Houston Methodist Pharmacy Annual Report 2022-2023 by Houston Methodist Professional Publications

HOUSTON METHODIST DEPARTMENT OF PHARMACY Annual Research Report | 2022-2023

2022-2023 HOUSTON METHODIST POSTGRADUATE PHARMACY RESIDENCY & FELLOWSHIP CLASS Houston Methodist Department of Pharmacy The Department of Pharmacy at Houston Methodist collaborates with the health care team to provide innovative, personalized, cost-effective pharmaceutical care in a culture dedicated to quality and safety. The pharmacy department’s vision is to be recognized as a global leader of pharmaceutical care in the health care setting. To that end, we strive to: • Continuously improve the quality and safety of patient care and the medication management process. • Cultivate an environment of collaboration and teamwork. • Provide high-quality training and education to our technicians, student interns, residents and pharmacists. • Maximize the use of automation and information technology. • Maximize cost efficiencies and resource utilization.

TABLE OF CONTENTS 2 Letter from Daniel L. Metzen, PharmD, MBA System Director of Pharmacy Services, Houston Methodist 3

Letter from Alex C. Varkey, PharmD, MS, FAPhA

Director of Pharmacy Services, Houston Methodist Hospital

Letter from Jill C. Krisl, PharmD, BCPS, BCTXP

Chair of Pharmacy Research Committee

Pharmacy Research Committee Members

Pharmacy Research Funding

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2022–2023 Houston Methodist Hospital Pharmacy Postgraduate Trainees

7 PGY1 Pharmacy Residency

Aliya Abdulla, PharmD John D. Fields, PharmD Christopher Nelsen, PharmD Morgan Pritchard, PharmD Sonya Sial, PharmD Zoe Tu, PharmD

13 PGY1 International

Graduates Pharmacy Residency Patricia Huang, PharmD

14 PGY1 Pharmacy

Residency – Sugar Land Duc Huynh, PharmD Rustin Pevehouse, PharmD

16 PGY1/PGY2 HealthSystem Pharmacy Administration Residency

Atra Mouser, PharmD Luning Shi, PharmD Alfred Awuah, PharmD Alan Luu, PharmD

20 PGY1/PGY2 Pharmacy Informatics Residency Haley Blanck, PharmD

21 PGY2 Critical Care

Pharmacy Residency Hala Halawi, PharmD Mariah Sigala, PharmD

23 PGY2 Infectious

Diseases Pharmacy Residency Evan Steere, PharmD

System Pharmacy Research Bibliography

24 PGY2 Internal Medicine Pharmacy Residency

Eileen Sullivan, PharmD

25 PGY2 Oncology

Pharmacy Residency Emily Allen, PharmD Karimi Solmaz, PharmD

27 PGY2 Solid Organ

Transplant Pharmacy Residency Alyssa Chaplain, PharmD Eric Rubido, PharmD

29 Clinical Pharmacy

Fellowship in Outcomes Research Phuong Duong, PharmD

LETTER FROM THE SYSTEM DIRECTOR OF PHARMACY SERVICES Thank you and congratulations to all who contributed to the accomplishments in this year’s PRC annual report. The report speaks volumes to the Pharmacy’s elevated commitment to unparalleled excellence in patient care, quality, medication safety and scholarly activity. Our patients thank you for your energy, effort, and dedication. I am honored and grateful to be part of such a highly talented team. Enjoy the read!

Daniel L. Metzen, PharmD, MBA System Director of Pharmacy Services, Houston Methodist

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HOUSTON METHODIST THE WOODLANDS HOSPITAL 99 69

HOUSTON METHODIST WILLOWBROOK HOSPITAL 1960

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HOUSTON METHODIST WEST HOSPITAL

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HOUSTON METHODIST BAYTOWN HOSPITAL 1093

HOUSTON METHODIST HOSPITAL

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288

HOUSTON METHODIST SUGAR LAND HOSPITAL

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LETTER FROM THE DIRECTOR OF PHARMACY SERVICES On behalf of the Houston Methodist Hospital Pharmacy Management Team, I want to extend my sincere appreciation to all our graduating residents and fellows. Our residents and fellows fully invest in their respective opportunities to grow both personally and professionally, and in the process, make a lasting impact on HMH Pharmacy’s effort to optimize patient outcomes. The last few academic years have been especially challenging given our need to respond to the global COVID-19 pandemic, and as usual, HMH Pharmacy responded with unparalleled efforts in patient care and in facilitating cutting-edge research. We emerged as a national leader in the provision of COVID-19 vaccines and monoclonal antibody treatments. Our system efforts continue to be lauded by state and national leaders and have been highlighted in several highly reputable publications, including the Journal of the American Medical Association (JAMA) as well as national and international conferences. This past academic year, several of our outstanding pharmacists and leaders at HMH have been awarded significant grant funding to advance research in a variety of areas including infectious diseases, RFID technology, pharmacy education expansion, and critical care practices – totaling over $210,000. Our team across the Houston Methodist system has contributed over 55 new publications to the literature across several specialties in the last academic year. As has been the case for over 35 years, a catalyst for our department-initiated research success has resided in ourpharmacy training programs, and we continue to be grateful for the hard work and dedication of our pharmacy learners, preceptors/practitioners, and staff. Each of our achievements took considerable commitment and an immense amount of work. Our successes in research and scholarship are a true testament to HMH pharmacy’s commitment to working alongside other health care disciplines in advancing patient care. I continue to be impressed with the quality of pharmacy’s efforts in growth and innovation, and I have our residents, fellows and their preceptors to thank for much of that. We remain in position to develop and share innovative practices in part because of our Pharmacy Research Committee, a group dedicated to ensuring excellence in the quality and feasibility of research conducted by HM pharmacy. As we move ahead to the 2023-2024 residency year, we will continue with laser focus on what we do every day. That includes enhancing our medication distribution, clinical services, and regulatory/quality compliance efforts to provide an environment of unparalleled safety, quality, service, and innovation for our patients. Our patients always deserve our best – and it is the reason we all work so hard to develop safe and effective processes and practices from which our patients will benefit. Thanks for all that you have done and continue to do for patients.

Alex C. Varkey, PharmD, MS, FAPhA Director of Pharmacy Services, Houston Methodist Hospital

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LETTER FROM THE PHARMACY RESEARCH COMMITTEE CHAIR Welcome to our Department of Pharmacy’s eighth edition of the Annual Research Report. This report serves to showcase the dedication to research and patient care of the pharmacy department across the Houston Methodist Hospital system. The pharmacy department continues to strive towards the advancement of pharmacy practice and patient care across the hospital system. Over the course of the 20222023 residency year, members of our pharmacy department have lead research collaborations within internal medicine, infectious diseases, transplant, critical care, anticoagulation, and oncology patient populations, as well as research in informatics and pharmacy management. Department research has been presented at local and national platforms, including in our own hospital at the Sixth Annual Pharmacy Research Committee (PRC) Symposium in June 2023. The mission of the PRC is to ensure excellence in the quality of research conducted and the research training provided by the Department of Pharmacy at Houston Methodist. The PRC has continued to optimize established programs including project proposal development, project approval, resident project alignment, support, education, visibility, and building a more robust research infrastructure and partnership with the Research Institute. Over recent years, we have enhanced our educational programming through collaboration with experts in the research field including manuscript writing and statistics. We look forward to applying additional innovative ways to our programming to enhance the research experience for our residents and our clinical teams. The PRC saw tremendous growth over the course of the year, with expansion to meet our growing residency programs across the system. We now have 16 committee members, plus one pharmacy research fellow assisting with our support lead. Members of the PRC represent the pharmacy department across the system hospitals and clinical specialties. Our Department of Pharmacy preceptors, residents, and staff remain committed to high quality and innovative patient care, education, research, leadership and advocacy. As always, our goals are grounded in our mission to be unparalleled. I am forever grateful for the dedication and hard work of this committee and am proud to serve as its Chair.

Jill C. Krisl, PharmD, BCPS, BCTXP Chair, Pharmacy Research Committee

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PHARMACY RESEARCH COMMITTEE MEMBERS

Michael Sirimaturos, PharmD, BCNSP, BCCCP, FCCM Vice Chair

Punit Shah, PharmD, BCPS, BCIDP Education Lead

Hayley Brazeale, PharmD, BCPS Project Approval Lead

Mobolaji Adeola, PharmD, BCPS Project Approval Lead

Chelsea Lopez, PharmD, BCCCP Project Development Lead

Godsfavor Umoru, PharmD, BCOP Project Alignment Lead

Elsie Rizk, PharmD Project Support Lead

Reba Forbess, PharmD, PhD, CPPS Member

David R. Putney, PharmD, MPH, BCPS - AQ Cardiology Member

Engie Attia, PharmD, BCPS Member

Alex Rogers, PharmD, BCPS Member

Karen Abboud, PharmD, BCOP, BCPS Member

Luma Succar, PharmD, BCCCP Member

Dan Galipeau, PharmD, BCCP Member

Will Musick, PharmD, BCIDP Member

Phuong Duong, PharmD Member - Fellow

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PHARMACY RESEARCH FUNDING Michael Sirimaturos, PharmD, BCNSP, BCCCP, FCCM, and Elsie Rizk, PharmD, were awarded a $156,900 grant from Grifols Biologicals, LLC to conduct a prospective, observational, multicenter study to evaluate the safety of human rabies immune globulin when administered to pediatric patients per standard of care for rabies postexposure prophylaxis in the emergency department. The study will collect safety data using surveys and medical record chart review and will be supported by the Houston Methodist Clinical Pharmacy Fellowship in Outcomes Research.

Elsie Rizk, PharmD, serves as a co-investigator on a phase 3, multicenter, randomized, controlled trial to evaluate the efficacy and safety of inhaled isoflurane delivered via the Sedaconda ACD-S device compared to intravenous propofol for sedation of adult patients receiving mechanical ventilation in the intensive care unit (INSPiRE-ICU1 trial). The trial compares the effects of inhaled isoflurane vs intravenous propofol on sedation adequacy, opioid use, wake up time, cognitive recovery, and spontaneous breathing effort. Patient enrollment and all trial activities are supported by the Houston Methodist Clinical Pharmacy Fellowship in Outcomes Research.

Cynthia El Rahi, PharmD, BCOP and Godsfavour Umoru, PharmD, BCOP received an ASHP Foundation Residency Expanision Grant for $25,000.

Haley Blanck, PharmD, MS; Amanda Beck, PharmD, MS; Niaz Deyhim, PharmD, MS, BCPS; and Ghalib Abbasi, PharmD, MS, MBA received the Enhancing Adoption of Radio Frequency Identification (RFID) Technology In Medication Use Systems grant in the amount of $29,003. This was awarded to Houston Methodist Hospital on behalf of the ASHP Research and Education Foundation (ASHP Foundation).

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Impact of Early Versus Late Addition of Enteral Analgesia, Sedation, and Anxiolytic Adjuncts in Patients on Veno-venous Extracorporeal Membrane Oxygenation Aliya Abdulla, PharmD; Mariah Sigala, PharmD; Diane Dreucean, PharmD, BCCCP; Kevin R. Donahue, PharmD, BCPS; Prakruthi Voore, MD; Celia Morton, PharmD, BCCCP PURPOSE

RESULTS

Patients on veno-venous extracorporeal membrane oxygenation (VV-ECMO) have been shown to have higher intravenous (IV) sedation requirements and prolonged mechanical ventilation time. Recent literature suggests that early extubation and mobility improve rates of survival to discharge; however, inability to wean IV analgosedation may be a barrier. One potential strategy to decrease IV sedation is use of adjunct enteral sedative, anxiolytic, and analgesic agents, although there is limited data to support their use. The objective of this study was to assess the impact of early versus late addition of enteral adjunct agents on continuous sedation/analgesic requirements and clinical outcomes in VV-ECMO patients.

The study included 65 patients in the early group and 62 patients in the late group. There was no significant difference in time to ≤1 continuous infusion analgosedation agent from ECMO cannulation. Incidence of adverse drug events such as QTc prolongation were not shown to be significantly increased between groups. No difference was seen in mechanical ventilation duration; however, early initiation of adjuncts resulted in a shorter intensive care unit (ICU) length of stay.

METHODS

This was a retrospective cohort study comparing early to late (≤72 hours versus >72 hours from time of cannulation) addition of adjunct sedation, anxiolytic, or analgesia agents in VV-ECMO patients. The primary endpoint was time to ≤1 continuous infusion analgosedation agent from ECMO cannulation. Secondary endpoints included time to adjunct initiation, duration of use, characterization of adjunct agents, adverse drug events, IV analgosedation requirements, length of stay, and mortality.

CONCLUSION

While early adjunct use did not significantly impact weaning of IV sedation, the lack of major safety events and potential benefits seen may support adjunct use in this patient population.

PGY1 PHARMACY RESIDENCY

Aliya Abdulla, PharmD Aliya earned her PharmD degree from the University of Georgia College of Pharmacy in 2022. Following the completion of her PGY1 residency, Aliya will continue her post-graduate training as a PGY2 Pharmacy Resident in Critical Care at Houston Methodist Hospital. Primary project preceptor: Celia Morton, PharmD, BCCCP Presented at Vizient Pharmacy Network, Las Vegas, NV and 2022 Midwest Pharmacy Residents Conference, Omaha, NE

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Impact of Carbapenemase Gene Detection on Selection of Antimicrobial Therapy Among Patients with Carbapenemase-Producing Carbapenem-Resistant Enterobacterales JD Fields, PharmD, MS; William Musick, PharmD, BCIDP PURPOSE Carbapenem resistance among Enterobacterales spp. is a growing public health issue and is associated with significant morbidity, mortality, and healthcare costs. Since 2015, several novel betalactam/beta-lactam inhibitor combinations have revolutionized the treatment of carbapenemase-producing CRE (CP-CRE). Prior to the introduction of rapid NAT-based assays that identify specific carbapenemase genes, qualitative phenotypic assays, such as the RAPIDEC® Carba NP assay, were limited in detecting nonspecific carbapenemase production. With the introduction of carbapenemase gene detection via NAT methods (Xpert® Carba-R) at Houston Methodist Hospital beginning in August of 2021, clinicians now have the capability to tailor antimicrobial therapy to overcome a specific mechanism of resistance among CP-CRE. The purpose of this study is to describe the final antimicrobial selection between the rapid NAT-based and historically used qualitative phenotypic assays employed by Houston Methodist Hospital for patients who are infected with CP-CRE. METHODS This retrospective analysis includes all adult patients with CP-CRE infections from a non-cerebral spinal fluid source between August 1st, 2020 and July 31st, 2022. Patients will be divided into two groups based upon whether the phenotypic or NAT-based method was used to detect CP-CRE isolates. Microbiologic isolates were included if they displayed resistance to either ertapenem based on a minimum inhibitory concentration (MIC) of > 2 mcg/mL, meropenem based on a minimum inhibitory concentration (MIC) of > 4 mcg/mL, or the microbiology laboratory reported as resistant. The primary endpoint was the distribution of definitive treatment choice (i.e., antibiotic choice) selected or continued at 48 hours after the results of carbapenemase testing were available. Secondary endpoints include the epidemiologic rates of specific carbapenemases, the distribution of antimicrobial therapy based on carbapenamase, and in-hospital patient mortality rate.

RESULTS A total of 119 CRE isolates were included in this review. The majority of CRE isolates recovered and tested was K. pneumoniae (63.9%), followed by E. coli (8.4%), E. cloacae complex (7.6%), M. morganii (5.9%), and other Enterobacterales species (14.3%). The percentage of CRE isolates tested via the use of the CarbaNP assay was 60.5% while the percentage tested via the use of the Carba-R assay was 39.5%. The majority of CRE isolates were treated with meropenem-vaborbactam (26.9%) or with nonbeta-lactam antibiotics (e.g. fluroquinolones, sulfamethoxazole/ trimethoprim) (26.9%) followed by ceftazidime-avibactam (24.4%), eravacycline (5%), and cefiderocol (2.5%) as definitive therapy within 48 hours of CRE testing results. Three isolates were treated with either imipenem-relebactam plus aztreonam (1.7%) or ceftazidime-avibactam plus aztreonam (0.8%). The majority of CPE isolated harbored serine beta-lactamase genes (81.1%) while the remainder produced metallo-beta-lactamase genes (18.9%). Of the serine beta-lactamase producing CREs, KPC was the primary gene harbored (69.8%) followed by OXA-48 (11.3%), NDM-1 (11.3%), and VIM (7.5%). The IMP gene was not detected in any isolates during the analysis period. Of the patients included in the analysis, 8.9% expired during their hospital admission. CONCLUSION A large number of highly resistant isolates were identified, primarily in urine cultures. Traditionally, decisions regarding the definitive selection of antimicrobials for these isolates were based solely on the in-vitro, phenotypic susceptibility testing. Now with the use of NAT-based molecular assays, the treating clinician is able to tailor therapy more appropriately based on the genotypic profile of the CRE isolate. The majority of isolates at our large, academic institutional health system produce the KPC genotype and patients were placed on antimicrobial therapy suggested by the recently published IDSA guidance document to treat these resistant microbes.

PGY1 PHARMACY RESIDENCY

JD Fields, PharmD JD Fields earned his Bachelor’s and Master’s degree from The University of Texas at San Antonio in 2014 and PharmD from the University of the Incarnate Word in 2022. Following completion of his PGY1, JD will begin as a Clinical Pharmacist in Internal Medicine at Christus Santa Rosa Hospital in Texas. Primary project preceptor: William Musick, PharmD, BCIDP Presented at 2022 Vizient Pharmacy Network, Las Vegas, NV and 2022 Midwest Pharmacy Residents Conference, Omaha, NE

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Evaluation of Anticoagulant Use in Cirrhosis with Coagulopathy Christopher Nelsen, PharmD; Chelsea Lopez, PharmD, BCCCP; Corey Dinunno, PharmD, BCPS; Kevin Donahue, PharmD, BCPS, Constance Mobley, MD, PhD, Luma Succar, PharmD, BCCCP PURPOSE

RESULTS

Patients with cirrhosis develop endogenous deficiencies in pro and anticoagulant factors resulting in a coagulopathy with heightened bleeding and clotting risk. This complicates the decision to utilize anticoagulant agents and creates uncertainty regarding the agent of choice. Previous studies addressing anticoagulation in patients with liver disease have been inconclusive, with no one agent proven to be superior and/ or safer. Additionally, most studies have excluded patients with international normalized ratio (INR) values >2, thereby limiting the generalizability of the data. We sought to describe the safety of prophylactic or therapeutic anticoagulation in the setting of cirrhosis and an INR >2.0 and to identify potential risk factors associated with bleeding and/or thrombotic events.

Two hundred and twenty-six patients met inclusion criteria and 4 (1.8%) experienced a major bleeding event. Fourteen patients (6.2%) developed acute thrombosis during the study period. No correlation was seen with INR values and bleeding or thrombotic events, but the highest incidence of thrombosis occurred in the INR subgroup with INR values >3 (7.1%). Patients utilizing therapeutic anticoagulation strategies experienced numerically more bleeding events, but had a similar incidence compared to patients on prophylactic anticoagulation (1.8% in both groups). Patients with AKI at time of study inclusion had a higher incidence of both bleeding and thrombotic events compared to those with baseline renal function (4.5% vs 0.6% bleeding and 13.4% vs 3.1% thrombosis).

METHODS A single center retrospective descriptive study was conducted on patients with ICD-10 codes related to liver cirrhosis that had an INR >2 and received a dose of systemic oral and/or parenteral anticoagulant between June 1st 2018 and May 31st 2022. Patients who were admitted with a primary diagnosis related to a bleeding event were categorically excluded from the study. Patients who were post-operative from an intervention requiring discontinuation of anticoagulation were included in the study until the time of procedure. The primary endpoint was defined as the incidence of major bleeding according to The International Society for Thrombosis and Haemostasis criteria. Secondary endpoints included the incidence of acute thrombosis and subgroup analyses were performed based on anticoagulation strategy (prophylaxis vs therapeutic dosing), INR values, and presence of acute kidney injury (AKI), according to the Acute Kidney Injury Network criteria, at the time of study inclusion.

CONCLUSION In our evaluation of anticoagulant safety in patients with cirrhosis and coagulopathy, elevations in INR did not confer a reduced risk of thrombotic events or increased risk of bleeding events. Acute kidney injury was associated with an increased risk of both bleeding and acute thrombosis. To our knowledge, this represents the largest retrospective analysis to date of cirrhotic patients with coagulopathy receiving concurrent anticoagulation. In order to develop an optimal approach to anticoagulant use in this high-risk patient population, future prospective studies should focus on identifying bleed/thrombosis risk factors and distinguishing the most reliable monitoring tools which accurately reflect underlying coagulopathy.

PGY1 PHARMACY RESIDENCY

Christopher Nelsen, PharmD Chris earned his Bachelor of Science in Neuroscience from The University of Texas at Dallas in 2015 and PharmD from The University of Texas College of Pharmacy in 2022. Following completion of his PGY1 Residency, Chris will continue his post-graduate training as a PGY2 Pharmacy Resident in Internal Medicine at Houston Methodist Hospital. Primary project preceptor: Chelsea Lopez, PharmD, BCCCP Presented at 2022 Vizient Pharmacy Network, Las Vegas, NV and 2022 Midwest Pharmacy Residents Conference, Omaha, NE

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Incidence of Acute Kidney Injury After Cardiac Surgery Before and After Implementation of a Nephrocheck® Protocol Morgan Pritchard, PharmD; Jesse E. Harris, PharmD, BCCCP; Diane Dreucean, PharmD, BCCCP; Edward A. Graviss, PhD, MPH; Duc T. Nguyen, MD, PhD; Juan J. Olivero, MD; Jose Francisco Saille Cuevas, MD PURPOSE

RESULTS

Traditional markers used to diagnose acute kidney injury (AKI) have marked limitations in early detection of AKI in the cardiac surgery (CS) population. The implementation of urinary biomarker testing, such as the Nephrocheck®, has been shown to identify patients at high risk of AKI earlier than traditional markers. The purpose of our study was to evaluate the outcomes of a protocolized care approach in conjunction with Nephrocheck® testing to reduce the incidence of post-CS AKI.

Incidence of AKI within 72 hours after CS was similar between the Nephrocheck® and pre-Nephrocheck® groups (52.4% vs. 46.3%; p=0.42). The PPV and NPV for AKI based on a positive Nephrocheck® score (≥0.31) were 58.6% and 83.3%, respectively. A high-positive Nephrocheck® score (>2.0) resulted in a PPV of 80% and NPV of 51.4%. There was no difference between groups for the remainder of secondary outcomes. CONCLUSION

METHODS

This retrospective, single-center, propensity-matched cohort study assessed the incidence of AKI pre- and post-Nephrocheck® protocol implementation. A total of 164 patients were reviewed. The primary endpoint was incidence of AKI (defined by Kidney Disease Improving Global Outcomes [KDIGO] criteria) within 72 hours after CS. Secondary endpoints included the positive and negative predictive value (PPV, NPV) of the Nephrocheck®, time to development of AKI, stage of AKI based on KDIGO classification, initiation of renal replacement therapy after CS, and intensive care unit and hospital length of stay.

The use of the Nephrocheck® test in conjunction with a protocolized care approach did not reduce the incidence of AKI post-CS compared to standard of care alone.

PGY1 PHARMACY RESIDENCY

Morgan Pritchard, PharmD Morgan earned her BS in Applied Health Sciences from the University of Nebraska-Kearney in 2018 and PharmD from the University of Nebraska Medical Center in 2022. Following completion of her PGY1, Morgan has accepted an Antimicrobial Stewardship Pharmacist position at Faith Regional Health Services in Norfolk, Nebraska. Primary project preceptor: Jesse E. Harris, PharmD, BCCCP Presented at 2022 Vizient Pharmacy Network, Las Vegas, NV and 2022 Midwest Pharmacy Residents Conference, Omaha, NE

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Utilization of Transplant Medication Questionnaire in Identifying Risk Factors in Liver Transplants for Medication Noncompliance Sonya Sial, PharmD; Allison Yun, PharmD; Megan Cooper, PharmD; Mozhgon Moaddab, PharmD; Edward A. Graviss, PhD ,MPH; Duc Nguyen, MD, PhD PURPOSE

RESULTS

Pharmacologic management is a key factor to the success of graft survival in transplant recipients. Up to one-third of solid organ transplant recipients may have immunosuppression non-adherence during the first-year post-transplant resulting in acute and chronic rejection, diminished graft function, graft loss or mortality. Transplant pharmacists are an essential asset to the transplant team with their expertise in pharmacological management. The Immunosuppressant Therapy Adherence instrument (ITAS) is a validated tool that has been utilized when assessing compliance of transplant patients.

During the period from April 2019 to March 2020, a total of 155 index liver and liver-kidney transplants were performed. Of the 106 patients who completed at least one survey, 186 surveys were reviewed, with some patients filling out multiple surveys. Analysis was performed on the remaining 165 surveys. The median age and MELD score at the time of transplant being 59 years (IQR 48-64.6) and 31 (IQR 24-37), respectively. The most common indication for transplant in this population was alcohol-associated liver disease. Of the 90 patients, 40 were in the ICU prior to transplant, and the median number of ICU days after transplant was approximately seven (4.7,13.4). The average number of medications prescribed for pre-transplant was nine, while the number at discharge was 18. The median number of days from index discharge to re-admission was 51 (13.3,237.3). The primary caregiver for 80% of these patients was their spouse and approximately 32% of the patients had a full-time employment status at the time of transplant. There were 37 surveys that were completed within 30 days from index discharge. Of these, 2 surveys (5.4%) had an ITAS score ≤9.

METHODS A single-center, retrospective chart review was conducted on all liver and liver-kidney transplants preformed between April 2019 and March 2020 at Houston Methodist. The study included patients who completed at least one transplant medication questionnaire during their posttransplant clinic visit following index discharge. The survey included a comfortability portion, the ITAS portion and a medication knowledge component that was developed by the Houston Methodist Research Institute. Patients were excluded if they are unable to read English or if they were transplanted at other institutions. The primary endpoint of this study is the incidence of noncompliance (ITAS score less than nine on at least one questionnaire) within 1-month post-transplant. Secondary endpoints include mean medication knowledge score and rates of allograft rejection at 30- and 90- days post-transplant.

CONCLUSION In conclusion, our study findings provide valuable insights into the various factors linked to noncompliance with immunosuppressive medications in liver transplant recipients. These factors encompass socio-demographic characteristics, the highest level of education achieved, and the specific medications prescribed, among other relevant variables. Ultimately, these efforts can lead to improved patient outcomes and better overall management of postliver transplant care.

PGY1 PHARMACY RESIDENCY

Sonya Sial, PharmD Sonya Sial earned her Bachelor of Science from Penn State University in 2017 and PharmD from Rosalind Franklin University in 2022. Following completion of her PGY1, Sonya Sial will be joining the NICU team as a clinical pharmacist at Texas Children’s Hospital. Primary project preceptor: Allison Yun, PharmD Presented at 2022 Vizient Pharmacy Network, Las Vegas, NV and 2022 Midwest Pharmacy Residents Conference, Omaha, NE

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Immune Outcomes of Lung Transplant Recipients with Different Cytochrome P450 (CYP) 3A5 Phenotypes After Discontinuation of Voriconazole Antifungal Prophylaxis Zoe H. Tu, PharmD; Brett J. Pierce, PharmD, BCPS; Taylor Pasley, PharmD, BCTXP; Aaron Hutchins, PharmD; Howard Huang, MD PURPOSE

RESULTS

Tacrolimus forms the backbone of immunosuppressant regimens in lung transplant recipients (LTRs). It is extensively metabolized by cytochrome P450 (CYP) 3A5 enzymes, of which polymorphisms can significantly affect tacrolimus dose requirements. Voriconazole is a potent 3A5 inhibitor that is commonly used in the post-operative period to prevent fungal infections. The purpose of this study is to determine if coadministration of voriconazole with tacrolimus affects immune rejection rates or empiric dose adjustments needed after voriconazole is discontinued.

Thirty-four patients underwent full analysis: 13 IE, and 21 PR metabolizers. IE metabolizers were more often female (61.5% vs 23.8%, p=0.04) and African American (46.2% vs 9.5%, p=0.03). There was no statistically significant difference in composite immune outcomes, though there was a proportionally higher frequency of new donor-specific antibody development PR metabolizers (14.3% vs 7.7%, p=0.56). Both groups required approximately a 2.5 to 3-fold tacrolimus dose increase post-voriconazole discontinuation to re-attain therapeutic levels.

METHODS

CONCLUSION

This was a single-center, retrospective cohort study conducted at a large academic medical center comparing LTRs with poor (PR) vs intermediate/extensive (IE) CYP3A5 metabolizer phenotypes. Primary endpoint was cumulative immune outcomes within 3 months of voriconazole discontinuation; secondary endpoints included change in tacrolimus dose and dose-to-concentration ratios before and after voriconazole discontinuation.

PGY1 PHARMACY RESIDENCY

Zoe Tu, PharmD Zoe Tu earned PharmD from The University of North Carolina at Chapel Hill in 2022. Following completion of her PGY1, Zoe will complete a PGY2 in Solid Organ Transplant at Houston Methodist Hospital. Primary project preceptor: Brett J. Pierce, PharmD, BCPS Presented at 2022 Vizient Pharmacy Network, Las Vegas, NV, 2022 Midwest Pharmacy Residents Conference, Omaha, NE and 2023 American Transplant Congress, San Diego, CA

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Risk Factors for COVID-19 Breakthrough Infections in COVID-19 Fully Vaccinated Oncology Patients Yao-Hsuan Huang, PharmD; Breanna Hinman, PharmD, BCOP; Cynthia El Rahi, PharmD, BCOP; Godsfavour Umoru, PharmD, BCOP PURPOSE

Patients with cancer face an elevated risk of morbidity and mortality from COVID-19 infection. Although high efficacy of the mRNA-based COVID-19 vaccines has been demonstrated, patients with cancer were underrepresented in current clinical trials. The National Comprehensive Cancer Network (NCCN) and the Center for Disease Control (CDC) endorse COVID-19 vaccination for cancer patients and recommend a third dose for moderately to severely immunocompromised patients. This includes those who received cancer therapy within one year of their first COVID-19 vaccine dose, newly diagnosed or recurrent cancer patients about to undergo cancer therapy, individuals with malignant hematology diagnosis regardless of active treatment, and recipients of stem cell transplants or other cellular therapies. Despite vaccination, cancer patients remain in varying states of immune compromise due to cancer itself or its treatment and complications. Recent studies have shown that cancer patients are at risk of severe outcomes despite full vaccination in the event of breakthrough infections. This study aimed to characterize risk factors for breakthrough COVID-19 infections in cancer patients who completed both doses of the COVID-19 vaccine primary series and a booster. METHODS

This was a single-center, retrospective, descriptive, cohort study. Adult patients were eligible for inclusion if they received a full COVID-19 vaccination series along with a booster administered between August 2021 to August 2022, had received systemic antineoplastic therapy within six months of the booster, and tested positive for COVID-19 polymerase chain reaction (PCR) no less than 14 days after the booster vaccination. Patients with unknown vaccination status or timing, no antineoplastic treatment within six months after booster, and those receiving treatment outside the Houston

Methodist system were excluded. The primary endpoints were the characteristics of breakthrough COVID-19 infections, while secondary endpoints included severe outcomes such as hospitalization, intensive care unit (ICU) admission, mechanical ventilation, extracorporeal membrane oxygenation (ECMO) support, transition to hospice, and COVID-19 related mortality.. RESULTS

A total of 72 adult patients (53 solid organ malignancy, 23 hematologic malignancy) met the inclusion criteria. Of these, 72% were 65 years old or older, 64% (34 out of 53 patients) had stage IV solid cancer, 36% with Eastern Cooperative Oncology Group (ECOG) performance status ≥ 2. Two-thirds had received 2 or more prior lines of antineoplastic therapy. The most common recent systemic antineoplastic regimen prior to COVID-19 infection was cytotoxic therapy (37%). Notably, 11 (14%) patients were asymptomatic, and 3 (4%) experienced recurrent COVID-19 infection within six months. Severe COVID-19 infection outcomes were observed in more than half of the patients, with 62% requiring hospitalization and 14% of the mortality. Subgroup analysis revealed that more patients with solid tumor were asymptomatic compared to those with hematologic malignancy (19% vs 4%). Additionally, the solid organ malignancy group had a lower hospitalization rate (57% vs 74%) but higher COVID-19 related mortality (17% vs 9%). CONCLUSION

This descriptive study highlights that patients with advanced age, advanced cancer stage, or history of 2 or more lines of cancer treatments may be at a high risk of breakthrough COVID-19 infection and severe outcomes despite full vaccination with a booster dose. Consequently, this population may benefit from additional precautions.

PGY1 PHARMACY RESIDENCY FOR INTERNATIONAL GRADUATES

Patricia Huang, PharmD Patricia earned her Bachelor of Science in Pharmacy from Taipei Medical University in 2017 and PharmD degree from the University of North Carolina at Chapel Hill in 2022. Following completion of her PGY1 residency, Patricia will be staying at Houston Methodist Hospital, working as a clinical pharmacist. Primary project preceptor: Breanna Hinman, PharmD, BCOP 2022 Midwest Pharmacy Residents Conference, Omaha, NE and 2023 American Society of Health-System Pharmacists Summer Meeting, Baltimore, MD

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Safety and Immunogenicity of the Reference and Biosimilar Products of Trastuzumab in Patients with an Active Treatment Plan for Cancer Duc Huynh, PharmD; Rodrigo De La Torre, PharmD, BCOP; Erika N. Brown, PharmD, BCOP; Cynthia El Rahi, PharmD, BCOP; Tania Baigi, PharmD PURPOSE

Trastuzumab is a monoclonal antibody targeting the human epidermal growth factor receptor 2 protein with multiple biosimilars on the market (Trazimera™, Herzuma®, Kanjinti™, Ogivri®, Ontruzant®), providing alternatives to the more costly reference product, Herceptin®. Demonstration of similarity in terms of immunogenicity of a biosimilar in a head-to-head comparison to the reference product is a critical parameter to define the safety profile. As the abbreviated approval process for biosimilars creates opportunities in providing additional therapy options and patient access, healthcare institutions can play a vital role in post-marketing surveillance and monitoring of adverse drug events to ensure patient safety in the real-world setting. Currently, minimal literature exists evaluating the patient safety impact of biosimilar use. The purpose of this retrospective study is to contribute to the available evidence on the immunogenicity potential of trastuzumab biosimilars and provide further insight on the comfortability of biosimilar utilization and its adverse events. METHODS

This retrospective chart review includes patients 18 years of age and older with an active treatment plan including trastuzumab, and its respective biosimilars, for NCCNsupported indications from January 1st, 2021, to January 1st. 2022. Inclusion criteria consist of patients who were 18 years of age or older, received inpatient or outpatient trastuzumab as monotherapy or in combination with chemotherapy, HER-2 status positive, and a diagnosis with an FDA-labeled indication. Patients were excluded from the studies if they had a chronic autoimmune disease

(e.g., lupus, Crohn’s disease, and ulcerative colitis). The primary endpoint is the incidence of hypersensitivity reactions. Secondary endpoint includes incidence of adverse events (AE), new AE events leading to discontinuation, and new AE events leading to the switch of drug product. RESULTS

This study reviewed 205 patients who received either Trazimera™ (n = 121), Herceptin® (n = 60), Kanjinti® ( n = 23), and Ogivri® (n = 1). There was one patient on Trazimera™ who experienced a grade 3 hypersensitivity reaction that continued successful treatment with a 3-bag, 12-step desensitization protocol. The most reported all grade events at ≥ 10% were diarrhea (42%) and fatigue (17%). Patients who had an adverse event of any grade include Herceptin® (n = 10, 16.7%), Trazimera™ (n = 60, 49.6%), and Kanjinti® (n = 11, 47.8%). Adverse drug events leading to discontinuation was observed in the Trazimera™ (n = 9, 7.4%) and Kanjinti® (n = 1, 4.3%) arm. Other events leading to drug switch from Trazimera™ (n = 7, 5.8%), Kanjinti® (n = 5, 21.7%), and Herceptin® (n = 2, 3.3%) were a result of adverse reaction of any grade and were not correlated with a specific reaction. CONCLUSION

The results of this study suggest a benefit in pharmacistfocused review to optimize pharmacotherapy regimens in patients at high risk of falls. Future studies should aim to assess the association between pharmacist interventions with reduction in falls.

PGY1 PHARMACY RESIDENCY – HOUSTON METHODIST SUGARLAND

Duc Huynh, PharmD Duc earned his PharmD from the University of Houston College of Pharmacy in 2022. He completed his PGY1 residency at the Houston Methodist Sugar Land Hospital. Following the completion of his PGY1, Duc will continue his residency training as a PGY2 Oncology Resident at Houston Methodist Hospital. Primary project preceptor: Rodrigo De La Torre, PharmD, BCOP Presented at 2022 Vizient Pharmacy Network, Las Vegas, NV, and 2022 Midwest Pharmacy Residents Conference, Omaha, NE

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Evaluating the Utility of Procalcitonin and a Clinical Decision Support Tool on Duration of Antimicrobial Therapy Prescribed for Respiratory Tract Infections Rustin Pevehouse, PharmD; Punit J. Shah, PharmD, BCPS, BCIDP; Nitha Chou, PharmD, BCPS; Priya Oolut, MD; Suneesh Nair, MD; Raziuddin Ahmed, MD PURPOSE

RESULTS

Assess the impact of PCT coupled with CDS-initiated pharmacist intervention on antimicrobial DOT for RTI

Baseline characteristics were well matched except age, body mass index, and Charlson comorbidity index. The median days of therapy for inpatient antibiotics was 4 days (IQR=2.8-5) in the pre-intervention arm, with a reduction to 3 days (IQR=2-4) in the intervention arm (p=0.001; 95% CI 0-1).

METHODS

We conducted a quasi-experimental study, where the preintervention cohort was admitted from April 2021 through July 2021, and the intervention cohort was admitted from April 2022 through July 2022. In the intervention phase, a CDS tool was utilized to alert clinical pharmacists when patients met specific criteria. This alert was programmed to activate for individual patients when a reported PCT level was <0.25 ng/mL and on antibiotics prescribed for respiratory tract infection as indicated by providers in the electronic health record. Stewardship interventions were made by pharmacists via prospective audit and feedback strategy. Primary endpoint was inpatient antibiotic DOT for respiratory tract infection.

CONCLUSION

PGY1 PHARMACY RESIDENCY – HOUSTON METHODIST SUGARLAND

Rustin Pevehouse, PharmD; Rustin earned his Bachelor of Science in Entomology from Texas A&M University in 2015 and PharmD from University of Houston College of Pharmacy in 2022. Following completion of his PGY1, Rustin will be pursuing clinical specialist opportunities around the greater Houston area. Primary project preceptor: Punit J. Shah, PharmD, BCPS, BCIDP Presented at 2022 Vizient Pharmacy Network, Las Vegas, NV, and 2022 Midwest Pharmacy Residents Conference, Omaha, NE

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Impact of a Risk Scoring Tool on Prioritization of Medication Histories Atra A. Mouser, PharmD; Engie Attia, PharmD, BCPS; Mobolaji Adeola, PharmD, BCPS; Amaris Fuentes, PharmD, BCCCP; Niha Zafar, PharmD, MS PURPOSE The primary objective was to assess the impact of the implementation of the risk scoring tool on medication history capture rate of high-risk patients. METHODS This quasi-experimental, single-center study was conducted at Houston Methodist Hospital as a pilot study with the medication history team which consists of pharmacists and technicians in the emergency department. Prior to the intervention, medication histories were prioritized on a firstcome, first-serve basis, with the admission status serving as an additional screening tool. The workflow was adjusted to incorporate the risk scoring tool to prioritize patients based on classification. Patients with a cumulative risk score greater than fifty points are classified as high-risk, between twentyfive to fifty points as moderate risk, and less than twenty-five points as low risk. Parameters that contribute to assigned scores include age, polypharmacy, and selected high-risk medications. The pre-intervention and post-intervention periods were two weeks each, with an education period in between that allowed for feedback from the staff to address potential knowledge gaps. The pre-intervention data was collected by having the tool run in the background, not readily visible to users. Post-intervention data was collected once the tool

was made visible to users. The endpoints assessed included pharmacy completion rate of patients classified as high-risk, overall medication history capture rate, and the proportion of medication discrepancies identified after reconciliation. The study population included all patients with a medication history completed by the ED pharmacy team during the specified timeframe. RESULTS There were 1,293 admissions during the pre-intervention period, and 1,322 admissions during the post-intervention period. The number of medication histories completed by pharmacy decreased by 5.7% in the post-intervention period. Between the pre- and post-intervention period, there were less low risk patients being captured by pharmacy (89.7% to 59.9%, respectively). There was also a greater amount of medium and high-risk patients being captured by pharmacy staff. Additionally, pharmacy staff documented discrepancies more frequently for medium and high-risk patients in the postintervention period (58.1%) compared to the pre-intervention period (13.6%). CONCLUSION Use of a risk scoring tool allowed pharmacy staff to better prioritize workflow and capture more high-risk patients.

PGY1/PGY2 HEALTH-SYSTEM PHARMACY ADMINISTRATION AND LEADERSHIP PHARMACY RESIDENCY

Atra A. Mouser, PharmD Atra earned her Bachelor of Science in Neurobiology from The University of Texas at Austin in 2016 and PharmD from The University of Houston College of Pharmacy in 2022. Following completion of her PGY1, Atra will continue to complete her 2-year residency at Houston Methodist Hospital as part of the Health-System Pharmacy Administration and Leadership program. Primary project preceptor: Engie Attia, PharmD, BCPS Presented at 2022 Vizient Pharmacy Network, Las Vegas, NV, and 2022 Midwest Pharmacy Residents Conference, Omaha, NE

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Implementation and Evaluation of an Electronic Medical Record Integrated Perpetual Inventory System in a Large Tertiary Hospital Oncology Pharmacy Luning Shi, PharmD; Wenfei Wei, PharmD; Adam Smith, PharmD, MS; Ghalib Abbasi, PharmD, MS, MBA PURPOSE Effective pharmacy inventory management is crucial for ensuring high quality patient care and enhancing hospital fiscal stewardship. An optimal pharmacy inventory level is essential to guarantee timely and accurate delivery of inventory medication to patients. Inadequate pharmacy inventory management can lead to medication stockouts, which can ultimately impact the quality of patient care. This study aimed to compare the impact of an Electronic Health Record (EHR) integrated Perpetual Inventory Management System (EIMS) with the Traditional Inventory Management System (TIMS) on inventory accuracy, visibility, turnover, and Cost of Goods Sold (COGS) in a large academic tertiary hospital oncology pharmacy. METHODS The Pretest-Posttest Quasi-Experimental study was conducted at Houston Methodist Hospital (HMH) Oncology pharmacy over a period of 6 months pre-implementation and 6 months post-implementation, with an 11-month washout period. The inventory item in this study refers to a specific pharmaceutical product that was kept in the pharmacy stock. All inventory items captured by TIMS and TIMS during the study period were eligible for inclusion. Inventory items only captured by one of the two systems or missing cycle count and inventory data were excluded for this study. A total of 114 matched inventory items from both systems were identified and compared.

The primary outcome was inventory accuracy, calculated by cycle count accuracy. The secondary outcomes were inventory visibility, monthly inventory value adjusted for inflation, COGS adjusted for inflation, and monthly inventory turnover rate. RESULTS Analysis demonstrated a 6.02% increase in inventory accuracy (P<0.001) using EIMS compared to TIMS. There was also a significant increase in the captured COGS after adjusting for inflation, from $4.16 million to $5.16 million (P=0.009). The monthly inventory value, adjusted for inflation of studied inventory items, increased from $2.05 million to $2.33 million (P=0.026). The monthly inventory turnover rate showed an increase from 2.03 to 2.23 (P=0.305) when compared to the pre- and post-implementation periods. Inventory visibility increased from 133 inventory items to 264 inventory items after EIMS implementation, indicating a 98% visibility increase compared to pre-implementation levels. CONCLUSION The implementation of the EIMS was effective in improving inventory accuracy and visibility in the oncology pharmacy satellite of an academic medical center. The findings from this study and the lessons learned during the EIMS implementation can be valuable resources for other healthcare organizations looking to adopt similar technology.

PGY1/PGY2 HEALTH-SYSTEM PHARMACY ADMINISTRATION AND LEADERSHIP PHARMACY RESIDENCY

Luning (Luna) Shi, PharmD Luna earned her PharmD from University of Cincinnati College of Pharmacy in 2022. Following the completion of her PGY1 Residency, Luna will continue her post-graduate training as a PGY2 Health-System Pharmacy Administration and Leadership resident at Houston Methodist Hospital. Primary project preceptor: Adam Smith, PharmD, MS Presented at 2022 Vizient Pharmacy Network, Las Vegas, NV, and 2022 Midwest Pharmacy Residents Conference, Omaha, NE

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Development of a Medication Override Process for Obstetrics and Newborn Care at a Large Academic Medical Center Alfred Awuah, PharmD, MS, BCPS; Engie Attia, PharmD, BCPS; Mobolaji Adeola, PharmD, BCPS; Matthew A. Wanat, PharmD, BCPS, BCCCP, FCCM; Catherine L. Hatfield, PharmD, FNAP PURPOSE

RESULTS

Automated dispensing cabinets (ADCs) are decentralized dispensing machines used to make medication distribution more efficient and allow for more timely administration of medications in urgent scenarios. Although beneficial, ADCs pose a significant medication safety risk when a medication is overridden bypassing appropriate drug selection and dosage form dispensing. The purpose of this study was to evaluate the impact of existing interventions intended to reduce override rates as well as implement targeted interventions for Labor & Delivery (L&D)/Nursery units and assess its impact.

In the Houston Methodist Hospital L&D/nursery, the combined override rate from January 2022 to February 2022 was 21.4%. From January 2023 to February 2023, the override rate was 12.8, a difference of 8.6% between the pre- and post-intervention periods (P<0.001) and demonstrating a statistically significant reduction. The hospital-wide override rate also had a consistent downtrend during this time. Use of the inventory function feature was inconsistent with a large increase in January 2023 and a decline to baseline in February 2023. CONCLUSION

METHODS

This quasi-experimental study encompassed three interventions as a bundle. The pre-intervention override rate was captured from January 2022 to February 2022, and the post-intervention override was captured from January 2023 to February 2023. The primary endpoint of this study was the rate of nursing driven ADC overrides in labor & delivery and nursing units pre- and post-intervention. The secondary endpoints included the rate for hospital-wide overrides and the change in the frequency of the inventory function in the L&D/nursery pre- vs. post-intervention.

This study demonstrated that establishment of bundled interventions reduced the medication override rate in the HMH L&D/nursery without a substantial increase in workarounds through the inventory function, reducing the total hospital-wide override rate.

PGY1/PGY2 HEALTH-SYSTEM PHARMACY ADMINISTRATION AND LEADERSHIP PHARMACY RESIDENCY

Alfred Awuah, PharmD, MS, BCPS Alfred earned his BS in Biological Sciences from Georgia State University in 2017, PharmD from the University of Georgia in 2021, and MS in Pharmacy Leadership and Administration from the University of Houston in 2023. Following completion of his PGY2, Alfred will transition to a Medication Safety Officer role with the University of California Davis Health in Sacramento, CA. Primary project preceptor: Engie Attia, PharmD, BCPS Presented at 2022 Vizient Pharmacy Network, Las Vegas, NV, and Alcalde Southwest Leadership Conference, Galveston, TX

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Evaluation of Integration of a Health-System Specialty Pharmacy into an Employee Plan Alan Luu, PharmD; Kevin W. Garey, PharmD, MS, FASHP, FIDSA, FCCP; Javon Artis, PharmD, MS; Adam Smith, PharmD, MS, BCPS; Alexa Vyain Zhao, PharmD, AAHIVP PURPOSE

RESULTS

The objective of this study was to evaluate the impact of an internal specialty pharmacy partnering with an employee health plan on a health-system defined by the financial, operational, and clinical impact.

Over three months in each phase, the health-system’s health plan resulted in $285,476.79 (p <0.001) of bottom line savings. The estimated annualized savings to the health plan is $1,141,907.17. The composite prior authorization turnaround time decreased from 22 hours pre to 14 hours post (p < 0.001). Time to fill showed a composite decrease from 80 hours pre to 47 hours post (p < 0.001). Clinical endpoint such as lower script encounter percentage showed a composite increase of 4% pre to 7% post (p < 0.001). In the post subgroup analysis, the internal specialty pharmacy showed the lowest script encounter percentage of 2% with 1 emergency room encounter throughout that timeframe.

METHODS

This is a secondary database analysis multi-center study evaluating Houston Methodist’s hospital system. The internal specialty pharmacy services all eight hospitals within the Houston Methodist health-system. Services that are provided include benefits investigations, financial assistance, and coordination of medication delivery. The primary endpoint was dollars spent on specialty pharmacy services for health-system employees before and after partnering the specialty pharmacy with the employee health plan. Secondary objectives included operational metrics performance indicators such as the time to fill, prior authorization turnaround time and the clinical secondary objective of script to emergency department encounters percentage. The pre-implementation phase evaluation timeline was from August to October 2021 and post-implementation phase from August to October 2022. Data was obtained from the health-system’s health plan and contracted PBM.

CONCLUSION

This study demonstrated that having an internal specialty pharmacy partnering with the health-system’s health plan improved bottom-line finances, shorter prior authorization turn around times, time to fill and script encounter percentages. Future studies will need to address the total financial impact from having an internal specialty pharmacy, along with the risks and benefits of becoming the preferred specialty pharmacy for the health plan.

PGY1/PGY2 HEALTH-SYSTEM PHARMACY ADMINISTRATION AND LEADERSHIP PHARMACY RESIDENCY

Alan Luu, PharmD Alan earned his PharmD from the University of Houston College of Pharmacy in 2021. He completed his PGY1 and 2 residencies at Houston Methodist Hospital. Following completion of his residency Alan will become a Pharmacy Manager at Houston Methodist Hospital. Primary project preceptor: Javon Artis, PharmD, MS Presented at 2022 Vizient Pharmacy Network, Las Vegas, NV, and TSHP Alcalde Southwestern Leadership Conference.

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Evaluation and Comparison of Radio-Frequency Identification (RFID) Technology Tracking for Optimization of Crash Cart Operations Haley Blanck, PharmD, MS; Amanda Beck, PharmD, MS; Niaz Deyhim, PharmD, MS, BCPS PURPOSE

RESULTS

Radio frequency identification (RFID) beacons are small tags that have the ability to store and transmit data and information regarding crash carts via serial numbers. These RFID beacons communicate via Wi-Fi and Bluetooth connectivity to a real-time location system (RTLS) with the ability to track and maintain many types of data. We sought to evaluate the change in the rate of expired crash carts deployed on hospital units after implementation of two different RFID tracking technologies.

A total of 215 crash carts were identified and tagged with RFID beacons. A non-statistically significant large difference between pre-implementation (M=3.6%, SD 2.9) & post-implementation (M=0.8%, SD 1.2), p = 0.058 was found in the study.

METHODS

A single-center, quasi-experimental, pre-post study was conducted on all crash carts deployed at a large academic tertiary hospital. The primary outcome was the rate of expired crash carts deployed on hospital units, defined as the total number of expired crash carts deployed per month over the total assigned crash cart locations. Additional secondary endpoints included the incidence of crash carts being missing from an assigned location, the number of crash carts expiring each month, the incidence of RFID beacons not being received by their respective monitoring systems per location per day, and the comparison between two different RFID tracking technologies.

CONCLUSION

Implementation of RFID location tracking of crash carts decreased the rate of expired crash carts deployed and optimized the required labor for monthly crash cart operations. Further research with a larger sample size and longer study duration is being completed for more reliable data on performance and functionality.

PGY1/PGY2 PHARMACY INFORMATICS RESIDENCY

Haley Blanck, PharmD, MS Haley earned her Doctor of Pharmacy and Master of Science in Health Informatics from The University of Kansas in 2022. Following completion of her PGY1 Residency year, Haley will continue her post-graduate training as a PGY2 Pharmacy Informatics Resident at Houston Methodist Hospital. Primary project preceptor: Amanda Beck, PharmD, MS Presented at 2022 Vizient Pharmacy Network, Las Vegas, NV, and 2022 Midwest Pharmacy Residents Conference, Omaha, NE Recipient of the Enhancing Adoption of Radio Frequency Identification (RFID) Technology In Medication Use Systems grant in the amount of $29,003 was awarded to Houston Methodist Hospital on behalf of the ASHP Research and Education Foundation (ASHP Foundation).

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Bleeding Outcomes in Critically Ill Patients Receiving Continuous Intravenous Unfractionated Heparin with Discordant aPTT and Anti-Xa Levels Hala Halawi, PharmD; Mahmoud M. Sabawi, PharmD, BCCCP; Elsie Rizk, PharmD; Ahmed A. Mahmoud, PharmD, BCCCP; Nina Srour, PharmD, BCCCP; Jenny H. Petkova, MD; Kevin R. Donahue, PharmD, BCPS PURPOSE

RESULTS

Activated partial thromboplastin time (aPTT) and anti-factor Xa (anti-Xa) unfractionated heparin (UFH) are commonly used assays for UFH monitoring. Discordance between the two assays occurs in 50 to 60% of patients. The selection of anti-Xa versus aPTT for UFH monitoring and the effect of their discordance on critically ill patient outcomes is unclear. The objective of this study was to measure the incidence of major bleeding events among critically ill patients who received UFH and had at least one discordance in aPTT and anti-Xa levels compared to patients with no discordance.

Among 264 included patients, 108 patients had at least one discordant paired level, and 156 patients had consistently concordant paired levels. Major bleeding events occurred in 22 patients (14%) with discordance and in 5 patients (5%) with no discordance, with an unadjusted risk ratio of 3.0 (95% CI, 1.2-7.8; p=0.01) and an adjusted odds ratio of 3.4 (95% CI, 1.2-9.5; p=0.02). Thrombotic events occurred in 7 patients (4%) with discordance and 0 patients with no discordance (p=0.04). The average hospital LOS was 13.8 days in patients with discordance compared to 11.4 days in patients with no discordance (p=0.08).

METHODS

CONCLUSION

This was a single-center, retrospective cohort study of critically ill adult patients who had paired anti-Xa and aPTT levels while receiving continuous UFH infusion. Paired levels were defined as simultaneously drawn aPTT and anti-Xa levels. The primary outcome was the proportion of patients who experienced a major bleeding event up to 24 hours after UFH discontinuation. Secondary outcomes included incidence of thrombosis up to 30 days after UFH discontinuation and length of hospital stay (LOS).

Discordant aPTT and anti-Xa levels were associated with an increased risk of major bleeding events in critically ill patients receiving a continuous intravenous UFH infusion. While both aPTT and anti-Xa assays remain viable options for monitoring UFH in critically ill patients, closer attention to bleeding and thrombotic risks is required when managing patients with discordant levels.

PGY2 CRITICAL CARE PHARMACY RESIDENCY

Hala Halawi, PharmD Hala earned her PharmD from the Lebanese American University in 2020. She completed her PGY1 residency at Houston Methodist Hospital, Houston, TX. Following completion of her PGY2, Hala will be staying on at Houston Methodist Hospital as an overnight critical care clinical pharmacy specialist. Primary project preceptor: Mahmoud Sabawi, PharmD, BCCCP Presented at 2022 Vizient Pharmacy Network, Las Vegas, NV and 2023 TMC Critical Care Research Forum, Houston, TX

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Direct Oral Anticoagulant Transition Strategies: Role of Anti-Xa Concentrations Upon Intensive Care Unit Admission Mariah I. Sigala, PharmD, Corey V. Dinunno, PharmD, BCPS, Chelsea N. Lopez, PharmD, BCCCP, Luma Succar, PharmD, BCCCP, Edward A. Graviss, PhD, Duc Nguyen, MD, Jenny H. Petkova, MD, Kevin R. Donahue, PharmD, BCPS PURPOSE

RESULTS

The increased utilization of oral factor Xa inhibitors (FXaI) has led to a growing interest in the clinical utility of FXaIspecific anti-Xa concentrations. The critically ill population is at risk for FxaI accumulation, and associated bleeding, secondary to end-organ dysfunction. To mitigate this risk, a concentration-guided approach to transitioning between oral and parenteral anticoagulant therapy has been explored. The primary objective of this study was to compare the incidence of bleeding upon intensive care unit (ICU) admission between two different FXaI transition strategies: a concentration vs non-concentration-guided approach.

A total of 682 patients (314 in concentration-guided and 368 in non-concentration-guided groups) were included. At baseline, the groups were balanced in severity of illness and coagulation parameters. There was a trend towards reduction of major bleeding in the concentrationguided approach (2.9% vs. 5.2%; p=0.17) and no differences in thromboembolic complications (1.3% vs. 1.4%; p=1.00). Univariate analysis associated higher sequential organ failure assessment scores, continuous renal replacement therapy, and Impella® placement as predictors of major bleeding.

METHODS

CONCLUSION

This was a single-center, retrospective cohort study evaluating patients with objective evidence of oral FXaI exposure within 48 hours preceding ICU admission. The primary outcome was the incidence of major bleeding within 5 days of inclusion. Thromboembolic events were evaluated as a secondary endpoint and subgroup analyses were performed to identify characteristics associated with bleeding.

This analysis suggests that using FxaI concentrations to guide anticoagulation transition in the ICU setting demonstrates a trend towards reduction in major bleeding without an increased risk of thromboembolic complications. Our findings support ongoing initiatives to incorporate enhanced FXaI monitoring into the care of select, high-risk, patient populations.

PGY2 CRITICAL CARE PHARMACY RESIDENCY

Mariah Isabella Sigala, PharmD Mariah earned her Bachelor’s in Biochemistry and Doctor of Pharmacy degree from The University of Texas at Austin. She completed her PGY1 residency at Houston Methodist Hospital. Following completion of her PGY2, Mariah will continue her time at Houston Methodist Hospital as an Emergency Medicine/Critical Care Clinical Pharmacy Specialist. Primary project preceptor: Kevin R. Donahue, PharmD, BCPS Presented at 2022 Vizient Pharmacy Network, Las Vegas, NV, and Texas Medical Center Critical Care Research Symposium, Houston, TX

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Use of a Monte Carlo Simulation to Assess Cefepime Target Attainment in Patients with Augmented Renal Clearance Evan L. Steere, PharmD, MS; Truc Tran, PharmD; Vincent Tam, PharmD, FIDSA, BCIDP; William Musick, PharmD, BCIDP PURPOSE

RESULTS

Augmented renal clearance (ARC) is a frequently identified phenomenon among critically ill patients. Due to the supraphysiologic clearance of solutes, ARC may lead to subtherapeutic exposures of many beta-lactam antibiotics such as cefepime though little investigation has been conducted to evaluate optimal dosing regimens in this population. The objective of this study was to evaluate the percent target attainment (PTA) of distinct cefepime dosing strategies under conditions of ARC using a Monte Carlo simulation.

In total, 312 isolates were identified over the eligible timeframe including 91 P. aeruginosa (25%) and 277 Enterobacterales (75%) isolates. Most isolates included were susceptible to cefepime (85% for P. aeruginosa and 82% for Enterobacterales). Cefepime PTA was superior for the 3-hour infusion strategy compared to the 0.5-hour infusion strategy with a difference of ≥10% at MIC values of 4, 8, and 16 mg/L. Weighted cefepime PTA for the distribution of included isolates was 83% for the 0.5-hour infusion strategy and 90% for the 3-hour infusion strategy.

METHODS

CONCLUSION

A minimum inhibitory concentration (MIC) was extracted for non-urine Pseudomonas aeruginosa and Enterobacterales isolates collected between January 1, 2017 to December 31, 2021 from patients admitted to the neuro-ICU at Houston Methodist Hospital. Using a 1,000-patient Monte Carlo simulation, the PTA was assessed at a creatinine clearance of 180 mL/min. Target attainment was defined as a concentration of free drug > MIC of ≥ 60%, and PTA was determined across the distribution of isolates and at each distinct MIC value. Cefepime dosing strategies evaluated included 2 g every 8 hours administered as a 0.5-hour and a 3-hour infusion strategy.

A 3-hour infusion cefepime dosing strategy appears superior to a 0.5-hour infusion strategy in reaching drug targets among patients with ARC.

PGY2 INFECTIOUS DISEASES PHARMACY RESIDENCY

Evan L. Steere, PharmD, MS Evan earned his Bachelor of Pharmaceutical Studies in 2018, Master of Science in Clinical Research in 2020, and PharmD in 2021 from the University of Kansas. He completed his PGY1 residency at Houston Methodist Hospital. Following completion of his PGY2 residency, Evan has accepted a position as an Infectious Diseases pharmacist at the University of Kansas Health System. Primary project preceptor: William L. Musick, PharmD, BCIDP Presented at 2022 Vizient Pharmacy Network, Las Vegas, NV, and 2022 Midwest Pharmacy Residents Conference, Omaha, NE

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Evaluation of Apixaban Loading Strategies for Acute Venous Thromboembolism in Hospitalized Patients with Increased Bleed Risk Eileen Sullivan, PharmD; Corey Dinunno, PharmD, BCPS; Diane Dreucean, PharmD, BCCCP; Hayley Brazeale, PharmD, BCPS PURPOSE

RESULTS

Apixaban is increasingly utilized for the treatment of venous thromboembolism (VTE) due to its fast onset of action, comparatively low rates of bleeding, and minimal requirements for laboratory monitoring. FDA-approved labeling recommends apixaban loading doses during the first days to weeks of VTE therapy to prevent thrombus extension and VTE-related death. However, patients at high risk for bleeding were largely excluded from initial apixaban VTE approval trials; therefore, it is unclear if the standard loading dose should be applied to this population or if a modified loading strategy would serve as a safer alternative.

In total, 4862 patients were screened for inclusion, of which 133 patients (63 full load cohort; 70 reduced/no load cohort) met inclusion criteria. Overall, we found no difference in major bleeding within 7 days of apixaban initiation in patients receiving a full loading dose compared to a reduced/no load strategy. However, there was a greater incidence of CRNMB and new thromboses in patients who did not receive the full load. Patients receiving a reduced/no load strategy also had numerically longer hospital lengths of stay and more readmissions for bleeding or thrombotic events.

METHODS

CONCLUSION

Hospitalized patients receiving apixaban for VTE treatment with an increased bleeding risk, defined as a Registro Informatizado de Enfermedad Tromboembolica (RIETE) score ≥ 1, were included. All patients were admitted for at least 7 days after apixaban initiation. Patients were excluded if they received VTE treatment in the past six months, another oral anticoagulant or thrombolytic while inpatient, concurrent dual antiplatelet therapy, had known thrombophilia, or had a bleed prior to apixaban initiation. Patients meeting these criteria were categorized into two groups based on the intended loading strategy: full load (10 mg twice daily for 7 days) or reduced/no load (less than 7 days of 10 mg twice daily). Major bleeding within 7 days of apixaban initiation according to International Society on Thrombosis and Hemostasis criteria was the primary outcome of interest.

Use of alternative apixaban loading strategies for the treatment of VTE in hospitalized patients at increased bleed risk did not reduce the risk of major bleeding and may lead to increased risk of new thrombosis. Differences in baseline characteristics may have driven overall outcomes, but larger randomized controlled trials are needed to confirm these findings. When determining initial apixaban dosing in this patient population, bleeding risk must also be weighed against individual thrombotic risk and therapeutic need.

PGY2 INTERNAL MEDICINE PHARMACY RESIDENCY

Eileen Sullivan, PharmD Eileen earned her BS in Biochemistry and PharmD degrees from The University of Texas at Austin in 2021. She completed her PGY1 residency at Houston Methodist Hospital. Following completion of her PGY2, Eileen will be staying on at Houston Methodist Hospital as a Clinical Pharmacist in Internal Medicine. Primary project preceptor: Hayley Brazeale, PharmD, BCPS Presented at 2022 Vizient Pharmacy Network, Las Vegas, NV, and 2022 Midwest Pharmacy Residents Conference, Omaha, NE

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Incidence and Outcome of Immune Checkpoint-Induced Pneumonitis (ICIP) in Oncology Patients with History of Pulmonary Disease Emily Allen, PharmD; Godsfavour Umoru, PharmD, BCOP; Veronica Ajewole, PharmD, BCOP; Eric Bernicker, MD PURPOSE Utilization of immune checkpoint inhibitor (ICI) has increased over the past several years. These agents function by downregulating inhibitory pathways on T cells which ultimately leads to increased immune system activation, T-cell recognition, and attack of tumor cells. Since the introduction of ICI, pneumonitis has proven to be one of the most common fatal adverse events seen and account for 35% of anti-PD[L]1-related deaths.1,2 The incidence in literature has been reported to be 2.5-5% with ICI monotherapy (mean onset of 2.8 months) but recent data have suggested that the overall incidence and time to onset may be higher outside of clinical trial settings.3,4,5,6 A subgroup analysis of the KEYNOTE-001 study which investigated utilization of pembrolizumab for the treatment of metastatic non-small cell lung cancer (NSCLC) found that pneumonitis occurred more frequently in patients with a history of asthma and chronic obstructive pulmonary disease (COPD) than in those without this history (5.4 vs. 3.1%).4 However, given the underrepresentation of patients with underlying lung diseases in clinical trials, no other studies have supported this observation and it is unknown if certain preexisting obstructive lung diseases alter the risk for developing immune checkpoint inhibitor pneumonitis (ICIP). The purpose of this study is to evaluate the incidence and management of ICIP in a cohort of patients with pre-existing obstructive pulmonary disease. METHODS This retrospective observational study includes data collected from the electronic medical records of 139 patients with a history of an obstructive pulmonary disorder and immune checkpoint inhibitor administration between January 1, 2017

and August 31, 2022. Patients included in this study met the following inclusion criteria: adult patients 18 years or older, received at least 2 cycles of an immune checkpoint inhibitor, and had a history of an obstructive pulmonary disorder prior to administration. Patients were excluded if they had known risk factors for pneumonitis (previously received durvalumab with radiation, had a clinical suspicion of pneumonitis post-thoracic radiation, or previously received an EGFR tyrosine kinase inhibitor). RESULTS In this retrospective, single-center descriptive study 10 out of 139 (7.19%) patients were identified as experiencing immunemediated pneumonitis. At the time of ICIP identification, 90% of patients had immunotherapy held, 40% received oral steroids, and 70% received intravenous steroids. Following the initial ICIP event and management, 60% of patients experienced a complete resolution of symptoms and 30% experienced a partial resolution. 1 patient experienced a grade 4 ICIP events and subsequently passed after treatment with steroids, cyclophosphamide, and infliximab. After receiving treatment for the initial episode of immune-mediated pneumonitis, 6 patients were restarted on immunotherapy and 3 (50%) subsequently experienced a recurrent pneumonitis episode. CONCLUSION These findings indicate that a pre-existing history of an obstructive pulmonary disorder may be a risk factor for the development of ICIP and patients with this history should be monitored closely when starting ICI therapy.

PGY2 ONCOLOGY PHARMACY RESIDENCY

Emily Allen, PharmD Emily earned her PharmD from The University of Texas at Austin College of Pharmacy in 2021. She completed her PGY1 residency at Houston Methodist Hospital. Following completion of her PGY2, Emily will be starting an outpatient oncology pharmacist position at Houston Methodist Willowbrook. Presented at 2022 Vizient Pharmacy Network, Las Vegas, NV, 2022 Midwest Pharmacy Residents Conference, Omaha, NE and HOPA Conference, Phoenix, AZ

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Effect of Direct Oral Anticoagulants Compared to Enoxaparin on Objective Response to Immune Checkpoint Inhibitors in Patients with Lung Cancer Solmaz Karimi, PharmD, MS; Godsfavour Umoru, PharmD, BCOP; Karen Abboud, PharmD, BCPS; Eric Bernicker, MD PURPOSE While immunotherapy can induce unprecedented durable responses, primary and acquired resistance mechanisms limit its utility in a wide patient population. It has been shown that a hypoxic tumor microenvironment (TME) inhibits the normal metabolism of immune cells, T-cell infiltration, and T-cell function. Vaso-occlusion caused by intravascular cancerassociated thrombosis was shown in several preclinical models to lead to limited tumor perfusion and hypoxia. In addition, the activation of protease-activated receptors (PAR), and specifically PAR 2, by cancer cell-expressed tissue factor and coagulation factor VIIa or coagulation factor Xa (FXa), promotes tumor progression. Direct oral anticoagulants (DOACs) can penetrate tissue and reach FXa in the TME to specifically target the PAR 2 cell-autonomous signaling pathway and consequently enhance the infiltration of cytotoxic T cells and dendritic cells to the tumor site. It has been suggested that highly thrombotic cancers, such as lung cancer, may derive greater benefit from the combination of DOACs and immune checkpoint inhibitors (ICIs) since they are associated with a more hypoxic TME. The purpose of this retrospective study was to compare the objective response rate (ORR) and progression-free survival (PFS) of patients treated with DOACs to those treated with enoxaparin while concurrently on immunotherapy for advanced-stage lung cancer. METHODS This was a single-center, retrospective, cohort study that included adult patients with advanced-stage lung cancer who had received at least two cycles of therapy with an ICI in the inpatient or outpatient setting and at least one month of therapeutic or prophylactic anticoagulant with either a DOAC (Arm A) or enoxaparin (Arm B) between June 1, 2016,

to September 30, 2022. Patients were excluded if they were diagnosed with early-stage (stage I-III) lung cancer, received less than two cycles of ICI therapy, or transferred care to another institution. The primary endpoint was ORR, and the secondary endpoints were rates of complete response (CR), PFS, incidence of thrombotic events, and incidence of major bleeding according to International Society on Thrombosis and Haemostasis (ISTH) criteria. RESULTS In this study, a total of 73 adult patients with advanced-stage lung cancer (n=53 in Arm A and n=20 in Arm B) met the inclusion criteria. ORR at 6 months was 24.5% vs 25% while PFS at 6 months was 54.7% vs 45% in Arm A vs Arm B, respectively. CR rates at 6 months were 7.5% vs. 0% in Arm A vs Arm B. One patient in Arm A and two patients in Arm B had a recurrent acute deep vein thrombosis (DVT). Nine patients in Arm A were diagnosed with new acute DVT while on ICI therapy and were initiated on a DOAC as compared to two patients in Arm B who were diagnosed with new acute DVT and one patient with new acute PE who were initiated on enoxaparin. There were two major bleedings (pericardial and intracranial) according to ISTH criteria occurring in one patient in Arm B. CONCLUSION Our findings suggest a signal toward improved PFS at 6 months with no additional safety concerns in patients with advanced stage lung cancer who are on concurrent ICI therapy and DOAC. Improved PFS at 6 months has been shown to correlate with overall survival benefit at 12 months in ICI clinical trials and this could potentially change our way of practice.

PGY2 ONCOLOGY PHARMACY RESIDENCY

Solmaz Karimi, PharmD, MS Solmaz earned her Bachelor of Science from the American University of Sharjah in 2015, her Master of Science in pharmacology from the University of Vermont in 2017 and her PharmD from University of Florida in 2021. She completed her PGY1 residency at Duke University Hospital in Durham, NC. Following completion of her PGY2, Solmaz will continue her career as a lymphoma clinical specialist at The Ohio State University in Columbus, OH. Primary project preceptor: Godsfavour Umoru, PharmD, BCOP Presented at 2022 Vizient Pharmacy Network, Las Vegas, NV, 2022 Midwest Pharmacy Residents Conference, Omaha, NE and Hematology/Oncology Pharmacy Association Annual Conference, Phoenix, AZ

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Utility of Immune Function Monitoring for Infectious Complications in Liver Transplant Recipients Alyssa Chaplain, PharmD; Mozhgon Moaddab, PharmD, BCPS; Ashish Saharia, MD, FACS; Mark J. Hobeika, MD, FACS; Duc T. Nguyen, MD; Edward A. Graviss, PhD; R. Mark Ghobrial, MD, PhD, FACS, FRCS; Constance Mobley, MD, PhD, FACS PURPOSE

RESULTS

The Immune Cell Function Assay, Immuknow® (IKNOW), was FDA approved to quantify the immune response in solid organ transplant patients. Since infections are a known complication post-transplant, we evaluated the utility of IKNOW levels and their correlation to posttransplant infectious complications.

A total of 383 patients were transplanted during the study time period. Of the 64 patients who met inclusion criteria, 46 (71.9%) patients were low, 16 (25%) moderate, and 2 (3.1%) were identified as strong immune cell response on POD-0. The median (IQR) MELD score at the time of transplant for the low, moderate, and strong response cohorts were 32 (28, 40), 26.5 (26, 32.5), and 31.5 (26, 37). The median (IQR) IKNOW level on POD 0 and 7 were 134 (65, 253) and 279 (149, 438). The incidence of any new infection utilizing the POD-0 IKNOW level was 43.5% in the low, 12.5% in the moderate, and 0% in the strong groups, p=0.03. There was no significant difference seen in the incidence of infection between the low, moderate, and strong groups when utilizing the POD-7 IKNOW levels.

METHODS

A single-center, retrospective chart review was conducted in liver and liver-kidney transplant recipients between November 1, 2020 and September 30, 2022. Patients had an IKNOW level drawn on post-operative day (POD) 0 and 7. Patients were excluded if they were a re-transplant recipient or had less than 2 IKNOW levels. The primary endpoint was defined as the incidence of new infections in the low (< 225 ATP ng/ml), moderate (226-524 ATP ng/ml), and strong (> 525 ATP ng/ml) immune cell response groups within 1-month post-transplant. Incidence of infection was defined as a new positive culture posttransplant in correlation with clinical symptoms. Differences between groups were determined by Fisher’s exact tests for categorical variables and Kruskal Wallis test for continuous variables. A p-value of < 0.05 was considered statistically significant.

CONCLUSION

There was a higher incidence of infection, mainly bacterial, in the low immune cell response group based on POD-0 IKNOW levels. Tailoring immunosuppression and infection prophylaxis regimens for this population may aid in a reduction of infection post-transplant.

PGY2 SOLID ORGAN TRANSPLANT RESIDENCY

Alyssa Chaplain, PharmD Alyssa earned her PharmD from the University of Houston College of Pharmacy in 2021. She completed her PGY1 residency at Houston Methodist Hospital in Houston, Texas. Following the completion of her PGY2 Solid Organ Transplant residency, Alyssa will stay on at Houston Methodist Hospital as an Abdominal Transplant Clinical Specialist. Primary project preceptor: Mozhgon Moaddab, PharmD, BCPS Presented at 2022 Vizient Pharmacy Network, Las Vegas, NV, 2022 Midwest Pharmacy Residents Conference, Omaha, NE and 2023 American Transplant Congress, San Diego, CA

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Utilization of Non-Insulin Antidiabetic Agents Following Pancreas Transplantation Eric D Rubido, PharmD; Alex Rogers, PharmD, BCPS; Aaron Hutchins, PharmD; Archana Sadhu, MD; Richard J Knight, MD PURPOSE

RESULTS

Pancreas transplantation is a treatment modality used to restore insulin-independence to patients with diabetes mellitus and improve overall quality of life. To date, there remains a paucity of data describing the use of noninsulin antidiabetic agents (NIAAs) following pancreas transplantation and their role in prolonging insulinindependence. The objective of this analysis is to describe the utilization of NIAA therapy, their role in prolonging insulin-independence, and impact on graft and metabolic outcomes.

Of the 73 patients receiving NIAA therapy during the specified study period, 43 patients met criteria for enrollment. Median time from transplant to NIAA initiation was 36 months, with 90.7% of patients receiving simultaneous pancreas-kidney transplants. Median fasting plasma glucose and hemoglobin A1c at time fo therapy initiation were 121 mg/dL and 6% respectively. The most commonly prescribed class of NIAA therapy were the DPP-4 inhibitors, followed by the thiazolidinediones. Insulin-independence was maintained in 69.8% of patients. In patients requiring insulin therapy, insulin initiation was delayed by a median of 19.9 months (IQR 13.8 -34.7). Graft failure was reported in 18.6% of patients with a median time to graft failure of 16.6 months (IQR 2-30). The most common indication for graft failure was receiving a TDD of insulin > 0.5 units/kg/day (62.5%).

METHODS

This was single-center, descriptive analysis including adult pancreas and kidney-pancreas transplant recipients initiated on NIAA for a minimum of 6 months between 5/2016-10/2022. Patients were excluded if they experienced early graft failure, received a multiorgan transplant other than simultaneous pancreas-kidney, and if insulin was initiated prior to NIAA therapy. The primary endpoint was insulin-independence up until time of last follow-up. Secondary endpoints included time to insulin initiation, development and time to graft failure, and metabolic parameters. Safety endpoints included incidence of acute pancreatitis and hypoglycemia requiring hospitalization and/or medical intervention.

CONCLUSION

NIAA therapy appears to be a potentially safe therapeutic option to delay and possibly avoid the initiation of insulin following pancreas transplantation. Metabolic parameters remained stable out to 36 months and further studies are needed to assess the role of NIAA therapy in prolonging graft function.

PGY2 SOLID ORGAN TRANSPLANT RESIDENCY

Eric D. Rubido, PharmD Eric earned his Bachelors in Biological Sciences from Florida International University in 2016 and PharmD from University of Florida in 2021. He completed his PGY1 residency at Houston Methodist Hospital. Following completion of his PGY2, Eric will continue as a Transplant Clinical Pharmacy Specialist at Houston Methodist Hospital. Primary project preceptor: Alex Rogers, PharmD, BCPS Presented at 2022 Vizient Pharmacy Network, Las Vegas, NV, 2022 Midwest Pharmacy Residents Conference, Omaha, NE and 2023 American Transplant Congress, San Diego, CA

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Hypogammaglobulinemia and Intravenous Immune Globulin Use Following Lung Transplant: A Retrospective, Single-Center, Descriptive Study Phuong Y Duong, PharmD; Elsie Rizk, PharmD; Navjot Kaur, MS, PharmD; Linda W. Moore, PhD; Edward A. Graviss, PhD, MPH; Duc T. Nguyen, MD, PhD; Jill C. Krisl, PharmD; Aaron T. Hutchins, PharmD; Taylor Pasley, PharmD; Simon W. Yau, MD; Ahmad Goodarzi, MD; J. Georges Youssef, MD; Howard J. Huang, MD PURPOSE

RESULTS

Hypogammaglobulinemia (HGG) is a common complication that can increase infection risk after lung transplant, and replacement with intravenous or subcutaneous immune globulin is recommended for solid organ transplant recipients with HGG. However, intravenous immune globulin (IVIG) use in lung transplant has not been well-studied, and IVIG regimens have not been described in practice. The objective of this study was to describe the current practice of immunoglobulin G (IgG) monitoring, HGG incidence, IVIG use, and possible risk factors for HGG after lung transplant.

A total of 198 lung transplant recipients were included in this study. Within 1 year following lung transplant, IgG levels were monitored at an average of 5 times, HGG (IgG level<700 mg/dL) occurred in 89% of patients, and severe HGG (IgG level<400 mg/dL) occurred in 44% of patients. A total of 166 patients received IVIG within 1 year following lung transplant for the following indications: HGG in the absence of infection in 41% of patients, HGG in the setting of active infection in 48%, DSA in 36%, and AMR in 14%. Risk factors significantly associated with severe HGG were underlying obstructive lung disease (adjusted odds ratio (aOR)=3.6; p<0.001), baseline immunodeficiency due to corticosteroids (aOR=5.9; p=0.001), IgG administration within 1 year before transplant (aOR=11.0; p=0.004), and higher body mass index (aOR=1.1; p=0.045).

METHODS

This was a retrospective, single-center, descriptive study that included all adult patients (≥18 years of age) who received a lung transplant at Houston Methodist J.C. Walter Jr. Transplant Center from January 2018 to March 2021. Patients who received multiple simultaneous transplanted organs were excluded. The primary outcome was the indication of IVIG doses administered during 1 year after lung transplant and was reported as the proportions of patients who received IVIG for the following indications: 1) HGG in the absence of infection, 2) HGG in the setting of active infection, 3) donor-specific antibodies (DSA), and 4) antibody-mediated rejection (AMR).

CONCLUSION

HGG was a major complication that was commonly diagnosed in the setting of active infections within 1 year following transplant. The use of IVIG to treat HGG with or without an infection was documented in 65% of patients. Additional studies are needed to evaluate the efficacy of IVIG for HGG and infection prevention among high-risk patients following lung transplant.

CLINICAL PHARMACY FELLOWSHIP IN OUTCOMES RESEARCH

Phuong Duong, PharmD, MBA, BCPS Phuong earned her PharmD and MBA in 2019 and 2022 from MCPHS University. She completed her PGY1 residency at Cooley Dickinson Hospital in Northampton, Massachusetts. Following completion of her fellowship training in September 2023, Phuong will pursue a career in academia. Primary project preceptor: Elsie Rizk, PharmD This study was funded by Grifols Shared Services North America Inc. The funding agency was not involved in the design of the study, collection of the data, analysis of the data, interpretation of the data, or the development of this abstract.

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SYSTEM PHARMACY RESEARCH BIBLIOGRAPHY 2018 TO 2023 Abbasi, G. Effect of COVID-19 on Pharmacy Technology. PP&P. 2020;17(6):2-4. Abbasi, G. Deliver Pharmacy Services via Novel Technologies. PP&P. 2022;19(2):8-11. Abboud, K., Umoru, G., Esmail, A., Abudayyeh, A., Murakami, N., AlShamsi, H. O., Javle, M., Saharia, A., Connor, A. A., Kodali, S., Ghobrial, R. M., & Abdelrahim, M. (2023). Immune checkpoint inhibitors for solid tumors in the adjuvant setting: Current progress, future directions, and role in transplant oncology. Cancers, 15(5), 1433. Abdelrahim M, Mamlouk O, Lin H, Lin J, Page V, Abdel-Wahab N, Swan JT, Selamet U, Yee C, Diab A, Suki WN, Abudayyeh A. “incidence, predictors, and survival impact of acute kidney injury in patients with melanoma treated with immune checkpoint inhibitors: a 10-year singleinstitution analysis” OncoImmunology 2021;10(1):e1927313 Abdelrahim, M., Esmail, A., Umoru, G., Westhart, K., Abudayyeh, A., Saharia, A., & Ghobrial, R. M. (2022). Immunotherapy as a neoadjuvant therapy for a patient with hepatocellular carcinoma in the pretransplant setting: A case report. Current Oncology, 29(6), 4267–4273. Abdelrahim M, Esmail A, Xu J, Umoru G, Al-Rawi H, Saharia A, Abudayyeh A, Victor D, McMillan R, Kodali S and Ghobrial RM (2022). Gemcitabine Plus Cisplatin Versus Non-Gemcitabine and Cisplatin Regimens as Neoadjuvant Treatment for Cholangiocarcinoma Patients Prior to Liver Transplantation: An institution Experience. Front. Oncol. 2022 Jun 2;12:908687. Abdelrahim, M., Al-Rawi, H., Esmail, A., Xu, J., Umoru, G., Ibnshamsah, F., Abudayyeh, A., Victor, D., Saharia, A., McMillan, R., Al Najjar, E., Bugazia, D., Al-Rawi, M., & Ghobrial, R. M. (2022). Gemcitabine and cisplatin as neo-adjuvant for cholangiocarcinoma patients prior to liver transplantation: Case-series. Current Oncology, 29(5), 3585–3594. Abdelrahim, M., Esmail, A., Xu, J., Umoru, G., Al-Rawi, H., & Saharia, A. (2022). P-168 Combination of gemcitabine plus cisplatin compared to non-gemcitabine and cisplatin regimens as neo-adjuvant treatment in liver transplant recipients with cholangiocarcinoma. Annals of Oncology, 33, S309–S310. Abdelrahim, M., Esmail, A., Xu, J., Umoru, G., Saharia, A., McMillan, R., & Ghobrial, R. M. (2022). Gemcitabine plus cisplatin versus non-gemcitabine and cisplatin regimens as neoadjuvant treatment for cholangiocarcinoma patients prior to liver transplantation. Journal of Clinical Oncology, 40(16_suppl), e16202–e16202.

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SYSTEM PHARMACY RESEARCH BIBLIOGRAPHY 2018 TO 2023 Dreucean D, Nguyen SN, Donahue KR, Salazar E, Ruegger MC. Evaluation of characteristics and dosing regimens in patients with new or recurrent thrombosis on apixaban and rivaroxaban. Journal of Thrombosis and Thrombolysis 2021 52(1), 161-169 Duhon B, Varkey AC, Woodruff AL, et al. Chapter 16: Resiliency and Well-Being. ASHP Preceptors Handbook 4th edition. December 2019. U6263; ISBN: 978-1-58528-626-3 Ecabert D, Pham C, Pierce BJ, Musick ML, Nguyen DT, Graviss EA. Safety of valganciclovir dosed 450 mg three times weekly for cytomegalovirus prophylaxis in solid organ transplant recipients requiring hemodialysis. Open Forum Infect Dis. 2021 Aug 20;8(10):ofab436.. Ekinci E, Nathoo S, et al. Interventions to improve endocrine therapy adherence in breast cancer survivors: what is the evidence? J Cancer Surviv. 2018;12(3):348-356. Esmail, A., Xu, J., Umoru, G., Al-Rawi, H., Saharia, A., & Abdelrahim, M. P-169 Feasibility of gemcitabine plus cisplatin as neo-adjuvant in cholangiocarcinoma patients prior to liver transplantation. Annals of Oncology. 2022; 33, S310. Fong G, Skoglund EW, Phe K, et al. Significant Publications on infectious Diseases Pharmacotherapy in 2016. J Pharm Pract. 2018;31(5):469-80. Friemel M, Marlow B, Peek GK, Bhakta SB. Impact to Site of Care Trends: An introduction and Strategy to Identify the Issues with the infusion Center Enterprise. ASHP Section of Pharmacy Practice Managers’ Advisory Group on Management of the Pharmacy Enterprise. June 2018. Fuentes A, Truong M, Saldivar V, Adeola M. Integration of Medication Safety Training and Development of a Culture of Safety in Pharmacy Education. Patient Safety Journal (2022) Gohil S, Deyhim N, Mgbere O, Essien EJ. Predictors of opioid prescription among outpatients with osteoarthritis in the United States. Journal of Opioid Management. 2023;19(3):205-223. Haddad N, Paranjpe R, Rizk E, et al. Value of pharmacy services in an outpatient, preoperative, anesthesia clinic J Am Pharm Assoc (2003). 2020 Nov-Dec;60(6):e264-e278. Epub 2020 Apr 15. Haque, E., Muhsen, I. N., Esmail, A., Umoru, G., Mylavarapu, C., Ajewole, V. B., & Abdelrahim, M. (2022). Case report: Efficacy and safety of regorafenib plus fluorouracil combination therapy in the treatment of refractory metastatic colorectal cancer. Frontiers in Oncology, 12, 992455. Highsmith EA, Morton C, Varnado S, Donahue KR, Sulhan S, Lista A. Outcomes associated with 4-factor prothrombin complex concentrate administration to reverse oral factor xa inhibitors in bleeding patients. The Journal of Clinical Pharmacology. 61(5). 598-605 Hill B, Narayanan N, Palavecino E, et al. The Role of an Antimicrobial Stewardship Team in the Use of Rapid Diagnostic Testing in Acute Care: An official Position Statement of the Society of infectious Diseases Pharmacists. Infect Control Hosp Epidemiol. 2018;39(4):473-5. Hinman B, Umoru G, Burns E, Rahi CE, Zhang J (2023) Utilization of Dual Immunotherapy for Metastatic Pulmonary Pleomorphic Giant Cell Carcinoma: A Case Report. Clin Oncol Case Rep 6:4

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Hoang J, Krisl J, Moaddab M, Nguyen DT, Graviss EA, Hussain I, Kassi M, Yousefzai R, Kim J, Trachtenberg B, Bhimaraj A, Guha A. Intravenous immunoglobulin in heart transplant recipients with mild to moderate hypogammaglobulinemia and infection. Clin Transplant. 2022 Apr;36(4):e14571. doi: 10.1111/ctr.14571. Epub 2022 Jan 6. PMID: 34964505 Holyk A, Belden V, Sirimaturos M, et al. Volume-based feeding enhances enteral delivery by maximizing the optimal rate of enteral feeding (FEED MORE). JPEN. 2020; 44(6):1038-46. Howington GT, Nguyen HB, Bookstaver PB, Akpunonu P, Swan JT. “Rabies postexposure prophylaxis in the United States: opportunities to improve access, coordination, and delivery.” PLOS Neglected Tropical Diseases. 2021;15(7):e0009467. Hughes CG, Mailloux PT, Devlin JW, Swan JT, Sanders RD, Anzueto A, Jackson JC, Hoskins AS, Pun BT, Orun OM, Raman R, Stollings JL, Kiehl AL, Duprey MS, Bui LN, O’Neal HR Jr, Snyder A, Gropper MA, Guntupalli KK, Stashenko GJ, Patel MB, Brummel NE, Girard TD, Dittus RS, Bernard GR, Ely EW, Pandharipande PP; MENDS2 Study investigators. Dexmedetomidine or Propofol for Sedation in Mechanically Ventilated Adults with Sepsis. N Engl J Med. 2021 Apr 15;384(15):1424-1436. Hwang, G, Rutugandha, P, et al. Oral endocrine therapy agent, race/ ethnicity, and time on therapy predict adherence in breast cancer patients in a large academic institution. Clin Breast Cancer. 2020 Clin Breast Cancer. 2020 Dec;20(6):520-526.. Epub 2020 Jun 13 Iso T, Rizk E, Harris JE, et al. Viable Hemostasis Obtained with Prothrombin Complex Concentrate in Patients Who Refuse Standard Allogeneic Blood Transfusion and Undergo Complex Cardiac Surgery: A Case Series, A & A Practice. 2020;14(9):e01276 Iso T, Yuan F, Rizk E, Tran AT, Saldana RB, Boyareddigari PR, Nguyen NA, Espino D, Benoit JS, Swan JT. Avoidable emergency department visits for rabies vaccination. Am J Emerg Med. 2022;54:242-248. Iso T, Yuan F, Rizk E, Tran AT, Saldana RB, Boyareddigari PR, Nguyen NA, Espino D, Swan JT. Wound characteristics and infiltration with immune globulin for rabies postexposure prophylaxis in the emergency department. Am J Emerg Med. 2022 Dec;62:55-61. Epub 2022 Oct 7. Jakowenko N, Nguyen S, Ruegger M, Dinh A, Salazar E, Donahue KR. Apixaban and rivaroxaban anti-xa level utilization and associated bleeding events within an academic health system. Thrombosis Research 196,276-282 Jones N, Shah PJ. Challenges in antimicrobial susceptibility testing interpretation: Fluoroquinolone susceptibility discordance. Am J Health Syst Pharm. 2022;79(11):829-30 Kieser, R. B., Xu, J., Burns, E., Muhsen, I., Shah, S. M., Umoru, G., Mylavarapu, C., Sun, K., Zhang, Y., Crenshaw, A., Esmail, A., Guerrero, C., Gong, Z., Gee, K., Heyne, K., Singh, M., Zhang, J., Efstathiou, E., Bernicker, E., & Abdelrahim, M. (2022). Outcomes of patients with advanced urothelial cancer who develop infection while on treatment with pembrolizumab. Journal of Clinical Oncology, 40(16_suppl), 4573–4573. Klasek R, Kuten SA, Patel SJ, et al. Unexplained fever after pancreas transplantation. Clin Transplant 2018;32(9):e13351. Knight RJ, Graviss EA, Nguyen DT, et al. Conversion from tacrolimusmycophenolate mofetil to tacrolimus-mToR immunosuppression after kidney-pancreas transplantation reduces the incidence of both BK and CMV viremia. Clin Transplant 2018;32(6):e13265.

SYSTEM PHARMACY RESEARCH BIBLIOGRAPHY 2018 TO 2023 Koh L, Shah PJ, Aly S. Patient Case Report Daptomycin Holiday-A Daptomycin Dosing Strategy for Asymptomatic Increases in Creatine Phosphokinase Levels. J Pharm Pract. 2022;35(1):148-51 Krisl J. Potential Benefit or Risk of Harm?: Use of Herbal Supplements in Patients with Heart Failure, Texas Chapter of American College of Cardiology Heart Failure Blog. Oct 2018 Lai L, Alvarez G, Koh L, et al. The effect of gender disparity on migraine pharmacotherapy: a propensity score-matched cohort study. J Pharm Health Serv Res. 2018;9:191-7. Lista AD, Sirimaturos M. Pharmacokinetic and pharmacodyamic principles for toxicology. Critical Care Clinics. 2021:37(3): 475-86. Liu L, Brown EN, Abu-Shahin FI. Capecitabine-induced leukoencephalopathy in a patient with triple-negative breast cancer: A Case Report and Review of the Literature. Journal of Oncology Pharmacy Practice. October 2021. Lopez CN, Fuentes A, Dhala A, Balk J. Ramelteon for Decreasing Delirium in Surgical intensive Care Unit Patients. Clinical Medicine insights: Psychiatry. January 2020. Lopez CN, Succar L, Varnado S, Donahue KR. Direct oral to parenteral anticoagulants: strategies for inpatient transition. J Clin Pharmacol. 2020, 0(0) 1-9. Lopez CN, Sulaica E, Donahue KR, Wanat MA. Updates in Hemodynamic Monitoring: A Review for Pharmacists. J Pharm Pract. 2022 Oct;35(5):762-768. Epub 2021 Mar 26. Mason MJ, McDaneld PM, Musick WL, Kontoyiannis DP. Serum Levels of Crushed Posaconazole Delayed Release Tablets. Antimicrob Agents Chemother. 2019;63(5).pii: e02688-18. Molina TL, Kricl JC, Donahue KR, Varnado S. Gastrointestinal Bleeding in Left Ventricular Assist Device: Octreotide and Other Treatment Modalities. ASAIO 2018; 64(4):433-9. Monroig-Bosque PDC, Balk J, Segura F, et al. The utility of therapeutic plasma exchange for amphotericin B overdose. Transfus Apher Sci. 2018 Dec;57(6):756-8. Morton C, Lista A, Jakowenko N, Salazar E, Donahue KR. Apixaban and rivaroxaban anti xa level utilization for guidance of administration of andexanet alfa: a case series. J Thromb Thrombolysis. 2022 Jan;53(1):235-239 Muhsen I, Burns E, Umoru G et al. Hepatitis B reactivation with pembrolizumab, atezolizumab, and nivolumab: A pharmacovigilance study and literature review. J Clin Oncol 38: 2020 (suppl; abstr e15127) Mysore KR, Ghobrial RM, Kannanganat S, et al. Longitudinal assessment of T cell inhibitory receptors in liver transplant recipients and their association with posttransplant infections. Am J Transplant. 2018;18(2):351-63. Narasimhan B, Lorente-Ros M, Aguilar-Gallardo JS, Lizardo CP, Narasimhan H, Morton C, Donahue KR, Aronow WS. Anticoagulation in Covid-19, a review of current literature and guidelines. Hosp Pract (1995). 2021 Dec;49(5):307-324 Nazer LH, Lopez-Olivo MA, Brown AR, Cuenca JA, Sirimaturos M, Habash K, AlQadeeb N, May H, Milano V, Taylor A, Nates JL. A systematic review and meta-analysis evaluating geographical variation in outcomes of cancer patients treated in ICUs. Critical Care Explorations 2022 Sep 13;4(9):e0757.

Nguyen PAA, Enwere E, Gautreaux S, et al. Impact of a pharmacydriven transitions-of-care program on postdischarge healthcare utilization at a national comprehensive cancer center. Am J Health Syst Pharm. 2018;75(18):1386-93. Nguyen SN, Ruegger MC, Salazar E, Dreucean D, Tatara AW, Donahue KR. Evaluation of anti xa apixaban and rivaroxaban levels with respect to known doses in relation to major bleeding events. J Pharm Pract. 2022 Dec;35(6):836-845. Epub 2021 Apr 12. Oh M, Alkhushaym N, Fallatah S, et al. The association of BRCA1 and BRCA2 mutations with prostate cancer risk, frequency, and mortality: A meta-analysis. Prostate. 2019 Jun;79(8):880-95. Padmani, B., Abbasi, G., Hirave, B., Crooks, M., & Yassine, M. Management of Medication Preparation with Dynamic Processing. US Patent 20160210437. Padmani, B., Olsen, G., Abbasi, G., Dooley, C., Leech, D., Armstrong, C., & White, R. Automated Exchange of Healthcare information for Fulfillment of Medication Doses. US Patent 20160117472. Padmani, B., Valentine, M., Bender, J., Crooks, M., Hirave, B., Yassine, M., Abbasi, G., & Yevseyeva, K. Management of Medication Preparation with Formulary Management. US Patent 20160092638. Padmani, B., Valentine, M., Bender, J., Crooks, M., Hirave, B., Yassine, M., Abbasi, G., & Yevseyeva, K. Management of Medication Preparation with Formulary Management. US Patent 11107574 B2. Pai A, Swan JT, Wojciechowski D, Qazi Y, Dholakia S, Shekhtman G, Abou-Ismail A, Kumar D. “Clinical rationale for a routine testing schedule using donor-derived cell-free DNA after kidney transplantation.” Annals of Transplantation. 2021; 26: e932249 Patel SJ, Knight RJ, Kuten SA, et al. Ciprofloxacin for BK viremia prophylaxis in kidney transplant recipients: Results of a prospective, double-blind, randomized, placebo-controlled trial. Am J Transplant. 2019;19(6):1831-7. Pham C, Bilgili E, Krisl J. Tocilizumab in Thoracic Transplant Recipients. ISHLT Pulse Newsletter [online publications 2019] Pham C, Pierce BJ, Yau SW, Youssef GJ, Goodarzi A, Huang HJ. Belatacept dosing in lung transplantation: is there a method to the madness? OBM Transplantation. 2021;5(3). Pham C, Pierce B, Nguyen DT, Graviss EA, Huang HJ. Assessment of carfilzomib treatment response in lung transplant recipients with antibody mediated rejection. Transplantation Direct. 2021;7:e680. Pham C, Kuten SA, Knight RJ, Nguyen DT, Graviss EA, Gaber AO. Assessment of infectious complications in elderly kidney transplant recipients receiving induction with anti-thymocyte globulin vs basiliximab. Transpl infect Dis. 2020;00:e13257 Pritchard ER, Murillo JR Jr, Putney D, Hobaugh EC. Singlecenter, retrospective evaluation of safety and efficacy of direct oral anticoagulants versus low-molecular-weight heparin and vitamin K antagonist in patients with cancer. J Oncol Pharm Pract. 2019;25(1):52-9. Qin Q, Ajewole VB, Sheu TG, et al. Successful treatment of a stage IIIC small-cell carcinoma of the ovary hypercalcemic subtype using multi-modality therapeutic approach. Ecancermedicalscience. 2018;12:832. Rambaran KA, Huynh HA, Zhang Z, Robles J. The Gap in Electronic Drug information Resources: A Systematic Review. Cureus. 2018 Jun 22;10(6):e2860.

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SYSTEM PHARMACY RESEARCH BIBLIOGRAPHY 2018 TO 2023 Rana I, von Oehsen W, Nabulsi NA, Sharp LK, Donnelly AJ, Shah SD, Stubbings J, Durley SF. A comparison of medication access services at 340B and non-340B hospitals. Research in Social and Administrative Pharmacy. 2021;17(11):1887-1892. Rizk E, Haas EM, Swan JT. Opioid-Sparing Effect of Liposomal Bupivacaine and intravenous Acetaminophen in Colorectal Surgery. J Surg Res. 2021;259:230-241. Rizk E, Swan JT. Development, Validation, and Assessment of Clinical Impact of Real-time Alerts to Detect inpatient As-Needed Opioid Orders with Duplicate indications: Prospective Study. J Med internet Res. 2021;23(10):e28235. Rizk E, Swan JT, Cheon O, et al. Quality indicators to measure the effect of opioid stewardship interventions in hospital and emergency department settings. Am J Health-Syst Pharm. 2019; 76:225-35. Rizk E, Tran AT, Soto F, Putney DR, Fuentes A, Swan JT. Alteplase for the treatment of midline catheter occlusions: a retrospective, singlecohort descriptive study. Br J Nurs. 2022;31(14):S6-S16. Rizk E, Tajchman S, Fink E, Aryal DK, Iso T, Flores E, Brown AE, Chokshi SP, Desai SN, Dewan AK, Kazzaz SA, Guevara M, Nagaraj S, Robben CP, Vittone V, Swan JT. Quality indicators for osteoarthritis pain management in the primary care setting. BMC Musculoskelet Disord. 2023 Jun 30;24(1):538 Rizk E, Wilson AD, Murillo MU, Putney DR. Comparison of Antifactor Xa and Activated Partial Thromboplastin Time Monitoring for Heparin Dosing in Vascular Surgery Patients: A Single-Center Retropective Study. Ther Drug Monit 2018 Feb; 40(1): 151-5. Rizk E, Yuan F, Zheng F, Fink E, Kaur N, Tran AT, Iso T, Mohyuddin NG, Thekdi AA, Jackson GL, Wanat MA, Thornton JD, Swan JT. Optimization of Opioid Discharge Prescriptions Following Thyroid and Parathyroid Surgery. Otolaryngol Head Neck Surg. 2023 Jul;169(1):176-184 Rubido ED, Cooper MH, Donahue KR, Krisl J. Descriptive analysis evaluating the use of direct oral anticoagulation therapy in heart and lung transplant recipients. Clin Transplant. 2023 Feb;37(2):e14897. Epub 2023 Jan 11. Ruder TL, Donahue KR, Colavecchia AC, et al. Hemodynamic Effects of Dexmedetomidine in Adults with Reduced Ejection Fraction. Journal of intensive Care Medicine. J Intensive Care Med. 2021 Aug;36(8):893899. Epub 2020 Jun 17. . Salazar E, Perez KK, Ashraf M, Chen J, Castillo B, Christensen PA, Eubank T, Bernard DW, Eagar TN, Long SW, Subedi S, Olsen RJ, Leveque C, Schwartz MR, Dey M, Chavez-East C, Rogers J, Shehabeldin A, Joseph D, Williams G, Thomas K, Masud F, Talley C, Dlouhy KG, Lopez BV, Hampton C, Lavinder J, Gollihar JD, Maranhao AC, Ippolito GC, Saavedra MO, Cantu CC, Yerramilli P, Pruitt L, Musser JM. Treatment of Coronavirus Disease 2019 (COVID-19) Patients with Convalescent Plasma. Am J Pathol. 2020 Aug;190(8):1680-1690. Salgado BC, Fida N, Krisl J, Berens PM, Graviss EA, Nguyen DT, Hussain, I, et al. Remote versus early corticosteroid wean outcomes in heart transplant recipients in the contemporary era. Clin Transplant. 2021 Aug;35(8):e14382. Santalo O, Farano J, Igwe J, Deyhim N. Survey of health-system pharmacy administration and leadership residencies. American Journal of Health-System Pharmacy. 2020;77(6):449-456. Seo H, Lopez CN, Succar L, Donahue KR. Inhaled alprostadil for hospitalized adult patients. Ann Pharmacother. 2022 Jun;56(6):671678. Epub 2021 Sep 5.

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Shah PJ, Halawi H, Kay J, Akogun A, Wise S, Daoura N, Putney D. A Single-Center, Retrospective Cohort Study Evaluating the Use of Probiotics for the Prevention of Hospital-Onset Clostridioides difficile Infection in Hospitalized Patients Receiving Intravenous Antibiotics. Hosp Pharm. 2023; 58(1):57-61 Shah PJ, Koshy J, Everett N, Attia E. Severe Plasmodium falciparum Malaria Treated with investigational Artesunate in the United States. J Pharm Pract. 2018 Jan 1:897190018782367. Epub ahead of print. Sigala MI, Dreucean D, Harris JE, et al. Comparison of Sedation and Analgesia Requirements in Patients With SARS-CoV-2 Versus NonSARS-CoV-2 Acute Respiratory Distress Syndrome on Veno-Venous ECMO. Ann Pharmacother. 2023 Sep;57(9):1005-1015. Epub 2023 Jan 13. Sirimaturos M, Gotur DB, Patel SJ, et al. Clinical Outcomes Following Tocilizumab Administration in Mechanically Ventilated Coronavirus Disease 2019 Patients. Crit Care Explor. 2020;2(10):e0232. Smith AT, Kennerly-Shah JM, Kusoski CL. Development of a tool to allocate inpatient specialized pharmacy resources at a comprehensive cancer center. Journal of Oncology Pharmacy Practice. 2020;26(7):1686-1694. Smith A, Begnoche B, Mellett J, Hafford A, Rodis JL, Jordan TA. Defining, capturing, and validating pharmacists’ patient profile reviews in the electronic medical record, Am J Health Syst Pharm. 2022 Nov 22;79(23):2166-2173. Solomon JM, Ajewole VB, Schneider AM, et al. Evaluation of the prescribing patterns, adverse effects, and drug interactions of oral chemotherapy agents in an outpatient cancer center. 2019 Oct;25(7):1564-1569. Epub 2018 Aug 31. Sparrow HG, Swan JT(co-primary), Moore LW, et al. Disparate outcomes observed within Kidney Disease: Improving Global Outcomes (KDIGO) acute kidney injury stage 1. Kidney int. 2019;95(4):905-13. Srour N, Dasnadi S, Korulla A, Shah PJ. Early-onset neonatal ventriculomeningitis due to Streptococcus gallolyticus: A case report. Pediatr Neonatol. 2022;63(4):430-31 Srour N, Succar L, Nguyen P, Lopez CN. Vancomycin Dosing in High Intensity Continuous Renal Replacement Therapy: A Retrospective Cohort Study. Pharmacotherapy. May 2023. Steere EL, Eubank TA, Cooper MH, Greenlee SB, Drake TC. Impact of Hypoalbuminemia on Ceftriaxone Treatment Failure in Patients With Enterobacterales Bacteremia: A Propensity-Matched, Retrospective Cohort Study. Open Forum Infect Dis. 2023 Feb 27;10(3):ofad102. Succar L, Sulaica EM, Donahue KR, Wanat MA. Management of Anticoagulation with Impella Percutaneous Ventricular Assist Devices and Review of New Literature. J Thromb Thrombolysis (2019). 2019 Aug;48(2):284-291. Succar L, Donahue KR, Varnado S, Kim JH. Use of Tissue Plasminogen Activator Alteplase for Suspected Impella Thrombosis. Pharmacotherapy. 2020;40(2):169-173 Succar L, Lopez CN, Victor D, Lindberg S, Saharia A, Sheth S, Mobley C. Perioperative Cangrelor in Patients with Recent Percutaneous Coronary intervention Undergoing Liver Transplantation: A Case Series. Pharmacotherapy. 2022 Mar;42(3):263-267. Epub 2022 Feb 3. Sullivan E, Ruegger M, Dunne I, Sutaria N, Towers W. Comparison of effectiveness and safety of sodium polystyrene sulfonate and sodium zirconium cyclosilicate for treatment of hyperkalemia in hospitalized patients. AJHP. 2023 Jun 19.

SYSTEM PHARMACY RESEARCH BIBLIOGRAPHY 2018 TO 2023 Swan JT, Iso T, Rizk E, et al. Defining Vasoplegia Following Durable, Continuous Flow Left Ventricular Assist Device Implantation ASAIO J. 2022 Jan 1;68(1):46-55.

Wang H, Charles CV. A Review of Newly Approved Antibiotic Treatment for Community-Acquired Bacterial Pneumonia: Lefamulin. Sr Care Pharm. 2020;35(8):349-354.

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Wei W, Felippi R, Abbasi G, Pinn T, St. Rose K, Rana I. The Impact of Electronic Health Record Interventions on Patient Access to PostHospital Discharge Prescriptions. Hosp Pharm. 2023 Apr;58(2):212218. doi: 10.1177/00185787221130689. Epub 2022 Oct 31.

Thomas T, Fuentes A, Xu Q, Donahue K. Evaluation of heparin induced thrombocytopenia using probability scores in a mechanical circulatory support population. J Thromb Thrombolysis 2019, 48(1):134-140.

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Towers W, Nguyen SN, Ruegger MC, Salazar E, Donahue KR. Apixaban and Rivaroxaban anti xa level monitoring versus standard monitoring in hospitalized patients with acute kidney injury. Ann Pharmacother. 2022 Jun;56(6):656-663. Tran AT, Rizk E, Aryal DK, Soto FJ, Swan JT. Incidence of midline catheter complications among hospitalized patients. J Infus Nurs. 2023 Jan-Feb 01;46(1):28-35. Tran AT, Rizk E, Haas EM, Naufal G, Zhong L, Swan JT. Real-World Data on Liposomal Bupivacaine and inpatient Hospital Costs After Colorectal Surgery. J Surg Res. 2022;272:175-183. doi:10.1016/j. jss.2021.12.002 Umoru GO, Shah PJ, Tariq F. A Case Report of Neurotoxicity After Prolonged Doses of Acyclovir in a Patient with Renal Dysfunction. J Pharm Pract. 2020; 33(2):217-221. Umoru G, Taitano M, Beshay S et al. Pulmonary arterial hypertension in breast cancer patients on HER2-targeted therapy: a review of FDA Adverse Events Reporting System data. ERJ Open Res. 2020; 6(2):00199-2020. Umoru GO, Zaghloul H, El-Rahi C, Ensor JE. Evaluation of efficacy and safety of pegfilgrastim when given less than two weeks from dosedense chemotherapy regimens. 2021 Jul;27(5):1119-1124. Epub 2020 Aug 12. Wanat MA, Fitousis K. Comment: Critical Care Pharmacists and Medication Management in an ICU Recovery Center. Ann Pharmacother. 2019;53(1):105. Wang H, Brong M, Pham S, Dreucean D. Highlights of Clinical Practice Guideline for the Management of Community-Acquired Pneumonia. Infect Dis Clin Pract. 2020; 28(4):188-190.

Xia R, Varnado S, Graviss EA, Nguyen, DT, Cruz-Solbes A, Guha A, Krisl JC. Role of thromboelastography in predicting and defining pump thrombosis in left ventricular assist device patients. Thrombosis Research 2020;192:29-35 Yang T, Cutshall BT, Tatara A, Ruegger M. Combined insulin and GLP1 Receptor Agonists: Simplifying Treatment or Adding Obstacles? J Pharm Pract. 2018. Aug;32(4):447-449. Yang T, Murillo M, Vadharyia A, et al. Direct oral anticoagulants versus aspirin for venous thromboembolism after orthopedic surgery. Am J Health-Syst Pharm. 2019; May 17;76(Supplement_2):S55-S60. Yassine D, Brown EN, Putney D, Fasoranti O. Evaluation of the efficacy and safety of apixaban and rivaroxaban in cancer patients receiving concomitant active anti-neoplastic therapy at an outpatient cancer setting. Journal of Oncology Pharmacy Practice. 2020;26(7): 1650-1656. Yi Rogers AW, Saharia A, et al. Early Experience with COVID-19 and Solid Organ Transplantation at a US High-volume Transplant Center. Transplantation. 2020. Nov;104(11):2208-2214. Yuan F, Iso T, Rizk E, Saldana RB, Tran AT, Nguyen NA, Boyareddigari PR, Espino D, Swan JT. Implementation of Clinical Decision Support on Emergency Department Delivery of Human Rabies Immune Globulin. JAMA Netw Open. 2022 Jun 1;5(6):e2216631. Zhang, Y., Xu, J., Burns, E., Muhsen, I., Shah, S. M., Umoru, G., Mylavarapu, C., Sun, K., Crenshaw, A., Esmail, A., Kieser, R. B., Guerrero, C., Gong, Z., Gee, K., Heyne, K., Singh, M., Zhang, J., & Abdelrahim, M. (2022). Infections and their impact on patients on pembrolizumab-based therapies for head and neck cancer. Journal of Clinical Oncology, 40(16_suppl), 6035–6035.

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