primary grouping variable was whether or not students had previously taken a course focused on geriatrics. Main Results: A total of 193 pharmacy students completed the questionnaire which resulted in a response rate of 64.33%. There is no comparison group for the first year class as all students in this class had never taken a geriatric-focused course. Therefore, no tests for statistical significance could be performed for this class. Students in the second year class who have taken a geriatrics-focused course scored higher than those without course experience on all four of the attitude and beliefs questions (p = 0.104, p = 0.042, p = 0.045, p = 0.025). The same held true for the third year class (p = 0.006, p <0.001, p = 0.050, p = 0.653). Both classes showed a statistically significant increase in knowledge of geriatric care in those students who have previously taken a geriatrics-focused course (p = 0.032 for second years, p = 0.022 for third years). Conclusions: This study showed that pharmacy students at the University of Arizona College of Pharmacy who have previously taken a geriatrics- focused course have more positive attitudes and beliefs regarding geriatric care as well as a stronger knowledge base regarding geriatrics. With an aging population, it is important that pharmacists be knowledgeable and capable of caring for geriatric patients. Thus, we recommend that all pharmacy schools include a geriatrics-focused course as part of the standard curriculum for Pharm D. candidates.

Class of 2010 Abstract / OBJECTIVES: To evaluate the impact of interprofessional education on the perceptions and attitudes of pharmacy students. METHODS: A remodeled version of the Interdisciplinary Education Perceptions Scale (IEPS) was administered during a regular class time for first, second, and third year students. This adapted IEPS was designed and validated to assess three aspects of interprofessional perceptions: competency and autonomy (sub-scale 1), perceived need for cooperation (sub-scale 2), and perception of actual cooperation (sub-scale 3). Data regarding sex, age, previous health care work experience, and previous degree achievement were also collected. RESULTS: A total of 211 pharmacy students completed the survey (73 first-years, 85 second-years, and 53 third-years). Analysis of variants (one-way ANOVA) was used to analyze the potential difference in perceptions between the three groups of pharmacy students using both the total and sub-scale scores. No statistically significant difference was found between total scores, sub-scale 1, sub-scale 2, or sub-scale 3 with regard to pharmacy school year. There was also no significant difference in perceptions with regard to sex, age, work experience, or degree status for any scale scoring. CONCLUSIONS: Perceptions of interprofessional education did not differ between first-, second-, and third-year pharmacy students at the University of Arizona, College of Pharmacy.

Class of 2010 Abstract / OBJECTIVES: To determine and compare the ability and confidence of pharmacy students’ drug information skills at the end of their third and fourth years of pharmacy school. METHODS: This study used a self-­‐assessment questionnaire that was distributed to third and fourth year doctor of pharmacy candidates at the end of the academic year. The questionnaire consisted of 22 items using a 5-­‐point scale that ranged from excellent (5) to poor (1) and 5 demographic questions. The topics included five categories: communication issues, resource use, critical evaluation, questions and answers, and miscellaneous items. RESULTS: Seventy-­‐one of 86 (82.6%) third year students and 51 of 79 (64.6%) fourth year students participated in the study. Fourth year students were found to be more confident than third year students in their abilities to provide drug information responses in 21 of 22 questions and in all 5 category topics (p < 0.001 for each comparison). Compared to women, men were more comfortable in speaking with health care professionals about drug information requests (p = 0.047), and were more confident in their ability to use International Pharmaceutical Abstracts (p = 0.035), to prepare an appropriate recommendation when conflicting information was found in the literature (p = 0.040), and in evaluating meta-­‐analysis literature (p = 0.045). CONCLUSIONS: Additional drug information requirements and experiences during the fourth year clinical rotations were associated with higher confidence in the self-­‐perception of drug information skills compared to third year pharmacy students who only had didactic courses in drug information. More studies need to be completed that compare different types of drug information rotations and requirements.

Class of 2017 Abstract / Objectives: To explore the available literature for information on the types of medication errors committed in community pharmacies, the rate of occurrence, and potential causation of those errors. Methods: A literature search was conducted in PubMed for articles dating from 1995-present concerning medication errors committed in community pharmacies. A total of eight studies were used in the evaluation. Results: Error types identified in the literature include content errors, labeling errors, near errors, clinically significant errors, and any other deviation from the prescriber's original order. Each study had its own individual error rate. Combining all studies reviewed, the overall average error rate was 2.2% (516 errors out of 23,455 prescriptions total). Proposed causation of medication dispensing errors include low lighting levels, high sound levels, the use of manual prescription inspection alone, pharmacy design, problems with efficiency, the use of drive through pick up windows, errors in communication, high prescription volume, high pharmacist workload, inadequate pharmacy staffing, and the use of dispensing software programs that provide alerts and clinical information. Conclusions: The available literature proposes that medication-dispensing errors in community pharmacies continue to be a frequent issue. Error types include content, labeling, clinically significant, near errors, and any other deviation from the prescriber's original order. Of the observed errors, labeling was most frequent. The data indicated low lighting, amplified noise, and sociotechnical factors could contribute to error frequency. Future studies are required to focus on other potential causes of dispensing errors and how to minimize rate of occurrence.

Class of 2009 Abstract / OBJECTIVES: To evaluate patients’ perceptions of receiving a pharmacist-administered influenza vaccine in the community pharmacy setting. METHODS: All patients receiving a pharmacist-administered influenza vaccine at a Safeway Pharmacy in Tucson, Arizona were invited to participate in the survey. Participants completed the survey in a waiting area outside the pharmacy. At the completion of the study time frame, surveys were collected, and each response was entered into an Excel spreadsheet for data analysis. RESULTS: Seventy-five patients completed the Flu Shot Survey. One hundred percent of patients reported that getting the influenza vaccine at a grocery store pharmacy is convenient. Respondents reported being either very confident (97.3%) or somewhat confident (2.7%) in pharmacists as immunizers. Only 18.7% reported having never received an influenza vaccine from a pharmacist, and 13.3% reported having no prior knowledge that Arizona pharmacists could administer the influenza vaccine. CONCLUSIONS: All patients responded that receiving the influenza vaccine from a community pharmacist was convenient. Patients wanted to receive the vaccine next year from a pharmacist, and the majority of respondents were confident in the pharmacist as an immunizer. Few patients reported never receiving the influenza vaccine from a community pharmacist, and even fewer patients were unaware that pharmacists in Arizona can immunize.

Objective: The main goal of this study is to compare the Quality of Life (QoL) of Chronic Obstructive Pulmonary Disease (COPD) patients between three different regions: the United Arab Emirates (UAE), the United Kingdom (UK) and Morocco. Another aim of this research is to assess the predictive factors correlated to the QoL and study the extent of their involvement as well as any possible interaction between them. It is also designed to compare the QoL of control group (healthy individuals) among the same countries. Methods: A total of 1800 subjects were recruited including stable COPD patients (n=430), and a control group (n=1370) from the UK, Morocco and the UAE. St George’s Respiratory Questionnaire (SGRQ) was the instrument used to evaluate the QoL, while Mahler Dyspnoea Index was used to assess the dyspnoea. Lung functions were measured by a standardised Vitalograph spirometer, while a hand grip dynamometer was used to measure the muscle strength. Data was analysed using ANOVA Post Hoc test to compare the QoL between the centres and linear regression analysis used to assess the effect of various variables upon the QoL scores components. Extra questions were asked to the patients to study their awareness of their condition and its management, which have been tested using chi-square statistical method. Results: Our results show that differences in the QoL between the countries exist. The UK had better overall QoL than Morocco and the UAE, with no significant difference between genders. How well total SGRQ scores were predicted by BMI, dyspnoea index, total muscle grip and pulmonary function were assessed and the results indicated that age, total muscle grip, FVC% predicted, and dyspnoea index are significantly associated with the QoL. Regarding the control groups, our results indicated that there was a highly significant difference in all variables between the three countries. Conclusion: Muscle grip, age, dyspnoea and FVC% predicted are good predictors of QoL in COPD patients. Patients’ QoL deteriorates with older age and increased dyspnoea. COPD patients with poor QoL experience muscle weakness and poor lung function. There was clearly a difference between the QoL of COPD patients in the three regions and the reason behind this is mainly due to the socio-economic status and the health care system followed in each country rather than the demographic location.

Within the past fifty years, drugs from the sea have become an increasing industry for the identification and isolation of new medicinal agents. Bryozoa, sea squirts and corals are examples of many organisms that have been collected and tested for medicinal activity. Clinical testing’s of drugs such as bryostatin 1 and Et-743 have shown much success against various cancers such as kidney, prostate, and leukemia, etc. However, there are many problems affecting the economical availability of such drugs such as: 1. the potential endangerment of marine organisms due to massive quantities required for clinical use; 2. seasonal availability of the organisms and 3. numerous synthetic steps resulting in low percent yields to name a few. Detailed analyses conducted of the environment of these marine organisms resulted in the composition of chemicals that were used as an artificial property to mimic the host organisms and their environments, resulting in the cultivation of the bacteria suggestively responsible for the production of these active compounds. Other experiments conducted, involved the esterification of bryostatin 1 under various conditions, in order to show that such compounds produced, are more environmentally obtainable as opposed to being specie dependent. Computational studies binding Fe3+ to different marine natural products was also conducted in order to determine any siderophore properties that each may have. From this study cell line tests were conducted in order to determine the efficacy of a bryostatin-Fe3+ complex in comparison to bryostatin 1. Preliminary results from all the artificial media used to isolate and produce the bryostatins and Et-743 showed prominence; however, results were inconclusive due low detection values and marginal errors.

Antisense oligodeoxynucleotides can selectively inhibit gene expression provided they are delivered to their target site successfully for a sufficient duration. Biodegradable microspheres have previously been developed for the potential systemic delivery of antisense oligodeoxynucleotides and offer an excellent strategy for central administration of antisense oligodeoxynucleotides, providing a sustained-release delivery system. Biodegradable microspheres were formulated to entrap antisense oligodeoxynucleotides for stereotaxic implantation into site-specific regions of the rat brain. Release profiles of antisense oligodeoxynucleotides from biodegradable microspheres over 56 days that were triphasic were observed with high molecular weight polymers. Antisense oligodeoxynucleotides loaded into microspheres (1-10m) had a five-fold increase in cellular association with glial and neuronal cells compared to the naked molecule, which was partially due to a greater cellular accumulation as observed by a slower efflux profile. In vivo distribution studies of antisense oligodeoxynucleotides demonstrated that the use of microspheres provided a sustained-release over more than 2 days compared to 12 hours of the naked molecule. Efficacy of antisense oligodeoxynucleotides was demonstrated during locomotor activity investigations, which significantly reduced cocaine-induced locomotor activity, where no efficacy was demonstrated with microspheres, possibly attributed to antisense loading and measurements being taken during a lag phase of antisense oligodeoxynucleotide release. Biodegradable microspheres can be delivered site-specifically into the brain and provide sustained-release of antisense oligodeoxynucleotides, offering the potential of in vivo efficacy in these reagents in the brain.

Type 2 diabetes is an insidious disorder, with micro and/or macrovascular and nervous damage occurring in many patients before diagnosis. This damage is caused by hyperglycaemia and the diverse effects of insulin resistance. Obesity, in particular central obesity, is a strong pre-disposing factor for type 2 diabetes. Skeletal muscle is the main site of insulin-stimulated glucose disposal and appears to be the first organ that becomes insulin resistant in the diabetic state, with later involvement of adipose tissue and the liver. This study has investigated the use of novel agents to ameliorate insulin-resistance in skeletal muscle as a means of identifying intervention sites against insulin resistance and of improving glucose uptake and metabolism by skeletal muscle. Glucose uptake was measured in vitro by cultured L6 myocytes and isolated muscles from normal and obese diabetic ob/ob mice, using either the tritiated non-metabolised glucose analogue 2-deoxy-D-glucose or by glucose disposal. Agents studied included lipoic acid, isoferulic acid, bradykinin, lipid mobilising factor (provisionally synonymous with Zinca2 glycoprotein) and the trace elements lithium, selenium and chromium. The putative role of TNFa in insulin resistance was also investigated. Lipoic acid improved insulin-stimulated glucose uptake in normal and insulin resistance murine muscles, as well as cultured myocytes. Isoferulic acid, bradykinin and LMF also produced a transient increase in glucose uptake in cultured myocytes. Physiological concentrations of TNFa were found to cause insulin resistance in cultured, but no in excised murine muscles. The effect of the M2 metabolite of the satiety-inducing agent sibutramine on lipolysis in excised murine and human adipocytes was also investigated. M2 increased lipolysis from normal lean and obese ob/ob mouse adipocytes. Arguably the most important observation was that M2 also increased the lipolytic rate in adipocytes from catecholamine resistant obese subjects. The studies reported in this thesis indicate that a diversity of agents can improve glucose uptake and ameliorate insulin resistance. It is likely that these agents are acting via different pathways. This thesis has also shown that M2 can induce lipolysis in both rodent and human adipocytes. M2 hence has potential to directly reduce adiposity, in addition to well documented effects via the central nervous system.